American College of Physicians: Internal Medicine — Doctors for Adults ®


Dual-doctor couples learn to make time for each other

While juggling the demands of career and children, many physicians pay too little attention to their spouse

From the July-August ACP Observer, copyright 2004 by the American College of Physicians.

By Janet Colwell

NEW ORLEANS—Cardiologist Brian H. Asbill, MD, comes home tired every day from his busy practice. His wife, Sarah K. Warren, ACP Member, has spent part of her day seeing patients as a general internist and the rest chasing after the couple's two-year-old son. They're both ready to spend some quiet time together, but they often don't get a chance to do so.

"Being married to a physician means you are going to have a spouse who works an extraordinary amount," Dr. Warren said. "But relationships, like medical careers, require serious commitment to succeed."

Finding time for yourself and your spouse is a dilemma many dual-career couples face. As they juggle competing pressures to be good doctors and parents, physicians too often find themselves paying the least amount of attention to the most important person in their life: their spouse.

But a marriage neglected for too long, Dr. Asbill said, will run into trouble. He and Dr. Warren shared some strategies that work for them at an Annual Session panel presentation, "Dual-Career Couples: Keeping the Vital Signs of Your Career and Relationship Healthy." They were joined by psychiatrist Michael F. Myers, MD, a clinical professor at Vancouver's University of British Columbia, who specializes in counseling physicians.

Putting the relationship first

Many professional couples suffer from the "psychology of postponement," Dr. Myers said. "There is a tendency to put off issues because of the demands of training, practice, lack of time and financial constraints." The result? "A severe erosion of intimacy, trust and hope in the relationship."

Panel members listed some disturbing statistics: Almost 50% of first marriages end in separation or divorce during the first 15 years, while less than half of all married couples in one survey claimed their relationship was happy.

Bruising workloads are a big part of the problem, panelists said: In this country, 25% of men and 8% of women work more than 50 hours a week. With half of all women physicians married to other physicians and 95% of their spouses working outside the home, physicians are especially prone to work-family conflicts.

According to Dr. Warren, making time for a spouse often sits at the bottom of busy physicians' priority lists. Crammed schedules, childcare duties and household chores often push the couple's relationship into the background. In today's society, that "is not considered dysfunctional," she pointed out. "It is the new 'normal.'"

Dr. Myers agreed that physicians must make relationships a conscious priority, one that is at least as important as their career. That message resonated with many members of the audience, who said they struggled to find the right work-marriage mix.

One physician said that after two years of marriage, he and his physician wife ended up working drastically different schedules—and sleeping in separate rooms.

They solved those problems by making dramatic career changes. He now works every other week as a hospitalist, spending his weeks off caring for their child, while she cut back to working only three days a week as a general internist.

"I decided that our life was first, the job second," the physician said. "Internists preach to patients all day to take care of themselves, but we don't do it ourselves."

The childcare challenge

According to Dr. Warren, making childcare arrangements can be tough, given physicians' long and irregular hours.

Securing suitable childcare is especially challenging during an emergency, such as when a child is sick. One physician in the audience said that he and his wife each take a half-day off when their child is ill, so that neither misses a full day of seeing patients. Others said they call on relatives or make advance arrangements with agencies that provide emergency care.

Dividing household chores can be another source of tension. If one spouse starts working only part time—typically the woman in the relationship—she often takes on a greater share of those duties. Many women say they find themselves busier than when they worked full-time because of the combined demands of home, children and work. At the same time, her spouse may expect to see his household responsibilities reduced, now that his wife has "more time" at home.

Drs. Warren and Asbill said they've solved this problem by hiring yard and cleaning services. The extra expense is worth it, Dr. Asbill said, to gain more time together.

"We used to spend all our time cleaning and doing yard work on weekends," he said. "But we've learned to make more planned time for each other."

That includes separating couple time and family time, he added. Dr. Myers pointed out that it's easy to focus on children instead of making time for yourselves—which can lead to couples relating to each another as "co-parents," not husband and wife. To counteract the constant demands of parenting, he said, schedule "dates" with each other at least twice a month.

Finding a balance

Drs. Asbill and Warren said they have also been careful to choose family-friendly work arrangements. Dr. Asbill, for example, is on call only once a month on weekends and twice a month on weeknights, getting home most nights by about 6 p.m.

Drs. Warren and Asbill say they make time for their marriage by hiring help around the house and taking mini-vacations together during the year.

And to make their weeknights go more smoothly, they each take turns tending to their son so that the other gets some personal time to spend alone. They also spread out their vacation time, taking mini-vacations together over the course of the year instead of one long trip.

Some physicians worry that working toward that kind of balance will hurt their careers, Dr. Myers said. Indeed, striving for a "balanced life" is still viewed as a career liability in some workplaces.

On the other hand, he pointed out, some physicians use work as an excuse to avoid confronting personal problems—and feel relieved when their pager goes off in the middle of an argument.

The good news is that the culture of medicine is gradually changing to accommodate the modern reality of dual-career couples, he said. People are beginning to realize that there are profound costs to investing all your energy in a career—at the expense of your marriage.


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