The Arithmetic of Staying
Series: Calendar of Your Own · Episode 12 · Pillar 1: Work Life Balance
By Rod Gamble | Week 39, 2026 | Pillar 1: Work Life Balance
For years I told myself I couldn’t step back, because the need was too great — and I never once sat down and did the arithmetic.
It sounds like humility when you say it out loud. It isn’t. It is a way of avoiding a calculation you are afraid to see the answer to. When I finally did the sum, the answer was not that the need was smaller than I believed — it was every bit as large as it felt. The answer was that my extra hours were not touching it.
The Argument That Never Ends
Every so often the same argument surfaces in our professions. Younger clinicians say they want a life alongside the work; more senior ones reply that this was never a job with balance in it. Both sides are arguing about character — who is soft and who is serious — which is exactly why it never resolves. You cannot settle a question about character with evidence, and the rota does not move an inch while you try.
The measurable part, meanwhile, has already shifted — just not in the way anyone hoped. NHS Employers reported in March 2026 that 71.75% of NHS staff say they can approach their immediate manager to talk openly about flexible working, up nearly five points since 2021. Yet fewer than six in ten say they achieve a good balance between working life and home life. Permission to have the conversation went up; the outcome did not follow. So if you have been filing this under personal failure — you are not failing to ask. You are asking, and being told the rota does not allow it.
The Sum a Doctor Did
The most useful thing I have read on this in a long time was not written by a coach. A physician posted it on a public forum for doctors, describing a practice in an underserved area where new patients were booking more than a year out and the waiting list was approaching two thousand people:
“I could work more hours and make more money and see more patients, but it wouldn’t even make a dent in the need and I would eventually burn out. I’d rather find something sustainable.”
Notice what is missing. No vocation. No self-care. No talk of balance at all. He did not give himself permission by deciding that he mattered — the move every wellbeing article asks for, and the one burned-out clinicians almost never manage. He gave himself permission by doing the sum and noticing that it does not work.
Once you look for that arithmetic it turns up everywhere, and the cleanest example I have seen this year comes from allied health. In the 2024 ASHA schools survey the national median monthly caseload for school-based speech and language therapists was fifty students. The clinicians themselves put the number at which they could deliver quality services without undue strain at forty. That is the whole crisis stated as a gap of ten. The same source puts indirect work — reports, notes, billing — at ten to fifteen extra hours a week, in settings demanding 75–85% direct patient contact. There is no window left, so it becomes an unpaid second shift at home. Nurses know that shape by another name; so do doctors, in an inbox nobody counts as work.
Thirty Days in a Row
I know how long this sum takes, because I avoided it for years. While I was finishing a master’s in computer science and working agency shifts around Long Beach, I once worked thirty consecutive days of twelve-hour shifts. Nobody ordered me to. Every one was a yes I gave, one at a time, to a unit that was short and to colleagues I did not want to leave carrying it. By the end I was fogged in a way I had never experienced — not tired, tired is Tuesday, but slower: reading the same line three times, driving home with no memory of the road. And I would have described myself, at the time, as coping.
What changed it was not rest. It was a sentence. A nurse I had worked with had moved into consulting, and when I told her what the month had looked like she said, almost in passing, that there is no such thing as an emergency in consulting. She did not mean the work does not matter. She meant that the permanent state of emergency I was living inside belonged to the setting, not to me — and settings can be changed. The nurse in me did not go anywhere when I eventually moved; he simply started working at a different magnification.
What the Sum Doesn’t Touch
Be ready for this part, because it caught me out: the arithmetic dissolves one guilt and leaves another completely intact. The physician who worked out that more hours would not dent the waiting list admitted, a paragraph later, that he still works while sick — not for the patients, but because he will not burden his staff with the rescheduling. A nurse on a public nursing forum put the other half of it bluntly: “I refuse to be a martyr for this profession.” You only say that out loud because the pull is real.
Two wounds, two treatments. Patient guilt yields to arithmetic. Colleague guilt does not, because it was never about scale — it is about the person who has to cover you. So name it accurately instead: if your absence causes a crisis, the rota was already in crisis and your presence was the mitigation. You were the buffer. That is a staffing design problem, and it is not yours to solve with your evenings.
Some of us should stay in the hospital, and some of us should move into digital health. I am not going to tell you which — that is not a decision anyone should make for you, and I do not stand outside it. But I would like us to make it on the numbers rather than on who feels guiltiest.
Steps You Can Take Now
None of these requires you to resign this week. All four are sums you can run on the back of a handover sheet.
1. Do the dent sum. Set the extra you give — stayed-late hours, swapped shifts, notes finished at home — against the size of the need it is aimed at: the waiting list, the caseload, the vacancy rate. Be honest about whether your extra moves that number. For most of us it does not, and seeing that on paper is the cleanest permission you will ever get.
2. Find your doable number. The speech and language therapists did something every profession should copy: they said out loud the caseload at which the work becomes deliverable. Write down yours — patients per shift, cases per list, hours of documentation. Now you have a figure to negotiate with instead of a feeling to apologise for.
3. Count the invisible hours. For one week, log the work that happens outside the paid shift — inbox, notes, calls, the reading the rota assumes you will do somewhere. That total is your second shift, and it is usually fixed by changing the setting rather than the person.
4. Separate the two guilts, then take one step. Answer them differently — arithmetic for the patient guilt, staffing design for the colleague guilt — then take one step toward work whose sum adds up: a conversation, a skill, an application. Digital health is not the only door, but it is a wide one and no longer fringe: ZipRecruiter put the average US salary for a remote informatics nurse at $98,409 in July 2026. That is a job-board aggregate, so read it as proof the roles exist in volume, not as a promise about your pay.
Flexibility, remote work and work-life integration are not soft goals in HR language. They are what it looks like when the arithmetic of a job finally works. You are allowed to want a job whose sum adds up.
When you’re ready to talk, rodgamble.com is where to find me.
References
1. NHS Employers. “NHS Staff Survey 2025: flexible working overview” (12 March 2026). https://www.nhsemployers.org/articles/nhs-staff-survey-2025-flexible-working-overview
2. NHS Employers. “NHS Staff Survey results 2025.” https://www.nhsemployers.org/news/nhs-staff-survey-results-2025
3. Personnel Today. “NHS staff survey reveals stability, not improvement.” https://www.personneltoday.com/hr/nhs-staff-survey-reveals-stability-not-improvement/
4. SpeechPathology.org. “SLP Burnout After Graduation” (published 27 July 2026, updated 18 August 2026) — source for the ASHA 2024 schools survey caseload figures, indirect-service hours and productivity standards. https://www.speechpathology.org/articles/slp-burnout-after-graduation/
5. British Medical Association. “A life outside” — less-than-full-time training trends (data to 2022). https://www.bma.org.uk/news-and-opinion/a-life-outside
6. Student Doctor Network forum thread, “Young Doctors Want Work-Life Balance. Older Doctors Say That’s Not the Job” (from 15 November 2024) — source of the quoted physician. https://forums.studentdoctor.net/threads/young-doctors-want-work-life-balance-older-doctors-say-thats-not-the-job.1502384/
7. allnurses forum thread, “Leaving Bedside Nursing” (April 2016) — source of the quoted nurse. https://allnurses.com/leaving-bedside-nursing-t610718/
8. ZipRecruiter, “Remote Informatics Nurse” salary data (10 July 2026), and Glassdoor remote clinical informatics listings (August 2026). https://www.ziprecruiter.com/Jobs/Remote-Informatics-Nurse
