Ethics and Wellness Column: Where Training Can Fall Short of Career Expectations and Work-Life Balance

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Mitchell Goldstein, MD, MBA, CML, T. Allen Merritt, MD, MHA

The delicate interplay between professional time and personal well-being, particularly when work-life balance results in difficultpersonal choices, is critical to professional development. The adage that “timing is everything” sentiment holds across various spheres of life, including career trajectories and personal wellbeing. Medical professionals are guided by a commitment to patient care that often requires an urgent response, whether during the day or night, and continuity of care is emphasized in training programs. (1-3)

Our medical educational system, particularly at the university level and beyond, requires a commitment to dedication to learning, and as one enters a medical specialty, training often shapes individuals with the anticipation of a linear progression into their chosen profession. However, this reality is more nuanced, and individual circumstances may alter professional choices. Timing of decisions and decisions to pursue opportunities impact the professional landscape in which a trainee both “feels” competent, and educators and professional boards affirm her or his competency. (4, 5) Once an individual embarks on a career, the chance to revisit certain educational or training opportunities becomes more limited, and the available options may differ substantially. For instance, consider the training of cardiovascular surgeons and psychiatrists. 

This is notably apparent in medicine, where career paths can be heavily influenced by decisions made during residency. The evolving landscape of residency programs, trending toward reducing working hours and overnight in-house calls completely, raises important questions about the long-term implications for trainees, patients, and their potential employers. While these changes may enhance immediate well-being and work-life balance, they inadvertently limit the breadth and depth of experiences contributing to a well-rounded physician regardless of specialty choice. (6) 

The shift in residency program structures is predicted to compromise the future opportunities available to residents and fellows both in clinical experience and a dedication to lifelong learning. The ability to handle in-house decisions both during the day and at night and the demands of a rigorous training program are often considered essential skills contributing to a successful and impactful career, especially in critical care and interventional specialties. (2, 5, 7) Limiting exposure to these experiences around the clock will make a workforce less prepared for the challenges of specific medical practices and may set a poor example for further expectations of future employers. 

The emerging trend of requiring remediation or retraining for incoming attending physicians to an institutional academic and practice culture and mandating new graduates to work elsewhere before applying for specific positions suggests a growing concern about the preparedness of recent graduates. (8, 9) While the intention may be to ensure a higher competency standard, it raises questions about the impact on individuals seeking a balance between their professional and personal lives. (10) 

While pursuing work-life balance, it is crucial to strike a harmonious equilibrium that prepares trainees adequately for the challenges they will face in their respective specialties and specific practice requirements. Striking the equilibrium between well-being and professional development is an ongoing challenge, and the direction taken by educational and medical training programs requires careful consideration lest graduates fail to meet the assumed obligations of their future colleagues who survived a more demanding training process. (2) As these issues are carefully addressed and navigated by program directors, assessing whether the quest for immediate work-life balance is inadvertently compromising the preparedness of individuals in their chosen specialty is imperative to both excellence in practice and commitment to patients. (5, 11, 12) 

References:

  1. Francesca Monn M, Wang MH, Gilson MM, Chen B, Kern D, Gearhart SL. ACGME core competency training, mentorship, and research in surgical subspecialty fellowship programs. J Surg Educ. 2013;70(2):180-8. Epub 2013/02/23. doi: 10.1016/j.jsurg.2012.11.006. PubMed PMID: 23427961.
  2. Sundaresan J, Ferrell ST, Hron JD. A Model for Work Intensity in a Pediatric Training Program. J Grad Med Educ. 2022;14(6):714-8. Epub 2023/01/03. doi: 10.4300/JGME-D-22-00323.1. PubMed PMID: 36591429; PubMed Central PMCID: PMCPMC9765907.
  3. Ahn E, LaDonna KA, Landreville JM, McHeimech R, Cheung WJ. Only as Strong as the Weakest Link: ResidentPerspectives on Entrustable Professional Activities and Their Impact on Learning. J Grad Med Educ. 2023;15(6):676-84. Epub 2023/12/04. doi: 10.4300/JGME-D-23-00204.1. PubMed PMID: 38045932; PubMed Central PMCID: PMCPMC10686661.
  4. Solarte I, Konings KD. Discrepancies between perceptions of students and deans regarding the consequences of restricting students’ use of electronic medical records on quality of medical education. BMC Med Educ. 2017;17(1):55. Epub 2017/03/16. doi: 10.1186/s12909-017-0887-2. PubMed PMID: 28288618; PubMed Central PMCID: PMCPMC5347834.
  5. Gustafson S, Shope M, Barrett Fromme H, Orlov N. Need for Time and Training: Pediatric Program Directors’ Perceptions About Mentorship of Residents. Acad Pediatr. 2023. Epub 2023/09/11. doi: 10.1016/j.acap.2023.09.001. PubMed PMID: 37690515.
  6. Heist BS, Torok HM. Contrasting Residency Training in Japan and the United States From Perspectives of Japanese Physicians Trained in Both Systems. J Grad Med Educ. 2019;11(4 Suppl):125-33. Epub 2019/08/21. doi: 10.4300/JGME-D-18-01046. PubMed PMID: 31428269; PubMed Central PMCID: PMCPMC6697274.
  7. Dopke KM, Kim A, Sewards JM, Marsh JL, Armstrong AD, Gallo RA. Training and Evaluation of Residents to EnsureCompetent Physician Metrics to Recognize Struggling Residents. Instr Course Lect. 2024;73:97-107. Epub 2023/12/13. PubMed PMID: 38090890.
  8. Sternszus R, Slattery NK, Cruess RL, Cate OT, Hamstra SJ, Steinert Y. Contradictions and Opportunities: Reconciling Professional Identity Formation and Competency-Based Medical Education. Perspect Med Educ. 2023;12(1):507-16. Epub 2023/11/13. doi: 10.5334/pme.1027. PubMed PMID: 37954041; PubMed Central PMCID: PMCPMC10637293.
  9. Vaa Stelling BE, Andersen CA, Suarez DA, Nordhues HC, Hafferty FW, Beckman TJ, et al. Fitting In While Standing Out: Professional Identity Formation, Imposter Syndrome, and Burnout in Early-Career Faculty Physicians. Acad Med. 2023;98(4):514-20. Epub 2022/12/14. doi: 10.1097/ACM.0000000000005049. PubMed PMID: 36512808.
  10. Shepherd L, Chilton S, Cristancho SM. Residents, Responsibility, and Error: How Residents Learn to Navigate the Intersection. Acad Med. 2023;98(8):934-40. Epub 2023/05/05. doi: 10.1097/ACM.0000000000005267. PubMed PMID: 37146251.
  11. Artino AR, Jr., Malloy K, Miller RS, Kirk LM, Brigham TP. A Redesign of the ACGME Resident/Fellow Survey Through Expert Reviews and Cognitive Interviews. J Grad Med Educ. 2023;15(1):67-73. Epub 2023/02/24. doi: 10.4300/JGME-D-22-00437.1. PubMed PMID: 36817519; PubMed Central PMCID: PMCPMC9934830.
  12. Koh SJQ, Woon TH, Fong W, Kwan YH, Lim SH, Lee JLH, et al. Residents’ Report of COVID-19 Associated Training Disruptions, Stressors, and Opportunities During the Pandemic-The Singapore Experience. J Grad Med Educ. 2023;15(4):494-9. Epub 2023/08/28. doi: 10.4300/JGME-D-22-00569.1. PubMed PMID: 37637339; PubMed Central PMCID: PMCPMC10449353.

Disclosure: The authors have no conflicts of interests to disclose.

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