In light of the COVID-19 pandemic, AACAP has created the Coronavirus Resource Library to assist families and physicians during this time.

1. Position Yourself: There are various career tracks women can choose from. Lifestyle implications must be considered. Some considerations include call schedules, flexibility of the position, and the presence of like-minded colleagues. (Table 1)
   
   
2. Location is Everything: “Keep the distances short.” How close are supportive family members? How far will you be living from the workplace so it will simplify your day/minimize travel time? Other factors to consider in location are day care, schools, place of worship, recreation for kids.
   
   
3. Time Management: This is probably the most vital aspect of integrating work and personal life. Don’t expect to do everything perfectly; learn time management strategies. Effective time management strategies can help you make the most of those few precious hours. Table 2 provides valuable strategies to achieve balance. However, you must accept real time and energy limitations and give yourself permission to address different priorities at various points in time/development. Finish any work that absolutely cannot wait after the children go to bed.
   
   
4. Set Goals and Maintain Accountability: One should set clear realistic goals and review them annually. Table 3 provides strategies to accomplish scholarly tasks when there is just so limited or no dedicated time for it. Clarify professional and personal/family goal in consultation with significant others. Develop a personal and professional mission statement and periodically revise. Be aware of different career choices available at different times in life cycle.
   
   
5. Pick Your Partner Well: Select and work with partners to ensure a mutually supportive relationship and commitment to maintain and nurture the relationship. A supportive spouse or partner is key to maintaining a good work-life balance. At least one partner should be flexible, if possible, and understanding. Negotiating clear home-front responsibilities early on and at predetermined intervals prevents unrealistic expectations and allows for the possibility of shifting roles/relationships.
   
   
6. Children: There is never a perfect time to have children. Consider advantages/disadvantages of having children at different stages. The woman physician should consider timing for beginning the process of trying to get pregnant and/or adopting. This would include thinking of whether or not one would do so as a single person, or if pregnancy were not an option. Having an age in mind which one would begin the process regardless of their situation may be helpful as well. There are the financial burden and child-care dilemmas when rearing a child during medical school and then during the most demanding residency years. Flexibility in the individual training program and level of support provided by the program director can help alleviate some of the physically and emotionally exhausting demands of rearing a child in residency or fellowship. Some residencies offer part-time training. A benefit of pregnancy/adoption during residency typically provides paid leave and a modest income. Some advantages of waiting to have children after medical training include higher income, more control over schedules, greater flexibility, and the power of a contract that may include a pregnancy clause. Financial, medical and other issues may preclude one from being able to plan in a way that is ideal. Involve supportive others in helping to adjust as needed in order to pursue pregnancy/adoption while in a work setting.
   
   
7. Child Care: Some of the worries for mothers are the safety and emotional well-being of their children. Having a trustworthy and stable child care situation is a prerequisite to successful career. Understanding that situations arise that one cannot predict and trying to anticipate how one may be able to get support from partners, friends and family members may also be helpful. One has to be diligent in checking references and constantly monitor your child’s progress. Pay attention to your instinct….go with it.
   
   
8. Kids Come First: Allowing oneself as a physician-mother to prioritize one’s family and to have work/life balance is critical to one’s well-being and to prevent burnout. Don’t let an unnecessary task, meeting or conversation steal time away from your children. Minimizing unnecessary interruptions and protecting time where they are able to have your undivided attention is mutually important. Although, don’t make promises you can’t keep. If called or paged apologize to them and ask for their forgiveness. Children are forgiving. Respect your child.
   
   
9. Get Help – Delegate: Seek out senior colleagues to serve as mentors --meet with supportive peers regularly. Make use of growing literature on combining career/personal life –professional societies may help guide you. It is impossible to do everything yourself and still do it well. Decide what you can give up control of and hire or delegate someone to do it for you. Table 4 provides suggestions on some duties and qualities to look for in a “good help.” Family and friends are also sources of help. (www.amwa-doc.org; www.mommd.com)
   
   
10. Get Organized: Getting and staying organized increasingly becomes more difficult as the woman physician’s career advance and home life expands. Table 5 offers strategies to streamline the home front.
    
