EP164: The Art of Not Doing It All: A Conversation with Dr. Annie Im

Balancing Hematology, Oncology, and Parenthood with Dr. Annie Im

In this episode of The Girl Doc Survival Guide, Dr. Annie Im, a hematologist oncologist and Program Director for Hematology Oncology Fellowship at the University of Pittsburgh, shares her insights on balancing a demanding medical career with personal sustainability. She discusses the unrealistic expectations of 'doing it all,' the importance of work-life integration, and the challenges women physicians face with childcare and career advancement. Dr. Im emphasizes the need for prioritizing and being realistic about time management while advocating for systemic changes to support working mothers and parents.

00:00 Introduction to Dr. Annie Im

00:36 Balancing Family and Career

02:34 Work-Life Integration Strategies

06:54 Challenges and Boundaries for Women Physicians

08:38 Advocacy and Speaking Up

11:27 Personal Experiences and Overcoming Stigma

20:38 Advice for Aspiring Women in Medicine

23:13 Final Thoughts and Encouragement

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today I'm joined by Dr. Annie Im, hematologist oncologist who has mastered the art of balancing multiple demanding roles. As Program Director for Hematology Oncology Fellowship at the University of Pittsburgh and a leading researcher in leukemia treatment, she brings practical insights into thriving in high intensity medical careers while maintaining personal sustainability, including having three children who are all under the age of 10. Welcome to Annie. 

Annie Im: Thank you so much for having me. I appreciate the opportunity to be here. 

Christine Ko: I'm thrilled to be talking to you, and can you first just share a personal anecdote?

Annie Im: My three kids who are eight, seven, and five really dominate my life. Most recently, my daughter had her Squish Malow themed seventh birthday party, which I hosted at our house. Squish Malow are these stuffed animals that have become bigger than [00:01:00] Beanie Babies. It was so much work and so much fun all at the same time, which I think exemplifies so much of what we all do. So much work and so much fun. 

Christine Ko: I like what you just said about doing stuff that is a lot of work but also a lot of fun. That segues into my question. You juggle a high intensity career: clinical research, program leadership, patient care in oncology, very demanding. Cancer is very scary to people. What do you think is the most unrealistic expectation you've had to challenge about this idea or concept of doing it all? 

Annie Im: The challenge is the idea of us doing it all. I think that while it sounds like "a lot of us are doing it all", the reality is we're not doing all the things we probably want to do. For example, in patient care or in research and with leading the fellowship program, or in my home life with my [00:02:00] kids, I can think of so many things that I would do more of and that I wish I could do more in each of those areas in a silo. But in reality, that's just not possible. And so I think that I've had to come to terms with I'm not gonna do it all in all of those areas. I'm gonna do as much as I can to maintain enjoying all of those things. But I think that it was hard for me to wrap my head around that I can't just have it all. Letting go of that idea that I can or will do it all has been helpful.   

Christine Ko: That's useful. So you let go of the idea of having it all or doing it all, and what does that mean practically?

Annie Im: Yeah, so that means it's not work-life balance. It's more work-life integration. For me, at any given moment in my life or my day, there's a pendulum, and it's swinging in one direction or another. There are days or times, weeks or periods of time where the pendulum is very much in the [00:03:00] direction of my family, and things at work, aside from patient care, scholarly kinds of things that can take a backseat do. And similarly, there are times when certain things at work take up my time and attention, particularly traveling for work, for meetings or talks or things like that. Then I have to put family a little bit in the backseat. At any given moment, I'm thinking about what to prioritize. My default is honestly my family. But very honestly, like I said, in any given time, that pendulum could be anywhere. And then within work of course, there's various places where I could be swinging as well. It's just figuring out what's the most important at that moment. 

Christine Ko: Yeah. I've learned that I really cannot do more than one thing at one time. It's really one thing, whether it's a family thing or a personal thing, just a me thing or a work thing. Related to that, do you have a certain [00:04:00] approach to time management?   

