Partner, Parent, or Physician? A False Dilemma

Commonly, our prior struggles highlight lessons learned when we look back with our retrospectiscope.  For example, going through bankruptcy as a kid and racking up more debt than I should have served to highlight my hatred for debt when I became financially literate.  That hatred helped my family pay off $300,000 in combined student loans and auto debt in 24 months.

Another struggle that highlighted a lesson learned for me was battling through my work-life balance issues in 2019.  While I didn’t realize until later that much of this was caused by a smoldering Grave’s disease diagnosis, the lesson I learned still rings true:  Expressing a desire for work-life balance can impact people’s perception of your dedication to medicine.

There is a false dilemma in medicine.  Despite 92% of younger physicians clamoring for work-life balance, there exists an expectation that we are not allowed to have it.  Maybe worse still is the idea that if we want work-life balance we are worse doctors for it.

Even our patients expect it.  The following is from a comment on a KevinMD article where I talked about how being a good husband and father was more important to me than being physician.

“I’ve bookmarked this article. I will take it with me when I meet my anesthesiologist if I’m [ever] scheduled for surgery.  If she [had] said, ‘way to go, TPP,’ I would request a different doctor.”

Medicine often forces us to choose between being good partners, parents, and physicians.  Even our patients sometimes expect this. Is financial freedom the way out of this false dilemma?

Below, I’ll discuss the problem in greater detail before providing you 5 ways to find better work-life balance for physicians.

What is a False Dilemma?

In philosophy, a false dilemma is a situation where you are presented with only two choices that seem mutually exclusive.  In form, this would present itself as having to choose between “Either X or Y”.

Yet, the truth is that there are often other alternatives not presented, or there is a way the two choices can co-exist.

An example of this in personal finance would look like this.  “If you want to save more money and produce positive cash flow, you must spend less.”  What is really being said is that you can:

A) Keep spending, and continue to stay poor.
B) You can spend less, and have positive cash flow.

While this seems true at the outset, it is a false dichotomy.  There are really two different ways to produce positive cash flow. You can earn more or spend less.  Yet, the way the dilemma is set up only gives you one choice.  If you want a positive cash flow, you must spend less money.

Hence, it is a false dilemma.

Partner, Parent, Physician: Another False Dilemma

The false dilemma I want to explore in this post is often subtle but remains rampant in medicine.  Here it is:

“You can be a good physician or you can choose to be a good partner/parent.” 

It takes various forms, but the idea is the same.

Here are some real-life examples:

• Doctors are discouraged from discussing “work-life balance” as a major goal when interviewing for jobs. This suggests that you aren’t committed.  I know physicians who weren’t offered interviews/jobs after they mentioned this, despite being otherwise well-qualified for the job.
• Many physicians are never truly “off”.  I know multiple doctors who have been called while on vacation to complete their EMR documentation.  Other physicians are constantly available to administrators, billers, and patients via EMR, email, or even texting.
• Possibly the biggest area where doctors are forced to face this false dilemma involves the myriad of decisions women physicians are forced to make that impact both their career and their family lives.

Is it so impossible to imagine the possibility that we could find a balance between work and life?

Work-Life Balance

Before I dive into some specific ways that I’ve found a better work-life balance, I want to mention that many of these things are only possible after you experience some financial freedom. How do you go about doing this?

You must produce a positive cash flow by earning more and/or spending less.  The larger the gap between what you earn and what you spend, the more cash flow and financial freedom.  The most tangible way to do this is to limit your fixed monthly expenses and then pay down your debt.  Doing this has produced very meaningful financial freedom long before my family will be financially independent.

Using that freedom, we instituted many of the following ways to find better work-life balance:

1. Hell Yes Policy

Possibly my favorite, and most effective tool, for finding work-life balance is my Hell Yes Policy.  The institution of my HYP looked like this:  I say “no” to anything that doesn’t make me say “Hell Yes!”

This has provided me the freedom to focus on things that I am truly passionate about, while ridding me of other things that don’t produce a lot of meaning or satisfaction in my life.

Here are some examples of some things I’ve said “Hell Yes” to:

• Attending 90% of kids’ after school activities.
• Creating a personal finance curriculum for the 4th year medical students at Wake Forest.
• Producing the Money Meets Medicine podcast (new shows each Wednesday!)
• Becoming the fellowship director of the Regional Anesthesia and Acute Pain Medicine fellowship at Wake Forest.
• Creating an online course to help physicians find the financial freedom that they deserve through cash flow planning (coming soon!).
• Publishing research on adjuvants in regional anesthesia.

2. Focusing on Your Passions

Another option provided by financial freedom is the ability to focus on parts of your job that light your fire but may make less money. This could involve teaching, research, a side hustle. or focusing on lower-paying procedures if you are a proceduralist.

The AMA study listed above suggests that for most young physicians, this is appealing because the majority of us want to have a side-hustle of some sort.

The trouble is that many side-gigs don’t make a lot of money at first.  In fact, for the first 18 months on this blog, it pretty much broke even. Yet, I would consistently spend 10-20 hours per week on this project during my non-work hours.

3. Setting Expectations & Boundaries

While the HYP helps set some boundaries, it doesn’t always set them all. I found it helpful to set other boundaries and expectations to find the work-life balance I desired.

For example, I work on academic items during my academic time or during shifts where I have some free time to do so. Typically, I am not going to work on these efforts on my post call days, weekends, evenings, or vacation days.

Another area that I’ve set some boundaries includes my email. I try to batch tasks so that I can focus on deep work.  And email is a constant distraction. So, I push it to my phone every 6 to 12 hours.  This means I am not constantly available via email.  I’ll get to it when I get to it.

4. Work a Full-Time Job 

The average physician works between 40 to 80 hours per week.  In fact, the last time I saw the numbers, around 20-30% of physicians work 61 to 80 hours per week.

Yet, most jobs in our country have an expected full-time workload of 40 hours.  It took me time to realize that, for many physicians, “cutting back” was really just getting to full-time hours for most professions.

This is a great way to find better balance.  It obviously comes with some financial consequences, including lower pay and possible reduced benefits.  That said, if you have produced that positive cash flow we talked about above, this becomes a very real possibility for finding a better work-life balance.

It also may eliminate the false dilemma of having to choose between being a good partner/parent and physician.

5. Outsource Tasks

Having a positive monthly cash flow allowed us to finally get to the point where we can consistently outsource tasks.  This includes our lawn care, cleaning services, virtual assistant help on The Physician Philosopher, and many other tasks.

Prior to paying down our debt, I mowed my own lawn and we cleaned everything ourselves despite Kristen working a full-time job and me working essentially one and a half jobs between my anesthesiology work and the blog and podcast.

Having the financial freedom to outsource tasks has freed up so much time. We now have much more time to focus on our passions and we even have some time to play 7 Wonders Duel, our favorite 2-player board game, many nights.

Take Home: 

While the struggle last year was very real, looking back I learned a lot – and I’ve taken very big steps towards finding the work-life balance that my family and I need.

The take home? Don’t let the cultural norms and expectations from outside naysayers determine your work-life balance. You don’t have to choose between being a good partner/parent and physician.  You can do all three.

Has work-life balance been an issue for you? What steps have you taken to improve this false dilemma? Leave a comment below.

TPP