It is 7 p.m. on a Friday night. I am sitting alone in my office, in a darkened building devoid of any other employees except for the janitor. Everyone else has had the good sense to go home. My 12-year-old son, home alone after school, called me at 4 p.m., very upset about a personal matter. I feel awful for not being there with him. My 17-year-old daughter is out with friends. There is no dinner in the house (or in my office), and my husband arrived at home 10 minutes ago. A resident just left my office, having asked if I would offer him a tutorial. (He is young and single and has no family waiting for him.) I missed my exercise classes this week due to my work schedule and am crabby, yearning to get away from the computer and move. I left home this morning before my children awoke. I have been in meetings nonstop, seeing patients, doing an internal review of the neurosurgery program, and supervising students, all of which I enjoyed. I am collecting reams of paper off my desk to bring home so I can write reports over the weekend as well as work on two manuscripts that are past due. I decide to scan my 200-plus e-mails for emergencies before leaving.
An e-mail from Academic Psychiatry extends an invitation to me to submit a manuscript on the topic of work-family balance. I stare at the invitation and begin to laugh hysterically.
I quickly calculate my four response options. 1) I decline, on the grounds that I have lost any semblance of work-family balance and am therefore unqualified to comment. 2) I accept, because this topic is my passion, and my personal rule is to say yes to requests in my areas of academic interest and research. 3) I decline, because I am overcommitted and the only way to achieve work-family balance is to say no. 4) I interpret the invitation as a message from the cosmos that my life is out of control and I need to rebalance it yet again.
January 31: I draft a letter to my boss
I tentatively decide to resign from one of my two major job roles, thus reducing my percent-time appointment from full-time back to part-time. I went full-time a year ago, when I became the Director of Psychiatry Undergraduate Medical Education, in addition to being the Director of Graduate Medical Education Programming in the dean’s office (a job I’ve held for 6 years). I also teach, supervise, and see patients. I enjoy all of these aspects of my work. There is a nice contrast between working within the psychiatry department and reviewing all of the programs outside our department, as well as between undergraduate and graduate medical education.
In the letter, I explain that my overwhelming “to-do” list (both personal and professional) necessitates a percent-time reduction for the next year or two. Professionally, I need to work on a number of time-sensitive projects, most notably creating the adolescent version of my normal development DVD, before my daughter finishes high school next year. Personally, there are a number of big events coming up this year that require my time. These include my son’s bar mitzvah, my daughter’s college planning, my parents moving to assisted living out of state, and a major home repair. On a day-to-day level, our family (particularly my son) has needed me to be more available in the evening. The reality is that there is simply not enough time to do all that needs to be done. Going part-time again is the only way I can think of that will let me bite off only what I can chew, so to speak.
I end the letter by expressing my ambivalence about the decision. I hold off on sending it, since our institutional review is on February 28 and I do not want to create a ruckus while we are preparing for this site visit. I also want time to let this tentative decision settle to see if it is truly the right one.
I am frequently asked, by an endless stream of residents and junior faculty members who see me as a role model, about how I managed to raise children and also achieve some level of success in academia.
I joined the faculty fresh out of my fellowship, cobbling together two half-time positions with separate funding sources (state and university). Our first child was born the same year. I promptly quit the state portion of the job and was 60% time for the next 16 years. I realize now how lucky I was to be able to do this. I had supportive bosses who valued my skills. Two years after I graduated, I became the fellowship training director. Despite my part-time status, there was no doubt that I was a core faculty member, playing a central role. The happy synchrony between teaching development and child-rearing resulted in my children being welcomed at the workplace. When I brought my preschool daughter to demonstrate child development in my classes, she enjoyed visiting our department head. She would sit in his big leather chair and put her feet up on his desk while he laughed. As training director, I was able to set a family-friendly tone. Fellows with new babies brought them to seminars, where they were nursed, passed around, and loved. Graduation parties and orientation picnics were always family affairs.
