The Fallacy of Chasing after Work-Life Balance

As a pediatric intensivist and clinicianscientist, finding a balance between work and life is essential to my professional success and my personal happiness. Failure to achieve a healthy balance will result in burn-out. So I was warned all these years since the first day of medical school. In 2013, 180 articles documented that physicians are highly dissatisfied with their jobs. This is a testament to how poorly we are balancing work and life (1–4). Interestingly, to my best knowledge, to date only 12 articles have been published specifically addressing work-life balance in Pediatrics (5–16). Since entering medical school over two decades ago, I reached the conclusion that the concept of work-life balance acts as quicksand in our professional and personal lives resulting in slow drowning in frustration, depression, and exhaustion. The harder we fight the deeper and quicker we sink. Why are we taught to strive for work-life balance in the first place? The entire future of our modern “24/7” society appears to revolve around mastering this concept, with the ultimate promise that – once achieved – we will all be compensated for the misery and sacrifices that we endured along the way. Astoundingly, a recent study reported an almost 20% higher job dissatisfaction rate for physicians than for the general US population (17). In reality, the concept of work-life balance is imposed upon us by corporations, companies, and employers with the primary intent to maximize our productivity margins at the work place, not to improve our emotional or physical well-being. The cold truth is that all corporations are specifically designed to maximize their financial profit, not the happiness or well-being of their employes. For this vitally important reason, we can under no circumstances leave it to our employers to determine the quality of our own lives (18). To maintain intellectual autonomy as individuals, the task of creating our own happiness has to remain in our own hands. Some employers offer a free smartphone, a tabloid, free daycare, or other after-hour programs as part of their “benefits” package, but in reality they just provided us with the means to spend even more time at work or doing work for them. The new buzz-word in Medicine is“flextime” (19, 20). Besides the fact that for some medical specialties, such as Intensive Care, flextime is a less viable concept than for other specialties, the fact still remains that if my time is flexible somebody has to work the hours that I find inconvenient. This rarely results in two happy employes. Residents and fellows are now restricted to 80 work hours per week (21) and after subtracting even as little as 6 h of sleep per night, they are left with 46 h per week to fill with “life.” Therefore, medical trainees have at best half as many hours available for leisure as they are required to spend at work. Clearly, achieving a work-life balance under these conditions is extremely unlikely, probably even impossible. Importantly, despite work hour restrictions physicians’ dissatisfaction with both their jobs and lives is actually at an all-time high and rising (22, 23). One can argue that residency and fellowship are only temporary occupations but in reality I do not remember working any less in medical school or now as an attending. The increased amount of responsibilities assigned to a physician once out-of-training actually accentuates rather than diminishes our daily stress level and results in further spillover of work-time into leisure-time. As we follow our peers’ instructions trying to balance work and life, the question arises: when should we achieve this balance and How do we know we achieved it? Since most of us enter the workforce as teenagers, would our high school or medical school years be a good time to start embracing this concept? Our early professional career years? At mid-career level? After retirement? While common sense tells us that the pursuit of work-life balance should occur during all stages of our careers, we all have a tendency to constantly postpone any significant improvement in our daily quality of life until after the current project is completed, after this service week, after the next promotion, after the kids are out of the house. Just how poorly we balance our work and life throughout our careers was highlighted in a recent study showing that early career physicians had the lowest satisfaction rate with their overall career choice, and mid-career physicians reported the lowest satisfaction rate with their specialty choice and their work-life balance (24). Alarmingly, similar job dissatisfaction rates have been reported for medical students and interns (25). Particularly, the high institutional demands for the new generation of clinician-scientists, which are deeply rooted in our professional culture, add further barriers to a healthy work-life balance (26). Clinicianscientists face additional challenges dealing not only with the separation between work and life but also between clinical care and research. A key reason for early career physicians to leave academic medicine is in fact the disconnection between their own priorities and those of the dominant culture of academic medicine (27). It is obvious that as physicians we are facing tremendous struggles throughout all career stages in implementing what would