 From New America and Slate, I'm Bridget Schulte, and this is Better Life Lab. Not that long ago, I was talking with my colleague Haley Swenson. It was probably one of those days at work when I felt like I was juggling about 17 different things. What Haley told me, though, really got my attention. She'd found an intriguing new paper by a postdoc at Stanford University. Her name is Allison Wynn. Allison was studying overworked doctors, specifically doctors who teach and do research in medical schools. It's life-saving work with high pay and prestige, but long hours and tons of burnout. And Allison described a phenomenon that's been overlooked in so much of the talk about so-called work-life conflict. She called it work-work conflict. It made so much sense, and I wondered what insights Allison's research might offer to stressed-out workers in all kinds of jobs, present company included. So I gave her a call. Allison, so thank you so much for joining us today. Thank you for having me. Yeah, really excited to talk with you about something that I certainly struggle with. And one of the reasons I really wanted to talk with you, and I think you write about this in your research, is that, you know, sometimes we feel like we're pulled in all sorts of different directions between work and home, work and family. But that what we don't really look at is within work itself. Sometimes you have so many different jobs or tasks or different kinds of responsibilities that you can feel pulled in so many different directions at work. And you've come up with this term I have not heard before called work-work conflict. So can you tell me a little bit about this idea? Sure. We were asking questions about work-life conflict. That was really what we went in to study. And this other concept kept coming up, and for some people it was even more stressful, and you know, it drove even more attention for a lot of people and they would talk about, you know, what they spend their time on during the day and how they decide what different things to focus on at work. This combination of different work roles was actually driving a lot of the tension. And that certainly surprised us as work-life researchers. Yeah, and it's certainly something that resonated with me. You know, I have all sorts of different roles through the day and, you know, you get to the end of the day and you maybe feel like you've done one role sort of OK, and the other seven or eight just terrible. So I thought we'd explore this territory by listening together to some real world stories of people that we'd heard from who are also experiencing work-work conflict in a variety of different kinds of jobs and roles. First, we want you to hear the story of Virginia Grant. Virginia lives in a small town in Central Illinois, and for the past 16 years, she's worked for the Department of Rehabilitation Services, known as DOORS. And through this program, Virginia provides in-home care to clients with significant disabilities. She's worked in health care her entire career. A lot of my family members were health care workers, and I think it's kind of just in the blood. I had a great grandmother who was a midwife and my mother studied to be a nurse and all of my sisters worked in the field. And even though at first I was like, no, I'm not going to do that. That's exactly where I ended up. So you ended up spending your whole life or your whole career in this kind of caregiving? Like how many years have you been working at caregiving? Forty-two. Wow. Going on forty-three. Yes, so you, wow. Yes, I mean, I could go work in a factory, and I did for a little bit, putting parts on a machine, and it's so impersonal. Whereas when you're caregiving, you're making a difference in someone's life and they appreciate it and you know they do. I have two individuals, and I start the day with the lady that I take care of, and she has MS and she's totally disabled. She has the use of her right arm and she can move her head. But other than that, that's all she can do. So basically you do everything for her. You know, you're going to bathe or dress or feed her. We have a whole year left that we use to take her to the restroom now. Again, I do anything that you know what you would do for yourself in a normal day. I mean, as to even scratching her head. I mean, she can't even scratch her head. So if she has any that you have to scratch her head for. And the other element is, you know, we've been together for almost 16 years and I'm not young anymore either. You know, we used to go, like I said, we'd take the day and we'd go shopping and to her doctor and she would drag things home from the thrift store, you know, and things like that. And it got to where it's like, no, I can't drag furniture in your van and drag it out anymore. The other, the other person I have wasn't quite as physically disabled. So basically for him, I do cooking, cleaning, grocery shopping, you know, kind of helping him with his bills, his correspondence and laundry, that sort of thing. But he is declining also. So it, you know, it's now taking a little more for him also. Well, you mentioned that you're not, you know, that you're not as young as you used to be and that you've been doing this for almost 43 years. So do you mind if I ask how old you are? I'm 62. I, I'll be 63 in August. How much longer do you expect to go? Um, I hope to retire when I, you know, I can retire when I'm 66 and a four according to social security. Unfortunately, we don't have like a retirement fund. You know, doors is a great program, but it did not have a lot of things for the caregivers. That's why we formed a union and we have been able to get better wages and health insurance through forming a union. But one of the things we need is some kind of a retirement