These days, unfortunately, my sense is that leadership is less supportive of part-timers. I recently watched an outstanding clinician-educator end up at a different institution because her department preferred to hire someone full-time rather than accommodate her desire to work part-time in order to spend more time with her new baby. Joan Williams describes the “ideal worker” phenomenon, in which you are only taken seriously if you dedicate 110% of your time to the job (1). Drago and Colbeck (2) note, “Historically, the ideal worker norm was developed and enforced mainly by men. Women in this framework may attempt to succeed as ideal workers, but success requires overcoming both sex discrimination and expectations that women should and will serve as primary caregivers to their children. The combination of the ideal worker norm, norms around motherhood, and sex discrimination creates biases against caregiving in the workplace, and hence work-family conflict, particularly for women.”
Our culture is in continual evolution, and Generation X/Yers, both male and female, increasingly seek work-family balance. According to an American Council on Education report, “[D]ata do show that young White male faculty (members) are making career sacrifices for parenting and caregiving at a much higher rate than their senior counterparts. Young White males also are more likely to support family friendly institutional policies and resources, not only for the benefit of women, but for themselves as well.… [F]aculty homes with spouses or partners to manage the family and household are becoming obsolete” (3).
I’ve been working on developing flexible tenure policies so that junior faculty members involved in child-rearing can work part-time and take longer to fulfill the same tenure requirements. One of the reasons that there are few women in positions of leadership in medical schools is that in their quest to achieve work-family balance, they choose nontenure tracks as junior faculty (4). Flexible tenure would help both men and women have meaningful involvement with their families as well as their careers.
February 3: E-mail. Subject: Medical student with family problems
I am a fourth year medical student at UIC medical school and just finished my Psychiatry rotation. You gave us a lecture on Child Psychiatry 5 weeks ago. I have a problem with my daughter that I am hoping you could help me with.
My grandmother has been helping us take care of my 23-month-old daughter since she was born. She is now tired and has started to tell me and my husband that she will leave us. We are afraid that she will leave at any time.
I will not be able to pay for a sitter or daycare until I start my residency. My husband can barely keep up with our bills as it is. We were thinking of sending my daughter to my husband’s parents in Eastern Europe for a few months. They were very happy to hear that we were sending their granddaughter there but our problem is that she has never seen them. My husband and I do not have American citizenship yet so obtaining a travel passport will take us longer than it takes American citizens. There is an airline that takes unaccompanied children to Russia where her grandparents would be able to pick her up.
My question to you is whether there are ways we can make her transition as smooth as possible. I was also wondering if it would be a good idea to ask her pediatrician to prescribe benzodiazepines for her travel. Also, if you think that this transition will affect her psychology in a negative way, we would probably try to ask around for loans so we can pay for daycare or babysitting.
Thank you very much in advance. Your input would mean a lot to me.
What can I say that will help? Tell her not to medicate her toddler, not to send her off unaccompanied on a plane to live with (loving) strangers in a foreign country? Talk to her about attachment phases, the lack of a stable positive introject at this age, and the lack of comprehension of time? Explain that her daughter will not be able to understand that this upheaval is only for a short while and that in a few months she will see her parents and home again? Ask if the grandparents could come here? Suggest that she explore resources in her community or that another loan would be a good idea? These are loving, concerned parents who care about their child’s welfare. What can the university community offer to our students, faculty, and staff with young children?
March 3: Meeting with my boss
After the institutional site visit, I give the Senior Associate Dean of Educational Affairs the letter tentatively requesting a reduction in my percent-time and make an appointment to discuss it. He asks, “Don't you need the money?” After some discussion, I realize that by the time he finds someone else to replace me, the worst of the time crunch will be over. I need to pay for college, the bar mitzvah, and the home repair. As a friend who recently went full-time said, “For the first time, I think my children may need my money more than they need me.”
