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Choosing Where and How to Work

  • Andrea FloryEmail author
Chapter
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Abstract

As a child, it was always clear to me that my life was intended for meaningful work. After all, I was the tallest girl in my class; I knew that was a sign of my responsibility. Everyone told me I was smart. My social worker mother and nurse grandmothers showed me that women could care for people outside as well as inside the home. My family culture and community church told me that helping others was the highest good a person could do.

In addition, I could see for myself that other people needed help. I noticed the disheveled man rummaging through the sidewalk trash can for food as I held my mother’s hand. Later, my surprised parents wondered how my 8-year-old self was planning to get to the home of the blind church members to whom I had apparently volunteered to read. As I grew older, the earnest and philosophical young adult novels I favored told me the same thing—there was work to be done, and we owed the world our best effort. I considered training as a nurse, like my grandmothers or the ones in the Cherry Ames books. Then a beloved family friend, just home from delivering her son, proclaimed “There are lots of great nurses, but we need more female doctors,” and I heard my calling.

Keywords

Work/Life Balance Balancing Medical Career with Motherhood Motherhood and Being a Doctor Physician-Family Life Balance Mothering as a Doctor 

I got married near the end of my last year of residency. When I started medical school, in fact when I started residency, I hadn’t yet even met my husband, and I didn’t have any of the 3 kids I now have. That’s probably a good thing because I would surely have talked myself out of the specialty I really loved into something more “family-friendly”. There’s nothing wrong with family-friendly, mind you. I always read the classified ads in the New England Journal just out of curiosity, wondering whether there are more part-time jobs cropping up as women, who more often work part-time than men in general, represent a greater share of young doctors. So far, I don’t think much has changed in the job advertising sphere.

When I happen to have a bad day at work, which is fortunately rare, I permit myself to back up and take a different fork in the road. In my alternate life, maybe I became a dermatologist, where “full-time” seems to be 4 days a week…but who works full-time anyway? Or infectious diseases, where every other ad seems to start “Full-time or part-time”. Ah, travel clinic…seeing some healthy people and getting them ready to travel to exotic locales. Lest fear of boredom be a factor, keep in mind that the occasional traveler will come home with a fever of 40.8—is it malaria? Dengue fever? Ebola? See, that would spice things up. And clinic finishes at 3p.

But snap out of it. I became a medical oncologist, had my first baby midway through my second year of fellowship, another baby at the end of my third year, and a third baby about a year and a half into my first “real job”. At some point in late second year when other fellows were beginning to do their job talks and interviews, it dawned on me that I didn’t want to be away from my son and his future sibs for 60 hours a week. I didn’t want to miss first steps or first words or first anythings. It didn’t feel right to me that someone other than me—indeed, someone I hadn’t even met yet—would be there for more of my kids’ waking hours than I would, and that’s exactly what working full-time meant.

—Tempeh, “How to get a part-time job in medicine,” November 18, 2008

As a child, it was always clear to me that my life was intended for meaningful work. After all, I was the tallest girl in my class; I knew that was a sign of my responsibility. Everyone told me I was smart. My social worker mother and nurse grandmothers showed me that women could care for people outside as well as inside the home. My family culture and community church told me that helping others was the highest good a person could do.

In addition, I could see for myself that other people needed help. I noticed the disheveled man rummaging through the sidewalk trash can for food as I held my mother’s hand. Later, my surprised parents wondered how my 8-year-old self was planning to get to the home of the blind church members to whom I had apparently volunteered to read. As I grew older, the earnest and philosophical young adult novels I favored told me the same thing—there was work to be done, and we owed the world our best effort. I considered training as a nurse, like my grandmothers or the ones in the Cherry Ames books. Then a beloved family friend, just home from delivering her son, proclaimed “There are lots of great nurses, but we need more female doctors,” and I heard my calling.

In medical school, primary care spoke to me. I loved the detective work of investigating a brand-new symptom and was impressed by the power of the trust between a patient and his physician. I felt the pressure to pick a specialty with more glamour or income, but primary care felt like the essence of helping to me.

When I finished residency in Providence, I was excited to get out of the hospital and finally practice in the real world. I was happily dating where I was, so rather than move back to DC as planned, I took a job in a multi-specialty community practice in a nearby small town. The female physician who led the practice was someone I knew and admired. She was tough but fair. Everyone in the practice was expected to work hard, but there was a great sense of community with the patients who came to see us. Even the police officer who pulled me over for expired plates recognized me from the walk-in clinic; he apologized for having to tow my car and then drove me to work in his patrol car!

