Kick Work-Life-Imbalance’s Ass: Find Your Karate.

Many physicians and other professionals seek that elusive work-life balance. That is not surprising, since a high-power career and family responsibilities can generate the perfect storm to suck you into an imbalanced lifestyle. Part of why many of us get ensnared is because we have a strong sense of duty. Further, dedication to both career and family before all else are reinforced by the cultures around us. With limited bandwidth, something has to give. It is often self-care that gets pushed aside and eventually that can unravel the whole thing. Some find balance when forced – others don’t get a second chance. So, it is important to be proactive and assertive.

There are different ways to approach work-life imbalance.

Some decide to go part-time to free up time. Others buy time by outsourcing tasks. Personally, I have had a hard time doing either of those. I did cut-back to full-time a few years ago. However, it took me longer to get there than it probably should have and was facilitated by finding other responsibilities to draw me away from my medical career.

Fulfilling what I perceive as my commitments has been ingrained in me since a young age. So, the answer for me has been to find externally-accountable self-care time. A responsibility to compete with my other responsibilities. That could have the potential to simply add another rock to the bucket I carry – unless it is leveraged to my other roles. It is also easier to say “No” to extra work when it is because you have already said “Yes” to something else that people are depending on you for.

physician work balance

For me, that external force has been karate and its benefits have extended to our entire family. I am sharing my story, not in hopes that you’ll take up martial arts – although that would be awesome! Rather, my intent is to cause you to reflect on whether you have been sucked into the vortex of work-life imbalance and need to find your own “karate”.

Career and home fronts can collide to create the perfect storm.

work-life balance
The deadliest of all martial arts storms is Master Ken’s Hurticane. He claims it is effective against 10 men. Or 14 dwarfs. Click the image to witness the destruction.
Medicine is very alluring.

Intellectually, medicine is stimulating. It is emotionally and spiritually rewarding to help people who are generally in need and grateful. You’ve worked hard to become a doctor, and socially, that comes with a degree of recognition for your achievements. When you speak, people usually listen. Further, it is intrinsically satisfying to ply hard-won skills. Extrinsically, you even get paid well to do this.

Medicine also has unlimited potential .

Due to medicine’s attractions, it is easy to be drawn into doing more and more of it. It even feels natural. After years of putting in the prerequisite hours of study and work to start practice – the momentum is already built up and it feels normal.

Patient-need is not usually a limiting factor. You can work as much as you want. Except, possibly in areas where limited infrastructure (like OR time) limits you. Even medicine isn’t fully pandemic proof. Still, when there are limits in one area, there are usually other opportunities elsewhere.

So, a medical career has unlimited potential for growth. However, it also has unlimited potential to consume the rest of your life.

Maintaining a household and raising kids is also hard work.

Responsibilities on the home front can look different for different people. For example, you could substitute helping friends, parents, or other relatives for “raising kids”. I have also not met many couples where each member of the partnership didn’t feel that they made an out-sized contribution to the household without fully realizing all of the things that the other person does. My wife and I actually made a scoring system early on that included a time and “grossness multiplier” for tasks to ensure transparency and equity. The specific contributions have shifted around over the years, but neither of us spends much time sitting around.

The work and rewards of parenting also change with time, but it is a constant. Some revel in the early-parenthood stage. However, for me, playing repetitive games like peek-a-boo… not appealing. No big thank-yous for cleaning up poop-nadoes either. Even when infants develop into toddlers, it isn’t all unicorns and rainbows. Often kids listen and then try to do what they want anyway. Now that they are teenagers, the poop-nadoes have resolved, but the listening part is even more complicated. I wouldn’t change any of it, and we are fortunate to have enjoyable kids. But, there is a lot of input required and it isn’t on your schedule.

The storm formed by these colliding weather systems.

For some, the immediate input-reward balance favours spending more time working and less time at home. I have seen this happen with many friends and colleagues over the years. You can even feel a little self-righteous about it. Medical martyrdom is a strong part of medical culture. So is being a good provider for your family part of our broader culture. Practicing medicine brings home the bacon. You are doing your duty.