Annie Im: I have to be realistic about what I can actually do in a certain amount of time. I used to work on the weekends, I would work at night. When fellowship applications come out in the summer, I still review every single one. I used to do that after work, meaning at night. I realized that's crazy. That is my work. So I started blocking off time at work on my calendar. This is the time I'm reviewing applications, and then I don't bring it home. I used to think I could do it all. Like I can fit this in and this. I realized that you just have to be really honest with yourself about the time that things take. My calendar has been really useful for me to just block off time. This is the time I'm gonna go to my son's school play. Block that on my calendar. Things like that. Even just putting in time to work on things, I block off time for that. That's been helpful. But again, I think it's really just the mental [00:05:00] approach or attitude that you just have to be realistic about what you're taking on and how much time it takes.  

Christine Ko: It's true. The physical act of actually putting something in a calendar does make you realize, where does it go? How long do I think it'll take me? And then later, it can also serve as a sort of a check. I blocked off an hour for this. And I'm nowhere near done. So obviously it takes a lot longer than that.

Annie Im: One more thing I'll add to that is the other thing that I've tried to tell myself recently is that things can wait. In patient care, yes, things are urgent. I will take the extra time to call a patient or to follow up results, but outside of that, emails and even, I hate to say this, even deadlines sometimes. It's gonna be okay. It's gonna be okay if it's takes a little longer. 

Christine Ko: What you're saying is really important. Not to sound morbid but I realized I am replaceable, but like the one role that would be [00:06:00] hard to replace me or really impossible, at least biologically, is as a parent to my children. 

Annie Im: Yeah.

Christine Ko: So that made me think about my priorities. 

Annie Im: Time moves differently with your kids. At work, we're talking about deadlines, and if you absolutely can't get to it, that's okay. The world moves on. But I almost feel the opposite with kids. This time really does go fast. And if you miss this, you're not necessarily gonna get that back.

Christine Ko: I find being a mother extremely difficult. If it comes naturally to someone, that's just not me. It's a struggle for me to be the kind of mom that I wanna be. But it is worth it. Just like you're saying before, it's work. It's hard work, but it's also fun. So many times, I'll be frantic to get something done for my kids, and I have my job, and I have other things that I have to manage. Can you talk about the challenges that women, and maybe especially women physicians, [00:07:00] face in making and maintaining boundaries? 

Annie Im: That's such a huge issue. There's a lot of data out there that women tend to get asked to do service tasks, activities, committees that are service related but not necessarily gonna promote careers, but women are good at it. They tend to say yes, et cetera. That is true of me. That is one area that can be challenging in terms of boundaries.

The other thing, I try to speak up a lot about is women and mothers tend to have a more of the burden of childcare. That's certainly a gross generalization. But it tends to be that women take on more of the kind of childcare, house related kinds of tasks, and things that are scheduled outside of work hours, division meetings happen [00:08:00] after clinic time, so that means like 5:30, right? Or if it's not gonna be after, then it's before at 7:00 AM. Those are the worst possible times for parents with young kids. Mothers and fathers. But I tend to see, at least around me, it's the women who are impacted more. And so I think that's really challenging because if you're supposed to be at meetings and engaged and participating, you're sacrificing something. You can't be as engaged. And I think that's really hard too, because the boundaries are spilling into your other responsibilities. But what can you do about it? That's just the way the system is set up, and the culture is set up, and that's really hard.

Christine Ko: You mentioned that you speak out about this. Have you come to any potential solutions for that? 

Annie Im: I actually chair our women's initiatives task force for our cancer center. It's a group of women that include both physicians and scientists. We surveyed parents a few years ago to get a climate [00:09:00] survey. One of the things that came up in that survey was meeting times and how meeting times are universally difficult for parents. That did come up. Because we were able to get data on this, and everyone loves data, that we use that to advocate for, gosh, these meetings really should be changed. And so I got our faculty meeting changed from 5:30 to 5, which was a start. I hope we can keep going. It was a start, and I know that when I spoke up about it, other people, including men, were like, yeah, I agree. I have to pick up my kid from daycare, you know. As I get older in my career, I'm lucky that I feel comfortable to say these things, and not everyone does. I want to be able to speak up. That I think is such an important role for us as women in medicine, as we get older, more senior. That's something I feel very strongly about, which is why I love being on a podcast like this, being involved in these kinds of conversations.

