October 2001 Bulletin

Balance your work, home life . . . on most days there are too many balls in the air. I can’t keep them all the in the air and under control.’ Orthopaedists tell how they reorder their lives

By Sandra Lee Breisch

The sign hanging in his office reads: "Focus, Tempo, Balance." It’s a daily reminder of how he can achieve happiness and personal well-being in his life.

"All three are critical parts of an orthopaedic surgeon’s life," stresses Lowell D. Lutter, MD, a foot and ankle specialist in St. Paul, Minn. "Early in my career, the emphasis on performing or producing in the field of orthopaedics pushed other parts of my life out of balance. I think my three children, who are now 29, 30 and 34 years old, chose careers other than medicine because they were not interested in science. But I also wonder if one of the factors that nudged them that way was how they saw me as a doctor. To work 70 hours a week, to be on call weekends, to return home fatigued and crabby was not something they thought personally desirable."

Dr. Lutter’s quest to find balance between his professional and personal life is a constant struggle shared by fellow orthopaedists.

Fortunately, Dr. Lutter experienced a wake-up call early in his career.

"My wife, Judy, told me she desired to continue her graduate studies and needed some help," he says. "Although the help mostly involved getting my children off in the morning and was miniscule in the grand scheme of things, it made me realize I must slow down the speedy pursuit of a career. I found that the required modification to my program was not huge. It meant delaying a morning clinic until 9 a.m. and starting my surgical schedule later than 7:30 a.m. Minor [adjustments], but this was a break in the ironclad schedule I was led to believe I needed for success."

Every day is a balancing act for Steven E. Koop, MD, a devoted husband to Debbie and father of four young adults, ages 19 to 24, and a Deacon for the (Catholic) Archdiocese of St. Paul. He is also medical director for Gillette Children’s Specialty Healthcare and associate professor of orthopaedic surgeons at the University of Minnesota Medical School.

"Medicine is an obstacle because it’s time-consuming and unpredictably time-consuming," says Dr. Koop. "It would not be very accurate for me to say that every day and every week: ‘I’ve got it all put together.’ Things go haywire, schedules don’t work and commitments don’t always pan-out.

"I’ve come to this realization: on most days there are too many balls in the air. I can’t keep them all in the air and under control. I have to make choices each day–-about what it is I can and I cannot manage that day."

So, how does Dr. Koop handle the lack of balance in his life?

"For starters, I handled the lack of balance with God’s spiritual guidance and my wife, who is my ‘balancing indicator,’" he explains. "We’ve had a 26-year marriage and my wife is a wonderful source of advice and a good listener. She’s very supportive, but also very honest in pointing out what I’m doing that is ‘on-track and off-track.’"

Dr. Koop says he was guilty of compartmentalizing. "I realized that sometimes we orthopaedists try to put things into little compartments," says Dr. Koop. "Certain parts of the day would be the compartment for family or spouse; another part of the day would be a compartment for medicine; the other would be for faith and spirituality. What I realized was that those compartments weren’t real. There are separations between them, of course, but the walls are pretty permeable. You can’t separate like that. And when you try, you realize that all of the organizational skills and time management skills aren’t going to make the impossible happen. The day is going to come when conflicts emerge and that’s because you insist on compartmentalizing things."

A six-month sabbatical helped Amy L. Ladd, MD, an upper extremity specialist in academic practice at Stanford University’s orthopaedic department, do a little soul searching. She wondered how she could spend more time with her husband, three young children, practice medicine and do something goal-oriented. "I really wanted a change–to have more flexibility with family and to do something creative and academic that involved a multidisciplinary approach," she says. "Journal writing helped me figure out what was important in life, and to redirect my goals. I now have a part-time appointment to focus on the medium of computer education and graphics in medical education. Now, my professional side is more in balance due to creativity and interactivity with others outside my discipline. This permits me to work at home with some projects, which allows more flexible time with my family."

"If you haven’t experienced some feeling of your life being out of balance, then you’re probably not aware of it and/ or not a parent," she chides. "One of the things I tell women orthopaedic surgeons, ‘We ladies don’t have the luxury of saying to our families, I can’t do it, after all, I’m a doctor,’" she says.

Nonetheless, she "wants to" and "tries" to do it all.

"I have to keep some perspective on what’s important," Dr. Horstmann says. "Maybe that’s not having things in perfect order and things going ‘just right.’ Our family doesn’t put a high priority on material possessions and consequently, my job is not centered particularly on making the most money, but rather on something that is going to fit in with our family. For instance, I haven’t made career moves that might be optimal because the cost to the family would be too much."

Dr. Horstmann says that having a very supportive husband helps. "We have a value-centered life where we put God and religion as a high priority," she says. "This keeps a perspective on what we’re doing and where we’re going. We also spend as much time together as we can."

And prioritizing plays a key role in everything Dr. Horstmann does. "I think you have to prioritize whether it’s at home or work," Horstmann stresses. "My strengths are in running organizations, but I’ve had to leave some other things on the backburner such as research. One just can’t do it all. Everybody thinks that somebody is so great from afar, but often something is lacking. Somebody is running around the country as top dog, but maybe they’re not seeing their patients or their personal life is falling apart. You really have to pick and choose the things you want to do."

Because orthopaedists are often torn between professional and internal conflicts, learning to say "no" is an important element in gaining balance.