In Balance: A Family Affair

Mark Weadon doesn’t remember his father playing a lot of ball with him in the backyard when he was a kid, or many meals with the whole family around the table. He never saw his father putzing around the house on Saturday mornings because Dad, the only neurosurgeon in the Western Michigan area for a quarter century, always worked that day.

What he does remember, though - many times - is being stopped by people who would ask if he were Dr. Weadon’s son. “And they would say, ‘Oh, he saved my son’s life, or my daughter’s life.’ That’s an amazing thing to hear about your father,” Weadon says. “I was and I am very proud.”

Dave Gertler is proud, too, of his wife, Sue Kost - an emergency physician in Wilmington, Del. “I can’t tell you how many times people have come up and said, ‘Oh, [Dr. Kost] sewed up my son,’” he says. “There are worse things than strangers fawning over your wife.”

Still, it isn’t easy for physicians’ spouses and children. What do they have to say about it? And what can you do to make sure the time you have with your family is as good as it can - and needs - to be? Here are some solutions from some of those who know firsthand.

Not just any family

Medical families live in a different world: They deal with inconvenient physician call schedules. They tiptoe around during the day because Mommy put in a 12-hour shift last night. They reschedule Christmas. But what choice do they have? “For other people a bad day at work is you didn’t get a report in on time,” says Gertler. “For [my wife], it can be a child dies.”

Elaine Hale, wife of retired family physician Steve Hale, agrees. “It doesn’t sound quite as noble to say ‘signing contracts,’ instead of ‘saving a life.’” But the privilege of using such goose bump-evoking language doesn’t come free. “We learn right from the start that your family life takes a second priority to the needs of the patient,” she says.

Indeed, as difficult as it is to stay married in the U.S. today, it’s even harder for medical couples.

Some experts estimate the divorce rate for physicians to be 10 percent to 20 percent higher than the general population. Psychiatrists’ and surgeons’ marriages are at particular risk compared to other specialties, reports the landmark Johns Hopkins Precursors Study, which tracked 1,248 subjects who graduated from The Johns Hopkins University School of Medicine (between 1944 through 1960) for 30 years.

So understanding and embracing what you’re getting into is key for medical marriages, on both sides. You don’t want to isolate, ignore, pass over, or dump on your nonphysician spouse. And your spouse must accept that being married to a doctor means being truly flexible about plans; buried resentment won’t stay that way. You both have all the normal challenges of keeping your marriage together, plus the extra impact of your career choice.

How to do this? Be “intentional” about your marriage, says Miranda Horton, an internist who lives with her hospitalist-husband, Kyle, in Greenville, S.C. Seven years post-knot-tying - which occurred before graduation from medical school - the two realized that “all we were doing was going to work and coming home,” she says. Luckily, they’ve now learned to focus more on each other and the state of their marriage. They resist the temptation “to just go to sleep,” says Miranda Horton. Date nights stay as sacrosanct as possible, given the uncertainties of a physician’s job description.

The two struggle to make their schedules coordinate - difficult, she says, but they manage at least one weekend a month to spend together. Because they are both physicians, their challenge is perhaps greater than a one-physician marriage.

Then again, there are actually some advantages to marrying one of your own “kind.” Horton says, “When he calls and he says ‘I’m running late,’ I understand what that means; I’ve reciprocated. … He is a great cheerleader for me, and me for him. We understand the long work hours and how emotionally draining it is.”

A double-edged sword

Your being a physician certainly does have its perks for your family, too. Gertler is a stay-at-home dad, largely due to Sue Kost’s comfortable salary. He’s very grateful for the opportunity to spend so much time with their three kids, who are in ninth, sixth, and first grade.

He’s also appreciative of his wife’s diagnostic abilities. “I don’t have to know anything about medicine myself and my children are in very good hands,” says Gertler. “It’s a real load off my mind, if my kids get up in the middle of the night.” When their 2-year-old fell off the swing set, Dr. Kost heard the cry and calmly surmised, “Hmm, sounds like she broke her leg.” And off to the emergency room they went for X-rays and a cast. No panicking.

Your medical skills also give your kids something to look up to, in addition to the obvious practical benefits. Even very young children sense the singular aura of a physician. Gertler says his first-grader “gets it” that sometimes kids get sick unexpectedly, and that Mom might have to leave a birthday party to help out. You’re a walking inspiration; never doubt that.

Make sure you walk on the right side of the line between inspiration and pressure, though. It’s natural to hope your offspring will choose your career choice as their own; that may or may not happen.

Weadon did not; instead, he became a meteorologist. “I think [my father] would’ve been very proud if I had [gone into medicine],” says Weadon. “But he never expected me to.”