benefit as well as, you know, pay time off. I mean, if you're sick, you can't, you know, you, you end up going to work because you can't afford to take the day off with the people that we've worked with you. That's really not good for them because they may be more susceptible to illnesses and it's harder on them than it is us. But sometimes you don't have a choice. So have you, have you taken a time off? If you're sick, do you take days? Um, I'm able to take a little bit more time for myself now than I used to. But I don't remember when the last time I took a vacation was. Really? I mean, if I take time off, I'm not getting paid. If I'm not getting paid, nobody else is getting paid. My rent doesn't get paid. My, my utilities don't get paid. Uh, you know, I can't buy food. So yeah, he don't take a vacation. What kind of wages do you, do you tend to earn? Um, right now I'm at $13 an hour for our program. We don't necessarily get eight hours a day. The hours vary depending on who you are caring for. So you may only get four hours a day. You can't live on those wages. So like, how would you, how would you juggle the different jobs? I think my youngest son was like maybe eight or nine when I divorced. So my oldest son was old enough that he could watch the other two. Whenever I worked like an extra few hours of an evening for part of the time, I lived next door to my sister. And while she worked, I watched her kids. When I worked, she watched my kids. So I was able to pick up some extra hours. Um, yeah. And the thing is, you get caught up in the day-to-day struggle of working all these jobs. You don't even have time to go look for anything else or do anything else. Sometimes you're promote yourself out of that situation. So I guess one of the things that I'm wondering is you've got these very intensive labor intensive, also emotionally intensive jobs where people, they literally could not make it to the day without you. You play a critical role for these people. You know, is it an additional stress that when you, you know, you're, you're, you're looking at 66, just a few years down the road, you don't have a pension or a 401k? Yes, absolutely. Uh, you know, I, I, because, you know, like I said, I'm not that young anymore either and who knows what's down the road. And, you know, I wonder if I'm going to be able to work until 66 and a fourth and actually be able to draw off my full social security benefits. And then who's going to take care of me? You know, you think about these things. By the time I'm done taking care of all these other people, where am I going to be? So Allison, when you hear Virginia's story, she's got all sorts of these work life and work, work tensions pulling her in all sorts of directions. Yeah, I think there is so much to unpack here. Um, first just caretaking as a job involves so many different roles, right? And, and different sets of tasks, different, essentially different jobs, right? You're a chef, you're a chauffeur, you know, there's, there's so many different jobs that you're taking on and that she described doing. And so I definitely think, you know, I could hear that work, work conflict. I think the other thing that I heard there was how emotionally intensive it is to have so many different roles that you're dividing yourself between. And it really in the end sort of takes all of you to be able to do each of those roles well. And relating that back to the research, research describes work and life as greedy institutions. I'm glad you brought that up because when I read your research, I loved that. What is it? What is a greedy institution? I know, I love that too. But it's the sense that both work and home really do take all of you and demand your entire self. And that becomes really difficult. Then if you're trying to divide your time between those two spheres. And so the new idea that we're introducing is that within work and within family, there can be different roles that are similarly greedy. And I think caregiving is a great example because there are so many different types of tasks or roles that demand this huge emotional investment. And I think we saw the same thing among academic physicians that in order to be a really good physician, that takes all of you and to be a really good researcher or to be a really good teacher and mentor. That takes all of you. And so to do all of those things, it's really difficult to divide yourself between those different roles. Another thing that she brought up that we found in our research was the importance of compensation and the role, the important role that it plays, particularly when it's misaligned with job expectations. So if you're paid for one thing, but promoted for another, or if you're paid for one thing, but expected to do something else or a different set of responsibilities that are not compensated for, that can create a lot of conflict for people. And I think the example that we just heard, she was facing some of that where she needed compensation for various things. She was investing a lot of work and effort and time and emotion and wasn't necessarily getting back the compensation that that work demands. And that relates, I think, in her industry, in particular to a more general devaluation of caregiving work. But I think in many different types of jobs, you really have to look at whether the compensation is aligned properly with what the job expectations are so that not only first is it clear and transparent what is expected of them, but then they're adequately compensated for those expectations. Right. And obviously caregivers, care workers are not. You know, Virginia is in her sixties, earning $13 an hour. You know, and there have been all sorts of reports that, you know, for child care workers, they're still making poverty