Negotiation, like tying surgical knots, is a learned skill.

by Carol EH Scott-Conner, MD, PhD, MBA

Endocrine and Breast Oncology Surgeon

Professor of Surgery - Surgical Oncology and Endocrine Surgery 

University of Iowa Carver College of Medicine 

What image does the word “negotiation” bring to your mind? Do you think of a buyer and a seller haggling in some bazaar? Do you cringe, remembering a time when you had to go to your supervisor with a request for resources (and maybe got turned down)? Perhaps you envision a mother trying to get a toddler to do something. Do you think of bribery? Of weakness? Of strength? Of imbalance of power?

We negotiate all the time, in matters large and small. Negotiation, like tying surgical knots, is a learned skill. And that means that you can learn how to do it, just like you learned how to tie a secure knot (even though you had been tying your own shoelaces for decades).  

Negotiation involves give and take between two parties. Give and take implies that each party has something to gain and something to lose. A successful negotiation satisfies both; there is a sense of balance.

In Women Don’t Ask, Babcock and Laschever argue that many women are averse to negotiation. They give numerous examples and quantitate the way in which women sacrifice as much as half a million dollars over their working lives by neglecting to negotiate effectively for their first job. The damage extends far beyond monetary compensation. Failure to negotiate may hamper your ability to succeed, if you “low-ball” the resources and/or support needed to achieve a needed goal.

Suppose, for a moment, that you have been asked to take on a major responsibility such as becoming a Division Director. It’s a huge honor. You’ve actually wanted this job for quite some time. The moment has come, and you are in the office of your Department Chair. You’re quite excited, and yet afraid, somehow, that the offer will be withdrawn if you are too demanding. You will need to negotiate for: a raise (commensurate with your additional resources), some protected time for the administrative functions, administrative support, a commitment to recruit and grow your division, resources for your division (such as clinic space, operating room time, research support). 

How should you proceed? First of all, prepare ahead of time. You wouldn’t go into the operating room without preparation. Don’t assume for a moment that you can just “wing it”.

1. Do your research. Get as much information about the division as you can. Hopefully you have been doing this along as you prepared to move into an opportunity like this. Basic statistic such as volume and trends in clinic visits, diagnoses, patient satisfaction, surgical cases, complications, length of stay, salaries, size of division relative to other academic medical centers are easily obtained if you dig around a bit.
2. Do a basic SWOT analysis. What are the division’s strengths, weaknesses, opportunities, and threats? How can you build on strengths, expand into opportunities, correct weaknesses and avoid threats?
3. Put your findings into the broader context of the Department and the hospital (or university) in which you work.
4. What are your priorities and goals for your own career? How will this position advance your career? How will it complicate your life?

Next, take this information and make it into a concise set of needs/wants and rationale for each. Rank these. Consider a menu of options. Consider how factors are interrelated; for example, if growth is a priority for this division, then recruitment will require a commitment for additional clinic space and operating room time. Remember that the negotiation process involves give and take. Additional operating time may simply not be feasible at this point, but analysis might reveal that another division is about to lose personnel, or that some surgeons will be moving their practice to an Ambulatory Surgery Center. You may be able to get a commitment to get newly freed up time in the Main OR or to move a significant fraction of your division’s cases to the ASC.

Rehearse your negotiation with a trusted and experienced person. A network of mentors around the country, including friends in other disciplines, can be invaluable. You might (rightly!) not feel comfortable doing this with a colleague in your own department, or even a colleague at a different university. Seek someone with experience in another discipline if necessary. Use your spouse or partner. Go through the discussion. Have your partner throw objections at you. Use the mirror if you have to. Practice countering objections, resistance, even hostility.

Keep a collaborative focus. Both you and the person you are negotiating with want the division to thrive. If the other person does not, you may want to switch jobs or consider turning it down. Think about the priority of this particular division within the larger organizational structure. How does this division affect the whole? Do you provide a crucial service that no one else can do (for example, pediatric surgery) or do you overlap with other divisions (for example colorectal surgery overlaps with MIS, surgical oncology, and GI surgery)?