A fragile balance

Hopefully, your family is doing its part to accept your occupation with all its hazards. You must also return the favor, however, as best you can. Don’t succumb to the temptation of letting work rule your life unnecessarily. Specifically:

Keep work at work. Who hasn’t come home in a foul mood at times because of something annoying happening at work? A key employee unexpectedly quits. A higher-up habitually interrupts and wags her finger insultingly in your face while lecturing. And let’s not forget the public (who doesn’t feel good, in your case, making them even crabbier) and all the bad manners it can dish out.

Even the more dire issues, such as fighting to collect from payers, the threat of malpractice suits, the inevitable medical error - all weigh you down understandably. It’s all important, no argument there, but your kids can only love you, so be lovable. To them you’re Mommy or Daddy, not Doctor. When your foot crosses the threshold, assume the role of parent.

“Try to compartmentalize it,” says Weadon. “There’s work and there’s home. Even though emergencies can dictate, there are things you can control. Try to leave work and be a [parent] to the extent that you can.”

Not that you can’t capitalize on “teachable moments” that relate to your job. Weadon was well-apprised while growing up of the heinous nature of head injuries caused by motorcycle crashes. “A surgeon in my dad’s profession was called in at all hours, often in the middle of the night,” he says. This made a big impression on Weadon.

But when your tweener daughter meets you at the door, bubbling over with important news - Sarah told Billy that Shannon heard Adrian tell Carla that Derek likes her! - give her your full attention (even if you can’t follow the sentence). Resist sneaking peeks at your cell phone or uttering automatic “uh-huhs.” Nobody’s denying you have a uniquely important position in society. But your 6-year-old will think you’re a superhero if you challenge him to a third game of Sorry! to settle once and for all who is the supreme champion of the evening.

Confide in your spouse. This may sound a bit paradoxical, but if something bad does happen at work, discuss it. Your spouse promised to cleave to you, for better or for worse; take advantage of this avowed gift. “Even when she’s home at a regular time and doesn’t need to be napping, there can be tense times because of the nature of her work; it’s draining,” says Gertler of his pediatrician wife. “On days like that she really needs a lot of moral support. I’ve learned not to pry too much, unless she wants to talk about it.
… I let her decide what to do with it.”

But why leave your spouse to guess? Tell them, clearly and succinctly, during a noncrisis moment, what you need and how you need it when things go badly at work. Need to stew a couple hours and then talk about things over a bottle of wine? Fine. Or maybe a good long walk with your husband and two dachshunds, while you open your stress vent to relieve the pressure, works better for you? Great. Any (legal and safe) method is fine. Just make sure you share your ups and downs with your spouse. Don’t think you don’t need this, that “strong and silent” is better for your family.

Make adjustments when needed. Someday, you may have to make changes in the way you work for the good of your family. For example, when Elaine Hale was diagnosed with serious kidney disease halfway through rearing the kids in Orlando, her physician-husband closed his practice and took a job with the county. “He found something that allowed him to be more connected to home,” says Elaine Hale, for which she has always been grateful. “We’ve both given and taken over the years.”

Sue Kost made some changes for the sake of family life, too. Sick of missing so many of the kids’ activities, she now splits her time between the emergency room and supervising the day-medicine program at the hospital.

Even the Hortons, who have no children yet, have shaped their careers to fit their future family. Miranda Horton says she truly wanted to be an internist, but she also chose it because “it’s a good choice for making a two-doctor family work.” Indeed, she works Monday through Friday, and does no admitting. Kyle Horton, although currently a hospitalist, plans to specialize in endocrinology, which Miranda Horton likes because call will be rare or nonexistent.

Try to stay flexible and open-minded with your work arrangements. Eighty percent of the nonphysician spouses in one-physician couples also work. Certainly, their careers matter, too. The more you two can work as a team in support of common familial goals, rather than two people on parallel career tracks, the better.

So no, being a medical family is not easy. You might miss seeing your son finally score his first soccer goal, or your husband graduate with his MBA. Every time something like that happens, you’ll probably feel guilty. Who wouldn’t? But rest assured, if you’re doing all you can to be mindfully present when you’re with your children and spouse, they’ll know it.

“If I mention that Mom won’t be here for dinner, there’s moaning and groaning, but we deal,” says Gertler. And it’s OK, he says. “[Doctors] should know that even though their hours or specialty can put a burden on the family, we admire and support the work that they do. They’re being a part of the family and the community in the best way they can.”

Elaine Hale concurs. “You actually admire that about your spouse, that he puts other people first, including [before] himself,” she says. Maintaining this perspective has everything to do with home life staying sweet.

Shirley Grace, senior writer for Physicians Practice, holds an MA in nonfiction writing from The Johns Hopkins University. Her articles have appeared in numerous publications, including The Washington Post and Notre Dame Business magazine. She can be reached at sgrace@physicianspractice.com.

This article originally appeared in the February 2008 issue of Physicians Practice.