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AANS Neurosurgeon | Volume 28, Number 2, 2019


Navigating the Yellow Brick Road: The Quest for Work Life Balance of Women in Neurosurgery

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Women carry the majority of the workload at home; employed women still do the bulk of caregiving to children and elder parents. Employed women are more likely to lack job flexibility, and salary inequities still exist for women performing the same job as their male colleagues. As a female neurosurgeon and active mentor, I often get questions about the feasibility of having a family and pursuing a career in such a challenging field. As I will detail below, achieving this goal is possible, but usually not without some sacrifice.

I always tell my students and staff that adults learn best by making mistakes. By that criteria, I should be an expert on work-life balance. As I thought about how best to explore this topic, I turned to my family and colleagues, as well as my good friend Google, to understand the different perceptions and opinions surrounding this concept.

As a clinician exploring a topic, I like to start by defining the concepts involved. For this article, balance is defined as a condition in which different elements are equal, or in the correct proportions, while life is defined as a particular type or aspect of a person’s existence. Work is defined as activity involving mental or physical effort done in order to achieve a purpose or result. Work-life balance is often defined by its absence of work life conflict; a situation that exists when the role pressure between work and family are incompatible. In the introduction to their book, Work, Life and Family Imbalance: How to Level the Playing Field, Michele A. Paludi and Presha E. Neidermeyer summarize the research that supports the increased incidence of imbalance for women.

Finding the Right Path for You
I chose the imagery of the Yellow Brick Road because seeking work life balance is a unique and individual path, and reaching the Emerald City does not guarantee a happy ending. In fact, like Dorothy, we often have the answers we seek and only need to clarify our personal goals and expectations:

  • Do you want a family?
  • Do you want a partner/ spouse?
  • Do you want to work full time?
  • Are you interested in an academic career?
  • What are the roadblocks along the way?
  • How do you balance your intellectual needs with your emotional needs?
  • What are fears are holding you back and, do they limit your ability to attain your goals?


Next, explore your personal list of expectations. How do you define job satisfaction? What do you expect from your family, and more importantly, what do they expect from you? Obviously, these answers will vary depending on what stage you are at in your career.

Quality Over Quantity
I fell prey the stereotypical female surgeon behavior early in my career. I was afraid to say “no” to my chairman for fear of appearing less capable than my male colleagues. This lead to a huge imbalance within my chosen field. I had excessive clinical and teaching commitments, not to mention committee work, which left little time for research and no time for “a life”. I became so used to not saying “no” that this ingrained behavior then followed me to my role as parent. I ended up leaving my academic position for a hospital based job with more flexibility. Even there, I had a tendency to overextend myself, and I was not the only female surgeon with these conflicts. I noticed how the committee assignments and administrative tasks seemed to fall more to my female colleagues, even if we were still in the minority. Over the years, I have learned to focus more on quality, not quantity, as a personal measure of success.

Prioritization can Lead to Better Balance
Once you understand your expectations, as well as the expectations others have of you, the next step is to prioritize them. I found it most difficult when my children were infants to feel any sense of balance. I felt like I was not fulfilling my obligations as a mother and as a neurosurgeon. The constant lack of sleep also added to the general feeling of dissatisfaction. In retrospect, I blame myself for not having realistic expectations of family and work obligations. If I could get a “do-over,” I would certainly learn to delegate more. I would also have discussed my on-call responsibilities with my department head so that I had more time to adjust to taking care of a baby without the stress of being on call. Having my second child (I then had to take care of a newborn and an 18 month old) forced me to develop a basic priority list to help maintain my sanity:

  • Critically ill patients come first.
  • My children take top priority at all other times.
  • Other patient care
  • Family and household obligations
  • Me time (this includes sleep)


The list is flexible and can change based on a number of situations. For example, a sick child would move to the top of the list. This of course means someone “having your back,” and you being comfortable delegating. For those just starting their careers, finding the right mentor can make all the difference. They will help you navigate your roles at work and ideally, help you attain satisfaction at work. In addition, having friends and family that let you decompress is equally important. Something as simple as having a “girls’ night out” once a month can give the emotional support that is essential to maintain a satisfactory balance of our roles.

For those of you in academic medicine, the numbers are not encouraging. While medical schools have reached gender parity and the number of women entering academic medicine has increased, the number of women advancing to higher ranks remains significantly lower than the expected numbers (2). This study does not examine the reason for these numbers, but work family imbalance likely plays a role.

Care for Yourself, Not Just Others
On a recent trip to a neurosurgery meeting, I was waiting for my boarding call and looking for something to read. I realized that the only time I really had to relax was when I was away from both home and work. I picked up a book called The Happiness Project and started browsing. Now for the record, I am not a big fan of self-help books, but the author shared many traits with me. She had two children, a good job and family life and lived in a city that she loved, yet was still not happy. So that begs the question, does “work-life” balance equal happiness, and if so, is the opposite also true?

As I scrolled through the book, some key concepts emerged. While most women are caregivers, we tend to take poor care of ourselves. This is especially true in the surgical fields where chronic sleep deprivation is still an issue, even as we progress in our careers. This is where much of our sacrifice comes to play. We can either try to be at all the school plays, concerts and soccer games, as well as working our usual 60 hours (or more) a week, or we have to prioritize activities within each role. For example, share the school activities with the extended family. Understand that your children would rather have a pleasant and happy parent less frequently rather than a tired and cranky mom all the time.

Ultimately though, work and life cannot be separated, especially as a neurosurgeon. We spend many years working to reach our professional goal, often straining relations with partners and family, or putting them off completely. I have found endless articles, blogs, self-help books and consultants available to help in balancing one’s personal life versus professional development. I take some exception to the idea that your work and personal life are two separate entities. Being a neurosurgeon is an integral part of who I am, not just one of my many responsibilities. My children are “tweens” now, and while I still have not perfected the balancing act between the work of a neurosurgeon and the work of a parent, I have learned to spend my time more wisely.


1. Clair Yang MD, “The Elusive Work/Family Life Balance in Academic Surgery: Notes to Female Surgeons. 2016

2. Lynn Nonnemaker, PhD, “Women Physicians in Academic Medicine: New Insights From Cohort Studies. New England Journal of Medicine 2012 342(6) 399-405.

3. Gretchen Rubin, “The Happiness Project” Harper Collins 2009.

4. Michele A Paludi, Presha E Meidermeyer, eds, “Work, Life and Family Imbalance: How to Level the Playing Field. Praeger 2007.

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