I recently met a student and aspiring surgeon who asked me if I was happy with anesthesiology and a career in medicine in general. I told him that aspiring to medicine is wonderful and that while I am indeed happy with my career choice, it does come with daily challenges, both professional and personal. This led to a discussion of work-life balance, particularly with regard to family life, in which I told him what a surgeon had once told me in medical school, “if you want to be a surgeon, you need to love surgery more than anything else in life.” My encounter with this young man is not very interesting – we had a conversation many have had in the past and will have again in the future. However, what is interesting is the reaction of a colleague who, after hearing about this conversation, said, “Why did you sugarcoat it? Why didn’t you tell him the truth?” Initially surprised, I countered by saying that I had told him it isn’t easy, but many physicians do manage to “make it work” between career and family. “Yes,” she agreed, “but did you tell him how they make it work? With antidepressants, alcohol, and divorce.” At this, I was momentarily silent, but ultimately I had to concede. She was right; I didn’t tell him about the statistics on career regret or that the majority of physicians would not recommend the field to their children. I failed to mention the friends and colleagues I have seen medicine steal sobriety, marriage, and even life itself. Days afterward, I found myself still thinking about this conversation. I thought of my medical school classmates, my co-residents, my colleagues. I thought of the divorces, the alcoholism, the drug abuse I had witnessed, and the suicides I had heard. The silence that surrounded it all. It was a sobering realization. Certainly, I had read about the statistics of physicians struggling with substance abuse or depression and had seen friends or colleagues encounter personal “challenges,” but never did I think of it as anything more than an unfortunate coincidence. Someone I knew through medicine had a problem, so what? Correlation doesn’t mean causation. Yet somehow, being put on the spot to describe life as a physician and feeling that I could not be completely truthful – how could I tell someone so young and idealistic that his dream may one day destroy his marriage or drive him to take his own life? – made me realize that those “coincidences” are not a coincidence at all but rather evidence of the problems plaguing our profession. Medical training is rigorous, and rightly so. It is meant to instill aspiring physicians with the knowledge and stamina necessary to care for patients. It requires motivation, ambition, compassion, and a drive to succeed, all characteristics of successful medical students. Yet somewhere along the path from medical student to seasoned physician, like stones beneath a waterfall, these traits are slowly eroded by the increasingly difficult, borderline unrealistic, demands of medical practice today. I have always wanted to be a physician. The day I graduated from medical school and joined the noble profession I had long admired was one of the happiest and fulfilling days of my life. Since then, I have devoted years and countless hours to my training and my patients, routinely adjusting other aspects of my life to fit medicine’s demands. I love what I do, but I cannot say that I would be willing to sacrifice my marriage, my relationship with my children, or my life for it. In speaking with that young man, I told him about what one memorable surgeon had told me, but I didn’t mention another one. On that same rotation, I worked with a surgeon who, after asking me about my career plans, said, “well, that’s all well and good, but once you get married and have children, all you will want is to spend more time with your family.” It was a simple comment made over lunch in the hospital cafeteria. He probably doesn’t even remember saying it, much like I don’t remember what I was eating at the time. Yet, I look back on that moment over a decade ago as a pivotal point in my career because I realized that work-life balance was an important consideration. The concepts of burnout and physician wellness have fortunately become more mainstream conversations in recent years, even more so amid the COVID-19 pandemic. Work-life balance is not the only cause of burnout, as it certainly is not the only struggle that physicians face, but it is a significant factor. As a result of the current demands of practice and lack of balance, many physicians are pursuing opportunities outside of clinical medicine. Somehow, I doubt that the majority of those physicians planned such a career course from the start. Burnout is not unique to medicine. Other professions have recognized the value of preventing burnout through implementing strategies to improve work-life balance. Slowly, work culture in America is changing. Clinical medicine needs to embrace this change because prioritizing work-life balance opportunities would improve physician wellness, and in turn, the health of the system overall. I hope that eventually, work-life balance in medicine improves such that if my son ever becomes like the young man I met, someone can honestly tell him that a career in medicine is indeed still a wonderful pursuit. Kelly G. Elterman is an anesthesiologist. Source
