Finding a balance in life between work and home, finding time for oneself amid work and relationships, prioritizing time and energy: These are lifelong challenges. At times of additional stress, such as during fellowship, these challenges can become more acute. Losing track of important things such as relationships, family, and personal health and well-being can adversely affect one's fellowship experience, training, and ensuing career. We asked two young attending retina physicians to relay their experiences with these challenges and share any pearls of wisdom they may have for today's fellows. The following is part 1 of a two-part series.

— Eugene A. Milder, MD; Paul S. Baker, MD; and Allen Chiang, MD

Q: As retina faculty, do you feel that maintaining balance in life is a minor, moderate, or major challenge for fellows in general? What about for you personally during your fellowship training?
Jason Hsu, MD: The issue of balance is almost a daily struggle whether you're a student, resident, fellow, or even an attending. I hate to say it, but it just doesn't get easier. Focusing on retina fellowship, my sense is that maintaining balance is a major challenge. I approached my fellowship with the attitude that this was going to be 2 years of hard work, tons of new experiences, lots of learning, and, as a result, a fair amount of sacrifice. During my fellowship, I remember being pulled in many directions at work, on call, and at home, not to mention the various deadlines for research projects, chapters, and review articles. Although I never truly felt my life was in balance during that time, I really didn't mind it because I knew this was a finite period of time and that the experiences I was having were going to be invaluable for the rest of my career.

Carl Park, MD: I feel that maintaining balance in one's life will always be a major challenge, no matter at what stages of professional or personal life you are. Challenges that a physician faces when beginning fellowship obviously involve adjusting to a new work environment and dealing with the stresses of new responsibilities. For me, starting as a fellow at Duke in 2001, I faced balancing these professional expectations with the personal milestone of expecting our first child during the first 6 months of fellowship. What helped me most was learning not to internalize these balance conflicts, but discussing these issues with my wife and also with the younger faculty members at Duke who had recently faced similar challenges. Open and honest communication was truly what helped me get through the first 6 months of fellowship.

Q: Do you feel that you were able to keep up with your own health, fitness, and hobbies during fellowship? Do you have any specific tips for keeping up with different aspects of personal well-being?
Dr. Hsu: Never as much as I wanted to. During times of stress, especially when I'm being pulled in multiple directions, I end up trying to prioritize. Unfortunately, during fellowship, that often meant that hobbies went out the window first. However, I usually tried to keep active as much as possible. Often this meant a 20-to 25-minute workout in our building's gym. I saw working out as a good stress reliever: a time to unwind, decompress, and sort through the events of the day. This was definitely a healthier way to relax at the end of the day than watching TV or surfing the Internet. My advice for fellows would be to take at least a little chunk of personal time each day to do something that will help recenter your perspective, whether it's reading, exercising, enjoying a particular hobby, or even just meditating. It doesn't have to be a lot of time, and it doesn't have to be that structured, but I believe having some daily outlet is imperative to keeping your sanity during what can be a very stressful time.

Dr. Park: Clearly, as the time constraints started to kick in, some of my personal priorities were sacrificed for the sake of responsibility and harmony. However, I think that it will always remain important that you reserve even a small amount of time for your own personal growth and maintenance. This is particularly important in light of the realities of a modern vitreoretinal physician. Seeing 70 to 100 patients per day or performing 10 consecutive vitrectomy cases can be mentally and sometimes physically challenging. Keeping a sound mind and body will help you make the transition from a young fellow's body (which can take the abuses) to the not-so-young in-practice/attending's body (which will require coaxing and maintenance) and keep it at a level of peak performance!

Q: Did the rigors of fellowship put a strain on your relationship with a spouse or significant other? Was it more or less strain than you had anticipated? What advice would you give to fellows who are in this type of relationship?
Dr. Hsu: I think any unusually busy or stressful period of time is bound to put some strain on a relationship. Relationships take time, attention, and effort on the parts of both parties to grow and develop or even just to be maintained. As a fellow, you really don't have as much time to devote to your significant other as he or she may want, and sometimes there can be significant misunderstanding when it begins to seem that your job is taking precedence over a relationship. Add work stressors, and you have a perfect storm brewing.

