As a mother of two and full time physician, I often felt like time is limited. There are so many priorities and I felt like I was failing. I wasn't spending enough time with my kids. I was burned out. My mental load was overwhelming me. I've come to realize that it was my perspective. These are the things that have changed in my perspective and helped me see what I am actually doing and what I need to do to have a fulfilling life.
1. The mother's guilt
The societal expectation for mothers is to spend all their time with their children creating guilt for working moms everywhere. I would like to challenge that notion. Spending time with your children is not the same thing as spending meaningful time with your children. Being together in the same room for 16 hours a day is not the same thing as spending 16 hours giving your full attention to your children. Since I don't plan on quitting to be full-time parent, I decided what time I spend with them should be undivided. I would like to spend at least half their waking lives with them. They also need to experience other people and things away from me to grow. If I concentrate and spend the one hour with them upon waking and 2 hours before bed every day and all of the weekend, I am there for them for half their waking life.
Being present with them can be challenging. To make it easier would be to eliminate sources of distraction for me. Phones should be put away. Screen time is eliminated. We cancelled Saturday and Sunday movies. The only thing allowed to distract me away from them is chores or books while they are playing by themselves. They have to initiate that activity. I used to cook nightly and that would take an hour from my time with them. I've since decided to outsource that chore because my time with them is more limited. I might start cooking later in the evening but as you read on, you'll start to understand why I might not.
2. Work and burnout
The stories I hear from primary care physicians is that we work too many hours and thus that leads to burnout. I have had friends who went part-time to counteract this. While it does sound great to have more free time (because who wouldn't want more time for fun?), it actually counteracts my goal for financial independence. The less I work now, the more I have to work later. I could decide that financial independence is not important to me but I have not yet made that decision with 2 kids and a mortgage. I have locked in to this for at least the next 4 years. We have 168 hours a week. I trade 36 hours for patient contact hours. It felt like I was working for more than 40 hours because of that. When I actually tracked it, I was not. So now, I track my hours and when I hit 40, I stop.
Here are some strategies that I now employ to streamline my day in primary care:
1. Take care of 5 action items in the inbasket first - starting with the ones I tend to spend the most time thinking about. My brain is fresh in the morning. It's easier for me think about these things before I get fatigued later in the day (which was the time that I used to work on these items)
2. In clinic, I write my notes - the history, physical and plan right after seeing the patient. This may cause a delay of 3-5 minutes for my next patient but it guarantees that their chart is accurate and that I'm not trying to think about the patient I just saw before them. I do the same with my virtual visits. I find that I have more processing ability if I clear my mind. I save closing the charts at the very end of the half day session. At that point, it's a brainless activity. I just click the buttons that prevent me from closing the chart - like billing.
3. When my brain is tired, I work on the inbasket stuff that is not mentally taxing. These are things like refills. For example, thyroid tests were normal in past year. OK to refill. Cholesterol is high. Please work on your diet and exercise. If it is going to present chart review or mental challenge, I save it for tomorrow or start of my next half day when I'm fresh again.
4. Listening to my brain exhaustion. Sometimes I have patients who come in with long lists of things. I try to do as many as I can but I need to be watchful. If my brain becomes overwhelmed, they are not getting the best care. I have been asking patients with these long lists to come back. I can address 2-3 problems but not 10 effectively in 1 visit.
5. On days that I find myself up earlier than I expected to be, I will spend 15-30 minutes on my inbasket. It doesn't feel onerous. It doesn't feel overwhelming. It's only 15-30 minutes that I would have spent later but now I'm more efficient.
6. If I catch myself thinking about work in a negative way, I stop. I focus on things to be grateful for - at work and outside of work. If I keep work at work and don't spend a moment more thinking about it in my free time, I find that I am happier. This doesn't mean I'm not
3. The Mental Load and Chores
I used to have a cleaning service before the pandemic. I miss them dearly but my family have decided that we cannot expose our kids or ourselves to any additional risks than what we are already taking with my job. I am the person in charge of all papers in the house and the maintenance of the house. Don't get me wrong. My husband does chores but he does not carry the mental load. He is open minded and agrees with me that we should share the mental load and chores. But to be honest, this is not his strong suit and we should all be doing things that we are more skilled at instead of it just being equal.
