It Takes Two

When couples marry, they promise each other it'll be "for better or for worse." But when one or both of them is a physician, by the very nature of the profession, they generally face greater obstacles to keeping that promise than other couples. Long working hours and high performance expectations can lead to stress, resentment, and lack of time together, making the "worse" seem to outweigh the "better."

"The work-family juggling act faced by medical families is formidable," says Wayne Sotile, PhD, a researcher, consultant, and co-author of numerous books, including The Medical Marriage: Sustaining Healthy Relationships for Physicians and Their Families. "Three times more physicians work 60-plus hours per week than any other profession. We all know some hard-working fill-in-the-blank -- engineer, psychologist, whatever. But bear in mind that part-time work in medicine is 35 hours a week, not to mention that the context of physician work is more extraordinary than other professions."

To illustrate, Kay Durairaj, Los Angeles-based head and neck surgeon and mother of 4-year-old twins and an 18-month-old, describes her typical day: "There's not a single day that goes by that I don't bring work home. When I get home I try to put my work aside so I can take care of the kids. They get dinner and we play. Once they're asleep, it's my next shift of work. We sit down and go through the mail, pay bills. On top of that I have my dictation to do and various things from work."

Durairaj's husband is an interventional cardiologist in an academic practice. "He leaves early and is often late because he has to go in for pretty much every acute MI. He teaches the fellows, and there are a lot of academic events and research," she says. "When he gets home he has to do his dictation. He's also doing talks and lectures ... so we do a lot of stuff."

While their lifestyle may sound all too familiar, the couple -- and others like them -- have found ways to keep their marriages and families together and still maintain their passion for medicine. They all admit it's hard work, which is something they clearly relish.

Setting boundaries

Sotile reports that, in his experience counseling physicians and their spouses, the changing dynamic of practicing medicine is partly to blame for the stress in their relationships. What disillusions physicians today, he says, "is the complicated organizational dynamic they've got to run in order to pay their electric bills. They have to be managers of complicated businesses and developers of complex group dynamics even in a small private practice."

Sotile points out that the skills that make a successful physician often don't transfer to making a successful relationship, so be aware of bringing those burdens of the office home. "Skills like being perfectionistic, being hypervigilant, being an expert multitasker -- all of those things are survival skills in the practice of medicine. But any one of those things will wreak havoc in a relationship. You have to learn ... when to leave them in the trunk of your car."

Nancy Ryan Lowitt, MD, says she and her dermatologist husband began setting boundaries between work and home early in their relationship. "My husband and I met as residents, at a time when the work commitment can be overwhelming. We put limits up then; one was not to talk about work when we got home," says Lowitt, who is associate dean for GME/CME at the University of Maryland School of Medicine and an attending physician at the VA Medical Center in Baltimore.

But what to do, besides talk (or think) about work? Sotile suggests "multiple experiences of brief contact in which you are fully present and engaged with the other person, be it your child, your spouse, whoever it is. That might translate into 'I turn the TV off for 10 minutes and truly listen.' This is not a lesson in manners, or a lesson to my spouse about how he or she is running her life."

Still, Sotile cautions physicians not to chase what he describes as the myth of the balanced life. "It's not true that everybody leaves their work at the office, comes home, and tunes in to their family. Don't feel guilty if you're not doing that -- 85 percent of us still have some other sort of work to do when we get home. But the ones that are happy in their family life take time to connect with each family member, however briefly."

Durairaj admits that finding the time and energy to do that is difficult, but imperative. "It's important to spend time together, but it takes a lot of effort to actually go out and do it. If we do get a free moment, we're so tired we don't want to do anything. But once you do go out, it puts you in a good frame of mind," she says.

When asked how he and his wife make time for each other, Chuck Cha, an Atlanta-area orthopedic surgeon who is married to a general surgeon, says simply, "We don't." He adds, "We just took our first trip together without the kids [two sons, ages 3 years and 10 months]. That was the first time we've taken any time for ourselves since the kids were born. The first few days it was just worrying about the kids and calling them. Once we realized they were doing OK, we could enjoy the last three days."

