Finding Balance

I like to say “yes” to new opportunities. It is fun to try out different types of work, learn new information, stretch my brain and grow my abilities. Sometimes “yes” leads down an exciting new path and sometimes it results in a dead end; either way, I always learn something about myself and frequently about the subject.

Finding balance at an early age; photo circa 1974.

Finding balance at an early age; photo circa 1974.

Early in my career, I said “yes” to pretty much everything I was asked to do. As a newly-minted family physician, I had two assets: energy and time. Expertise was often not required, just a willingness to participate and learn, which fit my skill set well. Who needed sleep anyway? I often joked that 2:00am was my favorite time to send email…no one responded right away and I could clear my inbox!

As I took on more permanent projects (and got older!), there were various points in my life where I could no longer stretch the hours in the day to cover the volume of work to be done. I also found that some of the things I had committed to doing no longer brought the same spark of joy they had in the past. And, practically speaking, some of my “jobs” paid better than others!

Initially, I did the same thing we all do: I tried to work harder + faster + better + longer to get everything done. Inboxes at zero make me happy, and if I just pushed hard enough, I could get there…some days. I found new things I wanted to say “yes” to and struggled knowing that if I did, the work harder + faster + better + longer formula was going to create a a person who was exhausted + frustrated + stressed + unhappy. Eventually, I realized my life needed a reset and sorted out a way to prioritize the current things on my plate and make room for the next new thing I really wanted to do.

I call my technique the “four piles” method; it is self-invented, as far as I know, and here is how it goes.


Make a list of EVERYTHING you do/are responsible for: work, family, personal, volunteer, other. Write it down! Sit on it for a week or two, come back to it, add to it as you move through your day. When you believe it is pretty much complete, block an hour on your calendar for step two.


Put each item on your list into one of the “four piles” categories:

Pile #1
Things I love and I get paid to do.

Pile #2
Things I love and I do not get paid to do.

Pile #3
Things I do not love and I get paid to do.

Pile #4
Things I do not love and I do not get paid to do.

You will find that some things are very easy to sort. For me, practicing family medicine in Plainville and my work as a medical director for Aledade both fall quickly into Pile #1, my family into Pile #2. Some things are harder: they may be in a state of transition (will I love this again when it changes next month?) or I may have ambiguous emotions (I used to really like this, do I still love it now?). Once you have everything sorted, take another day or two to let it all “gel” in your brain and heart. Don’t be afraid to move things back and forth between piles until it feels right each time you revisit your list.


Make decisions and move forward. This, of course, is the longest and hardest part of the process. When done right, you will be eliminating things from your life, and that can be painful, even if you don’t like doing them anymore! Anxiety about passing work (and control) to someone else and guilt over saying goodbye to a great organization that no longer aligns with current goals and passion are common emotions for me during this step.

I find it helpful to evaluate the list in stages. First, put all of the items from the Pile #1 (do love + do get paid) on a “keep doing” list. Second, put all of the items from Pile #4 (do not love + do not get paid) on a “stop doing” list. Third, critically evaluate and sort the items from Pile #3 (do not love + do get paid) onto those same lists; I suggest asking the question “do I get paid enough to continue doing this?” as you work your way down the list. Finally, check the items on Pile #2 (do love + do not get paid) for any items you do not want to continue doing for free given the length of your “keep doing” list; if you find any, move those to the “stop doing” list and keep the rest.

Once you finish the decision-making process, it is important that there are enough things on the “stop doing” list that you have room in your life to 1) do all the things on your “keep doing” list, 2) say “yes” to some new things…and 3) breathe deeply every once in a while. If not, start step three over again and repeat until you can feel the balance returning to your world.

Finally, make a plan to close out the things on your “stop doing” list. Some things are a quick hand-off to another able person. Others require some staging: retiring from a board, finishing a term of office, notifying an employer or partner. The key is ensuring you have a plan for each item on the list and a timeline for stopping.

I find the need to repeat this process more frequently as I get further in my life and career; it’s time to do it again now so I can make space in my life to allow true and meaningful participation on the AAFP Board of Directors if I am elected. The good news is, it gets easier each time I walk through the steps. I feel confident in which pile items are placed, I am better at knowing when and how to say goodbye, and it is incredibly rewarding to pass along those projects I have helped grow to the next person ready to say “yes” in their own life.