audioLiz Cruz

Dr. Liz Cruz discusses the fallacy of work-life balance in an interview. She believes that a perfect 50-50 balance between work and personal life is not possible. Instead, she suggests prioritizing tasks each day or even each hour. Dr. Cruz, a primary care physician and mom, manages to find time to read 100-plus books a year by making reading a priority and dedicating even just 20 minutes a day to it. She challenges the idea of work-life balance and suggests that it makes people feel bad and like they can't succeed. She believes that it's more realistic to focus on what is important each day, rather than striving for a perfect balance. Dr. Cruz also acknowledges the gender roles and responsibilities that often fall on women, but emphasizes the importance of prioritizing and compartmentalizing tasks to be more efficient. She shares that it took time for her to realize that the 50-50 balance wasn't working for her and that she needed to shift her mindset Welcome to this episode. Today I'm speaking with Dr. Liz Cruz about the fallacy of work-life balance. Welcome, Liz. Thank you for having me. Can you start by telling our listeners what you do and where you're located in the country? Sure. I'm a primary care physician, Infection Chief of Internal Medicine. I'm in Southwest Washington State, and I'm currently practicing in a multi-specialty group practice. Great. Welcome. I wanted to start by first with a warm-up question, which is, what is a favorite thing for you to do on a rainy day? Probably read a book. Read a book. Do you have one that you'd recommend? Well, that's really, really difficult because I read a lot. Last year I read 104 books. That is kind of my usual halftime when I have a few extra moments. Right now I'm reading – I don't know if I'll get the title right – Flowers of the Killer Moon, I think. Yes. Do you think that's the right title? I could be switching the words around, which is really interesting so far. But I read a whole lot of different types of books. Well, and that feeds right into the topic because how is it that you, as a busy physician and mom, manage to find time to read 100-plus books in the past year, right? Yep. Well, I make it a priority and I read every day. And no matter what, even if it's for 20 minutes, I read. And I find that even just a little bit of time every day really adds up over a year. You can get a whole lot done just in short little snippets like that. Great. Well, let's start with the challenge that you wanted to focus on today. Yeah. The whole idea that a work-life balance is a reality, and actually I think it's a fallacy, I don't think that that exists. And I think a lot of people get pigeonholed into thinking that they need to have a perfect 50-50 balance of work and home life, and it just isn't possible. I don't think in any stretch of the truth at all. I think it comes more down to what you prioritize that day or even that hour. And I think that's an easier way to not get hung up over feeling like a failure for not being able to have a perfect balance. And even that word I don't really like. Go ahead. I was going to say, what word would you replace it with if it's not balance, right? Because so often we have used that term for decades to try to describe something that we as busy working women were aiming for, where we would have some of the home life that we wanted and some of the professional life that we wanted. So what is wrong with that idea? What doesn't work? How is it a fallacy? I think it just makes people feel bad. I think it makes them feel like they can't succeed, even if they are actually really doing a great job both at home and at work. And I think you just kind of have to look at each day as what is your focus that day or that half day. And I do work part time. So I'll put that disclaimer in there that I am not a full time position. But even so, I was having trouble not working every single day for very many years until about two years ago. And so when you were working every day and I believe you told me in the past you're working about point six FTE. That's right. How was it that you were working every day? That's that's considered part time. So what's going on? Yeah. So it just felt like there's always more to do. Like you're never done the type of jobs that doctors work. We were never, ever, ever finished. The inbox doesn't shut off over the weekend or on your administrative day or if you're on vacation. You could always work all the time. And I felt like sometimes that was the only way for me to keep up. There's a lot of expectations from patients that things need to happen instantaneously. And they have their results or their labs drawn one day and they're calling the clinic the very next day. Like, why haven't I heard my results yet? I'm really anxious for them. And and I realize that for most people and patients. Myself included at times, we everything feels urgent to us and to the patients. And I totally get that. And I try to be timely as much as possible. But it's just not realistic to be able to be that on top of everything all the time, because we're also human and people and we have other priorities and other needs that are pulling at our attention, like families and children and spouses and hobbies and other things. You just you can't be a machine and work all the time. But I was finding I was doing that. Give me a sense of what it was you were actually doing each of those. Sure. Yeah. So I work I