How Stanford Med Got “Work-Life Balance” Wrong

Screen Shot 2015-08-24 at 8.42.46 AMDid it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”?

Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white?

Every day, I go to work and see the example of the nurses and technicians who work right alongside me in tough thoracic surgery cases. Zanetta, for instance, is the single mother of five children. She leaves her 12-hour shift at 7 p.m. and then faces a 60-mile commute to get home. She never complains, and unfailingly takes the extra moment to get a warm blanket for a patient or cheerfully help out a colleague

When I leave work, I see the gardeners who arrive in battered pickup trucks and mow lawns in the Los Angeles summer heat for slim pay and no benefits. I can’t imagine these people wasting time worrying about work-life balance. They’re too busy working.

Or look at what it’s like to work in one of the world’s top restaurants. Edward Frame, now a graduate student in social research, described his first job in a Michelin-starred kitchen for an article in the New York Times.

“I worked in a small alcove, connected to the dishwasher,” he wrote. “Glass racks came out, I wiped away any watermarks or smudges, and then, just as I finished one rack, another appeared. This went on for hours, like some kind of Sisyphean fable revised for the hospitality industry. By hour two my fingers hurt and my back ached. But I couldn’t stop. The racks kept coming. Slowing down never occurred to me. There wasn’t time. I needed to make it nice. Iwanted to make it nice.”

Let’s face it—a lot of people have jobs much worse than being a physician. Apparently, they don’t expect to be coddled or to receive much sympathy about their rate of burnout, or their lack of “work-life balance”. Nor do they expect that workplace expectations will be altered just to suit them.

I can’t imagine having the gall to complain about how tough it is to be a physician when all you have to do is open your eyes and see what’s all around us:  people working incredibly hard, making far less money than we do, and then returning home to face the responsibilities of family life, child care, housework, home maintenance, and everything else.

We—physicians—thankfully can afford help with these tasks. The Medscape Physician Compensation Report for 2015 reported that the average compensation for a primary care physician was $195,000 and for a specialist $284,000.

When I was a new faculty member making an instructor’s salary right after residency, it’s true that I didn’t have a lot of take-home pay left after I made monthly payments for student loans, private pre-school for two children, housecleaning help, and a full-time nanny to provide transportation and after-school care. The full-time nanny was essential because a child with a bad cold or an upset stomach needs to stay home, and a physician can’t drop everything to stay home too. These were investments that my husband and I made because we felt that being a physician is important work.

But in medicine, the prevailing wisdom today is that the rigorous culture of the past needs to change—along with the expectation of dedication to duty, long work hours, and stoicism—because it’s all just too difficult and we risk getting burned out.

Now Stanford University has started a new “time-banking” program designed to ease pressure on faculty physicians and basic science professors. As admiringly described by reporter Brigid Schulte in the Washington Post, the program allows faculty members to “bank” hours that they spend on uncompensated activities such as committee work and earn credits to use for support services at home or work.

Dr. Gregory Gilbert, an emergency physician who was the poster child for thePost article, used his credits for delivery of meals to his home, housecleaning services, and employing a “life coach” to help him “find better balance in his life”.

Wait just a minute. I’m sure that Dr. Gilbert is a good person—a divorced father trying to be a conscientious physician and spend time with his children. He must be a smart guy if he’s on the faculty at Stanford. Do you mean to tell me that Dr. Gilbert couldn’t figure out how to order food delivery and arrange for housecleaning before Stanford came up with this program?

The sheer paternalism of the Stanford program is breathtaking. The assumption, apparently, is that Stanford faculty can’t be trusted to manage their own lives inside and outside of work. So Stanford needs to nudge them in the right direction, encouraging them to use time-bank credits for support services that free up their time, whether housecleaning or help writing grants.

Why wouldn’t Stanford provide grant-writing help for all faculty members if this is a university goal?  Or increase faculty pay by incentivizing areas of the educational enterprise that may be underserved, such as mentoring and committee work? Can’t the faculty be trusted as intelligent adults to spend their own money as they choose?

I wonder, too, what California taxpayers would think if they realized that some of the dollars they pay in support of Medicare and Medi-Cal are paying for physician “wellness” programs rather than for patient care services. The Stanford time-bank program was funded “largely”, but not entirely, by the Sloan Foundation, according to the Post. Though Stanford is a private university, it receives millions in public funds every year as do all academic medical centers. Medicare pays directly for healthcare services, and Medicare funds support graduate medical education programs and faculty salaries.