I feel fortunate to have a very supportive wife who was also going through similar experiences. She was a cornea fellow during my first year as a retina fellow and then a junior attending at a nearby academic institution during my second year. Because we were both going through much of the same thing, in many ways it made our relationship stronger. We understood and accepted that the fellowship years would be challenging and tried to support each other as best we could. As a result, in many ways, there was less strain than I would have anticipated.

My advice to fellows in a relationship is similar to the advice I would give anyone in any relationship. I believe the key element is communication. Whenever one of us was frustrated, we knew we could bounce things off each other. It was important for her to understand that when I had deadlines or was stressed out, I needed some room and vice versa. When one of us had a bit of down-time, that person could help out the other. There was always a sense of mutual responsibility and working together.

Another tip to remember is to make time for one another. As I mentioned above about prioritizing, I included my relationship on this list of priorities. My wife will be happy to know that she was always on top of this list. If she needed me, I was going to be there no matter what. Remember that fellowship is 2 years, but your relationship can and hopefully will last for a lifetime. You have a better chance of making this last part a reality by placing your significant other on the top of your list.

Dr. Park: I do not feel that the rigors of fellowship are substantially different from any other challenging periods of life that we all face. As with all challenging periods of life I feel that an open line of communication is the most important aspect of relationship survival and ultimately growth.

Q: Did you have children during fellowship? What were some of the most challenging aspects of parenting that you faced? What survival tips can you offer to fellows who either are about to become parents or have young children?
Dr. Hsu: My wife and I had our first child right at the end of my first year of fellowship. Having a newborn is always challenging, particularly when it is the first. I would hazard a guess that this is true regardless of who is having a child. As they say, there is really never a “good” time to have a child. One of the most challenging aspects for me was adjusting to the dynamics of having a new member in the family. No one is kidding when they tell you having a child is a life-changing event; suddenly you have even less personal time than before. Essentially, when I wasn't working, I was trying to help out with the baby in order to give my wife a break. There is certainly a lot of extra stress in having a new life in your hands and feeling quite inexperienced. Add to this a fair amount of sleep deprivation, and there is no question that a child throws your fellowship experience for a loop.

My main survival tip is working together with your spouse as a team. For example, my wife understood that I needed to get a decent amount of sleep, especially before I had to operate. Therefore, she ended up doing most of the weekday night shifts while I took the weekend ones. Of course, this meant no more sleeping in for me (and in fact, I felt much more rested on the weekdays), but this was a small sacrifice to make in order to still be able to function at my best during work hours.

As I mentioned above, you end up prioritizing what you feel is most important to get done in these kinds of situations. I made it a point to put my family first and fellowship second because I knew I wanted to get as much out of my 2 years of training as possible without sacrificing my wife and child. I also wanted to be very involved in raising our son, so I ended up using most of my down-time to be there for him.

Dr. Park: We had two children during my retina fellowship. Being a parent is perhaps the most challenging and ultimately rewarding aspect of one's life. The sleepless nights are what I remember the most about the first few months; however, soon these travails fade to the background and you remember the joys of coming home from a long day at the hospital to see a baby and then a toddler recognizing you with a big smile. In thinking back, I feel that having children at that time actually gave me further strength and motivation in pursuing my professional goals to their greatest extent.

Jason Hsu, MD, is a member of the Retina Service at Wills Eye Institute and a Clinical Instructor of Ophthalmology at Thomas Jefferson University in Philadelphia. Dr. Hsu serves as a lecturer for the Medical Resident Education Program at Wills Eye Institute and practices at Mid Atlantic Retina.

Carl H. Park, MD, is a Clinical Assistant Professor at Jefferson Medical College in Philadelphia. He also serves as an Assistant Surgeon at Wills Eye Institute and practices at Mid Atlantic Retina.

Paul S. Baker, MD; Allen Chiang, MD; and Eugene A. Milder, MD, are second-year vitreoretinal fellows at Wills Eye Institute in Philadelphia, PA, and members of the Retina Today Editorial Board. Dr. Baker may be reached at pbakerny@yahoo.com; Dr. Chiang may be reached at allen_chiang@alumni.brown.edu; and Dr. Milder may be reached at genemilder@gmail.com