As a young attending, my work filled my days. My helpfulness and attention to detail endeared me to my patients and I adored them back. I didn’t mind the way my clinic spilled into lunch and my charts filled my weekday evenings. I still managed a social life, enjoyed my hobbies and exercise, and had plenty of time for long baths and leisurely meals. I spent too much time worrying I would never have the family I wanted but was generally satisfied being the doctor I had dreamed of becoming.

Eventually, I tired of being a single woman in a town that seemed to be filled with extended families. All my close friends had spouses and young families; I was sick of tagging along. I wanted to be comfortable going to a movie or a restaurant alone, which never felt normal in Providence. I missed the diversity and variety of DC life. I hoped that I would have better luck in finding a partner with whom I could build my own family there. So, I moved back.

By the time I married, in my mid-30s, I was working for my old medical school, doing adult primary care and teaching students. It was engrossing work but harder in some ways than my previous job. The clinic was fast-paced and sometimes chaotic. My patients were sicker and had more barriers to care—and it took longer to earn their trust. Teaching medical students was intimidating at first, but I soon found my groove and loved it.

Fortunately, my husband also had a job with crazy hours. We made our marriage work by having independent workdays and restricting our time together to the weekends. By the time we started seriously contemplating having a child, neither of us could imagine how we could add a kid to the mix. I wasn’t sure anymore that it was a good idea. For one thing, so many things could go wrong with a late pregnancy, and I suspected that it would be my hard-earned career that would suffer if we had to care for a child with a chronic illness. While I loved my husband very much, the union of two strong-willed, independent people did not make for the easiest of marriages; I worried that adding the stress of a child might compromise our relationship.

My husband felt otherwise. He was certain that a child would enrich our lives. I decided to squelch my uncertainty and to trust him. We started to make changes to make space for a baby: he moved from his consuming law firm job to a lower-paying government position, and I arranged to work 4 days per week. My pregnancy was easy enough and I worked up to my due date. After our son was born, I chose to stay home with him for four largely-unpaid months. While I loved spending time with him, I felt restless at home. We found a wonderful caregiver, and I went back to work.

Shortly after my son’s first birthday, my responsibilities at work increased significantly. I was offered a medical school role that encompassed both the leadership of a large, established course and a rapid revision of that subject area to update and integrate it into a reworking of the overall medical student curriculum. There was no question that I wanted the position. While I recognized that it would be a tremendous amount of work, it was a topic about which I felt passionate. I was confident I could make positive changes and was excited to have the power to influence medical students in how they would care for future patients. My clinical work was reduced to allow for additional teaching and administrative time. We made plans to shift tasks around at home to account for my increased time at work. My husband and I expected that the first year or so would be rough, but then things would settle into a more regular routine.

That first year was incredibly difficult: intimidating, exciting, and exhausting. I felt unmoored, unsure of my decisions and frazzled by the amount of choices and plans that had to be made quickly. My advisors and helpers were also pulled in a thousand directions, so I learned to work efficiently and stopped second-guessing my decisons. As the months went on, the work continued to pile up. With un-meetable responsibilities in my clinical practice, medical school roles, and at home, I triaged remorselessly. Someone was always being shortchanged, but I tried to manage my guilt by rotating which areas got my attention.

As the first year stretched into two years and then three, it became harder and harder to maintain the pace. It was clear that more hands were needed but help was slow to arrive. There were signs of burnout; I dreaded going to work, was less efficient when I was there, and felt strung out much of the time. At home, I worked frantically to keep up with housework and chores—everything was done in a rush. I would calculate how much time I had to make a pot of soup before the dryer finished or plot how to combine errands to complete them in a single trip. My husband was frustrated that I was still so consumed by work, and my son, now 4, craved all my attention when I was home. I worried that I was missing too much of his life.

Beyond the tensions at work and home, I began to resent the loss of my personal time. Yes, my work felt important and was fulfilling, but I missed my friends. I missed entertaining, traveling, reading novels, having long conversations, and being outdoors. All of those had been given away in exchange for my work.

