Lean in or out: It is a tough balancing act, or my 10 best pieces of advice for women physicians.

Marriage still ain't equal, y'all. It ain't equal. I tell women that whole “you can have it all” — mmm, nope, not at the same time, that's a lie. It's not always enough to lean in because that s*** doesn't work. ― Michelle Obama

Sheryl Sandburg’s 2013 Lean In discussed the need for women to fearlessly “lean in” at work (Sandberg, 2013). Naively, I enjoyed the book and subsequently organized the women in my department to discuss it. When I gave my copy to my accomplished working daughter, her reaction was contrary to mine: a total rejection of Sheryl Sandburg offering life or career advice. Sandburg has resources (particularly financial) available to her that make the daily chores of living irrelevant to her. In other words, she can hire employees to clean her house, shop for food, do her laundry, prepare meals, and chauffeur her children. Nonetheless, as far as I knew, she was in a happy marriage, had a very successful career, and appeared to have well-adjusted children (assuming anyone outside the home can judge another’s children). Ostensibly, she was doing something right.

A summary of her book’s messages includes the assertions that

Women are afraid of being viewed as ambitious; some are even willing to give up their careers to become homemakers and full-time moms.

Women are less able to embrace compliments and are more afraid than men to take risks.

Successful women are not viewed as favorably or as likeable as successful men.

The road to success is not a straight ladder but a “jungle gym” with various paths to the top. Women need to learn to take alternative paths and be willing to make lateral or even downward moves during their career, especially if the immediate opportunity has future potential.

Women need mentors. They also need to learn to listen to different perspectives.

Women should not feel obligated to leave their jobs for their family (children).

A woman’s partner should share in parenting and household duties.

Women should not be expected to “do it all.” Men do not have this expectation, why should women?

Women need to address sexism in the work place.

Stay-at-home moms and working moms need not be enemies.

I do not agree with all of Sandberg’s conclusions. For example, in my experience, women are usually good listeners and are willing to entertain the opinion of others. Our fear of being perceived as ambitious and our inability to accept compliments arguably are, at least partially, due to how others perceive us (particularly men) and our desire to at least appear humble, eschewing arrogance. Whether a woman leaves her employment to become a stay-at-home mother is a very personal complex decision that involves more than her feelings of guilt; this decision usually also takes into account job satisfaction and finances. I agree with the concept that women do not need to “do it all,” but many women actually must do a lot due to their inability to pay for others to complete these tasks. Few of us have the net worth of Sheryl Sandberg. Additionally, single mothers likely have few alternatives to attempting to “do it all.”

Having been a wife, mother, and dermatologist for over 4 decades, I am of the opinion that there are three major areas that women need to address to be successful and happy: relationships, work concerns, and personal issues. I will start with the least important area and end with my opinion of the number one issue that must be addressed to thrive professionally and personally.

Personal issues

#10: Enjoy a few select hobbies; read novels and the newspaper; volunteer

It is important not to be unidimensional or relinquish your extracurricular interests in spite of the demands of work and family. Staying engaged in current events and the community helps us retain the values and joys of our neighbors, keeps us informed, and makes us more interesting. These activities also bring fun and diversification to our lives.

#9: If possible, hire someone to do things you do not personally have to do to be a good wife, mother, daughter, or doctor

Any mindless chores that you can afford to disengage from your own list of responsibilities will give you more time to enjoy things that bring you joy and require your special talent or passion. For example, housework, laundry, and cutting the lawn are necessary tasks that can be accomplished equally well by others. In contradistinction, I personally looked forward to eating meals with my family, reading to my children, helping them with their homework, and attending school events. These were activities that I chose not to forsake! Most importantly, I recommend that we prioritize what we really want or need to do personally and try to let go of the rest.

#8: Exercise to maintain your sense of wellbeing

Feeling healthy, strong, and good about our bodies has been demonstrated to result in not only better health but also more self-confidence, more energy, and a sense of well-being (Edwards, 2006, Fox and Lindwall, 2014, Spence et al., 2005). Therefore, it is imperative for us to make time to exercise regularly to sustain the energy level needed to accomplish the daily chores of living and employment and to feel better about ourselves.

Work concerns

#7: Mentor and teach; if possible, get a mentor

Being someone’s mentor is one of the most rewarding activities I have undertaken. In many cases, the mentee also mentors the mentor, so it is the ultimate symbiotic relationship in which both parties benefit (Blattner et al., 2015, Grant-Kels, 2015). During my youth, there were few female mentors because women in medicine were still the exception. Today, the number of women in medicine has increased dramatically, and many more experienced, respected, female physicians are available to guide the next generation.

#6: Set appropriate goals, and emphasize those that are intrinsic rather than extrinsic

Intrinsic motivation is based on personal internal rewards versus extrinsic motivation, which is behavior that is motivated by an external reward or avoidance of punishment (Benabou and Tirole, 2003, Ryan and Deci, 2000). External rewards, such as large salaries, homes, and fancy cars, rarely result in happiness. On the other hand, intrinsically accomplished goals often result in feelings of priceless personal satisfaction.

