Balancing family and career: advice from the trenches.

I was recently asked to address a group of residents on the subject of balancing family and career. Although I had never considered myself an expert on this topic, I provided these young physicians—almost half of whom were women—with practical advice from my own experience over the past 14 years. Although many of my suggestions seemed self-evident to me, the residents' enthusiastic responses encouraged me to offer my suggestions to a wider audience. Women currently make up a greater percentage of medical students, residents, fellows, and physicians in the United States than ever before. As a result, balancing family and career has become imperative for an increasing number of women physicians. This issue, however, receives little attention in traditional medical forums. Ideally, the art of balancing family and career is equally important to men and women, but as long as women are the traditional caregivers, this balance is more of an issue for them. This is particularly the case in academic medicine; because the academic clock and biological clock tick in synchrony, efforts to build a family and a career typically converge for a woman in her twenties and thirties. Obviously, all families are different, as are everyone's needs and wants. What works for me might not work for others. Nevertheless, it is the prerogative of middle age to become reflective. In so doing, it has become clear to me that certain things have been helpful, even essential, in having a family and a productive career and enjoying both on a full-time basis. Although my own experience is as a woman in academic medicine, my advice may be useful to physicians of both sexes in other settings as well. I am currently an associate professor in the Department of Medicine at a major academic institution. I was the first woman with children to receive tenure in this department. I am active in research, administration, education, and clinical care. I have two children, 14 and 10 years of age, and a partner of 22 years who is also a physician. I offer this information as evidence that my suggestions are drawn from experience and have resulted, at least to date, in successful outcomes. To start, set personal and professional goals and plot a course toward achieving those goals. Look in the mirror and ask yourself, "Who am I, and what do I want to be? Do I want to be a department chairman? Do I want to have a national reputation? Do I want to be a parent? Do I want to work fullor part-time? Do I want to do research? Do I want to live in a rural or urban area?" and so on. There is no right or wrong answer to any of these questions; they are personal decisions. I periodically ask myself, "If something catastrophic happened to me today, would I have any overriding regrets about the way I have lived my life?" If you ask yourself this question and the answer is "yes," I encourage you to change something soon. Once you have established your goals, be sure to choose a partner who shares these goals. Although I did not realize it at the time, this was the single most important decision enabling me to achieve both personal and professional success. During a recent conversation with several other women on the faculty, we surmised that women and men pursuing a career in academic medicine often view the ideal spouse differently. The average man in academic medicine is likely to seek a wife who will take care of everything on the home front—house, kids, shopping, laundry—so that he can spend long hours at work and feel nurtured at home. Women in this field, however, usually want a spouse who is willing to share responsibilities, negotiate tasks, and exist on a more equal professional footing. Thus, I would caution a woman to be wary of choosing a life partner who was raised to think that the worst form of humiliation was to be "beaten by a girl." I also advise women to avoid selecting partners who think that housework falls under the purview of the female sex. If a woman's goal is to be a tenured professor and her spouse's goal is to marry a domestic goddess, the relationship is doomed to fail. In my case, hiring someone to help with housework and laundry was the best thing for my marriage and my mood. For all the men reading this, I am here to tell you that dirty socks, underwear, and dishes are no more appealing to the x chromosome than to the y chromosome. The time you save is time you can spend with the kids, your spouse, or getting extra work done.