© Springer International Publishing Switzerland 2016
Mamta Swaroop and Sanjay Krishnaswami (eds.)Academic Global SurgerySuccess in Academic Surgery10.1007/978-3-319-14298-2_55. Balancing Global Surgery with Traditional Career and Life Demands
(1)
Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA
(2)
Operation Giving Back, American College of Surgeons, Consultant in Global Surgery, Newport, RI 02840, USA
Introduction
Over the past 10 years, global surgery has taken off like wild fire as a field of endeavor, and even a career focus, for many surgery residents and faculty. There is an ever-growing need to address all facets of surgical disease and treatment in low and middle income countries (LMICs), and academic surgeons in the US have developed an important role in ameliorating this problem. Reflective of this, the literature continues to grow on key issues in global surgery, such as healthcare delivery and management in LMICs, surgical workforce deficits and solutions, training and education, and economics. However, there remains a dearth of literature on how to develop and navigate a career in global surgery itself, especially within the traditional environment of academic surgery, and furthermore, how to best balance career goals in this unique and emerging field with other life demands and priorities. Accordingly, this chapter outlines the verities in pursuing a global surgery career through a series of interviews with nine established leaders, experts, and emerging trailblazers in the field who are based in the United States:
Haile T. Debas, MD, FACS (HTD)
William P. Schecter, MD, FACS (WPS)
John L. Tarpley, MD, FACS (JLT)
Maggie J. Tarpley, MLS (MJT)
Diana L. Farmer, MD, FACS (DLF)
Catherine R. deVries, MD, MS, FACS, FAAP (CRdV)
Raymond R. Price, MD, FACS (RRP)
Steven W. Bickler, MD, DTM&H, FACS, FAAP (SWB)
Robert Riviello, MD, MPH, FACS (RR)
How Does One Achieve Work-Life Balance?
It’s a lovely goal, but is it realistic? Interestingly, not one of these leaders felt they had achieved balance…
I am not a great role model for balance – one of my weaknesses. (DLF)
I do not believe I have ever had a balanced life. (HTD)
Don’t think there’s such a thing. (RR)
I wouldn’t know. Not sure it’s possible! (CRdV)
Aren’t we all just muddling along? (RRP)
The scholar, David Whyte, in his recent book, The Three Marriages, Reimaging Work, Self and Relationship notes, “The current understanding of work-life balance is too simplistic. People find it hard to balance work with family, family with self, because it might not be a question of balance. Some other dynamic is in play, something to do with a very human attempt at happiness that does not quantify different parts of life and then set them against each other. We can call these three separate commitments marriages, because at their core they are usually lifelong commitments and . . . involve vows made either consciously or unconsciously. To neglect any one of the three marriages is to impoverish them all, because they are not actually separate commitments but different expressions of the way in which each individual belongs to the world.”
This perspective was shared by several of our interviewees –
A balanced life is ‘holistic’. You can’t compartmentalize professional, family and altruistic goals; they overlap and complement each other. (RR)
To me, a balanced life means being able to do all of the things that you love. Sometimes that means taking risks, and stepping off the usual path. (DLF)
You can’t look at whether it works day to day; but rather whether it works out over time. (CRdV)
Pursuit of excellence focusing on the critical issues of life, first and foremost is family and friends and trying to do Tikkum olam – “repairing the world (WPS).
With this perspective in mind, and because the concept of “balance” is not well defined, nor is it tangible, we chose instead to focus on the idea of “integrating” global surgical pursuits into the rest of life for an academic surgeon.
The Questions
For each global surgery leader, a set of core questions was posed, supplemented by one or two more specific questions based on each person’s areas of expertise/renown. The core questions were:
What does a balanced life mean to you?
How have you achieved integration of personal + professional priorities?
What is the greatest challenge to achieving integration of personal + professional priorities?
Who are the critical people in your life necessary to support your professional goals?
