I was recently talking with my oldest son as we were preparing for dinner. He told me about a conversation that he had with a friend earlier that day at school. His friend said that he "Hardly gets a minute with his dad." The implication was that his dad was often busy with or at work. My son went on to commiserate with the plight of his friend. He told me that perhaps this shared experience was why they were such good friends.
I was met with a sense of sadness. Medicine (and academic medicine in particular) is a demanding profession. It often takes us away from home for long periods of time and at times that are inconvenient for family life. Too many physicians seem to be more accessible by their patients than their families. I don’t want this to be my kid's experience. In fact, earlier in the day I had a conversation with a fellow academic medicine sojourner about the need to prioritize family. Certainly, that has been my attempt. But the fact remains, my son's memory of me right now is governed by how much time I am not at home.
Now, to be fair, I have recently had an extremely busy stretch of shifts this month as we prepare for the birth of our fifth child. My shift schedule has been extremely front loaded. I recently completed a stretch of 6 shifts followed by a stretch of 7 shifts separated by 1 day off as I worked 17 of the first 20 days this month. Even for me, it seems like all I have been doing lately is getting up, going to work, coming home, and sleeping. So, there is some degree of recency bias in my son's words. But his words also illustrated a point that I have been thinking about for a little while.
One of the big problems with medicine is that it has become a 24/7/365, care on demand profession. Some patients cannot wait. Others will not wait. Physicians have always had an ethos of caring for the sick regardless of the day or time. Call has always been a ubiquitous part of the medical practitioner's experience. But this concept of "on-demand" and "off-hours" care is becoming increasingly a part of the health care system. Patients want to experience the same immediate convenience of fast food and Netflix in the exam room. This is particularly true for lights-on specialties that routinely work during non-business hours. Since most of the day happens outside the hours of 9a-5p, a lot of the time spent at work and away from home tends to be in the afternoon/evening/nights, weekends, and holidays.
This creates a particularly challenging dynamic for those who want to navigate the perilous water of balancing work requirements and home responsibilities. We are seeing a decoupling of our work schedule and home schedule that is creating a strain on medical families. I call this discordance in work and home schedules the "Coefficient of overlap". That is, how much does your job overlap with the responsibilities of your family and friends. Stated differently, how much time do you spend at work while your family and friends are not similarly occupied with school or work.
In my situation, my wife is a stay-at-home mom and I have several small children - 2 of which are school aged children. For me, the coefficient of overlap is a measure of how much my job overlaps with my kids' school schedule. The closer my schedule aligns with my kids' schedule, the more efficiently I can engage in work pursuits and be present as a parent. The farther the alignment, the harder these pursuits become. And as a result, the less involved I can be with them. For example, when I am on my day shifts, it is easy to be engaged. I am working while they are at school. We are all home together in the evening. But there are days that I drop my kids off at school and know that I won't see them until the same time the next day.
It is my belief that this coefficient of overlap has a huge impact on provider wellness and the wellbeing of medical family. For my family, a misaligned coefficient can have a huge impact the perception of fatherlessness on the part of my kids - or the perception that work is paramount. Personally, my priorities are faith, family, then work. So as this coefficient of overlap trends away from time devoted to these priorities it creates inner conflict and perpetuates the perception of workplace burnout.
So, absent quitting and finding a new job (not a great plan) what can be done? Let's just say that since this is a daily struggle, I can't say that I have this perfectly figured out. But here are a few thoughts.
Cut back
The first thing to consider is adjusting your schedule. In my specialty of Emergency Medicine, working nights, weekends and holidays are as central to EM as EKGs, Ketamine and Ultrasound. There is no way around it. For you, if it is not night, weekends, and holidays it is either long hours or call.
It is probably safe to say that the standard physician contract for 1 full time equivalent (FTE) roughly equals 40 hours per week - on paper. But we all know that in reality, if we are hired at 1FTE, by the time we see all the patients, write the chart, answer the pharmacy calls, arrange the prior authorizations, and complete all the work, we have actually put in closer to 1.25FTE.
We need to ask ourselves some questions. Do I need to cut back to full time? Or do I need to work 1 full FTE to be able to meet my personal and professional goals? This summer I am cutting back to 0.9FTE. It's not huge, but it represents a realization that the impact of an Emergency Medicine schedule on family life is not merely the number of hours you work but when you work those hours. At this stage of my life, I need to free up some work time to be able to devote time to being home, engage with my wife and raise my kids.
Change someone's schedule
At some point, depending on work responsibilities and specialty, there is only so much schedule manipulation that you can do to change the coefficient of overlap. The second option is to change the schedule and time variables for your family. Since my wife doesn't work, there is not much to change there. But the kid's school schedule offers an opportunity to change schedules.
This is something that my wife and I have been discussing. We currently have our kids attending a brick & mortar, classical school with traditional school hours. While we are very happy with the school itself, the nature of my work schedule exacerbates the coefficient of overlap for our family. We have been talking about the idea of bringing our kids home and homeschooling them for a period of time. We haven't made any firm decisions yet, but a compelling factor would be that this would afford us the opportunity to be more flexible with the schedule and emphasize schoolwork while I am gone and give us opportunities to engage as a family when I am home.
Set aside specific time
The final way is to be intentional with the time that you do have together. Whether you have perfect concordance with your work schedule and kids’ schedules or there is discordance, the amount of time that you have with your kids before they leave the house is limited. In his book The Family Board Meeting, Jim Scheils writes that you have 18 summers to engage with your kids. He recommends taking a half day every quarter to engage with each of your kids on terms that they would find interesting.
Several years ago, my wife and I purchased a camper. We enjoy the idea of camping but find that getting all of the stuff out of the basement, loaded, set up, torn down, cleaned up and put away was more exhausting than the joys of the journey. But we like outdoor adventures, and we enjoy traveling. Given the growing size of our family, staying in hotels is becoming prohibitively expensive. We now need 2 rooms. So, we decided to take the plunge and become camper people. However, one of the strongest reasons that we discussed for purchasing a camper was that it is an intentional investment in spending time with our kids and creating lasting memories with them. It is a physical manifestation of that commitment and a tool that we can use to creating opportunities for engagement.
There are many strategies to intentionally engaging with your kids both on a periodic and a daily basis. These are limited only by your creativity. The question is this. Are you planning regular time to engage with them and to build a relationship with them that will last a lifetime? While hearing that my son's perception of my job was that it takes me away from home too much, it was also a good reminder to slow down, set the to-do list aside and simply be present.
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