Christine Ko: As we advance in our careers and gain seniority in our jobs, in our departments, wherever we're working, we [00:10:00] are more able to speak out and not be as worried about potential negative repercussions for that. That is really important, that you're stable enough or protected enough in your career that you can say things about a given system and try to promote a better initiative like you did with moving a meeting from 5:30 to 5. 

You also mentioned you have been an advocate even earlier on in your career, and maybe that's just personality, but what do you think helps you to be able to have a voice? 

Annie Im: That's a great question. I feel really strongly about women's issues, and I've become this like staunch feminist later in my life, naturally, because of the challenges I have faced and continue to face. I've taken the attitude that if I can't be successful in my career and have the kind of academic career and clinical career that I want and have a family and [00:11:00] be really involved in my family, then I don't want to do it. And so I'm gonna speak up about it. I still am good at my job and wanna be good at my job, but I also have to be honest about these other things. Maybe it's the honesty piece of me. I'm a terrible liar. Maybe that's why I've been more comfortable being outspoken about these things. 

Christine Ko: Part of why you wanna speak up about this is because you face challenges and continue to face challenges. Would you be able to share what some of those are?   

Annie Im: While I can be outspoken about having a family and my kids, I do think there's a stigma that is unavoidable. I guarantee you if people were to ask, it's like, oh, Annie, she's the one who's always making excuses about her kids. Oh, she can't make the meeting because something with her kids. And you know, I own that, but it's certainly not always gonna work in my favor. 

Early in my career was much more macroaggressions. Within hem-onc, I do stem cell transplant and hematologic malignancies, and it's a lot of [00:12:00] inpatient, it's intensive patients, right? They get really sick. My boss at the time, I was graduating fellowship, and he was like, do you really want to do that? Don't you wanna have a family and have kids?  Discouraging me from doing that because I am a woman and wanted to have a family. And I was like, gosh, what does that mean? Things like that were just pretty blatant. Even more recently, I had this research opportunity to lead something basically directly taken away from me. The reasons that were given to me: one major reason was because I don't go to the group meetings, which occur on Tuesday mornings when I'm driving my kids to school. The time I drive my kids to school is golden. I get to hear everything, and so I don't wanna give that up. And so I don't attend the meetings. I could make the meetings, but I don't want to. That was something recently that I dealt with. I made my choice I have to own that.

Some other things are more subtle, with things like stigma. I had another previous boss who described [00:13:00] my leadership style with the fellows as 

too maternal. 

I was like, huh. I think he's saying that because I'm a mom of three young kids.

Christine Ko: Too maternal. It's like also putting down mother. 

Annie Im: What's wrong with being maternal? 

Christine Ko: I get the "too" part, but like too maternal so if you were just maternal, it would've been okay. 

Annie Im: And do you think a man ever gets called too maternal?

Christine Ko: When you have these macroaggressions or even smaller things that are maybe a little bit hard to pinpoint, just like stigma or something, and you're rightly owning certain things, like you choose to drive your kids to school Tuesday morning. You don't wanna miss that. I've been in that situation too, where I'm like, this is my choice. I'm gonna be there and do X, Y, or Z with or for my kids. And I'm not gonna go to a meeting, even a meeting that I really want to, even if it's like a one time meeting in Germany. I'm not gonna go. And you said just accept that. But it shows opportunities are taken [00:14:00] away from you or are not materializing because of these choices. We are making them ourselves as mothers or parents, but at the same time, when a meeting is consistently at 7:00 AM when most kids are getting ready for school, in a way, it's not really a choice because someone's gotta be doing that. 

