We get asked this all the time: “How do you do it? How do you raise kids, manage a household, remember that someone needs poster board for school tomorrow, get everyone to practice, and somehow sustain two demanding physician careers?” The answer is: not gracefully. We have calendars. We have systems. We have childcare. We outsource things. We occasionally feed our children cereal for dinner, and somewhere, at almost all times, there is a load of laundry that has been forgotten. What we don’t have is work-life balance, and we’ve stopped trying to find it.
Instead, we do something physicians already know how to do remarkably well: We build systems, create teams, anticipate failure, establish redundancy, and, when everything inevitably goes sideways, we triage. No one runs a resuscitation alone. Why did we ever think we were supposed to run a family that way?
The idea of “work-life balance” suggests that if we organize ourselves perfectly, the competing parts of our lives will eventually reach some magical equilibrium. They won’t. Some weeks medicine wins. Some weeks family wins. Sometimes everyone needs you at exactly the same time and the best you can do is decide what needs you most. The data suggest we’re not imagining the tension. In dual-physician couples, having children has historically affected women’s work hours far more than men’s. Physician mothers also report carrying a disproportionate share of domestic responsibilities, a burden associated with career dissatisfaction, particularly in procedural specialties. When a family simply “figures it out,” someone often quietly absorbs the difference, and historically, that someone has often been the woman.
We decided we didn’t want that to be the default. Instead of asking how we could balance everything, we started asking a different question: What do we need to build so our families, our careers, and we ourselves can thrive?
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From an emergency medicine perspective, this makes perfect sense. No single person manages the chaos of an emergency department. A good ED works because people know their roles, communicate clearly, anticipate problems, and trust one another. I bring that same mindset home. Our house has a command center: a monthly calendar of activities and a daily board of expectations. Everyone can see what is happening and what needs to be done. Laundry gets done. The dishwasher gets emptied. The dog gets walked. Most importantly, I am not standing in the kitchen after a 12-hour shift negotiating chores with people who suddenly have no recollection of ever having lived in this house.
The big things work the same way. Games, recitals, school events, call schedules, and travel don’t magically align. Who can be there? Who is driving? Where are the collisions? We figure it out early. Our nanny is a critical part of that system, but more importantly, she is part of our team. She knows our kids, understands our values, and has earned an enormous amount of trust. Our children are members of the team too. They have responsibilities. They help. They adapt. Clear expectations aren’t about rigidity; they’re about reducing friction. Paradoxically, structure gives us freedom because we aren’t spending our limited time and energy renegotiating the predictable parts of everyday life.
The surgical version of this philosophy adds another important concept: redundancy. When surgeons are raising children (and transplant or trauma is involved), work disrupting family life isn’t an occasional emergency; it’s the baseline. An organ becomes available. A trauma rolls in. An operation runs long. None of them care what the family calendar says. You can’t build a household around the fantasy that nothing will go wrong, so we build for the lives we actually have.
For one of our families, that means multiple caregivers, including a lead nanny who coordinates coverage and maintains continuity. It means evening and weekend support and knowing that homework, dinner, transportation, and bedtime can still happen when the operating room has other plans. From the outside, that infrastructure may look excessive. From the inside, it feels like stability. Medicine taught us a long time ago that a system without redundancy is a fragile system.
Good teams don’t simply appear, either. They are recruited, oriented, supported, and developed. We wouldn’t place a new resident into a high-stakes environment without orientation and expect them to immediately understand how everything works. Why would we approach the people caring for our children differently? We invest in those relationships, communicate expectations, and build trust over time. The goal isn’t simply coverage; it’s a team.
That leads to perhaps the hardest lesson for physicians, and particularly physician mothers, to accept: You do not have to personally perform every task for it to matter. We outsource cleaning, meals, childcare, and whatever else makes sense for the family and the season. Could we do those things ourselves? Of course. But that’s the wrong question. The better question is whether doing them ourselves is the best use of our finite time and energy.
We understand this instinctively at work. Effective leaders delegate, and physicians work in teams. We don’t draw every lab, transport every patient, perform every task ourselves, and then congratulate ourselves for being the most exhausted person in the hospital. Yet at home, we sometimes attach morality to doing everything ourselves. Cooking every dinner means we’re more devoted. Personally managing every school detail means we’re more involved. Doing our own laundry makes us more responsible. Needing help can somehow feel like being less capable.
We reject that premise. Delegation is not disengagement, and exhaustion is not evidence of devotion. The people who help us don’t replace us as parents. They expand what our families are capable of holding.
Perhaps most importantly, these systems protect something less visible: our identities. There is a quiet pull, particularly for women in medicine, to allow one role to consume all the others. We are mothers, fully. We are also physicians, educators, leaders, partners, friends, and people with ambitions that belong to us. Those identities don’t diminish parenthood. They coexist with it.
Research tells us that coexistence isn’t automatic. Women with children in dual-physician couples have historically worked substantially fewer hours than women without children, while the same pattern was not seen in men. Physician mothers carrying greater domestic responsibility, particularly those in procedural specialties, are also more likely to consider changing careers. That makes us wonder whether “work-life balance” is always an individual problem to solve through better time management or greater resilience. Sometimes the answer is simply a better system.
Of course, lest this sound as though our households operate like highly functioning command centers at all times, they absolutely do not. Calendars fail. Children get sick. Cases run late. Someone forgets the uniform. Dinner occasionally bears very little resemblance to dinner. Despite all of our beautiful systems, sometimes everything still catches fire simultaneously. That’s when we triage. Sometimes the answer is outsourcing. Sometimes it’s cereal. Sometimes it’s saying no or asking someone for help. And sometimes it’s accepting that something will be done adequately instead of perfectly. That’s not failure; it’s adaptability.
Our children see that too. They see adults ask for help and people contribute to a team. They learn that responsibility is shared rather than silently belonging to one person. They develop relationships with other trusted adults and learn to adjust when plans change. We don’t see those things as compromises. We see them as skills our children are learning by watching how a team (and a family) takes care of one another.
So, can two physicians raise kids, maintain demanding careers, and still preserve some version of themselves along the way? We think so, but not by accident, and certainly not because we discovered the secret to work-life balance. There isn’t one correct architecture. Five nannies isn’t everyone’s answer. Neither is a cleaning service, meal delivery, grandparents down the street, a neighborhood carpool, reduced clinical hours, or a color-coded calendar that looks like air traffic control. Resources are different. Families are different. Careers are different. The specific system isn’t the point. The point is to build one intentionally.
Identify the predictable failure points. Share responsibility. Create redundancy where you can. Outsource what doesn’t require you. Invest in the people who support your family. Protect each other’s careers and identities. And recognize that whatever you build won’t work forever. Children grow. Careers change. Call schedules change. Priorities change. So you reassess, adapt, and rebuild.
Maybe that’s the real answer when people ask us, “How do you do it?” We’re not balancing two medical careers, children, a household, and everything else on some impossibly narrow beam. We’re building a life sturdy enough to hold all of it.
And when it stops working, we build again, together.
Inna Massaro is an emergency physician. Saulat Sajjad Sheikh is a surgeon.
