Welcome to Part 5, the penultimate installment in our series on work-life balance in medicine.
In our very first blog we talked about how difficult it is for juniors to speak to their seniors about wanting a work-life balance. There comes a time, however, when it will be important that you describe your aspirations to others and then have the courage to ask them for what you want. As we discussed last month, being clear about your availability and plans can actually help your seniors because it lets them understand you and your colleagues as individuals and as a group.
This isn’t to say that asking for what you want is easy, or that asking is the same as getting. It’s not. We know this from our personal experience.
Throughout my training I had always planned to work part-time as a consultant. I was upfront with all my colleagues, and received positive feedback about my chances. Once I’d graduated though, I quickly discovered that the job market had changed. I was told early on in my job hunt that if I did not work full-time I was much less employable. This was deeply unsettling because it made me question whether I would ever get a job, and whether I should abandon my plans for work-life balance and simply accept that I had to work full-time.
I considered my options carefully and in the end Chris and I decided I would keep asking for what I wanted rather than abandon our entire plan for work-life balance.
Thankfully, I found another position advertised in a hospital where I had worked before. I had been upfront about my plans as a trainee so they already knew I wanted to work part-time and supported my application nonetheless. Incredibly (to me), I was offered the position and I was extremely grateful and relieved. At the time, however, I had a 4-month-old baby and I had wanted to take 12 months off work in total to look after him. Despite being in a tenuous position with no other job options, I courteously asked whether the department could accommodate moving my start-date back 8 months. This meant that my colleagues would need to cover all my on-call and clinical duties – a huge ask. What I offered in return was loyalty and hard work once I started. I am grateful that they agreed, which gave me 12 months off in total with my son and a wonderful part-time job that I love. There were many many factors that led to this outcome, but they all started with me asking for what I wanted: early (in training), on applying for my job and again when I was offered the position.
In our experience, you have the best chance of getting what you ask for if you know:
Choosing when to ask for something is a purely strategic decision. We all, instinctively, have some ability to read people and judge when is or is not a good time to ask. Even our two-year-old knows how to pick when we’re feeling tired, stressed or busy and choose that time to ask to watch television.
It can be very difficult to judge your seniors or admin staff in the same way. In lieu of observing them closely in different situations over a long period of time (which was how our two-year-old learned our weaknesses), this is how we approach the problem.
We always:
Being strategic means doing your best to understand the person or department you’re asking. If you want a highly competitive job then it would be wise to find out what the department or hospital wants in their applicants. This might involve additional courses, attending or presenting at departmental meetings, or starting an audit ahead of time. If you want a highly competitive rotation, or you have specific part-time requirements that will cause a headache for your JMO manager, then being useful to that manager in other ways would be sensible.
Depending on what you’re asking for, this might mean offering to do a particularly unpopular rotation in exchange, taking up some sick-relief on-call that’s empty, or offering to take annual leave at a less popular time. You have to be careful with tradeoffs to make sure they are worth it for you. Asking for clarity well in advance (“how likely am I to… be successful/get that rotation/be able to work part-time”) can give you a good idea of what might be needed and who else is out there working strategically just like you.
Asking early might be at the start of a year or a term, before a job application or even at the start of an entire training program if you have particularly specific requirements. No matter what terms, shifts or projects you’ve been handed, if you’d like to ask for something different then do it quickly. Asking early sets you and your seniors up with clear expectations that you can reference back to as events unfold.
We almost always ask in person. The one exception is with our College – our advice is to always keep an email trail when dealing with your College. Within a hospital, asking in person is preferable because it lets you and the person you’re asking understand each other and your respective situations better.
Having said that, if it isn’t in writing then it never happened. Always follow-up with a polite email that summarises what you agreed on. Our email template is short and simple:
“Dear ABC, thank you very much for your time today. As we discussed, I will do (…) and you will do (…). I really appreciate your help with this. Regards, X”.
We all know how to ask for more work, but what other things could you ask for? This is relatively simple if you’ve made a plan (we covered this in Part 3). A plan is crucial for figuring out exactly what you want, how far you can negotiate, and what price you’re prepared to pay to get it.
In the past we have asked for (though have not always received!):
This is controversial, but pragmatic, advice. Your family planning is your business. We advise trainees not to disclose their reproductive plans until they are 14 weeks pregnant. It’s illegal to discriminate against pregnant women, but there is plenty of anecdotal evidence of unconscious bias against women who are planning to get pregnant and who tell their managers.
What happens if you ask for something and the answer is “no”? What if you experience push-back against your request? What if you risk or start to incur reputational damage – becoming known as “difficult”?
We know from personal experience these are tricky situations that can make you feel awful. Bridget was told her entire family/career plan, workshopped over eight years of training, was not likely to happen. We’ve been told that we’d have to live apart geographically, work opposite shifts and complete additional training despite our best efforts to ask for something different. Chris once had to leave his own birthday party to perform a forensic examination for a child protection service because he had not managed to arrange relief from his on-call that day.
If you have made a clear, reasonable request that takes into account your needs and also your obligations but you’re not receiving support, you still have a few options:
Going into a request knowing what your backup options are can make the asking easier, because you’ve already decided what you’ll do no matter what the answer is.
We have had both success and failure asking for what we wanted. Being respectful, asking in person, asking early and having a plan for a “no” are not guarantees that you will get what you want, but they are the best way to start.
Good luck out there.
Bridget and Chris
We’re two consultant physicians sharing what we’ve learned about achieving work-life balance in Medicine.
Follow us on Twitter
Bridget: @drbjohn
Chris: @drcelliot
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