Lose the emotion. The best advice I ever got about negotiation was to think in these terms: “I care, but not too much” about the outcome. Don’t personalize it. This is not about friendship, or individual worth. This is about what you can do for the organization and what you need to have to do the job.

Get some distance, if you need to. If all else fails, make a graceful exit and return to continue the negotiation after you have both cooled off and reconsidered.

Remember the value that you bring to the organization. This is about maximizing that value, and continuing to contribute.

Let’s take a simpler example. You need better nursing support in clinic. You suspect that the male physicians are assigned more nursing support because they need to be chaperoned when they examine a female patient. You feel that you need to be chaperoned as well, but that your needs are ignored. Go through the same steps outlined above. Collect the data. Come up with a menu of options. Perhaps you can shift clinic days/times to a less busy slot. Perhaps the problem is that you are in clinic when a particularly busy and demanding male surgeon is also there, and he is sucking up all the resources. Options include tackling the issue head-on or switching.

The truth is that you are constantly negotiating. Shall we have dinner at home or eat out? Should we go to a basketball game or a concert? Does my case go first in our shared OR, or does yours? Will you add this procedure on to your full schedule to accommodate my patient? Once you become aware of how pervasive negotiation is, you will find numerous lesser-stakes opportunities to practice. This practice makes you ready for the high-stakes discussions.

What if you are the person in power? Make sure that all the facts are available. Have a menu of options to achieve a shared vision. Don’t take advantage of a naïve junior surgeon. If you feel that the person with whom you are negotiating is naïve, ask them to take some time to look at the data and come back to you with a list of needs. This is not only the right thing to do, it gives both of you a greater probability of success.

In 1995, I became the second woman in American surgery to Chair an academic department at a medical school. Every year, I would met with each faculty member to discuss salaries. The men came in with demands that were often outrageous, but they were usually also armed with data. Too many of the women came in and began the discussion by saying, “the money isn’t important.” I think that women don’t generally go into surgery without a strong sense of vocation. Money doesn’t taint that vocation, it is a just reward for what you do.

It is how people measure success. When I went to Scotland decades ago to meet with a textbook coauthor, I learned the phrase “good value for money.” It can mean a lot of things, but at the most basic it means that it is okay to spend more money if you get higher quality. You provide “good value for money” every day. Don’t hesitate to make sure you are appropriately rewarded and empowered with the resources you need.

The “c” word. I don’t consider myself a crier. However, when I was young, difficult negotiation, one-on-one, with a supervisor used to bring me to the verge of tears. In informal discussion with other women, I know that this is not a rare problem. The remainder of the session would spiral out of my control as I focused on keeping my emotions in check. We all know that crying on the job is almost never a good idea, particularly when you are up against a male surgeon.

I learned not to cry, and you can too. Incidentally, this is not just a female problem. Men cry, too. Rehearsal will help desensitize you. Taking the emotion out is easier if you think of it as an analytic problem rather than an interpersonal one. If all else fails, make a graceful exit and return in the near future with better armor!

Suggested Readings:

Babcock L, Laschever S. Women Don’t Ask, Bantam books, 2007. Get this book and read it!

Negotiation. Wikipaedia. http://en.wikipedia.org/wiki/Negotiation accessed January 2014. This is a very concise and nice guide to negotiation. It identifies three classic styles.

Creating your own academic timeline

by Christina Cellini, MD, FACS, FASCRS

This topic came to me during a grand rounds given by a well-known surgeon in his mid-career - henceforth will be referred to as “WKS”. I had just returned from my second three-month maternity leave in two years and was looking forward to hearing about what advice he had to give.

That morning WKS gave a talk about how he advanced academically starting from residency to his early attending years that eventually led to his promotion to associate professor. His talk was very informative, and he made a really big deal about being present for your family while trying to achieve your goals. All in all it was a thoughtful presentation. However a few things caught my attention and highlighted how everyone’s situation is unique.

One piece of advice given was that one should constantly “be writing papers” and even to “get up at 4 am before work” to write in order to fulfill that goal.