I was part-time for 16 years and never once considered being full-time for the money. Both my husband and I were raised in middle- to lower-middle-class families. We bought a “starter home” (three bedrooms, 1-1/2 bathrooms) when our daughter was ready for kindergarten. We never did move up, and we will be finishing in the same starter home. We live in a diverse community with an excellent public school. We have everything that we need, and more than most people in the world ever have. It seems to me that physicians have no business complaining about money. Most of our friends do have much nicer houses, more hired help, summer homes, and fancier vacations. I have been so lucky to be able to balance time with our children with a career that I love. Most working-class parents do not have that luxury.
We were fortunate to have had the same wonderful part-time babysitter from the birth of our daughter for the next 9 years. She became ill and stopped working when our son was 5 years old. After several failed attempts at replacements, I decided to take a partial leave of absence and worked only while our son was attending morning kindergarten. We had a wonderful year. I taught our son to read and to ride a bike. The loss of income was worth it to us.
That same year, my friend Barbara Brotman wrote a beautiful column for the Chicago Tribune (5) about her decision to take a summer leave of absence, which I reread until I had it memorized. It still gives me chills. Here is an excerpt:
What is your sweetest fantasy? Your most compelling daydream? The loveliest idea you hold in your head and inwardly imagine from time to time, like some beautiful imaginary jewel?
Maybe it is your dream house. Or the prize-patrol van at your front door. Or the perfect job. Or the perfect mate.
Or maybe enough life has happened to you that you find yourself looking at the children whose legs have gotten so long and the sky that glimmers so blue and the summers that are starting to feel numbered, and you find that all your other fantasies have dissolved into the only one that really matters:
Time, the thing they’re not making any more of. The thing that if you do not have, it does not matter what else you do have. The thing money cannot buy.
I will be taking a leave of absence this summer to spend time with my daughters.
I am going to walk to the park with them on warm, quiet mornings. I am going to hunt bugs and draw with chalk on sidewalks.
I am going to buy some time.
The prospect is dizzying in its novelty. I turn the beautiful jewel over in my mind and consider the possibilities.
How will it feel to be loosed from the rhythms of work? What kind of conversations will I have with my children when we cut the motor that runs our lives and slow down to an idle?
What will it be like to have time?
Of course, for part of the time I will be finding out what it is like to clean up the house. I have a heavy schedule planned of painting woodwork and throwing out old magazines. Cleaning the basement alone could take all summer.
I will look into dance classes for my children. I will buy them summer clothes. Maybe I will even invite friends over for dinner.
I consider the less-than-beautiful possibility that if you have to leave your job in order to buy your children clothes, there may be something seriously amiss in your life.
I am determined not to spend my entire time fortune on domestic labor. I know how lucky I am to be able to buy this time; I am guarding it as jealously as a miser.
There will always be a closet to clean. There will not always be a girl who collects spiders or a girl who sleeps with a worn stuffed bunny.
Me, I hear the voices of children shouting at the beach and birds singing and maybe a new puppy barking, and a quiet voice inside saying that if you are going to buy anything in life, you cannot do better than time, because the store doesn't stay open forever.
Many models come to mind for child care. When I was a fellow, a successful female faculty researcher told me, “Having children? No problem! Just hire a full-time nanny! I did!” This works well for many, but not for me. An 80%-time, tenure-track colleague maintained a full-time nanny even after her children were in school, to ensure coverage during school vacations and children’s illnesses. Another colleague hired someone to watch the kids after school, drive them to activities, and cook dinner. One of my trainees leaves her infant and preschooler with her own fabulous mother. My trainee is still trying to nurse her baby, has an hour-long commute each way, works full-time, and misses her children. Personally, I value being home after school whenever possible, to welcome our children home, hear their concerns fresh from the day, and make sure they are eating healthy food and not watching too much TV. My husband and I regularly reevaluated our preferred distribution of responsibilities. Generally, I cooked and did the laundry, he did the dishes and the grocery shopping, and we hired someone to clean the house.