I fell into that line of reasoning to a degree and worked a lot when my kids were really little. However, I also had a strong sense of duty towards my family, who needed my time and attention also. I did not want to be the workaholic absentee dad nor the husband who comes home and puts his feet up to watch TV. That stereotype was usually vilified in the movies and sit-coms that I grew up watching. I think many physician parents (male and female) struggle with the pressure to give to their career and do double duty at home. Unfortunately, that dual pressure, coupled with finite amounts of time and energy, meant that something else needed to give.

Exhaustion exhausted both my time and my self-discipline.

physician health
Beverly Hills Ninja, Tristar Pictures, 1997.

For me, the response was to over-eat and under-exercise. I had gained a significant amount of weight. That would ultimately be fatal, if left unchecked. My family strongly manifests the “efficient-energy-storage-famine-survival-phenotype”. Great for a post-apocalyptical scenario. However, in normal times, combatting that tendency requires extra effort and self-discipline because it doesn’t come naturally.

I was also getting burnt out. Both at work and at home. Medicine and parenting both require huge amounts of energy, time, patience, empathy, and problem-solving. Trying to do both well meant that I would oscillate between falling short on one end or the other. I either felt like I was slipping as a doctor or failing as a parent/husband in rapidly alternating cycles. Not a good place to be.

Duty: The problem and the solution

I am really good at accountability.

Fulfilling my perceived duty was a core value in my upbringing. To counter-balance the duties pulling me away from diet and exercise, I needed another competing accountability. Karate provided that for me. Part of the commitment was to attend at least two classes per week. Our senseis keep count, and call you out on it if you are behind. I needed some external accountability with immediate feedback to look after my health.

Even more influential in holding me accountable were my kids.

When I joined my kids to practice karate, they were five and seven years old. I was insisting that they meet their obligations, and I therefore needed to show leadership by example. Kids have a strong innate sense of justice (particularly injustice inflicted upon themselves). If I expected them to do their exercises and practice like they were supposed to, then I would get an earful if I did not. We kept each other accountable during those inevitable times where one of us felt like slacking off.

Families that kick together, stick together.

physician wellness

Karate is a great mix of fun and exercise. Our school has a good mix of exercise, self-defense techniques, sparring, and traditional karate. All of that involves a degree of control and explosive movements. While I have always liked the results of high-intensity cardio, I have never enjoyed the feeling of impending doom that often accompanies it. Somehow, it is much more enjoyable when you are hitting stuff.

It is also tough. There are some techniques that are hard to master. You fail at them many times before finally succeeding. Sometimes you feel like collapsing during a tough training session or belt test. Challenge, and sometimes failure, is a part of life. It is important to experience that to build and doing that together with the family support helps to build resilience.

Sharing fun and physical activity is great for a family. However, supporting each other through the challenges has really brought us closer together. Those who train for and perform in high-pressure situations like resuscitation, rescue, or combat know that the way you perform under pressure is determined by how you trained for it. You revert to your basic training as your reflex response. All relationships will face pressures, and karate has helped us train to default to supporting each other when the going gets tough.

We now have an extended karate family.

As I alluded to above, with work and home-life dominating ones time, it narrows your social circle. You see your work-family/friends frequently at work, and your family at home. Sure, you can meet other parents at kids activities which is helpful. However, the focus there is usually on what is going on with the kids.

Karate also provided me with a couple of nights per week where I could interact with other adults doing an adult-focused activity. My karate friends come from various backgrounds. Even the occasional doctor that I encounter in class doesn’t drift into conversations about medicine while we are there. Some of my classmates are parents of kids in the school and others are not. We don’t really talk kids much. The focus is on a combination of learning and having some fun together.

We even adopted a new member into our family. Bob. Great for getting out your Covid-lockdown frustrations. He also doubles as security. He lurks in a doorway of our basement to scare off would-be burglars.

Be Part of a Broader Community

Our karate family doesn’t just beat each other up. We also enmesh into a larger community. That extends both within martial arts, but also out into the community in which we live. We participate in various fund-raisers. March in parades. Travel to conferences/competitions together. Have social events.

You can do many of these things as part of a medical community. However, developing a sense of purpose and contribution completely outside of medicine is very important. Firstly, you probably won’t practice medicine until you die. You need to develop other ties. Secondly, building social capital both within your community and through doing it as a family is very synergistic. It is important role-modelling for your kids, who may well want nothing to do with a career in medicine.