Reading between the lines, it appears that Ms. Schulte has perhaps overstated the success of the Stanford program. She admits that the emergency department’s time-bank program is “all that’s left” of the more ambitious, two-year pilot program that was originally started, and that other departments in the university haven’t embraced the concept though it still has enthusiastic supporters.

Meanwhile, I don’t see why Dr. Gilbert, as an affluent single father, inherently deserves more help with “work-life balance” than does Zanetta, the surgical technician. He’s an American university and medical school graduate, and a clinical associate professor at Stanford. Zanetta’s goal someday is to go to college and become a registered nurse. I’m sure she would love to come home to a clean kitchen and find a fresh meal delivered to her door. But “burnout” and “work-life balance” are the vocabulary of privilege and entitlement. Everyone should be lucky enough to have these first-world problems.

Karen Sibert is an anesthesiologist based in Los Angeles.

4 replies »

  1. I am sympathetic to Zanetta, but:
    a) I did not make her have 5 children, she decided to do that all on her own.
    b) I was studying and going to school when she was not going to school, and having 5 children
    c) I was studying and going to school when she was getting a paycheck for 8-12 years.
    d) I was studying and going to school and borrowing $120,000 that I was going to have to pay back at 9% interest (Reagan economy years) which means I paid about $275,000
    e) now I am old and I STILL WORK more hours per week than Zanetta
    f) I drive 60 miles each way to work, and work 12 hour shifts, where I may stand on my feet for the whole time and exert enough energy to make a Fitbit’s brain explode
    g) I see 20-40 patients every day, most of whom have 100% FREE “visit the ER anytime day or night for any trivial reason” credit cards (aka “Medicaid) – that I PAID for with my taxes, but I do not complain either. [ok, maybe sometimes I do complain]
    h) I do not have a child healthcare subsidy
    I) I pay cash for my own healthcare insurance
    j) I pay cash for my own disability insurance
    k) I pay cash for my own life insurance
    l) I pay cash for my own malpractice insurance
    m) I pay approx. 27% of my income to the government
    n) I pay CASH for my child to attend college
    o) I am constantly told by insurance companies my job can be done by a nurse
    p) I am constantly told by the government that I kill people (44,000-98,000 every year, take your pick)
    q) I am constantly told by the media that I am greedy, lazy, inefficient, uncaring of people’s woes, don’t listen when patients try to tell me they have “severe fibromyalgia from living next to power lines,” and generally a racist, homophobic, misogynistic anachronism.
    r) I am constantly told by lawyers that I am stupid, and should know better than to give someone who has chronic atrial fibrillation a blood thinner, because after all, it can make people’s blood thin.
    s) I am constantly told by academicians and HIT “experts” that I am recalcitrant because of my lack of enthusiasm for being a data entry clerk instead of a doctor.

    Soooo. Ya’ll wanna talk about work-life balance?

  2. Or why was it only when a man had all the duties of single parenting was it noticed that it was tough, time consuming and hard to do everything well without help… when women had been doing this for years!

  3. This is an excellent posting and as I was reading it, I was wondering, yeah, this makes sense. Why the fuss about physicians? Then, the Eureka moment, the difference is that it’s a Libby Zion thing. An overworked associate at a law firm burns out, they lose a motion. An investment banker burns out, they misplace a decimal point. So what? A doctor burns out, and it’s Libby Zion all over again. In the other profession that comes to mind in which burnout can cost lives, which is airline pilots, hours are carefully controlled, ridiculously so. Way overboard in the other direction, if you ask me. Nonetheless, the point is there: if someone else’s actual life depends on a professional not burning out, steps need to be taken.

  4. “Burnout” and “work life balance” are universal phenomena that occur independent of class and occupation. That main distinction between professional and non-professional jobs is the perception of and reaction to management. The working class has a much more accurate view of the management not overlapping with their interests and where they have the power, they can contain that by rules. Coming from a family of railroad workers – a good example would be the number of workers in a locomotive and how much time they can work. Those rules are there as a complex regulatory system reflecting politics and public safety. We have seen that start to happen with the rules in residency that were established as a result of safety concerns with overworked residents.

    Professionals on the other hand are far less likely to directly confront management at any level. In medicine that equates to a loss of autonomy, medical decisions that appear to be more like business decisions, and a corrosive effect on the academic side of medicine that attracted many people to the field. It is this loss of autonomy and control that leads to burnout. Physicians have always had work-life balance problems. It is the nature of the job. Burnout is not and it clearly has to do with the way physicians are managed. They are managed like production workers, with none of the leverage that production workers might have.

    George Dawson, MD, DFAPA