I spoke to the lead author, Dr. Neda Ratanawongsa, who now practices general internal medicine at San Francisco General Hospital and is an assistant professor at the University of California, San Francisco.

“It’s partly a coping mechanism,” Dr. Ratanawongsa said. “We tell ourselves that we can do everything but not at the same time, so we are going to put off the thing that defines us as a person  time with children, running a marathon, painting, playing music  in order to get trained because being a doctor is also rewarding.”

That delayed gratification works well initially because residents believe it is only temporary. “A lot of what matters to residents at this time is the sense that they are learning to care for patients well and growing as doctors. They feel that what they are doing is going to be worth it.”

But when the imbalance persists for longer than initially expected, professional growth is not enough to sustain most young doctors. “The ones who are happier,” Dr. Ratanawongsa observed, "are the ones who have held on to one or two things and have said, ‘I’m not just another resident. I play the guitar, I run races, or I go home to family.’ They don’t do these things to the same extent as they did before residency, but they do them enough to maintain a sense of self.”

Residents who don’t find this balance are at risk of burnout, clinical depression or, more commonly, subtle forms of stress. “These residents may feel that even if they can give excellent care most of the time, there are times when they snap at a patient or don’t order a test fast enough because they are so burnt out."

Although her study focused on doctors in training, Dr. Ratanawongsa sees the same challenges among doctors who have finished and are currently practicing. “There is always this expectation that at some point things will turn around. The interns say, ‘When I finish internship and become a second-year resident, things will get better.’ The residents say, ‘When I finish training, I will finally have balance again.’ And doctors in practice may believe that they will find more balance once they have retired.”

The danger is that physicians may end up leaving the work force or will become less effective caregivers. Dr. Ratanawongsa suggests that doctors learn how to create a better sense of balance in their lives from the moment they begin training. “We are taught to put our patients before ourselves; it’s in our charter of professionalism. I agree with that, but I also think there has to be some sense that I matter, too, at some point. If something important is going on with our loved ones or with ourselves, we need to be able to advocate for ourselves. And we need time to reflect on who we are and where we are going.”