work in the clinic, seeing patients three days a week. And I technically have one like off day where I'm not expected to be in my in basket or working. And then I have one administrative day during the week and then obviously the weekend. So you think within all of that space, which is more days out of the clinic than in the clinic in a week, that I would be able to accomplish a day off in the week. But it was charting. It was doing my in basket results and refills and patient e-mails, messages and all of the other stuff and paperwork. And. Yeah. And then, you know, there's some call and that in my group is fairly a minor responsibility and didn't contribute a lot. But it was mostly charting, I would say, was the majority, but also in basket. OK. And I know that you took some very specific steps to improve that situation. But I want to come back to that. Sure. I want to start with more about this idea of work life balance being fallacy. And what is it that makes it truly impossible, like not realistic? What are the causes underneath that make that not realistic? Right. Well, there's only 24 hours in a day. And if you're working like in a clinic day, I would say I would start somewhere around 730. You don't around 530 with direct patient care responsibilities. But that is more than half the day already right there. And then if you count in sleep. So you can't have a 50 50. Focus on other stuff and work. So that day the priority is work versus, let's say, the next day is an off day. My priority and focus could be more on my family or doing other things that I enjoy and less of work. So it's going to be more of like an 80 20 or 10 90 kind of split. And I think it just is helpful to sort of for me anyway, compartmentalize days so that I'm not feeling guilty about not spending time with the other parts of my life. I see. So in a way, the work life balance, the connotation is somehow that that's 50 50. And part that is not realistic at each day going to look like 50 50. Right. What do you think are some of the underlying causes for our believing that that 50 50 is the goal? Well, I think it's especially for women specifically, I feel like. It's just sort of an ingrained thing. You know, for a long time, women didn't work outside the home and the last several decades, they are more and more and more. But there's still a lot of home responsibilities that do fall more on women, I think, just because of ingrained gender roles, which is being talked about a lot. And, you know, every situation and every partnership is different, of course, when some spouses or partners might take a lot more of that responsibility and so much less. But I think it's still common, like like for myself, I still kind of handle like all of my kids activities and schedules and rides and appointments and all of those other things that. I know that my husband doesn't necessarily think about as much and he'll always help if I ask. But. And he has other responsibilities that he takes care of that I don't think about, but I think there's a lot of mental energy that is expended on those types of tasks. It's hard to focus on one part of my life when I'm trying to focus on another, I just get distracted and inefficient and I waste time. So I find by. Kind of prioritizing like this day is more work related and this day is more family related, knowing that there's always going to be some interruptions that you can't anticipate. I think it's more helpful for me to focus and be more efficient and get things done faster than if I'm trying to do both things all the time. Yeah. So there's something about being clear on what you're prioritizing and if it's a 90 10 day, you know what that 90 is. Right. And what is it that helped you to come to that realization? Like, when did you realize that the 50 50 wasn't that that idea was not working for you and you were going to shift into something else? I think it's kind of developed over many years. It wasn't anything that sort of came to me. As a lightning strike, which some which we'll talk about later, kind of with my chart closure stuff was more of a lightning strike realization, I think. When I first moved here eight or so years ago, that was kind of a sort of a clean slate for me. Moving from one practice to another, I was constantly behind, horribly behind on my charts in my last position. And I swore that would not happen again this time. And it hasn't. But I still struggled with not working all the time to meet that ideal goal of being caught up. So it's just and as my kids were younger and got older and things kind of morphed, I just realized that it just isn't healthy to try to do it all all the time. So it was a gradual thing. I can't really pinpoint a specific spot, but I think it started to percolate when I first moved here and started a new job and kind of had a chance to reevaluate what I was doing. Right. And so, as you mentioned, you were finding that every single day you were touching work in some way. Right. So you didn't have those days off. Right. And when you looked at your commitment to trying to keep your number of open charts down, that was part of what led to working every day. Right. Right. And I know in our work together, you discovered some specific strategies to address that. Can you talk more about that? Sure. I think part I think a large part of being able to stay on top of things without working all the time every single day was actually just a mental switch in how I