4am??? I thought back to what I was doing at four A.M. that morning. Oh right… I was nursing an infant. I’m certain that’s not something that ever stood in his way of writing papers. Oh well, no time for paper writing this morning. Maybe tomorrow.

His next piece of advice was to take advantage of all the wonderful scholarships and traveling opportunities that are catered towards young attendings under the age of 45 . He showed lovely pictures of him and his family frolicking around a foreign country that was many time zones away.

I thought- wow! I didn’t know about these awards. I should think of putting something together. Then I thought of the logistics- I don’t think I’ll be able to leave my tiny children away for that amount of time. And since these days I need to plan about an hour in advance to take both kids out to a trip to Target…. maybe in about 5-7 more years. But then I’ll be too old for these scholarships!

Finally he mentioned being involved in society meetings and to bring family along so that you can take advantages of the opportunities there while your spouse and kids go and do fun things in the area. See- you can work and spend time with your family as well! I thought- that might be doable. I did have to skip the last 2 of my society meetings because I was either too pregnant to fly safely or did not have the resources to travel with an infant. Let me ask my husband how he’d feel about watching the girls in a strange place for a week while I do my surgery thing. I texted him- I got back “absolutely not”. Apparently dealing with two cranky, nap-less, off schedule children by himself while I do my own thing most of the day was not my husband’s idea of “family fun”. He encouraged me to go alone. Now don’t get me wrong- my husband is awesome and takes care of the lion’s share of child rearing and is supportive of my career- but I couldn’t blame him for not wanting to sign up for that.

WKS had a number of great ideas that worked for him to achieve academic success so quickly in his career. I am certain there are many young surgeons - both men and women- who can achieve that as well. However, WKS had a personal situation that allowed him to flourish early on. He was able to follow the typical academic timeline that usually consists of publishing 2-3 papers/year, obtaining some sort of early career development grant or funding in the first 5 years as a means for future funding, active involvement in the ACS and specialty societies - all in addition to growing one’s clinical practice at the expected pace. With this timeline one can usually expect promotion to associate professor within five years or so. I know that I will not be able to keep up with that timeline. My path to promotion will likely take a few (or more) years longer than others. Occasionally I get antsy about it when I perceive that my peers are advancing faster than me or that I am in some way “behind”. However, I have been lucky to have colleagues and mentors that understand my need to slow down for my family and are supportive of an “extended” academic timeline to academic advancement.

Now, if you can breastfeed and write scientific papers at the same time go for it! If not, I suggest the following:

1) Take some time to really think about what your future academic goals are. Make them very discrete, not ambiguous. Also, take the time to write them down.

2) Prioritize the goals and create a timeline to go with them. Give some real thought as to how you might go about achieving these goals. Again, the more specific you are, the more likely you are to realize them.

3) Share your academic timeline with a more senior colleague or mentor. Doing so may help you identify potential opportunities or pitfalls in your strategy that you may not have considered. As always AWS members are available to help- and have likely been in your shoes at one time or another!

4) Periodically look back on what you have written and adjust as necessary. Do not feel bad or guilty if it takes longer than you thought. Try not to fall into the “keeping up with the Jones’s” trap that can be prevalent in surgery (I know I have on more than one occasion). Take the time to write down and reflect on everything that you have accomplished up to that point. Remember no accomplishment is too small! As long as you remember what’s important to you and keep your eye on the prize you will no doubt be able to balance your personal and professional life and accomplish what you have set out to do.

