This Resident Roundup post comes from Andrew Harris, MD, who is a PGY5 resident with the Department of Orthopaedic Surgery at Johns Hopkins Hospital.
Work-life balance in residency often feels like a moving target—something we are encouraged to strive for, and yet are rarely given a clear roadmap to achieve. Early in training, I assumed there might be a hidden method: a better calendar system, a more efficient study schedule, or simply learning to “let things go.” However, I have come to realize there is no universal trick—just patterns, habits, and deliberate choices that either create structure or lead to disorganization.
A concept that helped me make sense of this is the “Flywheel Effect,” described by Jim Collins in his book Good to Great1. The idea is simple: small, repeated efforts may seem insignificant at first, but over time, they build momentum. Eventually, the wheel turns more easily. Residency is similar. The tasks may feel repetitive and even burdensome—reviewing anatomy, planning cases, logging cases—but when done consistently, they create forward motion. Waiting for the pressure to ease before starting usually means it never does. Instead, it is that steady input, applied early and often, that ultimately preserves both performance and well-being.
Residency has taught me that balance is not something passively discovered—it is something constructed through consistency. The old adage that “it is a marathon, not a sprint” may be overused, but it captures a core truth. The routines that feel mundane are the same ones that preserve mental clarity and prevent burnout. And more than anything, they feed the flywheel.
Don’t get me wrong; during some rotations, I remained organized and proactive, while during others, particularly during chief year, I fell behind. The difference was not just in how I performed, but in how I felt. When behind, even time off was not restorative. The flywheel, once slowed, takes effort to get moving again. And without consistency, that effort becomes harder to summon. As a chief resident, I was responsible for overseeing our residency education curriculum, and I learned this firsthand. When I stayed ahead on scheduling lectures, preparing materials, and coordinating faculty, the system ran smoothly. But when I fell behind (often due to clinical demands), the backlog quickly snowballed, affecting not only the curriculum but also my ability to stay on top of clinical work, emails, and even basic personal organization. Regaining momentum required extra time and focus, reinforcing the importance of small, consistent efforts.
Another lesson I have learned is the importance of engaging fully with the training system at your institution. Across programs, we are working with the same core resources—textbooks, surgical principles, and shared expectations. While the structure of programs may vary, the overarching goal is built on the same core orthopaedic training principles. I have come to believe that resisting the system often creates more friction than simply buying in. For example, early in residency, I sometimes tried to customize my own study schedule or skip formal didactics in favor of independent reading. But over time, I found that aligning with the curriculum—attending the lectures, completing the recommended modules, and engaging in conference discussions—not only improved my retention but also reduced the cognitive overhead of planning everything myself. Full engagement, rather than searching for shortcuts, allows those repeated efforts to compound, rather than dissipate.
Now, in the final days of residency, I have been reflecting on these patterns. There are certainly things I could have done differently, but I believe that putting in steady effort over a long period of time has made a meaningful difference. I rarely felt ahead, but I also rarely felt overwhelmed. That margin came not from working harder at any one moment, but from keeping the wheel turning.
Andrew Harris, MD
Interested in being published on the JBJS OrthoBuzz blog? Residents and other trainees are invited to submit a post to Resident Roundup. Share your experience, connect with others in orthopaedic training, and add your viewpoint to the orthopaedic conversation. Find out more here. Questions and submissions can be sent to: orthobuzz@jbjs.org
Previous posts:
Reach Out to Your Fellows and Short-Term Trainees Early and Often!
A Year of Growth and Gratitude at Rady Children’s Hospital, San Diego
References
- Collins, J. Good to Great: Why Some Companies Make the Leap…And Others Don’t. Harper Business; 2001.
