Balancing Act

Hard work. Long hours. Stress. That's what it means to be a physician. And a parent.

As more women enter medicine each year, balancing the demands of two demanding jobs (women physicians still shoulder 80 percent of domestic duties) has become an important issue. To be sure, male physicians as well are tending toward more active roles as parents than in generations past.

Those in the know -- both physician-parents and industry experts -- agree that some keys to meeting the demands are:

• assessing personal values,
• choosing among career, family, and income demands;
• reconsidering the physician's traditional role;
• seeking the support of their practice partners and family; and
• creating outside support systems.

But perhaps the most important thing to learn about balancing the demands of being a parent and a physician is that there's no secret to success waiting to be uncovered.

"I wish I had some pearls to say this is how I do it, but to be honest there is no big secret to share," says Frank Kane, a New Jersey family physician. Kane, a father of two, leads a 16-physician practice and volunteers for state and national specialty organizations, but makes sure he has time to coach youth sports teams and attend school events.

"There is no five-step plan; it just takes hard work," agrees Wayne M. Sotile, a clinical psychologist in Winston-Salem, N.C.

"Balancing your role as a parent and a physician is one of the most complicated issues in medicine right now because it gets to gender issues, generational issues, and how you construct a career that allows you to stay resilient," says Sotile, who has studied more than 1,000 marriages in which one or both spouses are physicians.

Define your values

Lisa Corum, a Fort Mill, S.C., family physician who works part-time, says her approach to handling both jobs was to decide what she wanted to get out of being a physician.

Before she joined her current practice as a part-time employee, Corum told the five physicians who own the practice that her priority was to have sufficient time to care for her two-year-old son, even if that meant delaying the opportunity to get on the practice partner track.

"I was moving to an area where I didn't have any family support and my husband travels a lot for his work, so I told my new colleagues before I was hired that I could not work full-time and could not take call. That was the condition I set," she says.

Corum says that physicians who want to handle more than a minimal share of child-rearing duties should first ask themselves:

• Is my spouse also working?
• What are my daycare options?
• Do I have family members who can help with childcare?
• How much do I need to earn to pay my bills?

"You have to be honest to yourself about what you are capable of doing within the boundaries of your life situation and say to your partners at home and at work, 'This is what I'm capable of doing and doing well,'" she says.

Even with her current arrangement for 25-hour workweeks, Corum still puts in full days now and then when other physicians travel, take vacation, or are ill. Like other physician-parents, Corum finds that balancing work and family life is not an exact science.

"For a physician to lead the totally balanced life is just a myth; it's a hard job," says Sotile, who has co-authored several books with his wife, Mary, including The Medical Marriage and The Resilient Physician. "Work in medicine always was and always will be extraordinarily demanding," he adds.

Sotile notes that finding more time for children is not exclusively an issue for women physicians. He finds many older male physicians looking for more time to enjoy their grandchildren or their children from a second marriage. "They figure they blew it and missed those precious years the first time around and they are not going to let a second chance slip by," he says.

Make choices, plan ahead

Having a family means learning to set limits, says Jennifer Shu, a San Diego pediatrician.

"One main reason I can say no to extra work is that my husband and I made a concerted effort to try to live below our means," says Shu, who returned to Sharp Rees-Stealy, a 300-physician multispecialty group, after a two-year maternity break.

Now, with a three-year-old son at home, Shu works an irregular part-time schedule, filling in whenever and wherever the group needs an additional physician. Sometimes, she has a month's advance notice of a new assignment; sometimes, just a few hours, but she is always able to say no.

"I don't have a contract that sets a minimum number of hours and I don't have a guaranteed level of income or benefits," she says. "If we had the same lifestyle and spending habits before having a child and my decreasing to part-time, I would never be able to set these limits."

Even full-time medical practice can be flexible, says Christine Myatt, a full-time hospitalist for IPC, The Hospitalist Company, in Houston. She says she was drawn to the emerging inpatient specialty because the flexible work hours allow her to grab precious extra minutes to attend school and family events.

