Who are you? This question seems like it ought to be incredibly easy but how you answer might have a profound impact on your ability to maintain a meaningful career and a life in balance. If, without hesitation, you responded with your career designation as the answer to the “who are you?” question, maybe think a little bit deeper on what that might say about you, how that might devalue all the other components of what makes you truly unique, and what your response might say about how you value those around you. In our careers, as in all aspects of our lives, balance is key. Omit that crucial component and we risk burnout, we risk losing those we care about, and we risk having nothing left waiting for us at the end of our careers. Too often, healthcare professionals remain shackled to their careers into their 60’s, 70’s, and even 80’s because they have not taken the time and prioritized achieving balance in their lives and cultivated a collection of people with whom to spend their time. When we prioritize work over everything else, it is at the expense of everything else. As Gary Keller pointed out, “Work is a rubber ball. If you drop it, it will bounce back. The other four balls—family, health, friends, integrity—are made of glass. If you drop one of these, it will be irrevocably scuffed, nicked, perhaps even shattered”(Keller 2012). Work is always going to be there. But, deprioritize these other components of your life and you risk achieving a solitary, unhealthy, and unhappy conclusion to your career.

“All work and no play makes Jack a dull boy. All work and no play makes Jack a mere toy” (Edgeworth 1825). In Stanley Kubrick’s film The Shining, it became abundantly clear that too much of a devotion to a particular vocation introduces the potential for significant personal adversity. For healthcare professionals, the value of outside interests, hobbies, and passions are in many cases what makes us unique. These pursuits provide something to talk about, work for, and help make us relatable humans to the patients and clients that we care for. At some point, our careers will end, our children will leave the house, and life may seem less chaotic. Therefore, there needs to be something that still exists to give our lives purpose and stir a passion for participation in the world. What exactly that thing is that makes you look forward to the weekend or long to seek the clinic exits is going to vary between individuals, but there is a whole world of options to choose from.

It may be that you are blessed with an innate athletic ability that steers you toward an activity where you are able to achieve significant recognition. However, your achievement in a particular athletic endeavor really has little bearing on the happiness to be derived from involvement in that activity. Take running for example. Between 2008–2018, marathon participation increased 49.4%. Evaluating participation trends reveals that this growth in the field of running was not solely from individuals setting personal records (PR) or qualifying for the Boston marathon. In fact, it seems that those joining the ranks of marathon participants were of more mortal constitution and these runners were responsible for increasing the average marathon time by 3 min and 55 s over that same time period (Runrepeat.com 2022). These marathons have now become so popular that the largest race, the New York City Marathon, has 50,000 participants and a lottery is held to determine who might have the opportunity to participate. It has become simultaneously evident that it is never too late to start participating in these events. In fact, runners in the 40–49 year-old group are the largest segment of marathon participants. Even more inspiring is the fact that those in the 90–99 year-old category represent the fastest growing segment of the running community. From 2014–2017, this group’s running participation increased 39% and serves to illustrate some of the inspiring things that can still be accomplished later in life (Forbes.com 2022). Too frequently, high-achieving healthcare professionals fall into the mindset of Ricky Bobby who, in the movie Talladega Nights: The Ballad of Ricky Bobby, was driven by the notion that “If you ain’t first, you’re last.” Overcoming this mindset can be a difficult concept for many in the high-achieving sect, but there is significant opportunity for pleasure merely through participation. Read any posting from RunDisney events (everything from a 5 k to a full marathon) and you will encounter amazing and inspiring stories from those participants merely seeking to improve their health and enjoy participating in an event centered around a place that they love. The absolutely most inspiring stories come not from those who are seeking to win, PR, or qualify for another event but instead from those seeking to stay one step ahead of the balloon ladies (the balloon ladies represent a group of volunteers marking the slowest permissible pace). So, if you are the weakest competitor in the body building competition, if you are a slow enough swimmer that the lifeguards are considering asking you to stay in the kiddie pool, or if the only way that you can go for a bike ride is for the electronic bike to handle half the peddling—who the f#$% cares? Get out there!

A recent blog post presented several potential mechanisms by which involvement in sporting or fitness activities can improve overall wellness and help contribute to balance. For one, engagement in these activities can be a great opportunity to facilitate team bonding and the expansion of social support networks that might ultimately be important in the setting of future adversity. These activities can also be a tremendous opportunity for enhancements in employee engagement (Vantagefit.com 2022). Nothing builds team unity better than rec league kickball and it is in these moments where bonds are built around insane commitments levied toward non-consequential athletic endeavors. These activities, even rec league kickball, can be a great way to achieve health and fitness goals. Ten-thousand steps is a great place to start but, in an era of increasing worship of our EMR overlords, significant time is now spent at workstations and any opportunity to get moving can pay substantial dividends. “Motion is lotion” and achieving the dream of a fit and active retirement is only possible if there is a steady commitment to fitness in the years leading up to retirement. Finally, engagement in athletics will inevitably lead to failure and micro-dosing with rec league failures enhances coping mechanisms for when a larger failure is encountered. The absolutely best baseball players in the world can only dream of a batting average of.400. As healthcare professionals, becoming comfortable with failure enhances our willingness to take chances and advance our fields. Without the freedom to make occasional mistakes, our collective professions would stagnate, and innovation would cease.

