Category Archives: Medicine

Work-Life Balance: Why It’s Not Nonsense


What does ‘balance’ mean to you? One simple definition states that balance is “…a state in which opposing forces harmonize, equilibrium.” I like this definition both because of its simplicity and also because it is the definition that lends itself most well to the concept of ‘work-life balance.’
As a member of my organization’s wellness committee I am very much interested in the concept of work-life balance and try to work to help others in my organization achieve that balance. Recently I came upon a piece written by leadership consultant Jason Lauritsen.  The gist of Lauritsen’s message is this: work-life balance is artificial because too many people are working in jobs that they hate. Lauritsen’s view is that if we can just get people engaged in their work, then they wouldn’t find it so onerous and wouldn’t feel ‘out of balance.’

Lauritsen’s sentiment is echoed somewhat in a response by Michah Yost: Work Life Balance is Nonsense. Both Yost and Lauritsen entertain the concept that work-life balance equates to separating work from life. I think this is where the logic becomes faulty. Both contend that work is part of life and to try to separate the two is a futile endeavor. I would tend to agree with this but I don’t think that is what work-life balance is all about.

Lauritsen states that people who truly enjoy their work and are good at it don’t talk about work-life balance. They don’t need to. The concept is foreign to them. In my experience these are precisely the kind of people who are at most risk for being ‘out of balance’ when it comes to work vs. life issues.

I have friends and family members who I would consider to be ‘out of balance.’ They are ‘always on.’ Vacations are interrupted by cell phones and emails. School programs and sporting events are not attended due to travel and other work responsibilities. There is constant conversation regarding their work. They seem to take great pride in promoting the image of how important or successful they are in their careers. Money seems to be a great motivator and their never seems to be enough.

I don’t claim to be in perfect balance but I’ve been told by colleagues that they admire what I have been able to achieve in my own personal and professional lives to achieve balance. I have a demanding career but it is work that I enjoy. Do I enjoy it 100% of the time? NO! For the most part, my work is stimulating and gives me a sense of accomplishment at the end of the day. Still, when my work schedule keeps me from attending a school event, enjoying a holiday or getting exercise, I feel bad.

I have made choices in my career that have allowed me achieve a greater degree of balance between my work and family life. Some may view this as not reaching my potential. This line of thinking is short-sighted and underscores a fundamental problem we have in this society: WE IDENTIFY OURSELVES BY OUR WORK. If I turn down a leadership position at work in order to have time to volunteer in the community, coach my kid’s sports team or train for an Ironman does that equate to ‘not living up to my potential?’ I don’t think so.

We are not one-dimensional. We are complex beings. We are more than just workers, employees, or executives. The concept of ‘work-life balance’ is not dangerous, not artificial and not nonsense. It is essential to our very being and too often overlooked. To go back to our original definition, the components of our lives need to be in harmony and equilibrium. When I was working 100 hour weeks as a surgical resident my life was out of balance. Similarly when I trained for my first Ironman, my life was out of balance then as well. Just because someone who loves their job or other activities does not PERCEIVE their life to be out of balance does not mean that it is not.

Teaching Old Dogs New Tricks-The Benefits of Dyad Leadership

Kiki relaxing with one of her many charges

Last year my family adopted a seven-year-old great Pyrenees from a local rescue. This dog has been a spirited and welcome addition to our family. For those that are unfamiliar with the breed, the Great Pyrenees is a livestock guardian. It is often used as a working dog on farms and has the instinctual tendency to alert to potential threats. As house pets, Great Pyrenees often adopt small children and other animals in the house as their “flock.” Whether in the mountains where they take their origin, on farms or in our family’s backyard, their instincts remain strong.

We live on a golf course. So there are a lot of “threats” to our “flock.” We spent the entire spring, summer and fall listening to the sturdy bark of our new pet as golfers and maintenance workers make their way down the path along our back fence. This can be irritating. It is particularly irritating to my wife who spends more time at home than I do.

The other day she was wondering what steps we could take to quell the barking.   While annoying, especially at 3am, it is the dog’s instinct to alert to potential threats and I don’t think that she should be punished for that. We knew what we were getting into when we adopted this dog and we have to accept these traits  as they are even if they are somewhat disruptive.

This made me think about management in the healthcare realm and in particular, physician leadership. Too often we select individuals for leadership and management positions based upon their performance as workers. However, all too often very traits that propel somebody to the front of the pack can be undesirable in the board room.

As physicians, we are often bred/trained to act decisively and quickly assimilating large amounts of complex data and making decisions independently in order to protect our patients’ health and/or life. I have seen physician leaders, myself included, admonished for failing to consider all aspects of the situation before making a decision. What many people don’t understand about doctors is that we are trained to do this. When a patient is crashing in the ICU, there’s no time to assemble a task force or hold a committee meeting. A leader needs to step forward and ACT. Act quickly. Act decisively. Act independently.  Few decisions that the physician leader makes on an administrative level have that kind of urgency; however, it is sometimes difficult to turn off that ‘fight or flight response’ we developed throughout our medical training.

