EP155: Carving Out Time: Managing a High-Pressure Career and Family Life

Navigating Work-Life Balance in ENT Surgery with Dr. Nina Shapiro

In this episode of The Girl Doc Survival Guide, we chat with Dr. Nina Shapiro, MD a seasoned pediatric surgeon from UCLA who has over 25 years of experience and has successfully balanced her demanding career with raising a family. Dr. Shapiro shares her journey, discussing the unrealistic advice on work-life balance she received, the challenges of internalizing societal expectations, and practical strategies for setting boundaries in a high-pressure medical career. She also emphasizes the importance of asking for help, maintaining mental health, and the value of appreciating mutual support in a dual-surgeon household.

00:00 Introduction to Dr. Nina Shapiro

00:22 Unrealistic Work-Life Balance Advice

01:16 Navigating Career and Family Expectations

05:08 Setting Boundaries in a Medical Career

13:40 The Importance of Buffer Zones

14:51 Asking for Help and Managing Stress

16:20 Final Reflections and Advice

Transcript

Christine Ko: [00:00:00] Welcome back to today's episode of The Girl Doc Survival Guide. We're joined by Dr. Nina Shapiro, a pediatric surgeon who's navigated 25 years as a surgical director at UCLA while raising a family with another surgeon. She brings unique insights into maintaining presence and well being in the demanding world of surgery. Today, she'll share practical strategies. What's the most unrealistic advice you've received about "work life balance" in medicine? 

Nina Shapiro: That's a great question. A lot of the advice came When my kids were pretty young, toddler age or early school years, there was still the notion that my work was less than my spouses. That was taken on to me as, you can work less and that'll be fine. My husband, he's a head and neck cancer surgeon, and I'm a pediatric airway surgeon. I think a lot of people didn't really understand that it's not something that you can just turn on and turn off. Especially with airway surgery and [00:01:00] babies, people would just be a little more quick to say you can just take that time off or do that. That was something that I navigated as best as I could and my husband as well. People would give sort of their own views or assumptions on how that could be done. 

Christine Ko: Okay, I'm fascinated by what you just said. One of the initial things you said is, my work was less, or if we just say present tense, it's, my work is less. It sounds like you internalized that?

Nina Shapiro: Oh, yes, definitely. I think a lot of women do that. And, I think now as well, that's a common notion. It's not always the case, but in general, the man is the primary worker, and the woman is the secondary worker. I think that has changed. I know plenty of couples where the dad doesn't work outside of the house, and the wife in the relationship does, and they make that work. That's becoming more and more common. 

One of the nice things of being with someone who's a surgeon is that we were [00:02:00] able to appreciate each other and appreciate each other's stresses, and work, and need for time off, and need to be with the kids. As hard as it was to have two surgeons, especially with young kids, it was easier in so many ways because it was this unspoken understanding of what the other person was going through on a day to day basis. That actually made a really big difference. 

Christine Ko: I still think that my work is not less important than my husband's, but if someone needs to take time off of work, it would be me. Without me truly thinking that my work is less or means less, my work is the one that would always be let go of. When you internalized, my work was less, did your husband as well, or not?

Nina Shapiro: When I think of work, it was also like your whole life, not just like your work when you go to work at the hospital, but it was everything. And I think he valued the importance of being with kids, and doing the school activities, [00:03:00] and all those other things. But yeah, maybe a little bit because, it was also different in that the types of patients that we take care of. It's hard to say, who's sicker? An older person with a head and neck cancer or a baby with an airway issue? You can't really play that, it's not a game, and you can't play that when it comes to a person's illness, but, I think for the most part, a lot of my work then and certainly now much more so now because I've left academics is that I do take care of, for the most part, healthy children. While their issue is important and critical and needs my 1000 percent attention when I'm with them, if they have their ear tubes on a Tuesday as opposed to a Friday, they're going to be fine. There is some reality to, not that my work is less, but my work is less critical, and I don't take care of sick patients to that degree. I don't do 13 hour [00:04:00] surgeries that need to be done on these sick patients. So, yes, I internalize that, but I think it's also a reality of the types of patients that we take care of.

Christine Ko: Yeah. There is this sort of like internalization of what we see around us. Definitely when I was growing up, almost all fathers worked, and most mothers did not, in the culture and society that I grew up in. So the unrealistic advice that you got was that, you can maybe cut back, is sort of what it boils down to? 

Nina Shapiro: A little bit of that. During my training and where I grew up in the Northeast, I trained in Boston, it seemed like everybody was working. Maybe that was just the environment I was in. It was men and women. At all ages and stages. When I moved out to the West Coast, to Los Angeles, the question was, do you work outside the home? The vast part of my career, I was the only pediatric [00:05:00] ENT at a large tertiary care medical center. So there was a lot of pressure just by that nature, a fair amount of juggling.

When I had my first child and my second child, I had to take some control over making some boundaries from work. Thankfully it didn't take two decades for that to happen. I was able to create the boundaries because I realized, unlike when you're a medical student or a resident or a fellow the boundaries are there for you. There's an on off switch when you're in training. There's no on off switch when you go out into the real world, whether it's academics or private practice or any sort of environment. You have to make those boundaries, and it's really hard to do because you're 30, 32 years old, and you've never done that before. Nobody's going to do it for you. Not your spouse, not your bosses at work, not your patients.