Exercise also has a number of important physiologic benefits that can benefit healthcare professionals. Decreases in stress, improved sleep, decreased fatigue, decreased illness-related work absences, improvements in mood, and a decreased incidence of depression and anxiety are all potential benefits associated with regular aerobic activity (Gerber et al. 2014; de Vries et al. 2015). Exercise may even make us better at our job through significant enhancements in brain health. It seems that exercise has the ability to improve cognition and concentration through a variety of mechanisms that can have immediate and long-lasting impacts. Exercise-induced increases in brain-derived neurotrophic factor (BDNF) have demonstrated the ability to increase neurogenesis, differentiation, proliferation, angiogenesis, neuroplasticity, neuron survival, grey matter volume, and cognition (Machado et al. 2015; Huang et al. 2014; Parry et al. 2018). With the constant acceleration of medical knowledge accumulation, it may become imperative to include regular aerobic exercise as a component of maintaining the ability to assimilate novel information and more effectively care for our patients. At some point, elevating exercise to the level of CME participation may be an effective mechanism for ensuring the longevity and fitness of our healthcare professionals.

It may be that our time spent outside need not be spent solely pursuing athletic endeavors to reap positive mental health benefits. Research is accumulating that demonstrates the positive impact of simply being/existing in nature and how spending time in that environment can provide a variety of physical and mental health benefits. Improved attention and cognition, decreased levels of stress, improved mood, improved sleep, a diminished risk of psychiatric disorders, increased levels of empathy, and improvements in cooperation have all been demonstrated through increased exposure to the natural world. Other studies have demonstrated that nature can provide an increase in happiness, subjective well-being, positive affect, positive social interaction, and be a source of purpose in life. There is emerging evidence that time spent in nature may have even more wide-ranging benefits and that it may be able to decrease systemic cortisol levels, alter prefrontal cortex blood flow, decrease blood pressure, improve immune function, and decrease the risk of obesity, cardiovascular disease, and diabetes. Nature exposure has even been reported to enhance the activity of natural killer cell activity and, through this activation, may have a role in enhancing the body’s ability to eliminate cancer cells. There is some evidence to suggest that exposure to green spaces has the ability to even impact overall mortality—a benefit that many of our expensive pharmacologic therapeutics are often unable to replicate. The etiology for these positive effects is not entirely well known and they may simply be derived from decreases in stress via parasympathetic activation associated with immersion in the natural world. There is a biophilia hypothesis that suggests that humans have evolved to exist within the natural world and therefore have an innate need to occupy space in that environment. The attention restoration theory suggests that time spent in nature and disconnected may facilitate increased mindfulness through an enhanced ability to overcome mental fatigue and focus. Finally, it may be that exposure to chemicals emitted by plants (phytoncides) is responsible for some of the beneficial effects associated with exposure to nature (Jimenez et al. 2021; Li et al. 2007; APA.org 2022). Whatever the etiology of these nature-based therapeutics, it is difficult to conceive of a less expensive, lower risk intervention than spending a bit of time occupying space and reconnecting with the natural world. Consider this a challenge to seek out green spaces near you where you can engage all of your senses as you feel the warmth of the sun, smell the grass, listen to the birds, and watch the effect of the wind on the trees.

For many, the recognition and appreciation of beauty that is created not by nature, but instead by man, represents a significant path toward fulfillment and wellness. John Dewey provided a potential pathway for wellness through art appreciation when he wrote “Art throws off the covers that hide the expressiveness of experienced things; it quickens us from the slackness of routine and enables us to forget ourselves by finding ourselves in the delight of experiencing the world about us in its varied qualities and forms. It intercepts every shade of expressiveness found in objects and orders them in a new experience of life”(Dewey 1934). Art offers an opportunity to see and experience objects/activities/situations through a lens that can transform them into something that is more than their mere components. In art, there is an opportunity to identify beauty and promise, even in the shadow of horrifying tragedy. There is also an opportunity to appreciate an expression of grief, despair, and hopelessness and recognize the value associated with these powerful emotions. Through exposure to and appreciation of art, a variety of healthcare professionals have demonstrated the ability to enjoy enhanced wellness and satisfaction. A 2016 review provided evidence that the simple act of listening to music resulted in improved staff mood, efficiency, concentration, focus, energy, enthusiasm, positivity, and happiness. In addition, passive music listening was also demonstrated to decrease stress and tension while easing the process of caring for patients (Wilson et al. 2016). Indeed, a study of patients presenting for orthopedic surgery under spinal anesthesia found that the use of perioperative music resulted in patients with decreased self-reported anxiety and that these patients required fewer intraoperative sedative medications. Visual art displays in the workplace have also demonstrated the ability to provide substantial improvements in well-being through the creation of a better and more home-like work environment (Karpavičiūtė and Macijauskienė 2016).