Readers, how have you adjusted your own professional timeline to achieve both personal and professional goals in a reasonable manner? Share your thoughts below.
 

~~~

 

Dr. Christina Cellini is an Assistant Professor of Surgery and Oncology at the University of Rochester Medical Center in the Division of Colorectal Surgery. After obtaining her undergraduate and medical school degrees at Cornell University she trained in general surgery at the NewYork Presbyterian Hospital-Weill Cornell Medical Center. Following residency, she completed a fellowship in Colorectal Surgery at Washington University in St. Louis. She recently completed a Masters in Medical Management at the Simon School of Business at the University of Rochester. She lives in Webster, NY with her husband and 2 children and enjoys running and snowshoeing in her free time. Dr. Cellini serves on the AWS communication committee.

Finding Strength in Setbacks

by Jane Zhao

Two months ago, I read a great book, and I’ve been raving about it ever since to whoever will listen. David and Goliath: Underdogs, Misfits, and the Art of Battling Giants by Malcolm Gladwell is a book that stays true to form to Gladwell’s other works. In it, Gladwell challenges readers to look beyond conventional wisdom to reevaluate the way we look at setbacks.

The nonfiction book begins with a vignette from the biblical passage of David and Goliath. Historically, David has always been painted as the underdog and Goliath the giant. But based on what criterion? The fact that David is of significantly smaller stature? Pfft. According to Gladwell, David wasn’t such a weakling. In fact, he had numerous other qualities that made him just as formidable (if not more so) than Goliath.

Gladwell writes early on in the book:

“There is a set of advantages that have to do with material resources, and there is a set that have to do with the absence of material resources—and the reason underdogs win as often as they do is that the latter is sometimes every bit the equal of the former.

“For some reason, this is a very difficult lesson for us to learn. We have, I think, a very rigid and limited definition of what an advantage is. We think of things as helpful that actually aren’t and think of other things as unhelpful that in reality leave us stronger and wiser.”

As I read, I thought bemusedly how his words could be applied to setbacks faced by women in surgery. How often have I heard of the challenges faced by my predecessors described as blessings in disguise? Based on his writing, Gladwell probably wouldn't think of that analogy as far-fetched at all.

So I came up with some examples of surgeons whose pasts as underdogs and misfits shaped them into amazing role models.

• In the 1970s, women were discriminated against from receiving credit in their own name at banks, and if these women were married, they were told to use their husband’s name on the checking account. Finally, in response to the refusal of service, a number of women banded together and formed the first ever women’s bank. Dr. Anita Figueredo was one of them. During the creation of the bank, these women received derision and dismissal from many of their peers. But after the bank’s successful launch, banks all around (even the ones that had previously refused them service) began to open up "women’s departments" and "women's divisions." Lessons learned: when these women didn’t feel welcome, they decided that instead of trying to fit in, they’d start from scratch elsewhere. As a result, they each became successful entrepreneurs with leverage of their own right in the banking community.
• Dr. Frances Conley never really considered herself the victim of sexual harassment. Anytime an off-color joke was directed her way, she’d fire off a snappy retort, and that’d be the end of that. She built an incredibly successful career as a neurosurgeon at one of the most prominent academic institutions in the country. She kept her head down and didn't rock the boat. But then came an incident of misogyny that she simply couldn’t ignore, and she publicly resigned from her tenured position in protest. Her office and lab were ransacked; she was vilified by the media and many of her peers. Thanks to her efforts, numerous medical schools, universities, hospitals, and research labs created or updated their policies regarding sexual harassment. When she finally performed the unsavory deed of “rocking the boat” that she’d spent so long trying to avoid, she became recognized and respected as a leader brave enough to speak the unspeakable.
• Dr. Linda Brodsky serendipitously discovered in 1997 during a residency program review that a recently hired male faculty member in her department with lesser qualifications, responsibilities, and seniority was being compensated by her university at twice her state salary. Upon further investigation, she discovered that this was not an isolated incident. After more than two years of trying to resolve her gender and pay concerns internally, she resorted to filing charges of discrimination by her two employers. As a consequence, she lost her job. She’s since spoken publicly about the innumerable times she became wracked with guilt over putting her family through the tortuous process. Often, she’d lose sight of the light at the end of the tunnel and question whether she’d made the right choice by filing a lawsuit. After ten long years, the lawsuits were finally settled. Because of that grueling period in her life, she is significantly wiser about the laws regarding fair gender compensation, and she has become a fearless leader in the global community by advocating for others who are now in similar situations. 
• And lastly, an orthopedic surgeon I know was teased and called “Token” by her co-residents all throughout residency because she was the token woman their program had taken in that year to meet its quota for diversity and inclusion. Being called by a nickname she hated irked her to no end, but that experience made her aware of just how damaging and alienating such taunts, however slight, can be over time. As a result, she is an infinitely more sensitive caretaker and teacher than she would have been otherwise.

The incidents suffered by these women were awful. They faced difficulties because they were different. The silver lining to all of this is that we wouldn’t know about any of these women and their heroic contributions to society if they hadn’t been pushed to the brink and been forced by their situations to find the inner courage to implement change when change was needed.

Globally, women and underrepresented minorities still have a ways to go before full equality is met. It’s a new year though, and with that as reason enough to celebrate, I’d like to raise a toast to the tremendous progress we’ve made as a society, all thanks to the efforts of underdogs and misfits who saw setbacks not as obstacles that blocked their paths but as walls to be climbed over.

Happy 2014.

Oh, and make sure to read David and Goliath: Underdogs, Misfits, and the Art of Battling Giants by Malcolm Gladwell. It’s a good book.

Do you have an experience where being an outsider made you a stronger individual? Share your story with us in the comments below.