thought about it, because nothing really specifically changed about my job. I wasn't seeing more patients or less patients or working more or less. It was all the same. But I think I had this belief that it was too hard to get it all done in a more timely manner, which just wasn't true. And I think because I had never been able to really do it, I just assumed it wasn't possible. And I used to my prior thinking was, well, I want to spend while I'm at work working. And when I'm home, I don't want to be working. That was my original thought that got me in trouble with being so behind on my charts. But then because I didn't want my kids to just think of me as like coming home and being on the computer all the time. And I wanted to be present with them. But that made it difficult to get everything done on time. And so I kind of gave up that idea of complete separation of work and home and melded it together. And I realized that I can't. I can't kind of have my cake and eat it, too. I can't. I can't only work at work and not work at home and still have my weekends off. So I was I realized I was going to have to do some extra work when I got home. And the tradeoff would be that I would actually not have to work every day and have more of a mental break because it was starting to break me a little bit to not have time away from work and my in basket and the constant thoughts about it. So it was more just believing that I could and then I had to one time because I was traveling and I didn't want anything kind of left open while I was gone. And it was on a more urgent basis. And I actually did it. I was totally exhausted. I don't know if I can do this again is what I thought. But but the fact that I could do it meant that there had to be a way that I could accomplish that. And so I did the main thing I two main things were just the way I thought about it. And the second way was pre charting the night before, which I had done in the past with varying success. But I really made a plan to just set aside one hour on the night before my next clinic day, which since I only work three days a week is really just three nights. Or, you know, sometime in the day before to do that. And then when I get to work in the morning, I with our system, we're able to kind of pre chart ahead of when the patient arrives, which is nice. Some of these system changes also kind of helped with the ease, I guess, of doing it. But then I would put in all my orders and get my notes started so that when I see the patient, I'm already like in it. Because I think half the trouble is just starting. And if it's already started, and there's less of a, I guess, a mental fatigue about how much there's left to do. So I think it's more I've just kind of split up the task. So it doesn't seem as overwhelming, because I think that feeling of overwhelm was a total mental roadblock to actually starting and doing it, even though it's really not. Really, it's just documenting. It's not. I took away the feelings about it, I guess. Of how hard it was or how overwhelming and just that this is just one other task I need to do. I don't have to have feelings about it. I can just do it. And it might be hard or might be not. And most of the time I find it's really not as bad as I was anticipating it would be for particular tasks or charts that I need to do. It's really not as onerous as I thought it might be. For our listeners, what specifically do you work on when you're pre-charting? What aspects of the note? I basically will just I do a sticky note for each person that I'm going to see, and I write down labs that are due. So I go through and I look and see what are they due for that I can order, or are they due for future labs? Because I've been better at ordering things ahead of time, because then they can come in sooner and then we can talk about results of their visit. And it's one less touch point that our staff has to do, or I need to do to get ahold of them. So that's help too. But I look at that. I look at any. We have to do like chronic diagnosis codes. So I write those down just so that they're kind of front of mind and any and I look at my last note that when I saw them and was there anything pending that I needed to address this time and I'll kind of leave myself notes on my last note to remind myself. I really only have to look at my last note. And then I'll briefly kind of look through, do they see any specialists or have procedures so I can mention like, oh, I see you had your colonoscopy done or whatever. But each person takes three minutes or so to kind of scan through it actually isn't that much time. And so three to five minutes. So if I'm doing a whole day, it's like an hour or less, depending on how complex the patients are that day. So what I'm hearing is there were two key things that you did. One was your mindset to say to first break it up into pre charting and the rest of it. And so that it wasn't so overwhelming. And with that mindset change to say, I can do this. This is not impossible. I can do this. So that was one piece. And then the second was the pre charting itself. Right. Yep. So with those changes, do you remember the difference in your closure rate for your notes? Yeah, I was still getting them closed. We we have to get them closed within 72 hours, so I never was behind here ever. I have actually never been behind for whatever the organizational cut off is. I've always stayed compliant. But I am able I set short term goals