Saturday, June 14, 2008

A quick note on "balance"


When one works 80 hours a week, there is no time for anything else significant. There are 168 hours in a week. About 56 of those hours should be spent sleeping, leaving 112 hours. With 80 hours of work, one is down to 32 hours. That leaves 4.5 hours per day to do everything else you want to do in a day. If you figure a half hour for personal grooming, an hour for meals (prep/obtaining/eating), and 45 minutes for commuting, that leaves you 2 hours a day to wind down. It leaves you 2 hours for any hobbies you might have or businesses you need to conduct in those usually very oddly timed hours you’re left with. That’s just 14 hours a week for every other activity you might have in your life. In medicine we don’t expect this of you just for a year. This is most of your life. It’s a life almost completely dominated by work. And it’s a high stress life. It’s a life full of constant competitive examinations. It’s also a life where one bad exam, one battle chosen with the wrong person, can lead to all of your hard work going up in smoke.

MD/PhD students are usually told they should find “balance”--the balance between professional obligation and personal fulfillment. There is no balance at 80 hours of work per week. There’s no time for anything outside of work. In my mind, the entire concept of balance in this career has become laughable. For MD/PhDs, there’s just a MD curriculum that expects you to be top of your class while doing PhD work. There’s a PhD experience that expects you to be as thorough as any other PhD student while completing your PhD work much faster. Then there’s an abbreviated fourth year and it’s time go off again to residency, where you can expect more of the same. You can be expected to continue with research and clinical work, being an expert in both, working hard in both simultaneously, well into your 40s. There’s no balance in this equation I just presented. From the time you start college to the time you get your first R01 grant, you are expected to be the best of the best. Everything from that 3.8x average undergrad GPA and 95th or higher percentile MCAT, to the high Step I and medical school grades to get the top “research” residency, onwards to the 10th percentile funding rates of the R01 grants. I find it funny that at every point everyone else is complaining. MD students complain about how hard it is for them, PhD students complain about how hard it is for them, residents complain about how hard it is for them. We do all of it. We have longer training, but with each piece condensed into a shorter amount of time, and with multiple pieces on top of each other. There is no balance there. 

Well, unless you think balance is what I’ve found—an expensive and hard to get bottle of beer in a city with crappy liquor laws and hopefully a dinner from a cart along side the street.