~~~

Jane Zhao is a fourth year medical student at the University of Texas Medical School at Houston. She completed her undergraduate studies in Medicine, Health, & Society at Vanderbilt University. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award. Her interests include healthcare social media, quality improvement, and public health from a surgical perspective. She chairs the AWS blog subcommittee and can be followed on Twitter. She is in the process of interviewing for General Surgery residency for the 2014 Match.

How I Make It Work

by Danielle Walsh, MD

December is the time of year when the constant struggle between the needs of work and the commitment to family become most strained. Holiday performances at school, parties for kids sports and other organizations pop up, work-related celebrations occur, and both of my children celebrate birthdays within a week of Christmas Day. After a long day of operating you try and shop online or in crowded stores before heading home to make dinner, ensure homework is done, and then proceed to whatever holiday event is scheduled for that night. It’s exhausting. But I can’t imagine it any other way.

People always ask how to make it all work. Lately, my response is more refined than in the past and it utilizes the tried and true analogy of the full bucket. You have to start with the biggest rocks. My kids’ birthdays, gymnastics meets, the annual AWS conference and a few other events are rocks. They are unmovable, non-negotiable events on my calendar. These are my biggest rocks. My OR days are Monday and Friday. My clinic days are Tuesday afternoon and Thursday morning. They are not movable and are the next size down rocks. I schedule a date night with my husband at least twice a month. Still a rock, but can fit around the other stuff. Then everything else gets filled in order of priority like the AWS, work on a grant, student and resident teaching – gravel, then sand, then water. Most of the time I try to leave pockets in “reserve” – an hour in my schedule for the gym, prayer, or just walking through a store undisturbed (my husband calls this retail therapy, even if I don’t buy anything). Often this is when I can review what the priorities are for that day or week to determine what goes in the bucket.

Sometimes the bucket overflows. I try to do too much at the same time or something unexpected causes the balance to tip. Then I call in the backup buckets – my husband, my parents, my partners, or some hired hand to take on what I can’t handle. Occasionally it means a paper is late (not unlike this blog, which I had hoped to write last week), emails get left in the inbox, and phone messages are not promptly returned. These times never feel good. I hate not being able to do it all on time. Some of the dislike is frustration of leaving others hanging, waiting for me to take action. Some of the issue is realizing that I made an error in taking on so much. But it serves a purpose – a reminder to be patient with others, accept imperfection, and continue trying to do better.

I always schedule at least some vacation time in December when the kids are off. The first day is set aside to clear out all the late assignments from work (like this blog) that will keep me giving my family my full focus. And then I sign out to my partners, turn off the beeper, set up the auto-reply for work email, and be just a mom, wife, and daughter to family for a while. It always feels good.

So as 2013 draws to a close, take a look at your bucket. What are the rocks, the stones, the pebbles, sand, and water? What can fit where and when? Find your time for work, time for family or friends, and time for yourself. May your bucket be full and satisfying.

Peace to all.

