1. Overbaugh Nature 2011; 477:27

2. What is work life balance? New term 1998—in pubmed, and most published literature is the last 5-10 years Definition: «achieving satisfaction in all life domains» (Kirchmeyer 2000) Medicine harder since it is more than a job Sometimes it seems EITHER/OR Kirchmeyer, C. (2000). Trends in organizational behavior: Time in organizational behavior (Vol. 7, pp. 79–93). Chichester, United Kingdom: Wiley.

3. Are we asking the right question? What is Balance? Oxford English Dictionary: An even distribution of weight enabling someone or something to remain upright and steady: situation in which different elements are equal or in the correct proportions:

4. Douglas LaBier Psychotherapist who has worked with professionals says: the word «balance» means we are only thinking of two solutions—work or life «Inside out solutions»—inner life and outer life –pay attention to our inner lives where our meaning, thoughts emotion, values (energy lies here) –Our outer lives are things that are scheduled at work and home. Washington Post February 2006

5. What factors seem to be important?

6. Generational factors Baby boomers (1946-1964) Medicine is a calling Generation X (1965-1980) less rigid more practical, rule questioning Generation Y (1970-early 2000) –In 1996 18% women and 28% men chose residency for life style control –2003, 36% women and 45% men made the choice for life style control (Dorsey et al Acad Med 2005;8: 791 Dageforde et al J Vasc Surg 2013; 57:262-7; Howell Acad med 2009; 84:985

7. Stress Factors—including specialty Attempt to maintain balance in the face of challenge trauma (Rama-Maceiras et al Eur J Anesthesiol 2012; 29:311-19) – Stress is good and bad (can lead to burn out, and decreased health physical health) High stress specialties (small acute care specialties): neurosurgery, cardiothoracic surgery, perinatology, neonatology (Kravitz Israel J Health policy research 2012; 1:51)

8. Role of partner and home conflict Survey from all specialties 7,288/89,831 physicians and 891/1,644 partners –Work home conflicts experienced by physician 44.3% and partner 55.7% within in 3 weeks of survey –Conflict associated with: more work hours and less autonomy More likely to have burn out symptoms 47% vs 27% (both physicians and partners) Dyrbye et al J Gen Intern Med 2013; 29:155-61

9. Swiss factors? Study done in University of Zürich 2009 –579 residents (292 women and 287 men) Basal, Berne, Zürich Women with children had lower rates of employment, self- appointed career success, more part-time vs men –Less mentoring –Less sure of self –Fewer surgical fields –More private practice –Less academics Satisfaction with income, friends, leisure activity Work-life balance—both sexes wanted medical careers and a «normal life» Conclusion: socially rooted gender role steroeotypes exist. Suggested career planning opportunities, mentoring, role models and flexible structures Buddeberg-Fischer et al BMC Health Services Research 2010 10; 40

10. What can be done to enhance integration of work and life?

11. Is lowering the number of work hours the answer? Gander et al found that fatigue (not getting enough sleep) (Gander et al Acad Med 2010; 85: 1526-36) –varied by specialty not gender. –More problems at home and with relationships –Not sufficient explanation for work life balance Yes, direct effect of the number of irregular working hours (Wirtz et al Chronobiol Int 2010, 27: 1124-34) No, but having control over schedule and work hours most important predictor of balance (Keeton et al Obstet Gynecol 2007; 109:949) (Cochran Review)

12. Role models and mentoring? Levine et al women who left academic medicine lack of role models for combining career and family (Levine et al Acad Med 2011; 86: 752-8) Mentored careers seem to help with satisfaction and work-life balance (DeCastro et al Acad med 2014; 89:301-11) Formal structured mentoring program produced more papers, greater satisfaction among women (Varkey et al BMC Medical Education 2012: 12:14)

13. Organizations can promote balance Promote physician autonomy—flexibility and control of schedule Support services: administrative, Collegial work environment—good communication Value oriented—mission and values alligned Minimize work and home interferences—coverage for life events Provide periodic breaks Leaders that reframe work challenges reduce stress improve balance (Syrek et al J Occ Health Psych 2013; 18: 252-61)

14. Tips for balance?

15. Strategies used by physicians Relationships—time with family and significant other, opportunities to share with colleagues Religious belief and spiritual practice—nurturing spirituality in self Work attitude: meaning in work; find the things you like (research, teaching) and discontinue or limit the things you don’t like Self-care practice—cultivate your interest professionally and personally (sleep, nutrition, exercise, reading) Life Philosophy—positive outlook Shanafelt et al Am J Medicine 2003; 114: 513

16. Take out meals once in a while depending on budget can take some of the stress out of having to prepare meals after rushing home after a busy day at work - and it can be healthy - salad bars, some prepared food at grocery stores can be great. Riding your bike to work can really be a great stress reliever, and in addition you don't need to find additional time in your day to exercise. Sometimes just taking 3 deep breaths in between seeing patients during a busy clinic day - just before entering the room - can really help center oneself. And listen bettter, too. Don't answer the phone during family dinners unless it's an emergency or an extended family member who lives far away. It's ok to outsource some of the home chores when you can - like housecleaning even if it's just once a month for the deep/bathroom cleaning. Once in a while take an "always on" slow down and only check email once or twice a day - if necessary leave an autorespond message that you will be responding to emails less frequently until a specified date. From Stanford’s Well MD Work life Balance tips http://wellmd.stanford.edu/healthy/work-life-balance/

17. From a young woman academic researcher “The thing that I prize the most, and I know I share this with other women [men] in academic medicine, is really being able to have both the family and the successful career…. it’s crazy busy with the two, but without the two, it just wouldn’t be as satisfying and fulfilling.” (Female, K- Awardee)

18. Overbaugh Nature 2011; 477:27