Looking back, it seems clear that I should have been thinking seriously about finding another job. At the time, however, it was not as obvious. Surrounded by a group of people who keep long hours and make sacrifices for work, doing a job I considered worthwhile, and lacking someone to whom I could hand off my project, I did not have the wherewithal to see it. I could not imagine trying to look for a new job. It was not until my husband emailed me a detailed financial plan for my unemployment that it occurred to me that I could simply leave my job. It was an amazing idea to me. Shortly thereafter, I submitted a letter of resignation.

It has been almost 2 months since I left my work and I am relishing the slower pace of my unemployment. I am still recovering; it has taken time to recalibrate. I continue to teach a bit, but most of my time is spent catching up on the things I have missed: time with my family, sleep, neglected house chores, and connecting with friends. I am so grateful to have this time.

I have started to ruminate a bit about future work and my thoughts center on the most basic of branch points. What role do I want my work to play at this point in my life? It seems to me that there are two possible paths to consider. I can choose to look for a new leadership role—what I think of as “important work” or “a big job,” the kind of work that will stretch and challenge me in new ways—or I could choose a clinical primary care job, difficult in its own way, but relatively comfortable after 15 years of practice.

Of course, it is a false choice. There are intermediate shades in between those two and many combinations that might work. The conundrum lies in the philosophical underpinning. If I pick an “easy” job, am I doing enough? Am I helping enough people, working hard enough, fulfilling my feminist leadership responsibilities enough? Alternatively, if I choose a “big” job, am I sacrificing my family or my happiness to my own need for a sense of purpose? How do I chart my new course?

One of the privileges of my work, both as a primary care physician and as an educator, has been the chance to hear people’s stories and the intimate details of their lives. I have observed how people make choices, both big and small. The most important thing I have learned is that decisions are extremely personal and that every option in a difficult choice has aspects that will be both positive and negative for that individual. With rare exceptions, there is no universal right choice. Given that, how can you make the best career and family choices?

Making the Best Balanced Work/Life Choices

Take Away the Pressure to Find the one Perfect Specialty or Job

Whatever you choose will probably work out well in some ways and less well in others. It will have downstream consequences that you should consider but will not be able to predict completely. Each choice opens some doors and closes others, at least temporarily.

Know Yourself Well

Unflinching self-knowledge can help you choose a life that gives you purpose and sustains you while minimizing the things that are likely to tire and frustrate you. In choosing medicine, we all committed to a life of service. It seems a simpler choice, however, when we are only giving our own time and energy. Things become more complicated when our own work choices compromise the ability to care for and enjoy our families. The second shift of parenthood limits the opportunities for self-care and recovery from work, so the personal cost of work is amplified. In addition, motherhood can change our values and perspectives. Caring for the vulnerable may carry more weight, demonstrating a life true to personal ethics may become more critical, and we may recognize more acutely how the choices we make play out over an extended time. Parenting also expands our skill set; those same clever tricks that get a toddler to eat can be repurposed on a reluctant administrator who does not like the options in front of him.

We commonly talk about work/life balance, leaning in and having it all, but those ideas get tricky in application. Our time and energy are limited resources, so while efficiency and smart planning can help maximize them, we had better make sure that the most critical needs and desires get priority. Every year in medical school orientation, one of our deans tells the story of the professor who fills a jar with rocks, pebbles, and sand. If you put all the sand in first, she explains, it fills the jar with small things and there is no room for the larger rocks. But if the largest rocks go in first, then there is room for the pebbles and the sand in the space they leave behind. If we can determine our priorities and place them first in our lives, then the smaller needs and wants can fit in the space around them.

Figure out what is most important to you. For a medical student considering specialty choices: which rotations did you enjoy most and, more importantly, what about them did you love? Was it pondering the mystery of an unknown diagnosis or the satisfaction of fixing something with your own hands? Do you want the surety of mastering everything about your subspecialty or the excitement of not knowing what might show up next? Think about your interests and hobbies outside of medicine; sometimes they can help you make the connection to what is most vital. Given that all careers have both joy and hassle, what do you imagine would be the best parts of a job for you? For trainees and career-changers: consider the aspects of your current (or most recent) position that were best. What did you love doing? What connects you to the reasons you entered medicine? If you are making a change, what did not work? How do you want things to be different for you?