So how do we mitigate this instinct to act independently and sometimes rashly when confronted with a difficult decision?  Short of formal training or education in the business leadership or administrative disciplines this instinct is usually tempered over time. The physician leader will make a few mistakes, hopefully not catastrophic, and learn from those experiences.  We are, after all, exceptional students.  However, not all physician leaders are ‘retrievers.’  By retrievers I mean friendly, malleable and easily realigned.  Some, many, are more like the Great Pyrenees- intelligent, bold, stubborn but fiercely loyal.

One of the things we learned about the Great Pyrenees breed before we adopted was that they require a strong master.  Does this mean that physician leaders need a strong ‘master’ as well.  Well, not exactly,  but they can benefit from good partnership and mentoring.

Our organization utilizes a ‘dyad’ leadership structure that pairs a physician leader with an administrative leader.  While the strength of any dyad partnership is dependent on the individuals involved, for me, it has been extremely advantageous.  My administrative partner helps to temper some of the aggressiveness, boldness and sometimes impulsiveness that I have been rewarded for throughout my years as a medical student and physician.  When properly constructed, dyad partnerships are more than just complementary but rather synergistic with the value of the pair being greater than the sum of its parts.  Ideally, dyads will evolve into their respective roles together, each taking on the more desirable traits of their partners in exchange for the abatement of less functional attributes.

We must understand what we are dealing with when we elevate physicians to leadership positions.  Any healthcare organization will benefit greatly with strong physician leadership; however, it is important that the tools and processes are in place to ensure that the proper choice is made initially and ongoing development is fostered.  Dyad leadership is not the answer for every organization but it can be a very powerful tool to keep physicians engaged in high levels of organizational leadership while ensuring that administrative leaders have the clinical data and expertise to make appropriate decisions.



Collaboration Versus Competition

The other day my wife and I were attending a parent information night at our daughters’ school. Our girls attend a small private school that utilizes a well-known alternative teaching method. During the course of the presentation, the teacher spent some time outlining the guiding principles of this alternative method. On this list of teaching philosophies was a bullet point that caught my attention. It read “collaboration versus competition.”

As a medical educator, this struck me. I’ve been reading a lot lately about what is wrong with medical education these days. It seems there are many who  feel there needs to be more emphasis placed upon “soft skills” rather than hard science. It is felt that enhancing these skills trains better physicians with greater ability to relate to patients.

I cannot say that I completely disagree with this idea. Having come up through a traditional medical school model and post-graduate medical training, I can see in my own self the changes that occurred  which can more or less be attributed to the system. This system breeds an ultra-competitive environment. As college undergrads we compete fiercely for GPA and MCAT scores to gain entrance to medical school. While in medical school we compete with our classmates to gain acceptance to coveted residency programs. While in residency, we work hard to distinguish ourselves among the group so that we can gain access to highly sought after fellowship training programs or practice opportunities.

It would be nice to say that the competition is limited to the educational and postgraduate training years but unfortunately it is not. Practicing physicians having gone through years of competition cannot shed this attribute easily. They often go into practice and continue to compete only this time for development of patient panels, income/compensation and now the increasingly important patient satisfaction scores.

Now more so than ever the practice of medicine has truly evolved into a team sport. Delivery of care that is compassionate, high quality and cost efficient will require adherence to the other “C – words.” These are communication, connectivity and collaboration. In order for the healthcare team to function effectively, the individual needs to be de-emphasized and the collective team approach should be championed. The good of the patient needs to be put in front of everything and failure to meet the needs of the patient should constitute a failure of the entire healthcare team.

I am fortunate in that I have the ability to participate in the development of a brand-new medical school campus. As a medical educator this is perhaps the most exciting prospect of my career. I see this as an opportunity to help create a new environment that rewards collaboration over competition. This would only make sense as this medical school is being born out of the collaboration between a major University and a private hospital. Furthermore, this new medical school, much like my daughter’s elementary school, will be an alternative educational venue. The school will be developed to marry the disciplines of medicine and engineering. The concept of collaboration is at the very crux of the development of this new institution. I can only hope that this spirit carries forward into the teaching methodologies of its future students.

I’ve been in practice for nearly 13 years. During this time I’ve seen rapid changes occur in the practice of medicine. It is essential that medical schools and postgraduate training programs adapt quickly to these changes. It is important that we are equipping the young men and women who carry our profession forward with the right tools to succeed.

I am not naïve enough to think that we can completely eliminate the competitive nature of medical education. There will always be some element of it being a “numbers game.” However, I don’t believe that there is a medical educator out there who can refute the idea that we all can do a better job of preparing our students to function as effective members of the healthcare team. This means more emphasis on developing communication and interpersonal skills. Perhaps medical students need to participate in more group project type activities like business school students. However,  it is incumbent upon us as the educators to lead by example. We ourselves need to change. We as educators and practicing physicians need to model the type of behavior that we expect in our students.

In closing, think about this. Many times when the healthcare system fails a patient, it is not based upon a cognitive or technical error. Often times is the result of a poorly functioning team and lack of effective communication. We’ve done a reasonable job over the years in teaching our students the hard skills needed to become physicians. However, we now need to expand this, to foster an environment of cooperation and collaboration. This will ensure that our students will thrive in the profession throughout the years to come.