Decision point

Friends,
Do you remember the early video games? PacMan, Donkey Kong? (Yes, dating myself). I loved some of the games that were absolutely chaotic but when I played Tetris, I got a sense of accomplishment b/c/o the "neatness" and symmetry since all the pieces just seemed to fall together with just a little bit of planning. As you know I am sharing quite openly in cyberspace the "trials and tribulations" of trying to keep the balance as a mom, OB and aspiring athlete and I share the times in which the pieces do NOT fall into place so neatly.

Private practice for OB/Gyns is particularly hard on family and free time because of the burden of calls (ie the frequent lack of sleep and resultant chronic fatigue) as well as the need for maintaining a high volume in the office to make a profit. I recall a local practice telling me that each OB practitioner sees 50 (FIFTY) patients in an office day, which I calculated to be one patient every 6 minutes (and that is with no break). I did not pursue the practice as I felt that patient care would be short- changed-- unless time for proper documentation to ensure there were no errors would be taken at the end of the day, after official office hours. (Delaying documentation for the end of the day hinders maintaining meticulous records -- there is recall bias, lapses in impressions, details, etc. Electronic medical records have indeed improved the quality of documentation, but practitioners whom I have informally surveyed state that the EMRs do not save time, EMRs merely allow the practitioner to document better with the use of pick lists as well as reminders for documenting family history, allergies, etc. ) Office volume and call frequency of this particular group would ensure family time would suffer. Ultimately I found a larger group practice with EMRs, but again, there was an issue of office volume and income. There was a proposal in the group for OBs to expand office hours in evenings and perhaps on weekends to increase volume. (Ummmm, as well as taking 24-36 hour calls one to two times a week? And so HOW does an obgynmom maintain the work/family/health balance?! )

So in pursuit of balance, perhaps to allow at least a few pieces fall together in some order-- I'm moving into academic medicine. Academia provides the ability to practice medicine without the stress of maintaining volume. That and the appeal of teaching and mentoring a new generation of physicians and being on the cutting edge of knowledge and technology is irresistible. A not-so-minor trade-off in joining academics is less pay and this may translate to a drop off in fitness and definitely competitiveness. We know that money helps promote health-- numerous studies show that wealthier people live longer. A study of Nobel laureates indicated that those who are wealthier live longer. A recent survey by USAT of its members indicates that the average income per triathlete is high-- well into the six-figures. These folks know what they are doing --cross -training reduces risk of injury, thus allowing one to continue to exercise, thus increasing odds of good health and longevity. As for me personally, the drop in income puts me at a second decision point --in order to gain a competitive advantage in triathlon, a significant financial investment is necessary-- the coaching, the bikes, timing and training devices are costly. With the income change, can I be satisfied with stating to myself, "Hey, keep training only for fitness, keep it noncompetitive, ride the older/slower bike (without reaping the fruits of training in terms of faster times or medals)?"

I believe that many folks who are suffering in this "job-less recovery" -- the unemployed, underemployed, are experiencing something similar-- a decision point in which loss of time and/or money dictates a change in direction for obtaining or maintaining health (and in some cases a sacrifice in competitive advantage). Will the sacrifices of the employee in a mature economy translate into better health for the developing world worker (or, taken cynically, will the CEOs of the companies who "outsource" be the sole beneficiaries)? Can the "health pie" be big enough?