"I do work full-time and I do want our business to grow, so I like how the hospitalist role gives me the ability to schedule my day to be with my children and complete my work at the hospital," she says.

Scheduling is critical, says Myatt, because her husband is an Army Reservist who is also working on a doctorate degree. Myatt and her family have moved frequently and learned how to make more time for their 15-year-old daughter and a six-year-old son. To do the same for your family, focus on:

• Planning. Getting dates for work and family obligations as far ahead as possible.
• Distance. Living as close as possible to work and children's schools.
• Childcare. Recruiting parents or hiring a nanny to help care for younger children.
• Help. Finding shortcuts -- hiring housekeepers, gardeners, etc. -- to help with household tasks.
• Limits. Controlling the time you spend volunteering for schools, community organizations, your medical specialty, and your practice.
• Efficiency. Using car time to talk and taking children along when making hospital visits if a supervised play area is available.

"Rarely do I miss any of my son's school activities and I am always -- almost always -- home in time to read a story before bed," Myatt says.

Larger practices may feature more scheduling options but many find smaller private practices also can be flexible. "I chose private practice and to be my own boss so that I could have the flexibility I wanted," says Rebecca Jaffe, a Wilmington, Del., family physician. "In a small practice, you work hard but you also can plan in advance."

Jaffe, a mother of two pre-teens, says advance planning is important in her practice because both of her partners in the three-physician group are mothers -- the newest physician to the practice was added specifically so the practice's other physician -- a new mother -- could take extra maternity leave.

Business matters

Considering that it can cost as much as $250,000 to replace a physician in a busy practice, helping physicians juggle professional and parental roles is a critical business concern, too. Some practices are recognizing that and taking action.

"As a breed, we tend to be perfectionist workaholics," says Tom Ewing, MD, medical director for PeaceHealth Medical Group, a 110-physician multispecialty practice in Eugene, Ore. "We're working toward a culture here that involves doctors in a meaningful discussion of their roles at home and at work and what the organization needs to do to help them better balance those roles."

Ewing says that when PeaceHealth asked its physicians how the organization could help them, many physicians cited a need to cut back on their increasing load of nonclinical tasks.

"We assigned a physician leader to review all of our forms, our laboratory ordering procedures, documentation, even how we handle phone calls -- all in the effort to get our doctors back to doctoring and reduce the stress and the time spent on administrative tasks that just keep physicians at work longer," he says.

So far, PeaceHealth has written new clinical protocols for telephone triage and streamlined how its physicians handle prescription renewal requests. As its leaders eye other improvements to improve workflow, Ewing points out that having an electronic medical record is another way to help physicians feel like they have more control over their work.

Seek support

Finding the balance between home life and work is like trying to hit a moving target. Younger children will demand more time than older children. Some weeks will be busier than others at work. The healthiest physician marriages are those in which the family members understand there will be days when the duties of being a physician will intrude on family time, Sotile says.

Support from the home front is more than desirable, it's critical, he adds. A 2001 study in the Journal of Applied Psychology found that incidences of depression, anxiety disorders, or substance abuse increased by two- to three-fold when work consistently interfered with family time. Yet, according to the study, which tracked nearly 3,000 men and women in several professions, those disorders were five to 30 times more likely when family demands consistently interfered with work.

Adds Myatt, "You can't really expect your partners to accommodate you in every way. You have to create your own support systems so that things can run smoothly."

"We've just made our own way here," says Corum. "It's always going to be down to the individual situation. The practice has to do what it can within the construct of who owns the practice, how they divide up the money, and what they need."

Considering the less-than-perfect balance between physician supply and patient demands for access, plus the trend for more physicians of all ages and both sexes to seek more personal time, the number of physicians negotiating and getting more creative job arrangements will likely be a trend to watch.

Robert Redling, editor, practice management for Physicians Practice, wrote about workers'
compensation billing in the April issue. He can be reached at rredling@physicianspractice.com.

This article originally appeared in the May 2004 issue of Physicians Practice.