Don’t judge your own preferences or values. It is dangerous to invest years of energy and time training in a specialty because you think it will be best for family life, if you do not love the work. Similarly, your grandmother may have held her obstetrician in highest esteem, but if you get queasy in the OR and are miserable when you are up all night, it will be hard for you to enjoy that work, no matter how much you would like to please her. Accept what is most important to you and your choices will be much easier to live with.

Recognize your personal biases and how they influence your ideas about what is acceptable. Many of us carry invisible boundaries that we learned early in life that may make certain choices seem transgressive. For example, it may not feel right for your husband to go part time to care for your baby, while you go back to work full time, even if you consider yourself an ardent feminist, because it conflicts with your unconscious expectations of how a man or a mother “should” behave. Making the biases conscious allows you to decide whether they are true and if they apply to your current situation.

Similarly, pay attention to the personal narratives that you tell yourself. We often make up our mental autobiographies based on a fallible interpretation of our life events and how we think other people perceive us. They may also contain echoes of things that we heard as children, like “Jenny is too lazy to be a leader” or “Sara needs to learn to keep her mouth shut.” If we do not hear those stories for what they are, they can have an undeserved power to become our self-image and to influence our choices.

Make Choices Consistent with your Values

Define a personal and/or family “mission statement.” This is a succinct summary of the values and desires that you wish to embody as a person or family. Creating one forces you to decide what is most important to you as a person or family (the rocks in the analogy above). You may want to make one specific to your career as well, which can describe your professional focus. Once you have a mission statement, use it as a tool to help choose which specialty or job option is most consistent with your priorities. It can also help you give yourself permission to say no when offered a role that is not consistent with your vision.

Make choices with a clear head whenever possible. Be ready with phrases that allow you to politely refuse to make an immediate decision, e.g., “That sounds like a great offer. Give me the weekend to think about it and I will get back to you on Monday.” Avoid making a choice when you are tired or upset. Get some real or psychological space from your current situation before making a change. Do use friends or mentors as advisors, but be aware of how their own interests or biases may affect their opinions about your decisions. Be cautious when revealing information to those who may have conflicts of interest.

Gather practical information about your options. Be realistic about the commitment that new career or social roles are likely to require of you. When looking at a new job, get as much information as you can about things like typical work hours, time required outside of work, and travel requirements. Try to get a sense of expectations that leadership may have for research, meetings, teaching, or administrative work that is not spelled out in a job description or contract.

Consider going part time. Part time can be a great choice when you have a growing family, since it allows you both professional satisfaction and more time to spend with family and get things done at home. If you do choose part-time work, be sure that you understand how it changes your pay and benefits, which can decrease more than proportionally. In addition, you may find that call and other expectations may not be lightened much when you decrease time at work . You will want to be sure that you will have appropriate coverage for all professional roles when you are out of the office. Decreasing from full-time work also has the potential to affect your advancement in academic or organizational settings.

Other creative options may exist, depending on your area of specialty and location. You may be able to telework or complete some work at home. You may be able to swap some clinical time for additional academic or administrative responsibilities, which tend to be more flexible. Alternatively, there may be walk-in clinic, hospital work, or nonclinical jobs in industry or the government that may offer more manageable hours for those who want to cut back.

Know your value. Understand how much leverage you are likely to have in a particular negotiation and use it to get what you need most. Remember that negotiation can be tricky for women; we can be penalized both for asking and for not asking for raises or promotions, so learn the best ways to engage. Consider your employer’s position, and see if you can find a way to frame your request that acknowledges those interests. You may want to practice role-playing the conversation, especially if you anticipate a challenging interaction.

Honor your intuition if something does not seem right when you are exploring a new position. There is no extra credit given for putting yourself in a punishing situation or tying yourself to someone who does not have your best interests at heart . Both medical training and attending jobs can be difficult to leave because of contract requirements, responsibilities to patients, and other factors, so make sure that you have the information you need before accepting an offer.

Lastly, be Ready to Course-Correct if Needed

What if you pick the wrong specialty, choose a bad job, or find that your priorities have changed? You cannot always anticipate what the consequences of a choice will be. When that happens, be truthful in looking at your thinking and motivations. Figure out what you can learn from the situation, review your priorities, and decide your next move.

As for me, I have no regrets about my choices so far. I feel lucky to have done work that I chose and was meaningful to me. I am thankful to have my family and the pause in my career to enjoy them. The next step is a mystery, but I am excited to see what waits in store.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Washington, DCUSA

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