The unpredictable nature of an orthopaedic trauma surgeon’s workday is partially responsible for both female and male orthopaedic residents’ historical lack of enthusiasm for undertaking trauma as a career path. Persons hoping to have a family may be wary of the impact unpredictable schedules, perceived long work hours, call duties and round the clock patient care responsibilities have on their personal relationships and their ability to participate in raising children. Changes in the management of orthopaedic trauma services, including the addition of physician extenders and the availability of dedicated trauma rooms, has mitigated some of these concerns by not only improving efficiency of patient care but also decreasing after hour surgical procedures.1,2  Both serve to lessen the time burdens faced by orthopaedic traumatologists.

While these changes to orthopaedic trauma services act to improve physician quality of life, other means of achieving balance in both personal and professional realms should be considered. The demands of cultivating a fulfilling surgical career, raising children, maintaining personal relationships, and running a household are onerous. Strategies for sustaining a livable schedule that places appropriate importance on each responsibility can be developed making the career path of an orthopaedic traumatologist with a family sustainable.

Surgeons are not alone in their struggle to achieve balance between their professional and personal lives. Working people across many occupations struggle with the same issues.  Anne-Marie Slaughter PhD, in reflecting on her own experiences at positions both within the State Department and in an academic faculty position, proposes schedule flexibility as a critical component to achieving work-life balance.3 Surgeons may not be able to plan personal appointments in the middle of surgical postings or a clinic day, but manipulation of their schedule through part-time work hours or regularly scheduled off periods can facilitate the attainment of life balance.

Flexible Work Schedules

Flexible work schedules can take various forms. Job sharing positions with a trusted physician willing to share patient coverage, as well as office and staff overhead and space is one variation.  During scheduled off periods, one’s practice partner covers patient care responsibilities allowing for predictable protected days with one’s family.  Another consideration is part-time work in practices where partners are feeling overworked but unsure about the financial viability of adding a full-time peer.  Surgeons in these practices might be hesitant to consider the addition of a full-time partner but be more amenable to seeing a less precipitous drop in their income with the addition of a person working four weekdays rather than five. This type of arrangement can allow for time protected from clinical obligations that can be spent on personal responsibilities and relationships. While workdays can still be unpredictable and long, knowing that one has designated protected time for family life can lessen the physician and family frustrations that arise with surgical practice.

Successful execution of a flexible work schedule in an academic setting can be accomplished, but consideration of key elements must occur.  An honest assessment of personal and professional goals must be performed.  Accepting part-time work for the sake of increasing one’s availability for family needs can affect career advancement. Achieving tenure is often limited to the first few years of a person’s career within an academic institution.  The part-time physician, by not working a full schedule, will have less time to devote to academic obligations required for achieving tenure.  Decisions regarding the awarding of tenure are based primarily on the applicant’s research, publications, grant support, and active participation in committees of academic and professional organizations. Seeking out and utilizing available resources including institutional or department funded research staff can be helpful. These community supported resources can allow a physician with limited financial means at their personal disposal to improve efficiency by delegating work.  Beyond research and publications, cultivating and maintaining professional relationships with mentors and persons who share professional interests facilitates involvement in professional societies and organizations. Realize that the pull of one’s career obligations can make achieving balance more difficult. One must also be willing to create protected time during work or personal periods to focus on academic pursuits. If one finds that academic pursuits placed on clinical or personal obligations are not worth the personal sacrifice to family and clinical obligations, accepting a non-tenure track position or lengthening the time frame for tenure are options.

Creating a flexible schedule that creates availability for personal obligations will naturally decrease the time free to generate revenue. This should be taken into consideration when overhead and partnership structures are negotiated. Practice overhead considerations should include discussion of equitable division of overhead among partners based on utilization of resources. Overhead structures that base expenses on equal division of costs are often unequitable and financially suffocating for persons with lower utilization.  Overhead expenses that can be negotiated include office materials, staff, and space, as well as malpractice coverage. Additionally, thought should be given to negotiating how anticipated or unanticipated personal leave will affect partnership decisions, patient coverage and overhead.

Various groups have reviewed the effect of flexible work schedules on physician fulfillment with positive correlations to physician satisfaction noted. Mechaber et al. studied generalist physicians working both part-time and full-time.  Those physicians surveyed who work part-time reported higher satisfaction with their jobs, lower rates of burn out and greater control over work as compared to their full-time peers. Importantly, patients surveyed demonstrated no differences in satisfaction or trust between full and part-time physicians.4 Cull et al., in a survey of pediatricians found those working on a part-time basis had greater levels of satisfaction in multiple areas of both personal and professional life.  Part-time pediatricians reported higher levels of contentment with hours worked per week, time for administrative duties, professional relationships, and their work environment.  In their personal lives they were more satisfied than full-time colleagues with the amount of time spent with children, friends, in community activities and on spiritual needs.  In no professional or personal category did the full-time pediatricians give higher satisfaction ratings, including financial remuneration.5 This is supported by independent research finding no increase in emotional well being at incomes above $75,000.6

