Employing Your Spouse at Your Medical Practice

Minnesota dermatologist Charles Crutchfield and his wife have partnered in practice for 10 years. As a co-owner, Laurie Crutchfield directs the finances and marketing of their thriving clinic. Charles Crutchfield easily expresses gratitude for her expertise and attention to detail.

"I know very little about the ins and outs of the financial minutiae of the practice, and she knows little about how to treat patients, but together we make a terrific team," he says.

Still he concedes his own difficulty with giving clear and directive orders to his wife, as opposed to his other staff, explaining, "She picks and chooses what she wants to do."

Employing your spouse could result in problems ranging from minor aggravations to issues requiring major shifts in your medical practice and home. More variables are factored into your interactions with this particular employee. You're intimately acquainted with each other's strengths and weaknesses and that fact itself may be helpful or harmful.

Houston -based marriage counselor Julie Nise says, "If both people are demonstrating respect and care for each other's unique skills and talents, it can be a very nice way to spend the day."

But even partners who are the best of friends shouldn't expect bliss, at home or in the clinic. For example, Neil Kirschen, a New York-based anesthesiologist and pain management specialist, notes that friction can arise among other employees if he and his coworker wife are experiencing tension in their relationship.

"If either spouse is unable to put aside their ego for the common good, they could end up airing a lot of marital laundry in the office setting, which makes it very uncomfortable and unprofessional," says Nise, who has seen many physicians and co-business owners in her clinical counseling office.

There's something very special about conducting business alongside your life partner, though. Despite their occasional tensions, Kirschen still describes employing his wife as "the best business decision I ever made. And Charles Crutchfield, whose wife chooses which assigned task to take, waxes philosophically, "Fortunately, for the most part, we have the same goals in order, and the most important things get done."

Setting boundaries

Nise, who defines maturity as "the ability to manage frustration and frustrated desires alone and in a healthy way," says it takes a lot to subjugate one's personal interests in favor of the practice and/or the marriage, "but that is the only recipe that makes that situation work best."

If you and your spouse are work colleagues, you probably won't have the luxury of compartmentalizing your life. A little thinking outside the box and a solid effort at boundary setting are required.

For most adults, the person with whom you have a breakfast table tiff won't be at your workplace all day. Sharon Lockridge recalls a time early in her relationship with husband, Brian Lockridge, when the two worked side by side at a busy hospital, she as an emergency room technician and he as a flight nurse.

"We weren't seeing eye to eye and had to work together that day," she says. "It increased my frustration with the situation, being able to see him but unable to work the problem out." Sharon Lockridge adds that resulting tension affected the emotional weather at home that night. The couple no longer works in the same practice, but the lingering impact of those days was uniquely positive. "It gives us empathy for each other's hard days. We thoroughly understand where each other comes from when we have tough situations at work."

Nise says the key for these necessarily fluid relationships is clear boundaries, with expectations set up in advance. She advises, "Revisit your expectations along the way, making sure issues get addressed and handled when they are small. Direct, straightforward discussions about who does what and the processes of the office need to be completely understood and agreed upon, as with any business venture or partnership."

Nise explains that in these relationships, there is a third entity in both the marital and the business setting. "Both entities require that the individuals put aside their personal needs for the good of the third entity. In a spousal relationship the marriage itself is the third entity to consider, protect and nurture first, and in the work relationship, it is the business."

Staff boundaries, too, must be brought into the light of discussion. Neil Kirschen, who collaborates with his acupuncturist wife, Patricia, at Pain Management Center of Long Island, says it's important that the spouse be willing to adhere to the same policies and procedures as other staff, depending on his/her position in the practice. In addition to seeing patients, Patricia Kirschen maintains greater vigilance, her husband says, over details that can facilitate a thriving practice, like office cleanliness and networking in the community. "Plus," he adds, "she makes sure I eat lunch and don't overwork."

Impact on your marriage

The day's events are likely to blend into the evening's conversations, which the physicians see as positively impacting their marriages and households.

"Not only do we have more interesting dinner conversations," says Neil Kirschen, "but we grow closer each year, instead of our interests diverging like so many couples' do."