Annie Im: And that's the hard thing. It's hard. The virtual world is a blessing in so many ways, but it's also challenging because I'm constantly on meetings on my phone and my kids think, oh, there's mom on her phone again, on another meeting. From their perspective, they don't know what I'm going to, or not going to, or choosing and not choosing. It's tough because I don't want to be on my phone on a meeting at home. I don't, but sometimes that's just how I make it work. I just wanna acknowledge that it goes both ways. There are gonna be opportunities, meetings that I decide, yes, I have this much to give to work or to take away from home, I'm gonna give it to this thing. That can be hard too, because then there's the guilt [00:15:00] from home. My husband is also a physician, and he's busy, and we have a nanny, but it's, oh, I feel guilty 'cause they have to do all the work when I'm gone. That is something we as women and mothers have to really get over and not let that bring us down. I was at a meeting recently in Italy for an oral presentation. It was this great opportunity and also an amazing trip to take by myself. It wasn't long, but I unfortunately let it get to me a little bit with the guilt. I enjoyed it, but it definitely brought it down. And I think that's something that we also have to contend with. 

Christine Ko: How were you able to deal with the guilt once you realized it was bringing you down? 

Annie Im: I just said, okay I'm gone. I can't look back. I'm just gonna look forward and be where I am. But it took actually just going and cutting off and being like, I don't know what time it is at home. I don't know what's happening at home. That definitely helped. 

Christine Ko: Yeah. My kids are 17 and 14. I feel [00:16:00] less guilty now than I ever have, but they need me less in a lot of ways than they ever have. I think that's why I've had the mental space to realize this. The guilt that I used to feel was because I wanted, going back to our initial question about doing it all: I felt like I was falling short, and that's what I felt guilty about. Another mother, woman, parent would be able to do all of this with more grace and more pizazz and more happiness. 

Annie Im: Yeah it's true. I think sometimes we're our own worst enemies. 

Christine Ko: One thing for me to get over that was just to really be able to freely admit like, I'm just human. I make mistakes all the time, and I can't live up to this standard of perfection at home and at work. But it was hard.   

Annie Im: Yeah. Sometimes too, we have this perception of ourselves and perfection, and we also see other [00:17:00] women, moms, women physicians, et cetera, and somehow think that other people have it all together and we don't. I try to be really honest about how crazed I am, or, gosh, I forgot to do X, y, Z for school. I forgot it was pajama day, and my kid went in normal clothes. Oops. I try to be really humble and upfront about how much I don't have it together, to normalize it. I think we should do that for each other 'cause who really has it together, right? Really, we're doing fine, but nobody in their own minds is living up to the perfection in their minds. So let's just be honest about it.

Christine Ko: No one's living up to the perfection in their minds because no one's perfect. I always keep coming back to that. It sounds silly, I've said this before too, but I've owned this now. I don't know when I internalized that expectation, at a certain point in my career and in my home life, I'm not supposed to be [00:18:00] human. It's really weird. Now I can say it, I'm like, yeah, I'm human. And I'm like, yes, it's totally true. But I remember the first time I said it, I was like. Oh, like that's a failure, too. 

Annie Im: Yeah. Physicians are used to overachieving, and doing everything.

Christine Ko: I was talking to someone recently and she was saying that medical students are very caring. And then in intern year, it's just sucked out of you. 

Annie Im: Survival.

Christine Ko: It's survival. Yeah. There's just too much knowledge, too many situations where I was out of my depth. Sure I had backup and senior residents and attendings, but still it takes an impact, and there isn't time really, I think, to process all of that. And so definitely for me at least without realizing, I did become hardened to the daily kind of medicine that was being thrown at me. 

Annie Im: Yeah. 

Christine Ko: I'm not sure, but I think that's probably when I [00:19:00] started to think without really realizing that, oh, I'm supposed to be more than what I really am. And yeah, it's a burden to try to be more than what you really are. It's impossible. 

