Feb 3, 2014

Too Much of a Good Thing: Maintaining Balance in Grad/Post-grad Programs and Busy Schedules

by David G. Nelson*

This article is number 4 in the series, A Living Faith for a Vibrant Mind, where you may access the other articles by following the link.

"My desire was to become the best physician I could be.  While on the surface this may seem like an admirable goal, I found that pursuing this goal came at the expense of the most important relationships in my life.  Specifically, my relationships with Christ and with my wife both suffered from neglect during these years....  My advice to any believer who finds himself slipping into this same trap would be this: Do not forget why you are engaged in whatever field of study you have chosen."

Recently, Brian Rickett approached me with the idea of writing a brief article about the effects of engaging in rigorous high level academic training programs.   I will confess that initially I felt completely inadequate to write such an article, knowing that the audience would most likely be composed of scholars, philosophers, and academicians.  However, I decided to take him up on his offer, but to approach it from a different angle than the other articles in the series.  What follows is a simple, informal essay drawn from my own experiences.  I hope that its readers, many of whom may at present be involved in their own educational pursuits, may be encouraged during a trying time in their lives.

I would like to begin by giving a little biographical information about myself.  I have been married for almost 11 years to my wife, Kristen, and we have two sons.  Our oldest is 3 years old and our youngest is 19 months.  Kristen and I were married after my first year of medical school, and she started medical school two weeks later.  We both have busy medical practices, she as a Pediatrician, and I as an Obstetrician/Gynecologist.   To say our lives are busy would be an understatement.   It is a constant struggle to maintain balance in the spiritual, physical, mental, and social areas of our lives. 

I don’t want to bore you with too many details, but I want to give you a basic idea of what is involved in becoming a physician in the United States.  Almost every student entering a U.S. medical school has a Bachelor’s degree, and let’s assume this took four years to obtain.  Most students graduate from medical school in 4 years, but this can take longer if they take any time off due to circumstances such as serious illness or having a baby, or if they have to repeat any courses.  During medical school, there are four separate licensing exams that must be passed, each of which requires weeks of study.  After medical school, residency and fellowship programs can take another 3 to 9 years to complete depending on the specialty.   In my case, I completed a 4-year B.S. program, 4 years of medical school, and a 4-year Ob/Gyn residency, for a total of 12 years of study following high school. 

Medical school is difficult.  The first two years are spent mostly in the classroom (except for the time spent in the Gross Anatomy lab dissecting your human cadaver, but we won’t go into that).  The amount of material that is covered in the first two years is so great that many professors describe it as “trying to drink from a fire hose.”  From my discussions with friends who went to law school or seminary, I know that they experienced similar challenges. 

If medical school is difficult, then residency is insanity.  I’m not sure how to describe it, although the term “indentured servitude” comes to mind.  The term “residency” comes from the fact that in earlier times, physicians in training “resided” in the hospital or in hospital-provided housing.  Medical residencies traditionally require lengthy hours of their trainees.  Only recently has there been any regulation of the long hours that residents were expected to keep.  The Accreditation Council for Graduate Medical Education (ACGME) has limited the number of work-hours of physicians in residency training to an average of 80 hours weekly.  These actions were largely a result of a large body of evidence that sleep deprivation leads to increased rates of medical errors.  In fact, one study on the effects of sleep deprivation showed that driving performance after 21 hours awake was equivalent to a blood alcohol content of .08 percent, which is the blood alcohol limit for drunk driving in Canada, the U.S., and the U.K. 1   How would you feel about the doctor taking care of you being legally drunk?

These types of demanding hours are not unique to the medical profession.  Each field of study comes with its own unique set of challenges, whether it is researching and writing a thesis, working as a graduate assistant preparing lectures and grading papers, or just working a part-time job to pay the bills.  Whatever the case may be, individuals working toward an advanced degree are vulnerable to developing a marked imbalance in their lives.  Although the pursuit of such a degree may very well be God’s will for their lives, they may find themselves succumbing to too much of a good thing. 

Personally, I struggled with this during my training.  My desire was to become the best physician I could be.  While on the surface this may seem like an admirable goal, I found that pursuing this goal came at the expense of the most important relationships in my life.  Specifically, my relationships with Christ and with my wife both suffered from neglect during these years.  I lost sight of the fact that my purpose is ultimately to bring honor and glory to Jesus Christ, not to achieve personal glory in the sight of the world.  My advice to any believer who finds himself slipping into this same trap would be this: Do not forget why you are engaged in whatever field of study you have chosen.  Paul’s wise instruction in Colossians 3:23-24 says “And whatever you do, do it heartily, as to the Lord and not to men, knowing that from the Lord you will receive the reward of the inheritance; for you serve the Lord Christ.”

