Strategies for the Dual-Physician Family

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Nearly half of all physicians are married to physicians, and those numbers are expected to rise. The good news is that dual-physician couples are less likely to divorce, but they face unique career and family experiences. In this JAMA Viewpoint, Lauren Ferrante, MD, MHS1 and Lona Mody, MD, MSc2,3 discuss the special challenges these couples face, and what strategies they can implement to find balance.

Professional

Dual-physician couples encounter unique hurdles in their professional lives, negotiating 2 demanding careers and often multiple career transitions through stages of training. Because many dual-physician couples meet in medical school, the stress of decision making as a couple often begins with the residency match. In 1984, the National Resident Matching Program instituted “couples matching,” which allows couples to submit rank order lists that are treated as a unit. In 2018, 1165 couples (2330 applicants) participated in the program and 1082 pairs (95.8 percent) matched.4 The couples match rate was similar to the match rate for the remainder of the applicant pool (96.1 percent), suggesting that these applicants are not at a disadvantage compared with other applicants. However, these percentages do not reflect whether 1 or both partners received a less desirable program as a consequence of couples matching. After residency, many fellowships offer opportunities for couples matching, but one of the partners may not be in the same year or stage of training. This mismatch can result in couples living apart as they complete their training or in staggering different parts of training.

Finding jobs after training can be difficult because ideal positions for each partner may not align geographically. Moreover, moving after a short time in a new position is not optimal in academia or in private practice. In academia, launching a career as a physician-scientist or a clinician-educator requires an infrastructure for mentorship and career development, and it can be difficult to move this infrastructure between institutions. In private practice, newly hired physicians are often expected to “put in their time” as associates for a given number of years before they become partners, and moving would require the physician to repeat the cycle in a new location. The job search for dual-academic physician couples can be equally challenging if the steps of the job search are not aligned. Institutions may also have to proactively manage conflicts of interest that may occur if a faculty member is hired into a supervisory role over their partner.

Personal

Just as difficult as navigating professional challenges are the personal challenges confronting dual-physician couples. The critical early years of a physician's career often overlap with peak childbearing years, and both partners must focus on balancing childcare duties with work-related responsibilities. Many employers still schedule early morning or evening meetings that can conflict with childcare and other obligations at home. As professional and family responsibilities increase and accumulate, it takes effort to prioritize time alone, even though this time is essential to preserving the couple's relationship.

Although domestic tasks have increasingly fallen on both genders, studies suggest they are often not equally divided. Among early career physician-scientist recipients of National Institutes of Health K08 or K23 awards from 2006 through 2009, women with children spent substantially more time on domestic activities than their male counterparts and were more likely to take time off for childcare responsibilities. Additionally, a national study of nearly 10 000 dual-physician couples from 2000 to 2015 in the United States found that female physicians with children contributed substantially fewer hours at work than male physicians.

Although both studies had a number of limitations, including reliance on self-report and inability to adjust for physician specialty, they have important hypothesis-generating implications. Are female physicians reducing hours after having children in response to societal norms and pressures, or because trying to juggle 2 full-time physician careers and young children is leading to burnout? Are there internal relationship pressures over childcare duties? Or could the latter study's findings be a positive, whereby the reduction in hours is a sign of female physician empowerment and employer accommodation? Even with a desired reduction in work hours, new parents of both genders must be careful not to lose out on career opportunities that could influence their future career trajectories.

Practical Strategies to Achieve Work-Life Balance in Dual-Physician Relationships

Strategies at the System and Institutional Level

  • Couples match (training years) allows 2 applicants to link their rank order lists
  • Tandem recruiting (faculty years), such that both hiring units or departments synchronously engage in the recruiting process so that both partners feel equally valued
  • Parental leave policies for both parents
  • On-site childcare with extended hours; subsidized program to care for sick children
  • Financial advising resources

Adaptive Strategies at the Individual Level

  • Strive to have the best résumé by optimizing rotations, scores on standardized tests
  • Assess whether being accepted into a specific program or going to a specific geographical location is more important; cast a wide net during the application process; identify role models
  • Seek out peer-to-peer support for information on professional assistance with domestic tasks as well as information pertaining to cultural and recreational activities outside work
  • Time management and open communication regarding career aspirations, goals, philosophy, and plans to raise a family are important
  • Be proactive in the coordination of work, on-call, childcare, professional meetings, and holiday schedules

The full JAMA Viewpoint with citations and more information on professional and personal strategies to manage dual physician relationships is available here.

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