A Black Belt: Important for more than holding your pants up.

One of the good aspects of karate, and most organized sports-training programmes, is that there is a natural progression with escalating challenges. That allows for continual growth in skills, fitness, and enmeshing into the community.

The peak of our challenge so far has been our black belt testing. That was a six-month major daily commitment to exercise, training, and a healthy diet. There are also a number of self-improvement or empathy training exercises along the way. It culminated in a 2 hour long high-intensity test, followed by another six months of demonstrating ongoing commitment. I have done many difficult things, but this was tough. Not only in intensity, but duration.

Fortunately, I also had the opportunity to do this in conjunction with my children. I did my 1st Dan while my daughter did her junior black belt and just recently was able to do my 2nd Dan while my son did his. Sharing such a challenge together has definitely strengthened our bonds.

This type of major rite of passage is also a concrete milestone. When faced with difficult times in the future, my kids can look back at how hard their black belt test was and that they did it anyway. Hopefully, they will also remember that while they have to do the work, they aren’t truly alone in their challenges. They have family and friends to lean on.

This type of easy-to-recall-challenge-milestone is important in building resilience. Both for kids and adults.

Do you need some karate in your life?

We all hear about the importance of work-life balance. However, it can be very difficult to achieve for those of us who are strongly pulled by accountability and duty to others. I think this is a common trait amongst physicians and many professionals.

Starting a career in medicine and starting a family are two major commitments that often strike at the same time. They can be all-consuming. That consumption can include your own personal health. Karate helped me to escape that path. It also helped to strengthen our family synergistically.

Karate isn’t for everyone. However, there are plenty of activities and organizations with similar characteristics.

The helpful characteristics of karate are what I think is vital:

  • External accountability to exercise
  • Shared experiences that both challenged me and my family together. Not just as a spectator. As an active participant.
  • Building a social network and community outside of medicine
  • Having separate adult-time that wasn’t focused on parenting
  • Progressive challenges
  • Concrete milestones

Our careers and our families can easily push out other aspects of our lives. As a temporary condition, that is tolerable. If left unchecked, it is ultimately destructive. Is that happening to you?

Do you need some “karate”?

What style of “karate” do you want to practice?

16 comments

  1. The thing with balance is that you have to constantly make little corrections and you can’t let up. It’s like a tightrope. We should probably ask ourselves more often whether we’re in balance rather than whether we are happy. You can be happy and fall off the tightrope if you’re inattentive.

    1. Thanks Dr. Latestart – That is a really good point and I think part of how we get ourselves into trouble. We don’t notice small changes until something major happens because we acclimatize. More frequent deliberate evaluations with smaller course corrections is better.
      -LD

  2. Thanks for this great article and the wisdom of your experience. I’d love to pick up some “Karate”. New to practice at 36. A PhD & an international move along the way extended things. Kids are 2&5. Currently picking up every shift I can find but will need to find some balance. I was thinking of working a ton in the winter (which I don’t particularly enjoy) and less in the summer. But that’s probably a binge-purge cycle that’s less healthy than trying to find balance in the first place.

    1. Hey Howl. In retrospect, we are also glad that we worked hard while our kids were very little. I upscaled shifts during the “rainy season” too. It was physically easier when we were younger and gave us more financial buffer to cut back now that it is harder. We started scaling back slightly when they were around 4 & 6. Now that they are teenagers, we are working much less (and able to due to our buffer). This has been important because they now require more time and mental/emotional effort to help guide them than when they were smaller and it has to happen on their schedule.
      -LD

  3. Thank you for this post. So relevant.
    Since 2012, camping has been our go-to wonderful experience to find balance for us and our children. No television, sometimes even no cell-service…….
    Chopping wood, cooking outdoors, kids making forts in the forest with fallen timber. Telling family stories around the campfire at night. Our kids, now 18, 20, and 21 just loved hearing about all the crazy things my husband and I did when we were younger and first married.
    Now the kids go camping with their friends, boyfriend, etc, and still love the experience.
    We feel very blessed when they come with us, and very lucky that they enjoy it so much to continue with it as adults.
    If you can find a family activity that you like, and does not involve technology, so much the better. Kids need to communicate with others by talking to them, not texting…..
    Covid has caused us to bring out board games, Catan, Cranium, etc., and it has been a blast.
    Appreciate your time with your children, because they grow up so quickly…….

