Work-Life Boundaries

By: Dr. Charissa Ho

Disclaimer: I am not an expert on this topic. In fact, I am writing this blog post during vacation. And because I find myself constantly struggling to draw boundaries, I figured this is a good topic to explore.

Work-life boundaries. We have all heard of them, but how well do we manage them?

These boundaries exist in many different settings: starts with reviewing the EMR in the morning with breakfast. Your clinic asking to cover a weekend shift. A colleague looking for someone to take on a research project (and of course it comes with the promise of “very little work”). A patient’s family requesting for an add-on appointment for a few simple things (prescription refill, compression stockings prescription, and a stomach ache that’s been going on for several months) since they’re here anyway. As you’re about to leave clinic, a pharmacy calls you for an urgent refill. You finish up charting at 9 pm on your couch. Then finally, as you’re brushing your teeth, you receive an email regarding the teaching session next week that you need to prepare for.

In preparing for this blog post, I found this article by Dr. Ellen Ernst Kossek: Managing work-life boundaries in the digital age. Dr. Kossek is a family-work researcher at Purdue University. Her work examines the dynamics between those who work and the work itself. This includes flexibility in time, work environment management, and how inclusion and diversity impacts work. The article has a self-assessment that is like a personality test for how we, as individuals, manage boundaries. We all manage boundaries differently and understanding how we manage those boundaries can help us identify where we improve so we can improve our well-being.

First, Dr. Kossek introduces the idea of boundary control. This refers to the amount of control an individual perceives that they have over their own boundaries. The more control one has over one’s boundaries, the better the sense of well-being. The less control one has over one’s boundaries, the worse the sense of well-being. Therefore, understanding how to control one’s boundaries is critical in staying well.

The article can then be broken down into two sections:

Identifying Your Style

Managing work and non-work interruptions:

• Are you an integrator?
  • Meaning you bounce back and forth between checking your Furbo, replying to EMR tasks, answering a research-related phone call, and scrolling through the latest COVID updates. How do you do with that?
• Are you a separator?
  • Work is work and home is home. They are like water and oil for you. How does that work for you?
• Are you a cycler?
  • Cyclers go through periods of focus on work and focus on home. For example, a person who does inpatient work has 7 days “on” and 7 days “off”. Do those longer separate periods work for you?
• Are you a hybrid?
  • Maybe you bounce around all the of the different ways to deal with managing interruptions. Perhaps you choose your strategy based on the scenario.

In all the above styles, do you tend to put…

• Work first
  • Work schedule goes ahead of personal schedule.
• Family first
  • Personal schedule ahead of work.
• Personal life first (hobbies, lifestyle, etc.)

Career and nonwork identity centralities:

• Some people identify as a physician first then a parent, others vice versa.
• Finding which identity (or identities) you value more can provide insight into where you can focus more of your precious time to feel fulfilled and validated in life.

Technology dependence:

• What is your relationship with your technologies? Do you work best with your phone off or do your pieces of technology make your tasks easier?

Need time for self:

• Your phone gets charged at the end of the day, how do you re-charge yourself?

How to Set Boundaries

Time management:

• Allocating work time for work, and personal time for personal life. It may not be 50/50, but it should be according to your values and your style.

Values assessment:

• What are the things that fill your cup?

Managing transitions:

• How do you prepare yourself when you go from home to work and work to home? That commute is an opportunity for attention shift to mentally and emotionally prepare for the next thing.

Create time buffer:

• Going back to the idea of attention shift, creating time between tasks to prepare yourself for the next activity (I.e. having a 10 minute break between a committee meeting and starting clinic).

Managing expectations:

• Physicians tend to be people pleasers. When we keep saying yes, then the expectation is to continue to say yes. It is okay to be firm with your boundaries, encouraged even. 
• It is okay to SAY NO

Beware of role creep:

• Do those work e-mail notifications come on during dinner time?
• Do those school e-mails notifications about parent-teacher conference come on during your work meeting?
• Finding how and when to shift your attention from one role to another is an important part of boundary setting.

Conclusion

After reading this article, I’m hoping I can keep the following take-aways with me as I trot through 2022:

1. Leave my phone outside the bedroom at night.
2. Stop checking my emails in between patient visits.
3. I find joy in being a pet mom and creating delicious meals – it is okay that I spend more time on those things to recharge myself.
4. Create a time buffer so my brain can adjust from one activity to another.

Creating and asserting work-life boundaries in medicine is hard. Much like eating healthy and exercising, it is much easier to establish boundary-setting habits now than 5, 10, or 20 years into practice.