Danielle Walsh

P.S. – Didn’t get around to Christmas cards yet. Might still try to do them, but don’t hold it against me if they arrive a little late.

~~~

Dr. Danielle Walsh is an Associate Professor of Surgery at East Carolina University in the Division of Pediatric Surgery. After obtaining her undergraduate degree at Columbia College and her medical degree from the University of South Florida College of Medicine, she trained in general surgery at Massachusetts General Hospital in Boston. She also completed a fellowship in fetal surgery and research at Children’s Hospital of Philadelphia and a fellowship in pediatric surgery at Children’s National Medical Center in Washington, D.C. She practiced in Jacksonville, FL holding faculty appointments at the Mayo Medical Center and University of Florida before moving to her current position in North Carolina. She is the 2013-14 President of the Association of Women Surgeons and mother of 2 children.

Pregnancy during Medical School & Residency

by Callie Thompson, MD

I have read a lot of discussions about “the right time” to have a baby during a career in medicine and most of them come to the conclusion that there is no right time. I don’t think that is really accurate. The more correct answer would be that the right time is entirely dependent on you and your situation. I feel well prepared to write this blog and give this advice because I have been pregnant during both medical school and residency (twice).

In chronological order, I will start with pregnancy during medical school. The first two years of medical school are typically spent listening to a lot of lectures and studying almost all of the time. The third year is usually heavy with clinical work and spending a lot of time in the hospital. And the fourth year is usually a few sub-internships and a lot of light rotations at your home institution. So, where would a pregnancy, birth, and caring for an infant fit in there? Again, it really depends on your situation. You have to weigh the physically demanding state of gravidity with what you will need to be doing at that time. If you are concerned about being on your feet all day, then maybe being pregnant in the first two years would work best for you. You also have to take into account the demands of a newborn/infant. If you need a lot of time to study or are not great at multitasking, then having a newborn prior to taking your USMLE Step 1 might not be the best idea for you. No matter what you decide, you must have a viable option for childcare in mind. I suggest that you do this prior to even becoming pregnant because you will need help.

Regarding taking time away from school, there are no universal rules as to how much time can be taken. This will be school dependent. You just need to make sure that you can fulfill the requirements to earn your degree. Some people choose to take an extra year and make medical school a total of five years to allow them to have their child. I do not think this is necessary for everyone and you are going to know your capabilities best. Don’t let someone push you into a 5th year just because others before you have chosen to do that.

Pregnancy in residency is a bit trickier because of the American Board of Surgery requirements for General Surgery Certification. I had a baby during clinical R3 year and another while I was out in the lab. From a time-off perspective, having a baby during your lab years is much easier. If you are NIH funded through a training grant you can have 6-8 weeks, though some lab work can be done from home so the actual time you get to spend with your newborn can actually be longer than that depending on your research. Having a baby during your clinical years requires a good understanding of “the rules.” The ABS states that:

“To be eligible for ABS certification in general surgery, the following must be completed: At least 48 weeks of full-time clinical activity in each residency year, regardless of the amount of operative experience obtained. The 48 weeks may be averaged over the first three years of residency, for a total of 144 weeks required, and over the last two years, for a total of 96 weeks required."

“For documented medical problems or maternity leave, residents may take an additional two weeks off during the first three years of residency, for a total of 142 weeks required in the first three years of training, and an additional two weeks off during the last two years of residency, for a total of 94 weeks required in the last two years of training.”

Translation: You can average your time over the first three years so, in theory, if you didn't take any other time off for three years, you could have a 14 week maternity leave. Similarly, if you didn't take any time off for vacation during your last two years, you could have a 10 week maternity leave.

In actuality, that isn't possible. For instance, you would have to know that you were going to get pregnant and have a baby during third year so that you could forgo a vacation in your first 2 years. And if you did that, you would surely go insane. So if you did take the regular 3 weeks of vacation a year, you could have an 8 week maternity leave during the year you did have the baby—as long as you don’t take any other vacation that year. A baby during the last two years is even more difficult because of the time constraints. Also, keep in mind that none of this accounts for the possibility of medical problems during the pregnancy and any time off that may need to be taken. None of this is meant to dissuade you from pregnancy during residency (see above where I state I did it twice) but knowledge is power and you have to be prepared to extend your training if you are unable to meet the ABS requirements. This is most important during the last 2 years because they have to be done in succession so if you were to get pregnant, become ill, and need extra time off during your 4th or 5th year, you may be required to start over at year 4.

This blog could end up being very long so the last topic that I will include for today is when/how to tell people when you become pregnant. I advocate telling people when you feel comfortable. For some people that is the minute you find out, for others it is after the first trimester. However, I would not wait much beyond the first trimester because arrangements will need to be made, either to your schedule if you are a student or for coverage from your co-residents if you are a resident. I also would also advise you not to tell anyone else before you tell your Dean or medical school adviser (for students) or your program director (for residents). It is best to give big, personal news yourself, and in person.