wages. Right. You know, I'd like to move on. And next, I'd like for us to hear from someone who is also keenly aware of the impact that that work, work conflict can have. But in a completely different line of work, and that's the nonprofit sector. Her name is Megan Carolyn. She's the director of policy research for a national nonprofit that focuses on early childhood development, health care and education. I think a lot of people get into nonprofits coming from very good reasons of the heart. You see an issue that bothers you in the world or maybe that you experience negatively firsthand. And you really want to commit yourself to it. It's a field that is not known for its compensation across the board. A lot of times benefits packages are a little dicey or sometimes because it's with small organizations. So people come in and they say, you know, I am mission driven. And so it's easy to settle into this superhero mindset where you feel that I have to keep pushing myself. I and my organization have to do everything in our power. We have to leave no stone unturned in pursuit of our mission. We need to be everywhere and talking to everyone. And trying to find every funder and needing every service target. And that is a really exhausting way to live life. If I can if I can extend the superhero metaphor, you know, at a certain point, there's going to be some kryptonite out there. There's going to be because it's not a sustainable way to live and to operate for individuals or for an organization. And the kryptonite could be a key employee gets struck down by the flu for a week or, you know, the panic I know of so many mothers in the nonprofit world who feel like they can't go out for their full leave because how will the organization function without me? So, Allison, I want to I want to break into Megan's story here because what she just said, so many people seem to feel that exact same pressure. I think it's so true. I love her use of the word kryptonite. I think that's a really great metaphor. Yeah. You know, I think in the work life literature, you see work life conflict tied to things like employee satisfaction, health outcomes, burnout, things like that. And work conflict can have similar implications, right? That if you're dividing your time and energy between these different roles that are really conflicting and really demanding a lot of you, that can also lead to burnout or act as kryptonite as you put it. So let's get back to Megan. There came a point in our conversation when in reflecting on the pressures of nonprofit work, she was almost at a loss for words, almost. These jobs can be very exhausting if they're if you feel alienated. You paused there. I did. I couldn't quite come up with the word that can be. I don't want to say exhausting is tough, right? Because I'm not on my feet all day. I'm not moving heavy boxes. I feel very lucky to do work that I love with people that I enjoy. But if we ignore the exhaustion, the mental toll and that that can become a physical toll, the burnout that goes along with that. You're hunched over a computer all day staring at a screen. You are not going to bed when you're supposed to be because you're trying to get one more spreadsheet done or you're not taking the time to rejuvenate with your family because you think maybe I can learn how to use this new social media tool after my kid goes to bed. Everyone has seen that little matrix of the urgent and the important, right? Sometimes you don't have the luxury of anything being not urgent or not important or sometimes your definition of what's urgent and is very different than the other people who need something done. I found myself last week just thinking, what do I do? You know, the day feels so short sometimes and you know that everything, nothing is going to be easy on the to do list, right? A budget isn't something that I can multitask while I'm on a conference call. And you have to sort of assess what else is on my calendar. Am I going to get interrupted in 45 minutes? What can I cram it to 45 minutes and still be meaningful work? And so I think that that real, that task freeze of just not knowing where to go, I think it's very frustrating. But I think really there is a lot of internal and external pressure for nonprofit professionals. You are not drawn to working in human services or animal rights or early childhood like I am because you don't care, right? So we come into these fields because we care about seeing positive change. And so it's very easy to feel like, well, if I just take it easy tonight, if I don't get this done, if we pass on this grant opportunity, is someone going to suffer for it? And so when you assign that kind of high value to everything, it can become really intensive. Big think is so important and being strategic, but that's also a really good way to drive yourselves crazy. So Allison, as we specifically think about people in mission-driven organizations, and the dynamics Megan just described, the big question is how can you do that good work, that mission-driven work that you really care about and not drive yourself crazy? Or does that just come with the territory? Right, it's such a good question. And the sense that if I drop anything, someone will suffer, which you said that, I really felt it, right? The sense that everything you're doing is so important and so critical that it's really difficult to divide your time. And it's tough. A lot of my research is targeted toward organizations and trying to help them change. But on the individual level, I think it's really tough and you do have to make sure you take the time for yourself and assess all of the different roles that you're trying to fill, understand what the expectations are of you, and make a determination about the best way strategically