    
11. Live with Margin: “Margin” is defined as the space that exists between ourselves and our limits, the amount beyond what is needed, the extra held in reserve for contingencies or unanticipated situations.” Margins are needed in emotional energy, physical energy, time, and finances. Working mothers are often at the limits of these margins. Contingency planning for a multitude of anticipated issues such as no-show nannies, sick children, one’s own physical and emotional needs is helpful, identifying people one can rely on in other emergencies is helpful to consider as well.
    
    
12. Take Care of Yourself: Busy women physicians tend to sacrifice themselves to maintain all activities of work and family. Do not sacrifice sleep; eat and drink in moderation, exercise regularly and keep own doctor appointments. Also, faith is positively associated with career satisfaction among women; build time into your day or week for periodic solitude, reflection, or worship. Make time for pleasure and relaxation, exercise and hobbies, even if it is just getting away.

Appendix

Table 1: Questions to consider when Evaluating a Position

• What kind of on call duties will you have?
• Will telephone calls suffice or will you be required to back to the hospital at night? (and who will care for your children)
• Will you be working among colleagues who also support family issues?
• Is a part-time schedule an option?
• What is the maternity leave policy?
• Is there flexibility in the schedule for family or household emergencies?

Table 2: Time Management Strategies

• Set priorities early on, this is essential.
• Make a to-do list for each day; be efficient at work to accomplish all tasks in a timely fashion.
• Use a planner.
• Establish designated times to read e-mail and answer phone messages rather than interrupting your day.
• Avoid taking on extra projects, committee meetings or task that do not contribute to one of your goals.
• Learn to say “no” and ignore the nasty looks when you do so. Do not allow anyone to make you feel guilty.
• Consider switching to part-time and do not work past part time. Evaluate whether part-time expectations are more full time but without financial remuneration.
• Accept that you will have to sacrifice one area at times, whether it is work or home. Do not feel like a failure.
• Protect what you are as an individual; do not lose yourself in your roles.
• Avoid getting caught up in image management.
• Let go of perfectionism.
• Make evening work meeting the exception.
• Limit out-of-town travel, especially when children are young.
• Make it a priority to get home on time.
• Finish all work that cannot wait after the children go to bed.

Table 3: Strategies to Accomplish Scholarly Task when there is no Dedicated Time

• Keep detailed to-do list for each project.
• Work on a project at least 10-15 minutes each day to maintain momentum.
• Use time on airplanes and in hotels to do work while traveling.
• Set goals for your academic projects. Do not take on extra work that detracts from goals.
• Consider turning a major presentation into an article; the work is already done.
• Enlist the support of a good medical editor who can strengthen and polish your writing style.
• Work at home after family is in bed or avoid working at home.
• Document everything on your CV, including educational administrative duties. This will help the next time it is promotion time.

Table 4: Get Good Help – consider adding some of these services, even if occasionally

At Home:

• Reliable, responsible nanny.
• Housekeeper.
• Personal chef or occasional cooking service.
• Personal shopper.
• Home repair services.
• Landscaper.
• Mother’s helper to run errands, shop, take car for servicing, etc.

At Work:

• Medical editor.
• Medical librarian to conduct literature searches.
• Efficient secretary.
• Medical assistant/physician’s assistant to field calls from patients.
• Professional organizer.

Table 5: Strategies for Streamlining Things at Home

• Prepares meals in advance or use a slow-cooker.
• Shop online as much as possible.
• Hire help (see table 4).
• Limit weekend commitments for you and your family.
• Limit children’s after school commitments.
• Eat together as a family most nights.
• Keep promises to children and avoid making promises that you might not be able to keep.
• Put children in bed at a reasonable hour – you need some time at home without them.
• Review schedules of every family member at least weekly.
• Maintain discipline with your children.
• Organize mornings. Give school-aged children a list of tasks to complete.
• Make a game out of chores to make it fun for the whole family.