    1. That is awesome Sask to AB! That is the type of glue that bonds a family together. We have RV’d since 2015. Not as rustic, but still bad or no wifi and great locations to hike, bike, swim, canoe, rock-climb etc. We ended up with an RV so that we could travel while bringing our pets with us. Covid has curtailed that unfortunately – closed borders and over-booked campgrounds. I tried to book some canoe or hike-in spots, but they were full too. Anyway, we’ve still broken out the Catan, although I am finding it much more difficult to dominate now. My kids are older and pretty cut-throat about moving the bandit.
      -LD

  4. I absolutely love this.
    I need to exercise for balance/me-time/(mental) health, but it can cut into my limited family time. You found a way to combine both so nicely!
    I wonder if I can find something like that. I also love the camping/nature connection, but it would be nice to have a year round activity suitable for young children.

    This is very inspiring. I’m really going to think about this.

    1. Hey Mtnldy. Thanks! Camping is great, but I agree that finding something regular to make part of your normal routine is key. Much depends on where you live. We actually moved about a year ago to get out of an urban area so that it would be in our backyard. We were fortunate to have the option. Mountain-biking in spring-fall and nordic skiing in winter has become a twice per week activity for us now. Goodluck!
      -LD

  5. I think your message hits the spot. However, 2020 has been a terrible year for Martial Arts. As a life time student (over 50 years) of many arts (Karate, judo, jui-jitsu), I have found this to be my toughest year-because on non-partner training. Martial Arts is a skeleton of its former self. I cannot wait to get back on the mats in a more productive way. So until we get back to some normalcy, balance is out. And I will be force to focus on my businesses. Hopefully, I will not be punished by this government for making more….

    1. Hey EHAN. Yeah, 2020 has totally sucked for Martial Arts. I actually wrote the article last February (just pre-covid) and it sat in my to do box for a year. We have been reasonably lucky because we have a dojo in the basement and we can train together. Still, not the same as our broader social network in the regular club with other kids for the kids and other adults for us. Zoom is definitely not great. Looking forward to normalization. On the business side of things, I think anyone who makes money is going to get hosed (even more) in the near future. I have taken most of my capital gains off the table investment-wise. We sold our giant house and bought a more normal, but quite nicem one. I have kept working a lot due to the physician leadership need and clinical need. Once Covid settles I plan to ratchet back my work substantially and live quietly amongst the masses.
      -LD

      1. “On the business side of things, I think anyone who makes money is going to get hosed (even more) in the near future. I have taken most of my capital gains off the table investment-wise. We sold our giant house and bought a more normal, but quite nicem one. I have kept working a lot due to the physician leadership need and clinical need. Once Covid settles I plan to ratchet back my work substantially and live quietly amongst the masses.”

        I’m surprised that this idea isn’t talked about more. It’s certainly high on my agenda as well.

        I’ve heard the counter argument that “…nobody refuses to make more money just because they pay more taxes…” There seems to be a large cohort of the population who don’t understand the nature of small businesses and equate them to free money trees. But that isn’t true.

        Where small business requires additional labour to create more jingle, there is diminishing returns to that labour. The extra tax burden will be the final straw. The most capable of this class will not be someone else’s fodder. They will simply close up shop, down grade, move (offshore) or retire. All of these outcomes are possible. The impact will be grave and it’s a shame that the government is attacking the very hands that feed it.

        Any ideas on how to turn this boat around?

        1. Hey EHAN,

          I am glad to hear that it is high on your agenda.