Here are a few suggestions for any Christian student who finds himself in a situation such as I did during my training.  Some of these may seem so basic, yet may be the first to go when time is in short supply.  

1.) Spend time devotionally in God’s Word

 “Your word is a lamp to my feet and a light to my path.”—Psalm 119:105

It takes discipline to stay in God’s Word when so many other things are clamoring for our attention, but that is when we need a light to our path the most.  During times of stress and exhaustion, God’s Word is a source of encouragement to the weak and the weary.  Make the effort to read and study the Bible regularly and with a purpose.

2.) Pray

“Rejoice always, pray without ceasing, in everything give thanks; for this is the will of God in Christ Jesus for you.” —I Thessalonians 5:16-18

What a privilege we have to be able to directly communicate with our Heavenly Father!  Yet how often do we forego this privilege when time is short, or how easily is our prayer life reduced to “Lord please help me make it through this test!”? Remember, God desires fellowship with us, so don’t skip out on this part.  Carve out part of your day to dedicate to prayer.  This may look different for everyone, but for me waiting until the end of the day didn’t work well because I was so exhausted that I usually fell asleep.  Don’t let a busy schedule push God to the periphery, keep Him central and give him the best part of your day. 

3.) Stay involved with your church

“Let the word of Christ dwell in you richly in all wisdom, teaching and admonishing one another in psalms and hymns and spiritual songs, singing with grace in your hearts to the Lord.” —Colossians 3:16

This was one of the most difficult, and yet one of the easiest for me during residency.  Logistically it was difficult because I was required to be on duty at the hospital most Sundays.  Yet it was easy because anytime I was around my brothers and sisters in Christ and heard God’s Word taught, I came away encouraged.  Whenever it is possible, be present at church.  Doing so will be of more benefit to you than whatever else you could be doing during that time. 

4.) Serve others

“Let nothing be done through selfish ambition or conceit, but in lowliness of mind let each esteem others better than himself.” —Philippians 2:3

I cannot tell you how many times my wife and my family served me during residency.  Meals, laundry, really anything that I was “too busy” to do myself.  It is so easy to become self-centered when you’re always on the receiving end of the relationship.  Try turning the tables on your loved ones.  Serve them for a change.  If you are married, learn what makes your spouse feel loved, and then go out and wholeheartedly DO THAT!  Don’t give your studies your best and then give your loved ones only what is left over. 

5.) Take care of your body

“Or do you not know that your body is the temple of the Holy Spirit who is in you, whom you have from God, and you are not your own?” —I Corinthians 6:19

Possibly the most basic of all of my suggestions is to take care of your body’s physical needs.  Eat a healthy diet and maintain a healthy body weight.  Exercise regularly, at least 3-4 times/week.  Try (and I emphasize TRY) to get enough sleep.  Get regular checkups (eye exams, dental exams, etc.)  Avoid excessive amounts of caffeine or the illicit use of prescription stimulant medications.  If you have to use medications to help you sleep or to keep you awake on a regular basis you need to see your doctor.

This list in not meant to be all-inclusive, and I realize that the concepts I have outlined are very simple.  It is my hope that at least some of what I have written has been interesting and/or useful.  I am not a scholar, theologian, or philosopher, but a Christian medical professional, and perhaps I have been where you find yourself now, and you can relate to some of my struggles.  I truly believe that our God values excellence in all of our endeavors, but I encourage you to pursue excellence in your relationship with Him and with others, rather than merely pursuing excellence in your chosen field of study.  May God bless you, and may he receive all the glory that He is due!


1. Dawson, Drew and Kathryn Reid (1997). "Fatigue, alcohol and performance impairment." Nature 388 (6639): 235

* David G. Nelson (M.D. Obstetrics & Gynecology, UAMS), brother-in-law to Brian Rickett, is a practicing physician, President of the Pope County Medical Society, and Chair of the Department of Obstetrics and Gynecology at St. Mary’s Hospital in Russellville, Arkansas.  He currently serves as a Deacon at First Baptist Church (Russellville), and along with his wife, Dr. Kristen Rickett-Nelson, was a founding member of The Bible Church of Beebe, in Beebe, Arkansas during their medical residencies.