Although the goal of having control over our environment is something we all strive to achieve in our pursuit of happiness, in medicine this is now more elusive than ever due to governmental regulations and consolidation of practices. Because of this environment, striving for intrinsically satisfying goals that ultimately result in making us happy and satisfied is more important than ever.

Most importantly, no matter what your goals are, do not set them at a level that is not achievable. Failure will only compound frustration and guilt. Goals also can be flexible in that they can change at various times in your life depending on what else you need to balance and accomplish. When I was a younger woman with two small children at home, I published only a few papers per year and was a rarity on the lecture circuit. Now that my children are grown, I am much more ambitious academically and educationally because I have the luxury of time to prepare and write. My daughter-in-law, an academic psychiatrist with four young sons, recently shared with me that many career women have sought her professional counsel because of their feelings of inadequacy and disappointment after setting their self-expectations too high and impossible to accomplish. Her advice: “Be kind to yourself.”

Relationships

#5: Get pets and love them

Pets have been shown to lower our blood pressure and make us healthier in general. There are also good studies to demonstrate that pets enhance our sense of happiness and wellbeing (Bao and Schreer, 2016). After working hard in clinic and dealing with the demands of children and aging parents, there is nothing quite as gratifying as the warm greeting from your pet who is overcome with joy and love at your return home. The sense of wellbeing this greeting results in is literally indescribable. Of course, pets are another responsibility that require time and work. Therefore, this would only be something to consider if you are an animal lover and gain more emotionally than the effort required to care for a pet.

#4: Make/retain some very close female friends

In my experience as well as those of others, friendships are vital (Chopik, 2017). This does not necessitate being involved with large numbers of people who require a great commitment of your time. I would recommend a select few friends whom you trust and with whom you share confidences. Sharing the landmarks and landmines of life with a good friend ensures the absence of isolation and loneliness.

#3: If possible, stay connected with family, especially parents

More often than not, adult children live far from family because job opportunities are now national and international. This does not necessarily have to affect the intensity of familial relationships. Although long distances create challenges, face time and air travel can help minimize feelings of isolation, separation, and guilt. Time with parents is fleeting, and if you ignore this fact, guilt and regret will haunt you later in life.

#2: Children require quality time but also quantity of time; set your priorities while dealing with guilt

In my opinion, and that of others, quality time does not substitute for old-fashioned quantity of time when it comes to children (Hsin and Felfe, 2014, Milkie et al., 2015). To think otherwise is to fool yourself and be ultimately disappointed at lost opportunities. Efficiency at work, creative scheduling, and some flexibility is required but manageable in the current work environment to ensure that we are present in our children’s lives. I worked early morning and late evening hours to be able to pick up my children from school and be with them every evening and weekend. My daughter works long weekday hours in finance but dedicates every minute she is at home in the evening and all weekend to her daughter. As long as we address this issue, there are many ways for each of us to try to balance this act in our own unique way.

To be balanced, there are others who disagree with this opinion. For example, there was a large study refuting the concept of quantity over quality. This study concluded: "There were no statistically significant associations between maternal time of either type and any child outcome. In contrast, social status resources, as measured by mother's education, family income, and family structure, was related to some outcomes. Mother's education was positively associated with children's performance in reading and math, and family income was positively associated with children's math performance" (Milkie et al., 2015).

#1: Pick a great life partner and never forget how lucky you are to have that person in your life

This has a lot to do with luck but is undeniably the most important decision of your life. Your life partner will, in many ways, determine your level of happiness not only at home but also at work. Shared responsibilities with the chores of life, raising the children, and creating a safe environment is just a small part of this relationship. Giving each other a sense of safety, reassurance, security, love, and honesty is the true gift of this intimate partnership. Although every couple has their own dance with regard to how they interact, there is no person in the world who shares the same values, goals, and successes with you more than your life partner. Realizing and embracing the uniqueness of this liaison and pulling together results in a happy home and happier work life.

Conclusions

I have been very lucky. I was born into a very loving, nurturing family. My life partner has been my best friend for over 45 years and has nurtured me in every imaginable way. My children have grown into loving, mature adults who are independent, happily coupled, and have their own children. However, I grew up in the 1950s, a time long before women’s liberation and the “me-too” generation. Challenges, sexism, and many chauvinistic events were endured along this journey. With the help of intrinsic motivations and the support and love of my spouse, family, and a few select friends, it has nonetheless been a great journey. I believe that the next generation is better than mine was; therefore, I have faith that they (including the millennials) will do things better than we did!

Conflict of Interest

None.

Funding

None.

Study Approval

The authors confirm that any aspect of the work covered in this manuscript that has involved human patients has been conducted with the ethical approval of all relevant bodies.