As I reflect on the concept of work-life “balance,” I realize that trying to integrate clinical and home responsibilities may feel like a juggling act while unicycling on a high wire. Instead, what we need is work-life “stability”; the reassuring feeling that we are firmly planted on solid ground. To achieve this, it is crucial to be three-dimensional, with three meaningful passions supporting our physical, mental, and spiritual well-being.
No one can be one-dimensional and identify solely by their career. Likewise, being two-dimensional divides one’s time and attention between two passions, causing conflicts, competition, and neglect. By embracing our multidimensional selves as 3D MDs, we can find the firm foundation we need to achieve work-life stability and nurture our holistic well-being.
In my journey through medical school clerkships, I took the AAMC Physician Values in Practice Scale (PVIPS), which revealed that I highly value family and financial security. This led me to contemplate the challenge of reconciling these values with the demands of a medical career. Seeking answers and guidance, I explored the topic of work-life balance through podcasts and conversations with experienced physicians. It became clear that the pursuit of balance plagues most of us who have chosen this vocation.
There were varying perspectives on work-life balance among physicians. Some praised the support of their spouses and shared how they achieved a semblance of balance by reaching significant milestones in their careers or personal lives. These landmark moments included professional and financial milestones like ascending the medical hierarchy, paying off six figures of student loans, and leaving an institution for private practice. Others were skeptical, believing that work-life balance was unattainable in the demanding field of medicine.
Many questions remained: How can we effectively support relationships and family while pursuing a medical career? How many physicians experience chronic burnout due to this dilemma? Am I just another doctor worrying about sustaining my roles as a partner, parent, and physician?
Initially, I formulated career goals that aligned with my present mindset: prioritizing training and career excellence in my thirties, working a ~40-hour week in my forties, reducing clinical time by 50 percent in my fifties, and retiring in my sixties. However, I realized that this mindset trapped me in the arrival fallacy, where I believed that reaching certain goals would bring happiness. For many aspiring and practicing doctors, the pattern of rationalization repeatedly extends from “once I get into medical school,” to “once I get into residency,” to “once I become an attending,” ultimately to “once I retire.” This fallacy conditions us to deny ourselves happiness throughout our journey and leads to continuous striving without fulfillment.
A poignant example of the arrival fallacy is recounted by Dr. Joshua Daily, a pediatric cardiologist at Arkansas Children’s Hospital who experienced divorce despite feeling comfortable, happy, and financially secure in his career. In the aftermath of coping with his emotions and navigating litigation, he struggled to understand how his work ethic, status, and success were not enough to sustain his marriage. He reflected on the messages conveyed during medical training that suggested personal sacrifices were necessary to excel professionally and that there will eventually be time to rectify personal lives later. In offering some encouraging wisdom from his experience and recovery after divorce, Dr. Daily writes, “Life is fundamentally about high-quality relationships; career advancement, public recognition, and wealth pale in comparison. I have committed to restructuring my life such that being a good father, friend, and husband are top priorities.”
Research indicates that physician divorce rates are significant, affecting one in four physician marriages, with higher rates among female physicians. Divorce often arises due to feelings of loneliness, lack of time spent at home, and depression stemming from workload and financial issues. Work-home conflicts (WHCs) resulting from the pressures of balancing work and personal responsibilities contribute to burnout, depression, alcohol abuse, lower relationship satisfaction, and career dissatisfaction among physicians. Female surgeons, who experience similar rates of WHCs, are less likely to be married, less likely to have children, and more likely to face challenges due to conflict with their spouse’s career.
Admittedly, I am frightened at the thought of becoming a doctor who resents his marital/parental responsibilities after a long hospital shift, who increasingly favors spending time at work to avoid conflicts at home, and who struggles to confidently advocate his career path for his children.
Therefore, I propose adopting a “physician third” mindset, where being a partner and parent are considered equal priorities to being a physician. To put this into practice, I suggest flipping the traditional front-loading career model. Instead of dedicating the majority of our semi-retirement time to later decades, when our families may have grown up, we should start our careers with a 40-hour work week and gradually increase clinical time as our personal lives stabilize. Aligning with Dr. Daily, those early years typically spent attaining career advancement and wealth can be more meaningfully dedicated towards high-quality relationships, such as strengthening a marriage and cultivating a family.
Sincerely, I hope I can speak for many who accept the reality of making sacrifices throughout training as part of delivering the best patient care. However, I believe that achieving work-life stability is a pressing issue for physicians. Considering the benefits of reducing burnout, preserving relationships, and fostering satisfaction, I hope that medical institutions may soon be open to acknowledging and supporting the next cohort of physicians who value high-quality relationships and prioritize family alongside our medical careers.
By embracing the “physician third” and back-loading career mindset, we can empower physicians with the conviction to create a fulfilling life that includes family, personal passions, and medical practice. Together, let us strive for a future generation of 3D MDs and a culture that encourages physicians to find stability, happiness, and success in all aspects of their lives.
Stephen J. Foley is a medical student.