~~~ 

Callie is a resident in general surgery at the University of Washington. She completed a two-year research fellowship and is now in her fourth clinical year.  Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children under the age of 7.
 

“The Advice Less Given”

by Stephanie Bonne, MD

As a relatively new mother (I have 2 boys, ages 3 and 1), I’m usually anti-advice. I often feel as if each person’s situation is unique and resources and priorities are variable, so it’s hard for anyone to give meaningful advice that fully applies to me. If you have a young family or are contemplating having a family, you have no doubt been inundated with advice from lots of very well-meaning people. Some advice is trivial (“Jen is the best Gymboree instructor!”) and some is not (“if you are going to have more than one, make sure you have them as close together/far apart as possible”), but much of it we hear over and over again. “There is no good time,” “make sure you have lots of help,” “remember to take time for yourself,” are all well-meaning, but tend to be a little vague and can mean vastly different things to different people. However, in recent months, I’ve gotten 3 pieces of parenting advice that were a bit different than the usual advice and pretty adaptable to most woman surgeons, so I thought I’d take the opportunity to share them here.

1. “Learn to let go of some stuff, but not ALL stuff.” This is a comment on balance. As a surgeon, I’m used to being in control of almost everything, but as a parent, I can’t be. This first became apparent to me when my son came home from daycare one day in a mismatched outfit my husband had put him in that morning after I had left for work. I suppressed the urge to say “You let him go to school wearing THAT?!” Having meticulously dressed children is just something I have to let go of, along with the occasional glass of non-organic milk, or extra half hour of cartoons. My first advice to young moms: Throw away the Pottery Barn Kids catalog the minute it enters your house. No four year old boy spends an afternoon quietly reclining in his sailboat-decorated bedroom, reading a Caldecott-winning book while snacking on a perfectly balanced meal from his personalized bento box (seriously, when did preschoolers start carrying bento boxes?). Now, that last statement might sound remarkably reminiscent of some jaded-but-funny suburban parenting blogs. My second bit of advice: unsubscribe from these too. True, there may be humor in highlighting all your first-world failings as a parent, or brazenly point out that your kids are still alive, in spite of your best efforts and constant feelings of failure. These blogs, however, in an attempt to use intellect to deescalate the “Pottery Barn” ideal of a perfect mom, somehow miss the mark and instead validate the very thing they are trying to dismiss. You are a surgeon; you don’t have time to get involved in the mommy wars. This means letting go of the things that don’t matter, but realizing that not everything can be marginalized, and recognizing which things do matter. Your kids need to be fed, clothed, washed, and most of all loved, but that’s just the start – they DO need intellectual stimulation, bedtime stories, play time, social interaction, and swimming lessons. You can’t cast these things off as insignificant in the life of a child, but you also don’t have the time to place too much importance on each of your child’s experiences being perfectly orchestrated to be both stimulating and meaningful. Balance.
2. “Teach your kids, right from the start, about what you do and why it is important.” My experience with this has been short so far, but I do tell my son when I leave for call that I have to go to the hospital to help take care of sick people. Naturally, after a few times, he mustered a fake little cough and said “but I’m sick too.” I think every doctor-parent has a story like this, and yes, it is heartbreaking. But my husband and I reinforce what I do and why it is important and I think my son does understand. He will ask me when I come home the next day if I fixed the hole in someone’s tummy, and burst out an encouraging “great job, mommy!” when I say yes. When I recently went to DC for the AWS and ACS meetings, he asked me if people in Washington DC have holes in their tummies too. I’m sure the day is coming when I will miss a big soccer game or first music recital, but knowing that they understand what I do will help them. Sometimes, reminding myself of the importance of my work helps me too. 
3. “Take time for you and your partner, and do it guilt-free.” This is a variation on the date-night advice, but the key here is doing it guilt-free. This came up last spring after my parents were graciously willing to watch the kids for a few days so my husband and I could have a little getaway. Afterwards, I was recounting our trip on two separate occasions to some older, wiser women when they pointed out that I was making excuses for why we didn’t take the kids on our trip. Both encouraged me to never feel guilty for the time I spend away from the kids, pointing out that having two parents who live together, and furthermore, love each other, is far more important to them than the couple of days spent away from us. I think there is balance here too – we can’t jet away together every weekend, but we can do it within reason and should do it from time to time. For different couples, this will look different – to some, it’s going on long walks or runs together, for others it’s a monthly date night, for others it’s a weekend away once a year. Whatever it is, it’s helping you stay together, so make it a priority, but the real point is - don’t feel bad about it.

