Milestones are quite trendy in medical education, aren’t they?

I recently reached a couple of big milestones. I turned 40, and it was not nearly as big of a deal as I thought it would be years ago. The more birthdays accumulate, the less they seem to matter. However, to others, “40” denotes a particular knowledge and skill set (complaining about younger people, holding items farther from my eyes, icing body parts, etc.)

My other big milestone was being promoted to Associate Professor of Emergency Medicine. It’s bold and italicized because it’s a big deal, right? I can describe this momentous accomplishment in one word…meh. I really thought I would have been more excited about it. Feels the same as the birthdays. Becoming a doctor: unreal; getting board certified: great. Assistant to Associate: meh. No pay change, minimal work change. I still get the pure joy of watching my future colleagues transition from being borderline dangerous medical students to respected clinicians I would be proud to have care for my family. But that magic word “associate” means much more to employers and colleagues than to me.

Blasphemy, you say! I should be excited. I should be honored. OK, I am…at the amount of work OTHER people did to help get my application through. But what does this promotion mean for me? Not all that much.

While the promotion is a bit underwhelming, the process of obtaining that promotion was eye-opening for me. What a wonderful opportunity for a long, hard look backwards at my professional life for the past decade. I did so many academic things for the first five or six years. I taught and designed courses, wrote abstracts and papers, and served on local, regional and national committees. I shot out of residency like a cannonball. I could have been the next Biros, Kuhn, Ankel, Herbert, or Lin. Then my “productivity” dropped like a rock.

It turns out trying to be Michelle Biros or Gloria Kuhn or Michelle Lin is really hard. I was trying to be all of them. That’s downright stupid. Thankfully, gravity took hold, and the cannonball crashed to the ground. I checked out, but why?

My career is just one part of my life. I find myself eye-rolling at minivans with stickers in the back window for all of the family members. Of course, I’m a complete hypocrite. The home image for this article, is in fact my own minivan!

A few years ago I realized I really like Boba Fett, Ahsoka and that cute little Ewok. Real Life “Boba Fett” gave up his bounty hunting career to raise our children…pretty much as a single parent. Ahsoka was (and is) a Daddy’s girl and has so many common interests with him. And my little Ewok was getting bigger and bigger. I needed more of a purpose in my family than to just provide for them. I needed to be a happy, healthy person in order to be a good wife and mother and actually be a part of my family. Boba, Ahsoka and Wicket (that’s my little Ewok) don’t give a s**t if I’m an Associate Professor.

New choices
I stepped down from committees. I stopped starting projects I thought would fail. I stopped choosing pursuits that I wanted to do, instead focusing on what my many, many, many bosses wanted (I believe the business translation of this is “aligning my needs with the organization’s needs”). I know that is completely opposite of so much advice out there. But, wow, life got easier and I started to figure out me.

Like all good pendulums, this one swung too far. When I stopped needing to come up with ideas, I stopped coming up with ideas. Easy is a little boring. So now I tiptoe back into academia. After all, I’m expected to progress to Full Professor at some point. But I will never end up where I was five years ago. I’ve made new choices, and now I’ve finally figured out how I made those new choices.

The Nelson Rule to Work-Life “Balance”
Rather than getting swallowed up by short-term crises, I looked to my long-term goals.

Here are my top 5:

1. Live long enough to see my Ahsoka and Wicket grow up
2. Live long enough to retire
3. Retire happily with Boba Fett
4. Have grandchildren and spoil them rotten
5. Take good care of my patients

Where does “be a Full Professor” or “be academically famous” fit? Probably not even in my top 10. My career is just a portion of my life. Keeping those goals in mind, I have three primary motivators:

• A healthy and happy me
• Quality time with my family
• Provide for my family

When faced with a choice, I consider its effect on the three big motivators.  Something that has a positive effect on all three motivators is exceeding rare. So I look at the net effect. If the effect is net positive, go for it. If neutral, think about it carefully. If negative, politely decline…or run like hell.

A simplistic example: Go to my scheduled shift or play hooky with my kids?

• Happy & healthy – neutral (get to play which is positive but screws over my coworkers)
• Quality time with family – plus 1 for the day, but a terrible example for the kids, minus 1. So neutral.
• Provide for family – Skipping work regularly will get me fired. Then I can’t provide for my family.

Net negative = Be a grownup and go to work!

So far the Nelson rule works for me. To survive and enjoy our working lives, we each need to think through what we do and don’t do. Decide why you work and what you are working for. Choose wisely.