While there certainly is an abundant amount of satisfaction to be derived from absorbing the creative works of others, there is evidence that engaging in the creative process may have substantial benefits for healthcare professionals themselves. In one study, nursing staff members engaged in silk painting activities once per week, outside of regular work hours, for a period of ten weeks (Karpavičiūtė and Macijauskienė 2016). Through engagement in these simple exercises, the nurses in this study were able to enjoy improvements in vitality/energy and their emotional wellbeing. In addition, participants in the limited-scale art project group reported decreased levels of general fatigue and barriers to activity. The authors of this study hypothesized that the beneficial impact associated with engagement in the arts may be related to entering a creative flow state. In this flow state, deep concentration and engagement may approximate what can be found through meditation and mindfulness and provide a link to the etiology of the improvements seen in mood and wellbeing. These activities may also produce beneficial outcomes through fostering a more positive work environment and thereby impacting a variety of wellness variables. Other collective healthcare setting art production activities have worked to combine collaboration, team-building, and environmental consciousness. In one example, a group of OR personnel worked to re-purpose otherwise discarded medication vial caps into large-scale art projects. This work brought together a variety of healthcare professional colleagues to create a lasting product that stands as a visual cue and reminder of their collaborative efforts and commitment to environmental sustainability (Zuegge et al. 2017).

Involvement in the arts may take many different forms. In one study, Irish healthcare workers were solicited to participate in a workplace choir (Moss and O’Donoghue 2020). This study demonstrated several qualitative benefits in healthcare professionals who elected to participate in this activity. Namely, they found that participation promoted social connection, enjoyment at work, and staff engagement. However, the authors did find that this activity had limitations in demographic appeal and, therefore, efforts would likely be needed to extend interest in this activity or alternate activities would need to be provided for workers uninterested in choir participation.

Clearly, exercise and other activities do not represent the only mechanisms through which healthcare professionals can develop a balanced and meaningful life. For many, leveraging their medical training as an opportunity to act in service to others and spread good in the world serves as a platform for wellness improvement. The perspective gained by individuals engaged in these activities is incredibly valuable and, in many cases, serves to place more petty concerns within a proper context. The benefits of these acts of volunteerism may not be entirely altruistic as there are well-documented physical, social, and psychological health benefits associated with serving others and focusing outside of the self. In a systematic review of studies evaluating the beneficial impacts of volunteerism for the volunteer, mental health appears to be significantly improved through altruistic acts. Through working on volunteer activities, decreased rates of depression and improved life satisfaction and wellbeing have been reported. In addition, previous research has demonstrated a 22% reduction in mortality in those engaged in volunteer activities (Jenkinson et al. 2013). Another study demonstrated that the impact of volunteer activities becomes more pronounced starting above the age of 40 and that these benefits continued to increase as the age of the volunteer increased (Tabassum et al. 2016). To a certain extent, it makes some conceptual sense that greater health benefits associated with volunteerism might be realized in older adults. Adults under the age of 40 are commonly engaged in childcare obligations, leaving fewer opportunities for additional activities. In addition, the care of these children represents a significant “purpose” for these individuals and serves as an effective antidote for generalizable malaise. Regardless, the results of these studies demonstrate the power of service and how those who routinely engage in service activities frequently seem to have a fount of wellness that can sustain them through various career difficulties. Consider how working to support and care for those in challenging conditions might change your perspective on the work that you do at your home institution and the value assigned to the resources made available to you there.

As written by Viktor Frankl in Man’s Search for Meaning, “Those who have a ‘why’ to live, can bear almost any ‘how’” (Frankl 1959). The challenge now is to discover a ‘why’ that exists outside of the sterile hospital or clinic environment. If significant time has passed since you last made an effort to engage in non-medical human activities, this may not be an incredibly simple task. However, micro-dose in failing. Try dancing. If it turns out that your dancing is so terrible that an ambulance is called for suspected seizure activity, maybe that isn’t the best fit. Try something else. Keep trying something new until there is an activity/pursuit/passion that rises first to your lips when you are asked “who are you?”