Annie Im: We're just so used to pushing to just keep seeing how much more we can do. At some point, like, you don't need to do that anymore. You don't need to figure out, where exactly are my limits? Or how much more can I do? That's not normal. 

Christine Ko: It sounds like you came to this point earlier than me, which is great. For me at some point I was like, wow, I came through overall successfully, nothing terrible happened. And maybe someone looking at me from the outside could think, oh yeah, she does it all. She has it all, and, no, really, no, I don't. I do try to normalize and be honest about the things that I'm constantly not able to do on a daily basis.

Annie Im: I agree. I think we all are experiencing that at some level, and [00:20:00] talking about it openly, being upfront about it, I think that humanizes all of us. 

Christine Ko: Yeah. Okay. Very ill patients who need stem cell transplants. And then once they get the stem cell transplant, they're very ill on the regimens. The sort of macroaggression of someone telling you, are you sure you wanna do that? Don't you wanna have a family? What would be your response now? To someone who does really want a family, does really want a career like yours, but also is like, I do wanna spend time with my family. I don't wanna just be attached to work. 

Annie Im: Yeah. I try to tell young women that it's okay to want to have a family and have a career, an academic career, an intensive career, or a heavy clinical career, whatever it may be. It is doable. I try to emphasize that it all doesn't happen at once. [00:21:00] I've heard women talk about gosh, if I wanna have kids, if I go on maternity leave, I'll lose all that time and then I'll get behind. I used to think like that too. Like time was so short, and I had to be successful tomorrow. And it's just not that way. Three months of maternity leave is nothing in the grand scheme of a career or a life. From the baby perspective, it goes in a second, it's gone. So you wanna hold onto that and from a career perspective, nobody even remembered you were gone. I don't want people to make choices based on, if I have a family, I can't do this. I think that's the most dangerous thing to do. But it's also important to be realistic. Prioritize, and that's the choice you make. Everyone's different in terms of where they want to fall along that spectrum and wherever it is that they choose. I try to emphasize to people that you can't have this thought of, well, I want it [00:22:00] all. That sounds great. And yes, you can do a lot of it. You can do both. You can do all three, whatever things you're talking about, but there are gonna be sacrifices in some direction whatever you choose. I hesitate to use that word. I don't wanna think about it as sacrifices. I really think it's like, you're choosing X, so great. Good for you. That's your choice. Enjoy it. You may have to give up some other things, but what a privilege it is to be able to choose, right? We're pretty lucky that we have all of those things to choose from. I would look at it that way. 

Christine Ko: Yeah. And would you have any ideas on a sign that someone's sacrificing, to use that word, too much for their career? 

Annie Im: I think ultimately if they're not happy and deep in their hearts, it's not making them happy or satisfying them, I think that's the sign that it's too much. So much of what we do, we do because people expect us to do it. Or at least that's what I did for a long time. I was like people expect me to do X, Y, Z, so that's what I should do. I don't know how [00:23:00] much soul searching people do to be like, no, this is what I actually want to do, regardless of how people will look at that decision or how people will judge it, or what people expect me to do or think I'm good at, any of that. I think it comes down to that. 

Christine Ko: This has been really helpful. You say a lot of things that resonate with me. We do make choices, we should own them and yet recognize also the system is not really for working parents. To just remember what we really wanna focus on at a given time point. I like your analogy of a pendulum, maybe it's swinging more towards something at work and another time maybe it's swinging more towards something at home. We do have to make those choices. We can't really be going in opposite directions at the same time. 

Annie Im: Yeah. 

Christine Ko: Do you have any final thoughts?   

Annie Im: I thank you for doing this podcast, letting me be on it, and I encourage everyone to keep having these conversations. It's important to talk to each other, but also talk openly to a [00:24:00] wider audience of people who need to hear these things. It's really powerful. I appreciate it and thank you so much. 

Christine Ko: Thank you Annie. Thank you for being here.