Wednesday, August 26, 2015

Is work life balance a first-world privledge problem, or not?

by: Alex Smith, @AlexSmithMD

In geriatrics, and to a much greater extent palliative care, work/life balance is recognized as critical to finding meaning in your work, to being at your peak at work and at home, and to avoiding burnout.


So last week I read with fascination a Washington Post story about pilot program at Stanford that supported physicians work/life balance.  Here's the brief story in bullets:
  • The powers at Stanford realized that many women were dropping out of academic medicine, despite generous leave policies, benefits for part time work, etc. They wondered why. 
  • They hired a firm to investigate.  The firm concluded that the at Stanford culture dictated "all-out devotion to work, all the time."  No one was using the generous family-friendly policies.
  • People were doing all sorts of unfunded work that ate huge chunks of time: mentoring, committee work, extra shifts, etc.
  • Stanford started a pilot program where physicians and basic scientists could use credits from the unfunded work to pay for services such as delivered meals, housecleaning, and assistance with grant writing.
  • The program, per the report, was enormously successful at improving job satisfaction.
My first reaction to this was elation.  Just offering generous policies and flexible scheduling is not enough.  You have to come close to forcing people to attend to their home life.  You have to align your policies to support those who want to work really hard, choose not take the leave, yet still desire a rewarding home life. 


So my bubble of elation was somewhat burst upon reading this reaction by Karen Sibert, an anesthesiologist at UCLA and mother.  You should go read the whole post here, which I will quote briefly:
  • "“work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white."
  • "Every day, I go to work and see the example of the nurses and technicians who work right alongside me in tough thoracic surgery cases. Zanetta, for instance, is the single mother of five children. She leaves her 12-hour shift at 7 p.m. and then faces a 60-mile commute to get home. She never complains, and unfailingly takes the extra moment to get a warm blanket for a patient or cheerfully help out a colleague.When I leave work, I see the gardeners who arrive in battered pickup trucks and mow lawns in the Los Angeles summer heat for slim pay and no benefits. I can’t imagine these people wasting time worrying about work-life balance. They’re too busy working."
  • On the Stanford program: "The sheer paternalism of the Stanford program is breathtaking. The assumption, apparently, is that Stanford faculty can’t be trusted to manage their own lives inside and outside of work."
Well.


Dr. Sibert makes some valid points here.  And yet something seems a little off-base about her argument.
  • We should not set our standards for what physicians can be concerned about based on how we treat worst-off groups.  Those who are in less privileged positions should be equally invested and outspoken about work-life balance.  They have at least equal claim to concerns about work-life balance.
  • In fact, I suspect many people who are not in positions of privilege and work long hours, similar to physicians, do worry about it.  They just don't complain about work-life balance to physicians. 
  • I hired a guy in a slim battered pickup truck, such as the one Dr. Sibert describes, to work on my garden.  Because I work all week, I arranged to meet him on a Saturday.  My first preference would have been Sunday, but he was clear: "I work all week, Saturday's too.  Sunday is for my family."  Work life balance.
  • Do nurses really not have any dialogue about work/life balance?   The ones I know well talk about it.  A lot.
  • Some of the physicians I know who are most concerned about work-life balance are not white. 
I suspect that work life balance is a universal concern, not unique to physicians.  Certainly, there is a spectrum that runs from legitimate concern to whining.  Whining sounds particularly grating when it comes from the privileged class.


We could claim exception because we're in geriatrics and palliative care, and are thus at risk for higher rates of burnout due to the exhausting emotional intensity of our work.  But let's set that aside for a moment.  That's the easy road. 


For physicians as-a-whole, where do you think concerns about work-life balance fall on the spectrum of legitimacy/whining? 

5 comments:

Anonymous said...

One item not mentioned in this article is the role that money plays in work life balance. How much is enough?

Nurses certainly know how much they can earn because most are employees. Who are the people being caught up in Medicare scams? Don't see too many nurses or technicians names in print.

I had a cousin that wanted to go into medicine. When asked why, he said to make money. He became a lawyer instead. And, he has a good work-life balance.

Maybe the whole culture of medicine needs to be reexamined for how and what trainees are exposed to and by the example set by their seniors.

Dan Matlock said...

Interesting Alex!

Work-life balance is a misnomer itself. The term causes problems. My life is multifaceted and work is one facet of that. I've worked very hard to have the opportunity to do work that I find meaningful. I think about home at work and work at home. When I have a bad day at work, my home life suffers. When I go home excited and fulfilled, that flows over into how I treat my family.

My father-in-law worked 40 hours a week and hated it. My wife still resents aspects of that hatred.

The Stanford program is great - but it about supporting multifaceted and busy people and making them feel appreciated, not about this stupid "work-life" balance construct.

Dan Matlock said...

Interesting Alex!

Work-life balance is a misnomer itself. The term causes problems. My life is multifaceted and work is one facet of that. I've worked very hard to have the opportunity to do work that I find meaningful. I think about home at work and work at home. When I have a bad day at work, my home life suffers. When I go home excited and fulfilled, that flows over into how I treat my family.

My father-in-law worked 40 hours a week and hated it. My wife still resents aspects of that hatred.

The Stanford program is great - but it about supporting multifaceted and busy people and making them feel appreciated, not about this stupid "work-life" balance construct.

Stacy Fischer said...

As an academic faculty who is also a woman and a mom, I am grateful that Stanford has taken notice of how many female faculty end up leaving academics. I appreciate their attempt at creative thinking about how to help them. I do not love their solution. I am someone who already outsources nearly all these mundane household tasks. I shop though an app and groceries are delivered, school supplies come form Amazon, I do not clean my own house, and I have a nanny help with some of the after school care. I am not sure I have the ideal solution but I will take some time to reflect further about what would really be helpful.

As far as Karen Sibert's response-I dismiss it. This is not the first tie she has spoken out against work life balance-see her op ed in the NYT 2011 about how as an anesthesiologist no less, she admonishes women in primary care for only working part time. Please.

And to your point Alex-agreed! this indeed is not a white problem. It is an academic problem-first world by its very nature. I mentor several minority faculty and they are burdened even more heavily than I am with these unpaid activities and unfunded demands of their time. As one of a few Latina faculty, my mentee gets asked repeatedly to interview any potential resident of color. I work really hard to help her say no to be able to ficus on her research so that she may be competitive in the future for funding and therefore stay in academics.

Anonymous said...

One other point she does not mention is that as physicians we are responsible for our patients 24/7, whereas a technician goes home and does not continue with charting and answering emergency pages.