You may have read or heard about Anne-Marie Slaughter’s recent article in the Atlantic, “Why Women Still Can’t Have It All.” The author tells how she left her dream job in the State Department after two years as the first woman director of policy planning in order to return to her husband, her two adolescent sons, and her tenured professorship at Princeton University. The weekly commute to Washington proved impossible, and her family needed her.
Professor Slaughter’s article is well worth reading for its meditations on how difficult it can be to combine parenthood and a challenging career. Her conclusion is that work practices and work culture need to change. Unfortunately, her take-home points have little application to the life of a physician. She quotes from Republican political strategist Mary Matalin, who wrote, “Having control over your schedule is the only way that women who want to have a career and a family can make it work.”
That certainly leaves me out. If there’s one thing I don’t have as an anesthesiologist, it’s control over my schedule. We’re expected to be in the hospital every day to have our patients ready to go into the operating room at 7:15 a.m. Unless I have a life-threatening domestic crisis at home—something like an actively hemorrhaging child or rising floodwaters—no one is going to show up and take over my cases so that I can go home.
One section of Slaughter’s article is titled, “Changing the Culture of Face Time.” She argues that time spent in the office isn’t always necessary, and that being able to work from home “can be the key, for mothers, to carrying your full load versus letting a team down at crucial moments.” She mentions video-conferencing as one way to manage working off-site. A clever mother can even use her smart phone to call in to a meeting while watching her child at a playground.
But if your job involves “face time” with a patient, it’s different. I can’t see any way to insert a central line or an epidural catheter from home. Just as soldiers speak of “boots on the ground,” most physicians have to be at the bedside or the operating table to get the work done.
Physicians aren’t alone in this. Nurses, traffic cops, beauticians, mechanics, dog walkers, personal trainers—all of us have to be on site to do our jobs. There is no way to phone it in. Nor do most of us have the freedom to be "open and indeed proud" if we defer a task for children-related reasons, let alone leave early whenever we choose. For most people in hourly positions, that would be a sure route to losing wages or getting fired.
Some physicians have started to play the trump card of work-life balance quite cleverly. I’ve had the dubious pleasure of working with a plastic surgeon whose marriage was plagued with infertility issues. He would routinely come in late on the days his wife ovulated, oblivious to the inconvenience he caused to the operating room personnel—mostly female—who were obliged to punch in on time and wait for him.
If there’s such a thing as a work-life balance abuser, the blue ribbon goes to one orthopedic surgeon at my hospital. He likes to go home, have dinner with his wife, and tuck his children into bed—all reasonable things to do. But he then books his emergency hip fractures for 8:30 or 9 p.m. This means that a host of other on-call personnel are held hostage in the hospital waiting for him. Work-life balance only works in this setting if you’re the one who gets to call the shots.
What would I do if I were in a position to control the OR schedule? For a start, I wouldn’t schedule the first case of the day before 8:30 a.m. My children are grown now, but I remember so well having only a moment to say goodbye in the morning while they were still snug in their pajamas. It would have meant the world to have an extra hour. But the reality of life as an anesthesiologist—then and now—is to be in the operating room ready to go, often before dawn, and heaven forbid that surgery should ever be delayed on our account.
Perhaps we shouldn’t complain. Work-life balance, after all, is a first-world issue, and even within the first world it’s primarily a concern of affluent white women. Most women of color, and for that matter women of any color who lack the advantages of money and education, seldom have the luxury of obsessing over whether to work, how much to work, and whether or not they’ve achieved optimal work-life balance.
Yet I agree with Professor Slaughter that we can do better. Not necessarily by working less—there is so much to learn and so much experience needed to do a merely competent job as a physician, let alone a great one. But maybe something as simple as starting the OR schedule an hour later could make a difference. Maybe we should eliminate grueling 24-hour calls altogether, and divide up the workday differently. Medicine may not be as flexible as other fields, but there’s a chance that with enough good will and open minds it could—perhaps—become more humane.