Who's on first?

Lack of time isn't the only potential trouble spot in the physician marriage. According to Sotile, "Two-doctor marriages see issues of fairness. Whose career is going to take precedence?" Physician couples agree it's an issue that demands discussion and consensus.

"My schedule is a little more flexible, but in terms of one career taking precedence, there are times when each one has to," says Lowitt. "For example, during months when one is on call, the other one has to be flexible. Then we look at [our schedules] half-day by half-day ... if one of the kids gets sick, who will go?"

Durairaj and Cha have approached the issue more deliberately. "One of the decisions I made early on was realizing we both can't work extremely hard, that there's no point to that," says Durairaj. "We don't want our kids raised by outsiders. I just made the decision that [my husband] is going to have this really difficult job and wants to do well in academics so I let him put his career first. I'm the mom and I should make more time for [the children]."

According to Cha, "We always knew that my career was going to take priority over hers. I was willing to do it the other way, hang out with the kids and be Mr. Mom. Actually when we were residents, I was pretty much primary caretaker of our first-born. Then when she got done, she decided she'd be the one to spend more time with the kids. She wanted to try to work full-time, but it was too much time away from the kids so she decided to tail back."

What about the kids?

It's no secret that women generally take primary responsibility for childcare, regardless of the parents' professions and work schedules. Even in medical marriages, says Sotile, "80 percent to 85 percent of the time, a woman physician is assuming the lion's share of responsibility for home and hearth," based on results of a survey on two-physician marriages published in the Annals of Internal Medicine in the late 1990s.

The caveat is this: Children's perceptions of how their parents interact and deal with the special circumstances of physician life will affect how they adapt to that life.

"Children respond to the special challenges of growing up in a medical family either with a tremendous amount of pride, or feeling a strange sense of shame that they don't understand," explains Sotile. "The determining factor is how the parents conceptualize the sacrifices they have to make. Kids are going to be taught how to feel about the other parent based on your reaction. So the spouse who says, 'Of course Daddy's not here, he's delivering some other family's baby' is going to shape an abhorrence of medicine. You've got to make it a family affair to be proud to be a medical family."

Lots of physicians, in fact, have grown up in medical families with good results. The Lowitts, for example, knew it was important to have realistic expectations for themselves and to involve their children in their day whenever possible.

"My dad was a surgeon, mom worked at home," says Lowitt. "I decided if I wanted to do both, I would have to scale back my expectations in both areas." When they bring work home in the evenings, they make it a family affair by doing it while the children, ages 6, 9, and 12, tackle their homework. And, says Lowitt, "They have seen our offices and where we work, so they understand it."

Durairaj and her husband also come from physician families, and she views it as a positive experience. "My mom and dad are doctors, and his mom and dad are doctors. Both of us had really good role models. We grew up in this culture of medicine and being able to juggle things," she says. "My mom had four kids and did her residency and training. I never considered it to be a hindrance. We grew up feeling happy that my mom was working. It made us that more independent."

"If it's high on your list to have relationships with your children," says Sotile, "you have to know the details of their lives, and be creative about how you do that. If you have to videotape their dance recital or ball game instead of being there, make a big affair of watching it with them. Or write them a note telling them 'good morning' because you have to go off to surgery, or use your Daytimer to remind yourself of their friends' names. Use your skills to keep up with them in a playful, affectionate way."

In any medical family, there's no way to get around the fact that being a physician is going to have an impact on home and family life. Striking the right balance can be difficult, but it's not impossible.

"It's a wonderful life being married to another physician, and it's possible to have a rich family life," says Lowitt. "But you have to have awareness. Is each child happy, are we living how we want? You have to ask yourself these questions."

Joanne Tetrault, director of editorial services for Physicians Practice, can be reached at jtetrault@physicianspractice.com.

This article originally appeared in the June 2003 issue of Physicians Practice.