I like to hula, I think it's really good
Woman I don't understand the words
But in time, I think I could, if I just had the time
Oh, if I just had the time.
Molokaʻi Slide – Ehukai
I was recently at an event out in the community with my physician colleagues. We were learning about and experiencing native Hawaiian culture and values. It was a change of pace; a fun, enlightening and enjoyable day, being away from the clinics and hospital. Later in the day, I saw the young child of one of the doctors playing by himself. I asked him, “Whereʻs Mom?” I received a single word reply, “Patient.” I looked off into the distance and saw Mom occupied on her phone. I thought to myself, Was this her work time, her family time, or her time for herself? And, Was there even enough time in the day for all of these competing needs? “Was this the result of the sacrifices made to accommodate these apparently conflicting purposes? Or, was this the life of a physician, an amalgamation of the time needed to fulfill a calling to heal, family and cultural values and the joy received from satisfying these passions. Or, was all of this, in reality, all her time?
Early on in my career, I looked in awe at my physician colleagues who were on the phone at non-clinical events. Wow, they must be really valuable and important to be so needed. This admiration waned as my practice evolved and became replaced by suspicion and cynicism. Does anyone have any respect for my own time? Was I not allowed to have my own time anymore? Or was the concept of my own time incongruent with reality. Was I a servant or slave? Or was this just selfish thought, don’t we need to sacrifice at times in order to reap the treasures at others?
There are only 24 hours in the day. No one, no matter how rich or how poor, gets more, and no one gets less. The buffer is usually the amount of sleep we get. We tend to shortchange the sleep to accommodate the time need for the other aspects of work and life. The fact that 35% of Americans are getting less than the recommended amount of sleep indicates that we do not have enough time for these other things (1).
How we utilize our finite resource of time encompasses the disciplines of time management and work-life balance. Witzig and Smith conceptualize overall life balance as a mixture of three components, Work, Yourself, and Others (2). Increasing one of these comes at the expense of the others. At different times in our life, we shift theses ratios to accommodate our needs.
The life balance slider. The 168-hour week is unchangeable, but how you distribute the time spent in the 3 phases of work, yourself, and others affects your overall life balance. Every movement of the “slider” affects the other components. We illustrate this concept with 4 examples that are common to medical professionals: normal times, vacation, hospital duty or research grant deadline, and military service (deployment) or other prolonged absence. This tool is available on Calculate by QxMD for iOS, Android and Web at: https://qxcalc.app.link/worklife.
In this framework, there is an optimal ratio at different times in our lives to achieve the right balance to result in the peace that we seek. However, each of these aspects is not without its own rewards. The profession we have as physicians encompasses several distinctive components, each with its own varying degree of appeal and value depending on individual passions. A Mayo Clinic study of the aspect of the work that their physicians found most meaningful revealed a spectrum of patient care (68%), research (19%), education (9%), and administration (3%) (3). The amount of time that an individual physician was able to spend on the aspect most meaningful to them was the largest predictor of burnout.
There is another way to look at the way we view our time. Instead of compartmentalizing the time we spend, can we make it all our time. This eliminates the competitive nature of time utilization. Buddhist monk Thich Nhat Hanh, in his book The Miracle of Mindfulness relates a story about his friend Allen and the demands being place on his time (4). “Then Allen said, "l've discovered a way to have a lot more time. In the past, I used to look at my time as if it were divided into several parts. One part I reserved for Joey, another part was for Sue, another part to help with Ana, another part for household work. The time left over I considered my own. I could read, write, do research, go for walks. "But now I try not to divide time into parts anymore. I consider my time with Joey and Sue as my own time. When I help Joey with his homework, I try to find ways of seeing his time as my own time. I go through his lesson with him, sharing his presence and finding ways to be interested in what we do during that time. The time for him becomes my own time. The same with Sue. The remarkable thing is that now I have unlimited time for myself!"
So maybe we shouldn’t be thinking “if I just had the time.” We have the time. We have it every moment of every day. We can realize that through mindfulness. We should not be looking at time as a quantity. It is the quality of the time and how we have the opportunity to make use of every moment that we have.
1. CDC. 1 in 3 adults don’t get enough sleep. https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html.
2. Witzig and Smith. Work-Life Balance Solutions for Physicians—It's All About You, Your Work, and Others. Vol 94, ISSUE 4, P573-576, APRIL 01, 2019 DOI:https://doi.org/10.1016/j.mayocp.2018.11.021
3. Shanafelt et al. Career Fit and Burnout Among Academic Faculty. Arch Intern Med. 2009;169(10):990-995. doi:10.1001/archinternmed.2009.70.
4. Hanh. The Miracle of Mindfulness. 1975. Beacon Press.
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