to divide up your time without going crazy. But sometimes people are in situations, I think, where just what's being asked of them, what's being demanded is not reasonable. And at that point, really, there's little an individual can do other than appealing to their supervisor or the broader organization and saying, this isn't right. You know, we're gonna get to some of that organizational change in a bit. But for her last vignette, Allison, I wanted us to listen together to Jonathan Chang. He's a plastic surgeon at the University of Texas, Southwestern Medical Center in Dallas. He works with kids who've lost limbs. He also has served as president with the faculty senate there. And the UT system has been seeking to address physician stress and overwork. And Jonathan recently worked with his colleague, Ann Caleri, on a major effort to evaluate burnout in the practice of academic medicine. It was one of those doctor heal-thyself moments. And yet, as we'll hear, things aren't quite there yet for Jonathan. And Octopus has eight legs and whenever all those are applied to a single task, it can do some amazing things, like unscrew a soda bottle and it can squeeze under, through the crack underneath a doorway. But my life often feels like that octopus where every one of the eight legs is actually doing a different task simultaneously or all the eight legs are going off in different directions, trying to fulfill all these competing needs. And it's a rare moment of respite when I can sit and think and concentrate on things that I need to address. I'm a plastic surgeon. I also run a laboratory that works on nerve regeneration as well as putting electrical interfaces or implants within the nerves of amputees who control robotic hands. A sample day would be maybe a Thursday. I get up at 4.30 and get myself ready to hit the door by 5.30 and show up to conference at 6 a.m. We have our conference with all the residents and fellows between 7 and 8 a.m. I may take some calls in my office or do some billing and coding, work on editing a paper or editing a grant. And then I go to clinic at a different building which starts at 8 a.m. and that clinic goes until noon and I may see 25 pediatric hand patients, little kids who have either injured their hands or have hand differences that they were born with. And then from there I rush off to the operating room and when I get to the pre-op area, I find that the operating room is delayed by an hour and a half and so I may close out charts or I may take care of various administrative things like my work for the Faculty Advisory Council that really has no scheduled time representation within my day-to-day life. And then I go to my surgery and I do surgery until 3 or 4 p.m. and then I go to another teaching conference. Good days could end at 6 p.m. where I get home by 6.45 or 7 and on other days it could end by 8.30 or 9. If I get home at 6 maybe I'll have dinner and put my kids to bed after reading them a story and then sometimes I'll work again from there on. And you know, being a surgeon I think that I actually still have it easy compared to many of our physician colleagues. Those who provide primary care who are in clinic every day of the week routinely spend three to four hours a day outside of normal working hours doing documentation. And that's gone so far as to have a name pajama time. Wow, just to do all the paperwork. Right. You would rather have that be an idea that you, you know, you've got like a cup of tea and you're with your kids or, or, and, you know. Right, right. It sounds like a lot of fun pajama time. It does. You make pajama time sound really awful actually. Maybe pajama torture or something like that would be better. Jonathan Chang, pajama jokes aside, that really is a life or death kind of situation because here in the United States, the statistics show that doctors are suffering from an epidemic of burnout, that they are pulled in so many different directions in academic medicine even more so. This is really critical for not only the health and wellbeing of physicians and doctors and the future of scientific research, but also for the people that they're operating on or seeing or treating. Right, it's a, it's a big question and burnout is definitely something that's been very present in the minds of people who study this work. Clinical shifts are typically very scheduled, very regimented. You have these shifts that start and stop at a certain time, a certain number of hours that can be very easily quantified, but the research time is much more nebulous and it's hard to estimate how long that's gonna take. In the case of medical faculty, the hospital and the university could collaborate to ensure that physicians can meet their clinical demands without sacrificing their research achievements and vice versa and creating a unified incentive structure so that what gets them paid isn't fundamentally different than what gets them promoted. And is that, is that the case now that what gets them paid is different from what gets them promoted? That's right, yeah. So in our sample, what we found was that their pay was determined by clinical shifts, but their promotion and tenure decisions were driven by their research. And this was something that faculty really struggled with. How do I make sure I get compensated in the way that I need to without sacrificing this necessary research time? Right, it's sort of like a catch-22 bind. Right, and not to mention all of the additional work that doesn't get you paid or promoted. So things like teaching, mentoring, serving on committees, these are essential for the smooth working of the university, but they're things that typically are devalued by both the hospital and the university. That would be sort of the first thing, is how do