1. Always be a student.  Medicine is a life-long commitment to learning.  No doctor can be on top of his\her game if they are using the knowledge and skills that they received when they completed their education or training.  Balance is achieved if you continue to pursue a life-long pursuit of knowledge.  A medical career is a journey and not a destination.  You should always make time to be a student for your entire career. Sir William Osler, honorary professor of medicine at Johns Hopkins University, recommended to physicians and students at the end of the 19th Century, "In order to receive the education of not a scholar, at least of a gentleman, you should read for a half hour before you go to sleep, and in the morning have a book open on your dressing table. You will be surprised how much can be accomplished inthe course of a year."

2. Be ethical. A recent report in a pediatric journal states (Arch Pediatr Adolesc Med. 2008;162(4):368-373), “that 44.7% rated their ethics education during residency as fair or poor."  As a result most of us have received very little training in medical ethics.  All of us have or will be faced with ethical decisions we will   have to make for or on behalf of our patients.  Examples include treatment of AIDS patients, care for under-aged patients (children), release of sensitive information, termination of the physician/patient relationship, etc.  Balance in our lives includes making the right ethical decisions at the right times on behalf of our patients.  Perhaps the best advice we can offer when confronted with an ethical issue is to do what is in the best interest of the patient, and you will probably make the right decision. Most state licensing boards now require that continuing medical education include regular courses in ethics.  Regard this not as a burden, but rather an opportunity to look at your patients and your profession from a different and balanced angle.

3. Take active control of your finances.  Most young doctors today enter practice with nearly $250,000 of debt, which will take years to pay off.  However, balance comes from financial security at the end of your career when you can practice because you truly enjoy the practice of medicine not because you have to work.  In order to have that security and that balance, we recommend that you start the saving process early.  Even in the face of daunting debt, you need to start a savings plan for your children's education and for your retirement.

4. Learn to say "no".  There is no faster road to burn-out than taking on too many projects and accepting too many responsibilities.  The next time you are called to join a hospital committee, to become a member of a board in the community, or to accept an invitation for an evening dinner ask yourself these questions:  1) Will the obligation enhance my career?  2) Will the commitment take away from my time with my family and friends?  3) Will this obligation lead to balance or imbalance in my life?  If the answer is that you are not furthering your career, and if it distracts from your family time, then you should probably turn down these requests.  Remember it is not a sin to say "no".

5. Set your priorities.  For most physicians that have balance in their lives they place their religion, their family, and then their practice as the order of importance in their lives. Rabbi Harold Kushner, author of “When Bad Things Happen to Good People,” pointed out that "He never met a man on his death bed who said he wished he spent one more day at the office" or “saw one more patient.”  This is good advice—it is never too late to spend one more day with your significant other, your children and your grandchildren.

6. Find a niche.  Ross Perot described success as finding an unmet need, becoming an expert, and filling that unmet need.  If you can do that, others will be knocking on your door to be your patients or to do business with you.  It is amazing how successful you can be if you focus your energies on a single area of interest or expertise.

7. Hang out with people one generation older or younger than yourself.  If you are a young, new physician, then meet older more seasoned doctors who can show you the ropes, share their valuable experiences, and give you wise counsel when you need it.  If you are an older physician, hang out with the Gen Xers.  This contact with younger people can keep you current, keep you energized, and keep you on top of your game. My advice is to balance your friendships.

8. Exceed patients' expectations.  To truly enjoy your medical practice it is important to not just meet patient's expectations but to go beyond what is expected and exceed those expectations.  We suggest that you adhere to "the extra mile philosophy."  This philosophy requires you to go the extra distance for your patients, to exceed their expectations, to provide a little more than other doctors.  And your patients will remember you for it.  Many businesses, from office product suppliers to upscale department stores, have found that providing deluxe services to their customers ensures that those customers will keep coming back.  A medical practice is no different from other businesses in this respect.  In today's health care market, it is very difficult to compete on price…they can’t cut our Medicare reimbursements any further. What you can do is to make sure you're filling your appointment book.  This can be accomplished by asking two questions:

1) What do patients want and give them more of it, and 2) Ask them what they don't want and make every effort to avoid it.  It's just that simple.

9. Be a disciplined doer and a decider, not a procrastinator.  Nothing adds more anxiety to our lives than having deadlines and commitments that we are having trouble meeting.  If you have several projects looming in the future, break them down into smaller projects and make a calendar marking off the completion of these little projects.  That way you won't be left with a huge project with only days to complete.  Discipline can bring balance to the busy professional: clean out your inbox, fill up your outbox, complete your medical records before the delinquency notice arrives, and look for an end point to your day. There will be a new set of mail, results, and problems tomorrow, and a clean slate creates a balanced perspective. Confront those challenging decisions: a professional who can decide in a few minutes to recommend radical extirpative cancer operation to a relative stranger ought to be able to decide about the new 3-year lease with a few days’ reflection.

10. And finally have fun.  The best advice to achieve balance is to take your profession seriously, but not yourself.  Find ways to put inject a little humor into your daily activities.  Start your day by listening to a humor CD of Jeff Foxworthy, Bill Cosby, or an old Abbott and Costello routine. A smile is the shortest distance between two people.  Let us not forget that medicine is the most enjoyable profession, and it can be the most fun and rewarding especially if we add a little humor.

Bottom Line:  No one ever said medicine was easy or fun.  But it can be both and even more if you have made an effort to balance your professional and personal lives.  It can be done; just follow these 10 suggestions. 

Hal Ornstein, DPM and Neil Baum