Charles Crutchfield offers his take on leisure time chats: "We might talk about work items, even on weekends, but it doesn't consume all of our time - and at least there's someone right there who understands where I'm coming from and can provide answers, and vice versa."

For some married colleagues, familiarity may not breed contempt so much as boredom. Besides working together in their northern Ohio alternative health clinic, physician Bob DeMaria and wife, Debbie (who heads up all administrative aspects), travel often for business and pleasure and are "together all the time." It's the only downside the couple, who has worked together since 1978, can find to their situation. In fact, they don't think it's too bad at all. "It just means we hear the same stories, so we have to consciously expand our relationships with others, to bring diversity into our lives," Bob DeMaria says.

Impact on your practice

Having your best friend along for the ride can make developing a practice feel like an exciting adventure - as long as that friendship is tended well.

"The structure must never be rooted in competition or rivalry. Cultivate a genuine state of appreciation and gratitude for the important and valuable contributions each spouse brings to the smooth running of the office and good care of the patients," Nise says.

Patrice Streicher, a senior consultant for VISTA Physician Search and Consulting, says her experience as a recruiter has demonstrated that additional physicians on staff might feel like "a third wheel, with worries about the cohesiveness of the office environment if there are tensions between the couple." A teamwork perspective, Streicher says, is key to success. The entire professional group must view themselves as a team, rather than "us" versus "him and her." Facilitating this friendly, collegial atmosphere begins on day one by structuring policies and procedures that engage every individual.

For the additional team-building steps required by a practice with married partners, Streicher recommends, "Provide new professional staff with a sense of ownership - appoint them with management duties or a leadership role on projects that spark their passion."

Often, physicians' spouses will run the financial side of the operation, a role that demands high levels of trust and respect between partners. Charles Crutchfield relates a story about the financial and emotional benefits of having a spouse as co-owner. "Because it's her business too, she has an absolute and total devotion and interest in the success of the practice."

He recalls his wife spending hours trying to track a missing $3.75 out of petty cash. "She has to have everything balanced at the end of the day or she doesn't sleep right. Watching her suffer so, and my not being very attentive to detail, I said, 'Oh, you know what? I took that out of there for lunch today and forgot to tell anybody.' She looked at me and smiled and said, 'No you didn't. I know you're just trying to save me the time. I'll find it.' And by golly, an hour later, she found it."

Patients also reap rewards from the presence of married partners in a practice. Nise says, "From a patient's perspective, it seems more intimate, like you have the key people looking after you, both administratively and clinically. Plus, if the spouses are modeling maturity and respect toward one another, they become a wonderful role model for all their patients to copy."

If problems erupt

The stressors of the medical profession and the types of personalities that often go into the field add a complexity to the lives of married coworkers. Nise describes two points of particular impact:

The medical industry attracts people with caregiving personalities. Often these are people who have a hard time balancing caring for others with caring for themselves, sometimes at their own expense. The stress from that imbalance is reflected in personal relationships. So married, co-working medical staff in general might have an even tougher time than couples in non-caregiving, working arenas.

Plus, Nise points out another personality type found readily in the medical field. "Some emotionally immature physicians don't feel they should be accountable for their actions in relationships. They believe others should just 'go along with' whatever they want because they're the doctor, and somehow above reproach." It's easy, whether through hindsight or as an outside observer, to see the possibilities for marriage derailment in such scenarios. Resentment by the spouse seems naturally in order, and the relationship can quickly become strained.

Nise says simply that the marriage relationship must be protected and nurtured, even if that means the nonphysician spouse needs to seek employment elsewhere to reduce strain. Counseling can help couples focus on the big picture and problem resolution - rather than over-analyzing details "as most left-brained people tend to do." With commitment to making all facets of their lives successful, together, couples can work toward increased maturity levels - and a fulfilling life at home and in the office.

Tracy Morris is a freelance writer based in Houston, Texas. She's been a writer and editor for healthcare industry publications and websites, as well as a consulting writer for practices ranging from solo physicians to national corporate networks. She is also a member of the Association of Health Care Journalists. She can be reached via editor@physicianspractice.com.

This article originally appeared in the March 2012 issue of Physicians Practice.