          I have heard “…nobody refuses to make more money just because they pay more taxes…” thrown around too. It is true, if it is “more money for no additional work”. If it is more work for more money, then it becomes an issue of return on time/effort. I think one of the major issues is that the average person has a fixed number of work-hours and gets a fixed rate for that. There may be some limited option to work more at a higher rate, but work-time is basically fixed. So, the diminishing return for time spent is an irrelevant concept when the time is fixed. This represents the vast majority of voters. The hand that feeds the government is really where the votes come from rather than the money. The income/productivity generators pay for government programmes that voters enjoy, but the connection between spending and actually paying for it has become very loose. I don’t think a connection will be made until the producers stop producing, produce elsewhere instead, and/or there is a debt crisis that actually affects voters personally. This situation used to make me angry and worried about where we are heading as a country, but I don’t know think that we can turn that boat around.

          So, I have switched focus to steering my own little boat rather than floating with the current or riding the mainstream boat. I think emulating a more average lifestyle is a good option for me. Key to that being able to cut back are having worked hard and spent/invested wisely to get here, but it is also gratitude. “Gratitude changes what you have into enough”. It is easier for me to do that having seen how much more work/sacrifice is required to have a little bit more. I have had the experience of having done it and decided it is not worth it. This is something that I can control, but it is still hard to be grateful when steeped in our consumer-driven society. It is also human nature to compare ourselves to those immediately around us. Having grown up in an average-income family, moving in circles with more average-income people (like at karate), and moving to a less affluent community has definitely helped. I feel bad for those who have gotten stuck on the work/spend treadmill without realizing that they do have choices.

          You are right that it is not talked about enough. One of the big reasons why I started this blog was to talk about these ideas more. To help people to understand time/money. To understand the trade-offs and that they have a choice (plus how to earn, spend, and invest wisely to grow the resources that make those choices easier). I think that >50% income taxation levels are psychologically important and one positive side effect is that it has given more high-income earners pause to consider the work/money trade-off since we crossed that threshold. I have been hearing it talked about more frequently amongst my colleagues for sure since about 2015. Many more are choosing to drive their own boat and find balance.

          -LD

  6. Thanks so much LD. Another great post that forces me to think and take stock.
    Like you our family has downgraded our lifestyle from the Mcmansion to something more reasonable, and it has been a huge boost to our finances and our wellbeing. Was a valuable lesson I had to learn. Similar to you I also took up a martial art in the last two years with my daughter. It has been an incredible and enjoyable journey. Zoom kickboxing sucks butt though, but looking forward to hitting the pads fo’ real.
    Keep up the good work Sensai.

    1. Hey Cowboy Cutter. Great to hear! Yeah- Zoom does suck butt. Fortunately the place we moved to is pretty low for Covid and we’ll be back in person tomorrow. Can’t wait. We have been hitting pads at home, but I am ready for my daughter to kick other teenagers. She kicks hard now.
      -LD

  7. Dear LD,

    After an intentional sustained blog “cleanse” I am coming back to old friends and catching up in a voracious binge. I feel like the castaway who just returned to the mainland (more Gilligan than the Professor). House downsized? Where have I been!?

    I so enjoyed this post:

    “Jazz and a grand mal seizure” might describe my least successful nights of parenting, my most memorable patient encounters in the ED, even the occasional first date prior to meeting my wife. If I still had the writing group that sustained me for the decade out of residency, I would eagerly assign that as a topic on which to riff.

    I noted the glaring absence of the fractured hand x-ray in this post extolling the virtues of karate. A sin of omission or commission?

    Finding lingua franca with adolescents is challenging work. Locating it in the precise application of controlled violence seems like the ultimate judo move – you have cleverly channeled your opponent’s force (I refer to your adolescent children) to disarm them.

    I love and plan to shamelessly promote your list of karate’s helpful characteristics. Every new attending should keep this list in mind. In particular developing the external accountability is a major impediment for efficiency-minded physicians who misidentify recreation as idleness and stigmatize it.

    I’ve missed your words, and it feels gluttonous to enjoy them in this moment, as if you’d written them just for me.

    Sincerely,

    CD

    1. Hey CD. Great to hear from you. I have intermittently been keeping track via your blog, but have just started writing again. We did a major life overhaul this past year. I look forward to sharing the journey. It was planned and started pre-covid, but was good timing. Work has been busier than I planned, but exciting to be doing some useful medicine and organizational work. I did forget the hand X-ray and my adamantium implants! They only come out when I am stressed or homework rules need enforcing.
      -LD

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