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Matching family and career goals.

It is not at all unusual for physicians to postpone marriage, child rearing, and associated responsibilities until the final years of postgraduate medical training. Therefore, at about the same time children enter their teens and many domestic relationships enter their middle innings, highly motivated health care professionals make the transition into management positions. Family development peaks for parents in the age range of 25 to 45 years; unfortunately, so do work responsibilities. This range also coincides with the male "energy peak," reflected in physical strength and endurance. Physically and emotionally, women are less episodic and maintain a high motivational level from their late teens well into their fifth decade of life.

Children derive their greatest adaptive behavior from their parents during the preschool (imitative) years and, to a lesser extent, during the teenage (directed and rational) years. Parental guidance is direct and intense in the home, but can also be influential if integrated into school activities and peer interactions. The greatest dilemma of working parents regarding child care is not the number of viruses harvested by children from each other in a communal setting, but the guilt-provoking question of who is raising one's children.

Therefore, for many physicians, climbing the corporate managerial ladder squares off directly with life at home. Spouses and children are impressed by consistency, comforting, and creativity in relationships, all of which require time and attention. The intensity of time ("quality time") is clearly important, but in most cases doesn't compensate for simply "being there." This is not the high-powered stufffrom which major deals are molded, but it is the cement in most domestic situations. It is not possible to assume a leadership role at home unless one is present often enough to have an impact. The backyard should not be confused with the hospital, and children are not orderlies.

Striking a balance assumes that one has an idea of what is proper. It is extraordinarily difficult to define the trade-offs, and sometimes equally impossible to make choices. There is no formula that can be applied to the story of a life; progress is measured in opportunities, decisions, and checks and balances. Even if a transition, such as from the educational environment into the workplace, is planned, it is most commonly not coordinated with family responsibilities, which are often unpredictable. Quite simply, it is easier to set schedules in the office than at home, becaue the needs of one's spouse and children (and, increasingly, elders) are unforeseeable and immediate. Precise allocation of time is a laudable goal, but highly unrealistic, as we all experience surges in professional and intellectual growth, along with fluctuating needs for financial security. The latter need can be overwhelming if it is a factor.

Being a manager is not the same as providing direct medical care. Ungrateful patients and malpractice attorneys aside, the practice of medicine is a predictably satisfying activity, with regular positive feedback to the clinician who treats his or her patients with respect and compassion. The strokes are not the same for a manager. Unless one has been extremely careful to engage the appropriate buffers, there is a constant stream of complaints, demands, and crises. Each evokes a challenge with discrete pay-offs, which are not often measured directly in an assessment of the self-worth of a manager. How one values the payoffs in large part determines where one channels his or her energy. Difficulties arise when one attempts to weigh the rewards of family life against those of corporate life.

The worst case scenario is putting family on one side of the scale and work on the other, and then weighing them out like so much fruit. In my observation, this is the method utilized by many highly competitive managers who wish to justify their personal preferences for work activities. It is extremely hazardous to force a family to compete for time. Such competition is a two-edge sword with no handle. In a win-lose situation, someone or something must be the loser, which leads to resentment and rejection on one side of the equation. A more productive strategy is to recognize limitations in each sphere, so that there can be achievement in both areas and expectations are achieved with a minimum of failures. Achieving balance should be an intergrative, rather than a sacrificial, process. Escape is not an answer either. Although we all seek our comfort zone in times of unusual stress, using the work environment as a hideout from a difficult situation at home can be nonproductive. On the other hand, going in the other direction is generally considerably safer.

The "mid-life crisis phenomenon" may reflect recognition of untouched needs. If an unsatisfactory balance has been reached between opposing needs, such as desire to achieve professional success versus recreational time with the family, the stresses of dissatisfaction lead one to pursue a change. Sadly, a major adjustment in one or both areas may be precipitated when minor adjustments have been inadequate. However, if the process elicits new insights based upon recognition of fundamental erros made in the past, the result can be a considerably more healthy and less anxiety-ridden existence. It is important to step back from time to time and survey the emotional landscape at home and at work. No one's corporate goal should be to wreak havoc on the domestic environment.

There are a number of ways to strike a balance:

* Don't deny feelings of guilt. They are generally a reasonable signal that a particular issue must be investigated and remedied. Guilt does not necessarily imply a criminal act or malconduct; rather, it indicates that something is out of balance and that you could have handled things a little bit better.

* Manage your career so that it doesn't manage you. For instance, build an educational infrastructure that will give you the greatest possible flexibility. When you stop learning, it's time to move on. One of two things is happening--you've grown lazy and unreceptive, or your people are not devoting enough effort to making you better in your position. Either way, you will soon be frustrated. When you reach the top, the situation changes somewhat, but there is always someone around who can teach you something.

* Learn to anticipate difficult situations. As the World War I saying goes, "Fifty million Frenchmen can't be wrong. Denying that problems that afflict everyone else will affect you is burying your head in the sand. If you do your best to et out in front of problems, you will be rewarded and your problems solved. Further, you will make decisions that benefit or discriminate against subsets of your employees, depending on how they handle similar situations.

* Use others for help in decision making. You wouldn't think twice about seeing a cardiologist for chest pain, so give your mental health equal time. Counseling can be very helpful if youfind yourself confused and angry when you should be oriented and even-keeled. If you feel that your work efforts are being sacrificed in order to devote time to your family, get help early.

* What works at work probably won't work at home. The needs and rewards are different. Make the most of transition times so that you can keep your worlds appropriately separated. Share the good times, but go easy when you feel you need to unload your angst on your family. Don't ever expect your family to understand the fire in your belly. This is your own personal flame, and you shouldn't use your spouse and children for fuel.

* Don't bring your work home with you. Clear delineation of work and family is the most productive and satisfying strategy. The fact is that most spouses and children need undivided attention, and can easily tell the difference when you are running the numbers when you should be running the bases. Furthermore, practice what you preach. Don't burden you underlings with responsibilities that won't fit reasonably into the number of hours they are expected to work.

* Remember that more people pay attention to you than you might ever imagine. When you are feeling negative and nonsupportive, get away from persons you might hurt. Work your way out of it alone if you develop the urge to be harsh. Pursue an outlet, such as recreation, a change of routine, or counseling.

* Be good at what you do, but recognize your limits. You can be running rough and not even know it. Every once in a while, take your foot offthe accelerator, and see if all of the spark plug wires are still connected.

Paul S. Auerbach, MD, MS, was Associate Professor of Surgery and Medicine, and Chief, Division of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn., at the time this article was written. He is now Professor and Chief, Division of Emergency Medicine, Stanford University Hospital, Stanford, Calif.
COPYRIGHT 1992 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:physician managers
Author:Auerbach, Paul S.
Publication:Physician Executive
Date:Jan 1, 1992
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