The successful implementation of a flexible schedule has also been studied in the business world.  In surgery, as well as business, establishing a career that accommodates personal obligations requires transparent communication with peers, establishment of a schedule, recognizing self worth within the organization and having a senior group member and peers who advocate and support the decision to work part-time.7 Being able to clearly communicate work and life priorities as well as future expectations for continuation of part-time or full-time work allows the group to better plan for future needs and tends to head off resentment that may build from colleagues who made different decisions in regards to work and home priorities. Communication can also include reminders to colleagues of sacrifices made in salary and or benefits in order to attain balance. Navigating issues that arise, or even developing a schedule and benefits that are mutually beneficial for both the surgeon and the group can be greatly facilitated if a more senior leader supports one’s attempt to achieve balance and advocates on their behalf.   Finally, making a schedule that is public and transparent allows both practice partners and family to know how your time is allotted and respect obligations to the other.

 Outside of the Office

Beyond altering the work environment, adjustment of expectations for home life should be considered. Often, the traits that were vital to completing medical school and a competitive residency are the traits that can hinder one’s ability to achieve balance.  The inability to say no to additional obligations both at work and home can lead to the surgeon taking on more than can be reasonably accomplished. Prioritization of responsibilities must occur. Hiring third parties to help manage household duties including home cleaning, laundry, shopping and meal preparation can significantly lighten the workload at home. Children should also begin to accept responsibility for age appropriate household duties early in their lives with increasing levels of accountability as they mature. Of particular importance is the ability to effectively communicate needs and expectations to your partner at home before resentment and frustration arise.

The addition of children to a family increases the complexity of achieving balance. Only 9.4% of female surgeons (but 56.3% of male surgeons) have a partner who makes the choice to be a stay at home child care provider.8  This indicates that childcare issues are a concern for many surgeons who often must mesh childcare needs with schedules that can occasionally be unpredictable.  The most common options include in-home nannies and day care facilities or a combination of both.  Cost and scheduling needs are two main factors affecting how child care needs are addressed.  Nannies can be a more expensive option, but availability beyond normal working hours can be negotiated as a part of the hiring process, as compared to day care facilities that often have fixed hours.  Having other options in addition to these two main choices can relieve the stress that parents face when a child or nanny is unexpectedly ill or schools and day care centers close due to weather. Help from extended family and friends living in surrounding areas can be invaluable. These persons may not be able to assume full-time childcare responsibilities, but they are often willing to take on more limited duties when the need arises.  Children also lessen time available for personal time or time spent with one’s partner. Dedicating time that is protected for both is fundamental to maintaining personal and relationship well being and happiness.

 Conclusion

Surgical careers can be rewarding and orthopaedic trauma is no exception. Issues regarding the successful balance between career and family life are becoming increasingly important to those pursuing or considering careers in surgical specialties.  Creating schedule flexibility at work can not only create more opportunities for surgeons to reliably participate in family life, but also increase physician satisfaction and lessen the odds of burnout without impacting patient perceptions of their quality of care.  With careful consideration and planning it is possible to negotiate a career path in orthopaedic traumatology as a parent and partner that is satisfying both professionally and personally.

Yvonne Murtha M.D.

Assistant Professor of Clinical Orthopaedics

Department of Orthopaedic Surgery

University of Missouri

References

1. Althausen PL, Shannon S, Owens B, et al. Impact of Hospital-Based Physician Assistants on a Level II Community-Based Orthopaedic Trauma System. J Orthop Trauma. 2013; 27:e87-e91.

2. Wixted JJ, Reed M, Eskander  MS, et al. The Effect of an Orthopedic Trauma Room on After-Hours Surgery at a Level I Trauma Center. J Orthop Trauma. 2008; 22:234-236.

3. Slaughter AM. Why Women Still Can’t Have It All. The Atlantic. 2012; 310:84–102.

4. Mechaber HF, Levine RB, et al. Part-time Physicians. Prevalent, Connected, and Satisfied. J Gen Int Med. 2008; 23:1525–1497.

5. Cull WL, O’Connor KG, Olson LM. Part-Time Work Among Pediatricians Expands. Pediatrics. 2010; 125:152–157.

6. Kahneman D, Deaton A. High Income Improves Evaluation of Life but Not Emotional Well Being. Proc Natl Acad Sci U S A. 2010; 107:16489–16493. Available at http://www.princeton.edu/~deaton/downloads/deaton_kahneman_high_income_improves_evaluation_August2010.pdf

7. Corwin V, Lawrence TB, Frost PJ. Five Strategies of Successful

Part-Time Work. Harvard Bus Rev. 2001; 79:121–127.

8. Troppmann KM, Palis BE, Goodnight JE Jr, et al. Women Surgeons in the New Millennium.  Arch Surg. 2009; 144:635-642.

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