How did you attempt (and succeed) in achieving legitimacy to your global surgical pursuits in an academic environment?
Several themes emerged:
1.
Family First and the Juggling Act
2.
Learning to Say No
3.
Academic Challenges
4.
Support Systems
5.
Legitimacy
6.
Making the Case for Surgery in Public Health Terms
7.
General Advice
8.
Future of Global Surgery
Family First and the Juggling Act
With regard to establishing priorities among competing demands, the first theme that emerged was family first.
First order relatives have priority over everything else, except in life and death situations. Between the happiness of the spouse and children vs. career advancement or patient care, I chose the former, with the exception of life and death situations. This may have negatively impacted my career. (WPS)
If I had to do it all over again I would not work 16 hours nearly 7 days a week. I would go home to dinner and spend weekends and holidays with my family. Many in my generation sacrificed family time, hobbies, and social life for work. Now that I am retired, I sincerely regret this. I am happy to see the new generation is much smarter and appreciates the need to live a balanced life in which work does not consume the time that should be set aside for their family, their hobby, and friends. (HTD)
The key is achieving the things that you think are important – for me family life is most important. If I don’t have the balance with family, the rest does not mean much. It is incredibly important to make time for your kids. It is impossible to spend the needed time with your family if you accept too many obligations. One has to constantly make choices about what you value most. (SWB)
Recognizing this, many described taking family along when possible to conferences or medical missions (participating as a general assistant) and then extending those trips to spend time and create shared experiences with family. Another benefit was the fact that taking them along allowed those family members greater insight and appreciation into the work that frequently takes them away from home.
Beyond family, the metaphor of juggling was commonly invoked – with the most urgent need becoming the glass ball that cannot be dropped without breaking. All recognized that what is being juggled changes over time, depending on the stage of your career, where you are working, who your colleagues are, whether you are married or have children, and the age of those children. In addition to work and family, some described church or other obligations outside their academic institute as another priority to be juggled. And several cited the importance of taking care of oneself, including leisure, health/exercise, and personal interests.
For the average surgeon, you have to take care of patients and family, so global work ends up third. At any one time you may be able to handle 2 out 3 of these – but they all think they deserve your full attention. At least 1 or 2 entities will be resenting you at any one time! (CRdV)
There are different “seasons” in a life – and the priorities will change in each. (JLT – referencing Osler)
It’s important to balance the needs of self and others. Particularly with so many conflicting messages: ‘The patient always comes first’; work hour restrictions; respect for family. (MJT)
Sometimes balance is not in your control. (MJT)Most of it is out of our control. (CRdV)
Working in low resource areas provides even greater challenges to “balance”. There is severe understaffing and you are always on call. There is constant high stress and limited resources. Even when you try to take time to tend to self, more work piles up and is waiting for you. The only way to get a break was to leave campus, but there was double the work on return.” It is so important to find “partners” – someone to run things by and decompress with – even if they are hours away… (JLT)
Without question, time management was the biggest challenge.
There are too many good things to do. And in global surgery, there are endless needs, endless requests . . . (RRP)
There are not enough hours in the day. Given that limitation, the challenge becomes establishing priorities and making choices. (DLF)
It’s important to use time ‘well’ – maximizing any travel time for writing, editing, reviewing – papers, grant proposals, etc. (RR)
Prioritize and recognize what you can realistically accomplish, and what things you can let go – it is impossible to do everything. There is nothing wrong with choosing and limiting what you take on – if you are spending your time doing things that are not important – you will never have enough time to do the things that are important. Choosing is key! (SWB)
Learning to Say No
Hand in hand with the challenge of limited time is the need to learn to say ‘No!’
And especially learning to say no to some very good things. (RRP)
I think it is important to be able to say “No” and accept requests, speaking invitations, and committee assignments very selectively. (HTD)Related posts:
Guidelines and Parameters for Ideal Short-Term Interactions: Disaster Relief
Academic Global Surgery: Current Research Needs and Priorities
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