Most of my friends from medical school chose independent practice. Some dual-physician households worked full-time with live-in help; in others, the physician-mother worked part-time. In the last few years, I’ve started to notice male junior faculty colleagues staying home with their sick children or arranging to work from home 1 day a week while their wives work.
Is this the career I envisioned when I decided to go to medical school? Yes and no. I planned to be a clinician and always had an educator lurking in me as well. By selecting administrative positions that allow me face-time flexibility and regular hours, I have not developed my clinical practice as much as I originally planned.
I do not pursue my own interests anywhere near as much as I would like. I love to read and rarely have the time (books-on-tape, anyone?). Figure drawing, photography, and ceramics have fallen by the wayside. I want to write about and learn so much more. I would like someone to make dinner for me. More time with my husband as a couple would be welcome, as would spending time with extended family. There is never-ending tension between the wish to nurture others (both at work and at home) and the desire to be nurtured (either by others or by taking time for myself).
What really troubles me the most is that we have an insufficient connection to friends and community. We find it difficult to schedule social events with other friends who are professionals—someone is bound to be on call, and who has time to throw the party? My parents had a “Couples Club” when I was a child; these friendships have flourished and sustained them for 50 years.
Work-family balance should include the larger human family. We do not commit sufficient time to worthy causes in our community. Several colleagues, whose children are grown, volunteered in New Orleans after Hurricane Katrina. Where was I?
I tell myself, “You can do it all, just not all at once.” But is this true? Colleagues die unexpectedly with much unfinished business. A dear friend from medical school, top of our class, has developed severe multiple sclerosis and is no longer able to work. I am ashamed of the level of stress I allow myself to develop trying to juggle commitments. Everything I’m trying to squish into my life is good stuff, our family is healthy, and we have at least the illusion of stability in our work and home. It is too easy to lose the perspective of gratitude.
My sister (whose children are grown) has been down in Florida helping my parents prepare for a move to assisted living. She calls and asks me to fly down immediately instead of a week later; the move is in process and the work is overwhelming. I drop everything and fly out the next morning. My parents are 93 and 85, and frail. I feel guilty that I am not there more often and that my sister has had to do the bulk of the work. It feels good to pitch in and help and to spend time with her while we work. I worry about how bewildered and exhausted my parents are from the move. I know that as soon as I leave, I will start thinking about when I can find time to visit them next.
Yesterday I got home late, tired. I made a nice dinner and the family was happy. As I was leaving for the gym, my daughter begged me to edit an essay she had written, due tomorrow. By the time I was done, the gym had closed and I felt lousy. Today I resolved to do better. On the way home, I called to ask my daughter to make pasta and stopped at the gym for an exercise class. When I got home, my son was in tears, worrying that something had happened to me.
This struggle is never-ending. When the kids were younger, I would leave a project unfinished at work and drive like a maniac to pick up my child from camp. I would be the last parent to arrive, facing the glares of the counselors and the woebegone expression of my nearly abandoned little one. You can't win for losing; I blew it at both work and home. I find Winnicott’s concept of “good-enough mother” handy here.
March 24: Reviewer Invitation for
On behalf of the editorial staff of Academic Psychiatry, I invite you to review a recently submitted manuscript on work-family balance. Please let us know by return e-mail whether or not you will be able to review this manuscript within 3 weeks.
As before, I calculate my response options. This time I decline. My own manuscript is thus far unwritten, another chapter is pending, I have several reports to write, I haven’t planned summer camp and summer school for the kids, and spring break starts tomorrow. We still haven’t planned which colleges we will be visiting this week, the bar mitzvah planning is no further along than it was 2 months ago, the house repair is scheduled, but the other workmen have not been hired. I need to do the laundry and make the grocery list.
I feel guilty for declining. I drop everything and play checkers with my son.
We have a really good time.