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    My attempt at work-life balance

    As a physician, finding time for a personal life outside of the daily pressures of a medical practice can be daunting. 

    Working to improve patients’ health while meeting government and payer regulations, keeping an eye on practice finances and managing a staff often leaves today’s doctors with little extra time or energy. Fortunately, many physicians do find ways to have a fulfilling life both inside and outside of their practice.

    For this year’s Physician Writing Contest, Medical Economics asked readers how they achieve a satisfying work-life balance. The result is a series of personal and professional anecdotes on how being a physician doesn’t mean sacrificing other interests outside of practice. Physician authors shared their own approaches and provided peer advice knowing that there is no silver bullet or one-size-fits all solution to maintaining balance.

    In this issue, we present our contest winners for 2017, selected by our editorial team and physician advisers. In future issues, we’ll present honorable mention submissions offering additional tips and insight from physicians to physicians.

    Third Place

    My attempt at work-life balance
    By Arvind R. Cavale, MD

    I learned early in my life that work-life balance was the most important gift I could give myself and my family. My father’s life ended at age 59, mainly due to his choice to devote most of his life to his business. My mother’s life ended at 50 due to stress related to my dad’s involvement with his business. 

    Being an immigrant physician in the United States demanded a huge learning curve and double the effort of American grads, just to land a decent job at a reputable endocrinology practice. So when I was offered a position with a well-respected endocrine practice in Philadelphia in 1999, I was overjoyed. Having trained at a busy county hospital, it was a breeze seeing 32 patients on my first day in the practice.

    With time, the daily patient count increased to over 45. It felt great being part of such a busy practice, but by year three, I began to realize I was seeing my wife and son less and less. I was visibly aging too. And, we were expecting our second son. 

    This baby came into the world four weeks after September 11, 2001, and while admiring the wonder of life, it dawned on me that life could be extinguished in a flicker of a moment. Memories of becoming an adult without my parents’ guiding presence came back to me after a gap of 12 years. I couldn’t let history repeat itself. 

    Six months later, when I was up for a partnership in my practice, I decided to walk away from it, much to the displeasure and surprise of the senior partners. I was determined to find my own way of practicing endocrinology without sacrificing my family, especially after seeing how the partners (who were about 12 years my seniors) worked. I made up my mind that when I was their age, I was not going to be working like them. 

    So I set up my own solo practice renting a small office. My wife was the “front office” and my seven-month-old son was the “mascot” in a playpen, napping in the extra exam room in the afternoon. While this was tough, it allowed me family time while at work. Wonderfully, many patients got to know “mommy and baby.”

    Another decision I made early in my solo practice life was to start with an electronic office. In 2002, mine was one of the first offices to be paperless. This helped us avoid the pitfalls of paper charts, and using software, I could connect to my electronic health record (EHR) from home. This allowed me to come home early in the evening, play with my kids, hang out with my wife and have dinner, and then connect back to the office and finish my notes, messages, etc.

    Similarly, I was an early user of a service that relayed my office calls to whatever phone I was at. I cannot underestimate the role of technology in allowing me to create a semblance of work-life balance.

    Despite the predictions of my practice’s demise, I survived. But, as most doctors do, I began to overstretch myself, serving five hospitals and having four-and-a-half full days at the office. The next “lightbulb” moment came in 2004, after a President’s Day weekend. My older son did not know what a long weekend was when his kindergarten teacher asked him what he did over the long weekend. 

    Again, I had allowed myself to be pulled into the irresistible addiction called work. My urge to help others in need, combined with my inability to say no, was dragging me into a similar quagmire as my dad. 

    But I was determined not to repeat his mistakes. So I started pulling out of the hospitals, one every six to eight months. Once again, I was admonished by my peers not to make this mistake; “you will lose 40% of your revenue,” they warned me.

    But life was more important to me than money could ever be, and I continued my withdrawal from hospital work. Of course, I did not miss the politics and useless regulations of hospitals. And then it was November 10, 2007.

    A cold Saturday morning had just turned into the afternoon, and I was returning home after making rounds at my only remaining hospital. Driving over a hilly road in beautiful Bucks County, Pennsylvania, I was suddenly confronted by a car coming at me head-on. When I swerved to the right, hoping to avoid a direct hit, this car hit my SUV in the left-rear, up-ending me. In a fraction of a moment, I was hurtling at 35 miles per hour upside down, hanging strapped to my seat until I hit a utility pole.

    I crawled out of my car unhurt, thanks to three angels that came out of nowhere. Once again, this was a sign that I shouldn’t have been there at that time. I gave up all hospital work at the end of 2007. Just like that, nights and weekends were mine to spend with my family. My sons would never again not know what a long weekend was!

    Having quit hospital work, it was imperative that I maximize my revenue from office work. Without the hassle of hospital claims, I was able to identify sources of low office productivity and high stress for our staff and myself—lousy third-party payers who paid poorly but demanded a ton of administrative work. In response, I started weaning myself from such contracts, starting with Medicaid and ending with for-profit private insurers. Again, I got a ton of blow-back from peers, but I needed my peace of mind. Over time, most patients who valued my care continued to visit me, paying cash. 

    Finally, what I have learned is that my staff and my patients are indeed my extended family. Therefore, spending time with them should never be considered strenuous. My nuclear family understands this. My patients understand this. So does my office staff. So if I leave the office at 4 p.m. in June or July to catch nine holes of golf with my son or end my Friday at noon to catch a matinee movie with my wife, they don’t mind.

    Similarly, if I have to excuse myself from a Saturday dinner to troubleshoot an insulin pump issue with my patient, my family understands. Everybody has confidence that I am there for them when they need me. I am also quite assured that they will be there for me when I need them. 

    In spite of all this, I have one deep regret—I can’t/don’t take enough vacations and haven’t been able to travel like I have dreamed of. But it is next on my list. Ultimately, we all have to realize that true work-life balance is a myth and is usually a product of our definitions. I find solace that when I am away from my core family, I am always with my extended family. In essence, I never leave my family, hence I am perhaps the luckiest man in the world.  

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