American College of Physicians: Internal Medicine — Doctors for Adults ®

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Surviving the tug-of-war between career and family

Women physicians say that getting organized and learning to relax can help balance competing demands

From the July/August 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Edward Martin

NEW ORLEANS—Seven years ago, Jacqueline Fincher, FACP, struggled to balance her practice in rural Thompson, Ga., with her role as the wife of a physician and mother of a new daughter. Then she was diagnosed with breast cancer, an event that helped her set new priorities.

"My daughter was 11 months old at the time, and I was given a 10% chance of survival," Dr. Fincher recalled. While she still struggles to balance medical practice with volunteer service and caring for her grandmother, who is 93, deciding what comes first is no longer as difficult.

"I still might not have the balance thing down just right," said Dr. Fincher, a 1985 graduate of the Medical College of Georgia. "But the primary source of energy for the rest of my life will be the love of my family and children."

Dr. Fincher shared her experience with a group of mostly women physicians during a panel discussion on managing the complicated demands of family, practice and personal life held during the College's recent Annual Session. While some of the revelations were humorous—one audience member jokingly talked about saving time by lifting patients out of bed on the count of two instead of three—most of the discussion was serious.

"Once, I was paralyzed by feeling bad for not getting everything done," explained Ellen F. Hughes, ACP-ASIM Member, a faculty member at the University of California, San Francisco. "I learned to ignore the judgmental voice that says you are a bad person because you can never get everything done."

Linda Hawes Clever, MACP, panel moderator and medical director of the Health Professional Renewal Program at Sutter Health System in California, told the group that while there are no easy answers, there is one certainty: Balancing priorities "is a struggle you will face your whole life as a physician." She quickly added that physicians who do the best are those who do not allow medicine to consume their lives.

The session, which used electronic tabulators to instantly record internists' concerns, pinpointed many of the conflicts that women face trying to balance children, personal lives and medical practice. Almost half of the attendees said that their greatest conflict was the growing amount of work and the diminishing time in which to do it. More than half—52%—said that this squeeze leaves them too little time for their family or themselves.

Family, according to 48% of the women, is the greatest source of satisfaction, substantially surpassing work, which earned the same rating by only 24% of women in the group. "The message here," said Dr. Clever, "is both take a lot of time."

While the problem may be universal, physicians cope in a variety of ways. One internist, for instance, said she became so burned out that she left practice when her three children were still young. "By the time I got home," she explained, "I had given all the good things I had to my patients, not my family." Now that her children are older, she has returned to her former job as associate medical director of a hospital.

Others described the techniques they use to simplify their lives, from exercising to relieve stress to setting aside a quiet half hour early in the morning to read. An Alaskan internist with a 6 1/2 month-old daughter continues ski racing and has modified her dogsled to accommodate the child. She credits her success at balancing her life to having a husband who shares child rearing.

Another audience mem-ber called the $400,000 she borrowed to buy her practice "the best money I ever spent." Despite the debt, she said, she is now able to set her own patient load and no longer faces pressure from partners to place work above family.

Panelist Barbara J. McGuire, FACP, the College's Governor for New Mexico, outlined how she has organized her life while forming what has become an eight-physician hospitalist group. Many of her techniques were simple: She lays out her clothes the night before, reads summaries and briefs of medical articles, shops from catalogs rather than malls and banks online. She also hired a housekeeper.

Plus, she has changed her attitude to avoid feeling frenzied. "I now pick one goal each day, and don't fret about other things if I get that done," she explained. "I've also learned to cut my losses and surrender control. If I'm on hold for 15 minutes, I hang up and move on to something else. I've learned that it's a real art to say 'no' nicely, and that it's important to give up a little control, to learn not to micromanage."

Dr. McGuire and other physicians stressed the value of networking, not just with colleagues, but in their daily lives with people like housekeepers and hair stylists. "I looked at what I was paying my homemaker compared to the lowest-paid person in my office," said Dr. Fincher. "Now I make sure their salaries are at least equal. If you pay well, you have a partner who can get you through rough times."

Dr. Fincher said that after her diagnosis with breast cancer and the birth of her daughter, she learned another important lesson: "When you are faced with your own mortality, you don't find yourself wishing you had spent 10 hours a week more at the office."

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