Props to the awesome women who gave me this advice – some of you will be reading this, and you know who you are. For the rest of us, take the advice that is given to you gracefully – remember, advice is rarely given in a malicious spirit, and most of your advice-givers really do have your best interest at heart. But take each piece and either toss it later, or process it and make it fit for you, and if it’s really good, pass it on later.

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Stephanie Bonne is an Assistant Professor in Trauma, Acute, and Critical Care Surgery at Washington University in St. Louis. Her husband, Jeremy, is a trademark attorney for Anheuser-Busch. She has two sons, Evan, 3, and Colin, 1.

Family Life

by Jennifer Knight, MD, FACS

I picked this topic because for me, Family Life is a work in progress and sometimes putting thought into something you are working on often allows for enlightenment. As a surgeon, the idea of work life balance is a moving target. I struggle with it most days, but recently a colleague of mine told me that they wished that they could master the work life balance like I had. Master seemed a strong word!  There are things I have mastered; work life balance is not one of them. But I think because I do “try” perhaps that’s as close to mastering, as I will get. I though maybe I’d list a few things that I do as my attempt to try.

1. You need a team. A friend, who is not a surgeon, pointed out to me that I need a team of people in the operating room to ensure that my cases go smoothly and efficiently. Why didn’t I have the same type of team for home? Would a team help my home run smoothly and efficiently as well? So I got a team! I already had a nanny but added someone to clean by house, I signed up for after school play dates, and developed an arrangement with a caterer for parties and functions. 
2. Facebook. Everyone has an opinion about personal pages on Facebook. I find that I can use Facebook to stay involved with friends and relatives. I can post pictures of my family and send birthday wishes to friends. When I am able to meet face to face, I don’t need to “catch up” as much.  And while I am a peripheral user, a select “like” or “comment” lets other people know I am still around and care.
3. Plan ahead. I clearly communicate to everyone that if they want me to participate, I need 3-6 months advance notice. I’ve been able to go on class trips with my son, plan weekend get-away with girlfriends, and make most birthday parties. My friends have commented that planning in advance has helped them be more organized as well.
4. Have a good partner. My husband is also a surgeon and has a high level administrative job in our hospital system. We have to have great communication about each other’s schedules. But he is equal parent. He likes doing laundry and I like yard work. We complement each other’s strengths and weaknesses and both give 100%.
5. Mow the grass. Maybe not literally. But I love mowing the grass. And while I have a “team”, the one job around the house that I love is mowing grass. I put on my headphones and put my John Deere into drive and have great personal quiet time attacking the lawn. The point is, make sure you have alone time and if that alone time contributes to the family in some way, even better.
6. Family-friendly and fun-friendly are two different things.  I have friends and work partners who are single. Make sure that your focus on family life doesn’t trump your friends or work partners needs or plans as well.  

This is not a perfect and complete list but each of these things have helped me. Your family life is YOUR family life. Make it what you want it to be.

What tips do you have that help balance your work life and your family life? 

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Jennifer Knight, MD, FACS is an Assistant Professor of Surgery at West Virginia University. She serves on the AWS Communications Committee.