for myself initially, which I don't do anymore because it's kind of more ingrained. But I started with let's let's try to get half the charts closed before I leave today out of however many people I saw that day. And then once I met that pretty consistently, I moved it to 60 percent and then 70 and I tracked it. And most of the time I could do it. There were you know, there's always some days that are more chaotic and it just doesn't happen that way. But they were becoming more of the exception than the rule, which before it was I'd consistently leave work with maybe one or two charts closed of the whole day. And now, you know, most of the time I'm at 80 percent 70 to 80 percent because I don't. I don't like I used to look at it and be like, oh, that's going to be it's going to be really hard. I don't I don't want to do that. And then I would go like in my inbox and, you know, do some results or I would, you know, kind of wasting time. Not that those tests didn't need to be done, too. But I focus more on trying to close the chart that day than kind of flip from one thing to another because that was very inefficient and ruined my focus. So I try to do as much as I can that day before I leave. That has helped a lot. And I have some weekend days off now. So in general, you used to be working seven days a week or you would be in work in some fashion, seven days a week. What is it on average now? Now, I would say six, five to six, definitely five. And usually I'll have a little bit, maybe like a couple hours on a Saturday morning or a Sunday. I pick one of the days, but I pretty much always make it a point to have one full day away from work every week if possible. And I would say 90 percent of the time I can accomplish that. It just depends, but it's much improved. And what is the kind of the consequence of that, of having that day? How has that made a difference? I can spend more time with my family uninterrupted and not distracted. I feel like I am able to, my kids are involved in a lot of activities. They're 12 and 15. And so we have lots of soccer games and music performances. And I'm able to go to more of those. And when I'm there, I'm not distracted thinking about this monkey on my back of all the work that's waiting for me either when I get home or the next day. So I feel I'm able to be more in the moment and enjoy what I'm doing and focus on what I'm doing more. Great. Well, that's really excellent that you were able to make those changes and get that time for yourself to really be present with your family. Yes. Wonderful. So let me just pause there for a second. Let me see where we are. I just want to see if I have any other questions. No, I think we'll go to the closing. So any advice, it'll be about any advice. Oh, so any advice you want to leave folks with, anything else you want to say about the fallacy. And then, and this will be more for if you want in the show notes. Do you want people to be able to contact you directly? So do you want to give an email address or whatever, Facebook or LinkedIn? Or would you rather they contact me if they had questions and I would get in touch with you? What do you suggest? It's really up to you. I mean, if for people who are like trying to, I don't know, they just wrote a book or something and they want people to connect with them, they might give their website and say, yes, connect me. If not, I don't know. I can screen anything that comes in. Yeah, I'll have you do that. Okay. Yeah. All right. So, Liz, what advice do you have as we finish up? What advice do you have for our listeners? About either how to think about this idea of work-life balance or about how to achieve more time off? I would say the first thing is just to get rid of the guilt that you may be carrying around about not being able to provide for yourself. I would say the first thing is just to get rid of the guilt that you may be carrying around about not being able to perfectly balance out your work and your home because it's just give that up. It's not worth the time and energy to spend thinking about that. And I think one other thing I didn't mention, which I have found helpful, is to do a calendar of some sort. Most people use a calendar. I use, like, three calendars, but I have a paper one that lists out every single hour of the day, and I find that that's helpful for me to do every Sunday to actually put things on my calendar that I want to do. Like yoga or read so that there's, like, a time set, especially for the days I'm home where I could just sit and work all day. I have blocks of time where I'll work and then I take a break and I do something fun. And that helps me to be more engaged when I go back to my results in basket. So, that's also something I found very helpful to sort of help compartmentalize. And that works for me and probably not for everybody, but helpful. Great. So, it sounds like using a calendar for time blocking and then to be able to toggle back and forth between work that you're doing at home and also time that's just for you. Correct. Great. Well, thank you, Dr. Liz Cruz, for joining me today on this episode. I am so happy that you joined us and wait, let me go back and start that again. Yeah. Thank you so much, Dr. Liz Cruz, for joining me today on this episode. It's been a pleasure to have you and have you share your specific strategies on how to have some time to yourself and to let go of that guilt. Thank you. It's been really fun. Great. Okay.