We started using an app called Tody. It assigned efforts and chores with recurring frequency. He likes to do the dishes and kitchen clean up. He just puts on a podcast and does it. He hates talking on the phone. I don't mind it so I schedule all the appointments for the kids, him and dog. At first, we strived for 50/50 in terms of effort but after 2 months, he kept asking me to stop doing chores so he wouldn't have to do anymore beyond his kitchen duty. Our solution was to take the money that we would have used for the cleaners and distribute it between us. For every effort over 300 that month, we get a dollar to go in our own discretionary fund. If you go under that goal, you get money substracted from your discretionary fund. This way, we can decide if we want to do more or less without it being competitive. If I decide that I'm going to let the house go for the rest of the month, it is a decision I can make without resenting him and vice versa. If I want to spend more money on my hobbies, then I would just do more chores. Same for him. Any future fun money is also divided up proportionately based on what percentage of tasks we did for the month prior. For example, last month, it was my goal to get the house back to tip top shape. I made sure to do extra to get it done and completed 500 efforts while my husband kept up his 300 efforts. If there is 100 dollars to be distributed for the fun money fund, I would get 5/8 and he would get 3/8.
My current plan is to 30 minutes of chores a day and see if I can keep up the house maintenance. After all, my cleaning service would come work for 3 hours every 2 weeks. They are professionals who are much more efficient at it than me. Spending 7 hours every 2 weeks to keep my house tidy and also working on my mental load is reasonable in my mind.
4. Free time
When you ask people what is stopping you from achieving that goal or doing that thing you love, you will often get the answer that they don't have enough time. I used to be one of those people. Now, I'm better but not perfect.
Let's do a deep dive in my expected time use over a week:
- Sleep - 49 hours
- Work - 40 hours
- Chores - 3.5 hours
- Eating/Personal Care - 7 hours
- Commuting - 2-3 hours
- Children - 36 hours
- Date night - 10 hours
- Exercise - 7 hours
- Free time: 12 hours
You might say that 12 hours is not a lot of time. I beg to differ. In those 12 hours for the past 2 months, I have read 11 books. I have been trying to read one book a month for the past 2 years. Each year I have failed miserably. Additionally, I have also taken the mock test for TOCFL which was one of my goals this year. I have spent time thinking about how to improve my life and figuring out where I want to go next.
You might be wondering, "where did this free time come from?" The answer is that I was watching too much television and scrolling through Facebook which neither fulfilled me nor added quality to my life. I implemented some strategies.
1. I wished I could say I removed Facebook from my phone but I have a lot of accounts linked to it. I worry about losing the ability to log in via Facebook. I had my husband set a time limit on it. I tried to but the addiction is too strong. I get 30 minutes throughout the day and that's it.
2. I removed my email from my homescreen. It's now sitting somewhere in the mess of apps I have. I try to check it only twice a day and not more.
3. I deleted most iphone games. I have kept celtic tribes. I don't log in as often as I used to but I have a pretty large kingdom there. Sometimes there's still activity but mostly, we are growing slowly in peacetime.
4. I outsourced cooking as noted above. I can spend an hour cooking every day or I can continue to work fulltime. I chose work because I am more efficient at work than cooking. It will remain a hobby but now I don't have to think about grocery shopping, meal planning and lose precious daytime hours with my children. My mind is freer as a result. If I decide the economic cost is too much, I can always choose to work more.
In conclusion, when I look at my time and life now, I feel great. I am spending time on the things that are important to me. I am tracking my time to make sure I'm keeping myself honest (Atracker app). If I see that I'm spending too much times on chores, I know to hold back. If I see that I'm not reading enough, I read. When I see I'm not sleeping enough, I make a plan to go to bed early. When I feel a void in my time, I know now that it is a decision point for me to do something that aligns with my priorities or to waste it. It is my time and I get to decide what to do with it.
Reading recommendations:
168 hours by Laura Vanderkam
All the money in the world by Laura Vanderkam
When: The scientific secrets for perfect timing by Daniel Pink
Financial freedom: a proven path to all the money you will ever need by Grant Sabatier
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