As an Academic Surgeon, I have the privilege of being able to share my passion with trainees and hope it is contagious. I also have the privilege of mentoring medical students who are deciding if surgery is the right specialty for them. In this process, I am very open about having a toddler and being married to a surgeon, and this prompts questions about my work-life balance and how happy I am with my career choice. I have no regrets in my career choice and that I have great “balance.” I have been reflecting a lot about this recently, and I think the answer to that question is more complicated and needs a more complete answer. I want to address here what I think work-life balance is and why I do not think that term works for surgeons, whether in academia or not.
What is work-life balance?
Work-life balance is defined as “the amount of time you spend doing your job compared with the amount of time you spend with your family and doing things you enjoy.”1 This concept has gained attention in recent years with increasing reports of physician burn-out, which are reportedly worsened by work-life conflict.2,3 McKenna et al mention that the concept of work-life balance emphasizes “life as separate from work and pleasure as separate from profession”2
What is work-life integration?
As Gade et al put it, “work-life integration means coordinating and blending elements of life into a unified whole where work, family, friends, and self are valued, and time is allocated proportionally.”4 This concept is based on the flexibility the modern work environment has allowed for many professionals. For example, a professional might take a mid-morning break to go to the gym and finish up a project before going to bed in the evening. The boundary in work-life integrations between work time and “life” time are not as defined, allowing flexibility throughout the day.
What works for the surgeon?
In their most pure forms, neither work-life balance nor work-life integration accurately addresses the work of an Academic Surgeon. There are discrete times when a surgeon can only be a surgeon-the operating room and clinic, and times we need personal time to decompress. But, especially for the Academic Surgeon, there are a lot of times where the two blend (taking calls at home or writing research papers at night, on the weekend, and sometimes during my toddler’s gymnastics lesson). Which is why I think the concept of work-life harmony is more apt. Work-life harmony is the concept that satisfaction or any positive valence in one aspect bleeds into the other, as does distress or any negative valence.5 This concept reinforces the circular and interconnected relationship in our work and personal lives.
Why does it matter?
In a survey of 7197 surgeons, Dyrbye et al found that surgeons who reported having work-life conflict were more likely to consider reducing their clinical hours or leave their current practice than those who did not report having recent work-life conflict.6 They also found that those reporting work-life conflict were more likely to report burnout, relationship difficulties, and career dissatisfaction.6 The concept of work-life harmony reinforces that success in one’s work and personal life are interconnected. This understanding not only helps the individual to appreciate the importance of each aspect of their life, but it is also important at an organizational level for the development of policies, practice, and benefits that can improve group productivity and performance.5
Three top pieces of advice that I have found to be helpful:
- Manage your time.
Setting a schedule and being efficient with time are two of the hardest parts of finding balance, integration, or harmony. I recommend “Work-Life Integration and Time Management Strategies” by Gade et al for tips on time management.4
- Obtain stakeholder buy-in.
It takes a village to make a happy and successful Academic Surgeon. Not only does your work family need to understand what you need to be successful, but your home family also has to have an understanding of how much fulfillment you get from being successful at work.
- Outsource tasks that you don’t enjoy but take up your time.
This isn’t easy as a medical student or a resident, but it is possible. As residents, my husband and I solicited our friend’s live-in nanny to help with daycare pick-up and drop-off. This was affordable since the caregiver was not relying on us for her full income. As an attending, I am getting more comfortable with delegating household tasks to our nanny that I had previously thought could only be done correctly by me.
- Definition of work-life balance. In: Press CU, ed. Cambridge Business English Dictionary.
- McKenna KM, Hashimoto DA, Maguire MS, Bynum WE. The Missing Link: Connection Is the Key to Resilience in Medical Education. Acad Med. 2016;91(9):1197-1199.
- Sullivan MC, Yeo H, Roman SA, Bell RH, Jr., Sosa JA. Striving for work-life balance: effect of marriage and children on the experience of 4402 US general surgery residents. Ann Surg. 2013;257(3):571-576.
- Gade L, Yeo HL. Work-Life Integration and Time Management Strategies. Clin Colon Rectal Surg. 2019;32(6):442-449.
- McMillan HS, Morris ML, Atchley EK. Constructs of the Work/ Life Interface: A Synthesis of the Literature and Introduction of the Concept of Work/Life Harmony. Human Resource Development Review. 2010;10(1):6-25.
- Dyrbye LN, Freischlag J, Kaups KL, et al. Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce. Archives of surgery (Chicago, Ill : 1960). 2012;147(10):933-939.