I have always thought work-life balance was fleeting — like a see-saw hovering in the horizontal position for a split second, until one side becomes heavier and pulls the entire contraption out of equipoise. Whether it be a sick child, a colleague who resigns and leaves you with a heavier clinical load, or a patient emergency, life happens. The perfect balance is not sustainable, and working toward it can be exhausting and frustrating.

I started my career as an academic family physician and quickly became overwhelmed with the many aspects of my job. I was coming from a fellowship, but starting a clinical practice in a new place was challenging. I was also expected to train residents and medical students and complete scholarly activities. My goal — to teach the next generation of family physicians how to provide high-quality, respectful care to patients — was overshadowed by the multiple hats I had to wear. Then I had children, and my default response to any request became “no.” I called it the “lean-out” stage of career development.¹ I cut back my hours to part-time, and then more part-time, desperately trying to find that elusive balance. I spent many years feeling like I was failing. I wasn't the physician or teacher I wanted to be, and I wasn't the mother I wanted to be.

I'd like to say I had an “Aha” moment — one transformative experience that clarified everything for me. But that didn't happen. What did happen was that my children grew up. The passage of time lightened some of my home responsibilities, and I began to feel like I could breathe again. I also realized that everything didn't have to be perfect, and I could ask for help at work and at home. When my kids got to high school and then college, I started to explore new work challenges. But since I had been saying “no” for almost 20 years, people didn't really ask me to do things anymore. I had to go find new opportunities, and then I had to convince myself (and everyone else) that I could handle them.

My children are now out of the house, and I feel energized by new responsibilities — things I would not have even considered 5, 10, or 15 years ago. Here are a few lessons I have learned along the way.

1. Be patient. Your career is a marathon, not a sprint. As time passes and kids grow up, you will likely get a second wind. This is a common career trajectory for women.^2–4 While many men achieve leadership positions in their 40s, for women it is more common in their 50s, once family responsibilities have decreased. Whatever your path, remember that as family physicians we are lucky there will always be job opportunities and ways to reinvent ourselves. Do what is right for you right now, knowing that in a few years you will likely find yourself in a different situation.

2. Set boundaries, but be careful about saying “no” too often. I made this mistake. I was so overwhelmed in the early part of my career that I didn't even consider taking a new position or joining a new group. And I missed out. When I wanted to reengage, it was difficult to convince others I was the right person for the job.

3. Ask for help. At home, this might mean hiring someone to clean the house or ordering groceries online. At work, it might mean delegating tasks to your team, speaking up if your schedule is unmanageable, or getting coverage so you can take a vacation. Not all suggestions will work for everyone, so find the areas where you can offload some responsibilities comfortably and give yourself permission to do it.

I don't claim to have achieved work-life balance. Although some aspects are easier, life still happens. But now I can see the trajectory, and that puts things in perspective.