Once I was able to do that and [00:06:00] really create some boundaries at work, it made my family life much better.

Christine Ko: You sound super wise to me. So how old are your children now? 

Nina Shapiro: 17 and 21. 

Christine Ko: Okay. 17 and 21. About how old were they when you realized this about the boundaries?

Nina Shapiro: 17 and 21. No, no, no. It was gradual. Some of the boundary making actually came before kids. I wrote a little article for our ENT bulletin. I did write a little piece about how the only one who's going to turn off your pager is you. Those boundaries need to be created by you. It's really hard because you've never done that before and you're already early thirties. I did start to see that. It wasn't really an aha moment or a, okay, they're ages five and nine. It's time for me to set boundaries. It wasn't like that at all. It was gradual. 

Within the work environment, there were so many people who were supportive of the fact that I had kids, and the fact that I needed [00:07:00] extra time. And I needed to ease back in. I took plenty of maternity leave. I took a full three, three and a half months plus, and I eased back in. Within the work environment, they were pretty supportive of my having kids.

It was the school environments, I think, that was a little bit trickier, where I had to really carve out time, based on what were the needs of my kids. For instance, if every Friday there was a school assembly that 99. 9 percent of the parents go to, I started late every Friday. I would make that. I would carve it out again. I think if you do that with some conviction, people will respect that. 

Christine Ko: Yeah. We have to have the awareness of what we want, right? We have to want to be able to turn off our pager or whatever. It sounds silly because I think no one would say, Oh, I want to work 24 hours a day, like forever and ever. In perpetuity. [00:08:00] But I think what you said is so true that oftentimes we're in our early 30s, or usually at least the late 20s, by the time we're done with training. And the way that medical training works in the US is it's very set. You don't really have very many choices about what you're doing, while you are actually an adult. And so I think it's easy to forget what you really want, and I would almost say necessary that you lose your boundaries when you're in training because you're not really allowed to just choose your schedule, for example, in most programs. 

Nina Shapiro: But there's some sort of relief. It takes some of the pressure off when someone else is dictating your life a little bit. It really does in a strange way. 

Christine Ko: I've never really thought about it that way, but I think you're absolutely right. Most doctors are hard workers, and maybe it's from the training, we become even more like this than we were. There's like [00:09:00] almost a workaholic kind of tendency. And so to constantly have to be okay, this next and this next feeds into that. It's an interesting way you put it-- a relief, in a way, that you have no choice. My next step is just mapped out for me. 

Nina Shapiro: When you're out in the world and someone says, what do you want for your schedule? Or, how many days a week do you want to do X, Y, or Z? It's a little jarring and sometimes a little bit uncomfortable. To make those decisions is nice., but it's a little bit uncomfortable for some people, certainly when it starts. 

Christine Ko: When you were having this gradual realization of needing to set boundaries, did you just know from when you were younger how to set a boundary? How did you go about that? 

Nina Shapiro: Oh, definitely not from when I was young. I was a real rule follower, by the book. That's why we are where we are, a lot of us. We follow the instructions. There was no boundary. When I was [00:10:00] in college and medical school and residency, you do what you need to do to get the work done. And you're often told, whether it's a deadline or a time you have to be somewhere or the type of work you have to do, you just do it.

And again, it wasn't really until after training, before kids even, that I realized that I have to set some boundaries and that was a little uncomfortable. And then once I did, and again, I did some of the boundary setting during the early years of being in academics before I had kids. For instance, even taking a vacation, I realized, when I started working, that there were no, at least in my program, it wasn't like, okay, so you have one week off every quarter, or you get X number of days per year. It was a different model. So you can take no vacation, or you can take a lot of vacation. And it was very self driven. And it was really hard for [00:11:00] me to take that first vacation, and I even had my pager on my vacation, and I would check in with the residents and see how some of the patients were doing and, let them, be in touch with me. I still had one foot in the door of work because I didn't know what to do. It wasn't like a resident where you're off that rotation. And so you get a week off in between and it's a different attending and a whole different service, different hospital. It wasn't like that.

Christine Ko: So how did you figure it out? 

Nina Shapiro: I think it just got to the point where maybe about a year into practice, I realized that I was feeling like a resident but worse. I felt like there was no break, and then I realized the residents, wait, they switch rotations. They're getting these breaks. When you're a new attending, you're basically the same age as a lot of the trainees. It dawned on me that I should be doing something for myself. This is not a continuation of the last 10 years of medical school [00:12:00] and residency and fellowship. This is different now. And so I have to handle it differently. Once I made that move, it actually made those boundary setting moments when I had kids, had one kid and then another kid, a little bit easier because I had already done it. That was really the way that I made it work for me and for my husband and for my kids. I would just carve out time during the work week, these mornings or these afternoons or these whatever times of days. I would just carve it out, and so those were untouchable, and that made it work, as opposed to, Oh, no, I have to finish early. I have to run today, and I have to rush through. It's, no, I'm going to have this block of time. And that made it help my sanity.