you value the actual teaching that goes on in medical school? Right, no, exactly. And really thinking through what are the activities that are essential to the working of our organization? And how do we make sure we design incentive structures in such a way that we incentivize those activities that are necessary and not only do we incentivize them, but we make it clear to our employees, this is what's expected of you. This is what's gonna get you paid, promoted, rewarded. And I think that would go a long way to reducing this work or conflict. You know, one of the things that Megan said that really struck me, because I'm in the nonprofit world now, and so a lot of what she struggles with, I struggle with. You know, I'm a writer and I got into this to do more writing, but I'm also a program director. So I've got to do management and budgets and fundraising and the thing that I like and want to do most of, that often gets squeezed. And you know, I heard you saying for the individual, be more strategic about how you divide your time. I'm like, yeah, how do you do that? I know, it's not. I mean, really my big recommendations are for organizations. I think it shouldn't really be the individual's responsibility. If you're put in a situation where too much is being asked of you, it is unfair to tell an individual, oh, just strategize better. So I definitely don't want that to be the takeaway message that can only take you so far. I mean, organizations, it's really, the responsibility is on organizations to fix this. Well, do the organizations, do they have any motivation to do it? I mean, the fact that physicians are burning out at a dangerous rate doesn't seem to have brought about much change in academic medicine. I mean, what's it going to take for organizations to really change? I think organizations definitely have an incentive to change. Burnout is critical. It's super costly for organizations in terms of turnover, in terms of health outcomes. So it's something that organizations should definitely care about. Maybe I'm naive in thinking that perhaps they haven't fixed it because they didn't understand the problem well enough, you know. We can only hope. I know, maybe they just needed us to point out, I mean, I think a lot of attention has been paid to certain concepts like work-life conflict, but maybe things like work-work conflict. People aren't aware of it. And I mean, I think in my work with organizations, I've found that often they just don't understand the problem or they focus on things that are outside of their control. So in the technology industry, one big complaint is that there just aren't enough women majoring in STEM fields. The sort of common argument is called the pipeline argument. And this is why we just don't have enough women in tech. And I find in some of my research that actually there are plenty of things companies can do to increase the number of women who are entering technology jobs. And so I think of this in a similar way that often organizations think the problem occurs outside of their jurisdiction. Maybe physicians are burning out because of things they can't control. But actually there are steps that organizations can take to improve the problem. You know, there was really kind of ironic a couple of years ago in the Obama administration, they were trying to create these rule changes so that more people could actually qualify for the overtime pay. And one of the organizations arguing against that was a nonprofit saying, no, no, you don't understand where these kind of small scrappy nonprofit, we rely on young people who are so passionate that they'll come in and they'll work for nothing and overwork themselves and work these Superman hours. How do you solve the organizational or the work redesign challenge in the nonprofit sector? Or for Virginia, how do you solve those bigger problems? I question our assumption as a society that more hours leads to better products. I really take issue with that. I think we have this fundamental assumption that if people give more hours to something than the product, whatever they're making or the service or whatever they're doing will be better. And I'm not saying that that's never true, but I think it's certainly not true in all of the instances we assume it's true. And I think there are instances where we think more hours leads to more productivity, but in fact, we know that people get less productive with time. And so I think we really need to think more creatively about how can we get better products and better services by treating people better? And so I think that's true in the nonprofit sector as well. I think people who are mission-driven, they also need time and more hours is not necessarily going to lead to better outcomes. Alison Wynne, she's a post-doc at the Klayman Institute for Gender Research at Stanford University. She's also lead author of the article, Pulled in Too Many Directions, The Causes and Consequences of Work-Work Conflict in the journal Sociological Perspectives. For more resources on working healthier, visit us online at newamerica.org. Click on the link for Better Life Lab. Better Life Lab is produced by New America in partnership with Slate. Thanks so much for joining me for our podcast about the art and science of living a full and healthy life. It's a collaboration with Ideas42, supported by the Robert Wood Johnson Foundation. I'd like to say a special thanks this episode to the Better Life Lab's Haley Swenson for her help with the research. The producer of Better Life Lab is David Shulman. If you enjoyed this episode, and maybe now you're using just six of those eight tentacles, how about writing us a review on Apple Podcasts? It really does make a difference. From New America's Better Life Lab, I'm Brigitte Schulte.