Christine Ko: I love it that you're talking about boundaries because I only really started thinking about boundaries no more than two years ago. Going along with what you said, the thing about it is that number one for me, I need to know what I want. And so for me, I think what you were just saying, [00:13:00] I do want to go to my kids' sports games. And if there's something special at their school, then I want to go. But I need to know ahead of time. Usually at the beginning of each sports season, their whole schedule comes out, and then I can plug it into my calendar and at that time rearrange things. Sometimes when I'm more busy and I forget, I'm just rushing like I'm a chicken with its head cut off. So there is a contrast in the two ways of one, having planned and having a set time set aside versus not planning and just trying to struggle to get to where I want to get to. 

Nina Shapiro: It's the buffer zone. We as doctors, it's, okay I have to be somewhere at four. I know it takes me 50 minutes to get there. So I'm gonna finish at 310. 

It never works, and you're always like that chicken with your head. Now as I've matured and I recommend this: slow down. You can drive more slowly or talk to somebody [00:14:00] on the phone, just scooch it like at half hour or even an hour. I do exactly what you do. I get the sports schedule, I get whatever performance schedule, meeting schedule. As long as we know in advance, you give yourself that buffer, and it's the same buffer on the other end. Buffers on both sides have really helped my state of being and it just makes for more of a comfortable existence. 

Christine Ko: I like this tip of having a buffer zone. I am terrible about that. I am chronically late, like just one to two minutes because I don't have this buffer zone. Either I'm right on time or one to two minutes late. So I like this of you setting boundaries. So it sounds like especially you'll be aware of what you want. And then you'll make sure to make the time for it and have a buffer zone for it.

Do you have other tips that you think have really helped you? 

Nina Shapiro: If you have the means, if you can have some help at home I think that does help a lot. And that could be in any [00:15:00] form, whatever anybody's comfort level is, and especially if it's for things that don't necessarily involve your children, but give you more time with your children. So whatever that is, whether it's cleaning or grocery shopping or errands or some driving; every family's different. But, help does help. People sometimes have trouble asking for help or enlisting help, but it really does make your life a little smoother.

Christine Ko: Yes. Absolutely. Boundaries. Being aware of time, buffer zone. Asking for help, either paying someone to do it, or just family or friends or whatever. 

But still, sometimes, I'm sure there are still emergencies or kids who are sick. How do you handle what I would call a high pressure career with your own mental health, but then also that of your kids and family and those around you? 

Nina Shapiro: With any stressful job, not just in medicine, it does seep into your family life, and I don't think that's necessarily bad. We're not automatons where we [00:16:00] can just turn it off: that's work, and this is home. It's part of who you are, and it's not necessarily a bad thing if you are worried about another person. It doesn't even necessarily take away from your family because, my kids, even when they were young, they would say, how's so and so doing? Like the kid that I would be talking about.

Christine Ko: Is there something that you think that experienced physicians can model that would help a younger you? 

Nina Shapiro: Someone told me, another doctor told me early on was, as hard as you are working, it's always harder for the patient. When you step back and realize that, I think it does help you a little bit as a doctor. The other thing I think to consider early on is this go, push push, everything is now, and you have to be the busiest and the best and, write the most and do the most. You don't get a prize for that, and it's not necessarily the best [00:17:00] patient care. It's always good to step back every so often when you're in the grind. It's hard to do that when you're in training, but when you're soon out of training, just every so often step back and say what's really important. Sometimes takes some of the burden .

Christine Ko: When we remember that it is hard for the patient, it does put into perspective. It's not easy to be a patient, and patients are definitely, I think, vulnerable in a way that doctors aren't. It reminds me of something that someone else said on this podcast. She said it's important to remember that we are influencers, and she didn't mean it in the social media sense, but she meant that we do have an influence on each patient that we see. And then so on and so forth, the people around us.

 I'm going to move on to a final question. What's one piece of advice you wish someone had given you about surviving and thriving in surgery?

Nina Shapiro: I'm going to think for a minute there. I think it would have been nice to know that it's okay to ask for [00:18:00] help. I don't just mean in the OR . I think help in a broader sense of, I'm feeling a little bit off with my career or my life or, whatever it is, family. We were taught as interns as a joke, they would say, call me if you need me, but calling is a sign of weakness. That really stuck with me, and to this day, I'm not quite sure what they meant. The calling is so important, especially these days when, there's a lot of challenges with mental health at all levels, doctors especially are included that it, you don't realize how many other people are going through it until you actually say that you're going through something yourself. There's always somebody who's going to be able to help you. I think the hardest part is not necessarily finding them. It's just telling yourself that you need to get some help. 

Christine Ko: Traditionally the medical culture is definitely one of like being a cowboy. You're on your own and figure out how to survive in the wilderness, and that's [00:19:00] the mark of truly awesome doctor. You just go alone, and you do it alone, and you're fine. I can't believe they said that calling is a sign of weakness. It suggests that we're trying to train people to not be human, to be someone who doesn't have basic human needs.

I've really enjoyed talking to you. Thank you for your time. 

Nina Shapiro: This was great. Yeah. Thank you so much.