Healthy Healthcare Marriages
Doctors have had a bad rap on the marriage front for a number of years. We’ve long been accused of having a much higher divorce rate than the general public. For many years, there was not a lot of data on healthcare marriages, but strongly held popular opinion characterized a high percentage of us as
By Autumn Dawn Galbreath, MD, MBA | September 15, 2016
“It turns out that there are, actually, documented cases of successful physician marriages.”
So begins an article by Sanjay Gupta, MD, physician and media reporter. Tongue-in-cheek though it may be, Gupta’s comment is a response to headlines like these:
Doctors have had a bad rap on the marriage front for a number of years. We’ve long been accused of having a much higher divorce rate than the general public. For many years, there was not a lot of data on healthcare marriages, but strongly held popular opinion characterized a high percentage of us as overworked divorcees whose devotion to our patients cost us our marriages. In fact, several articles I read quoted an old cartoon caption: “Show me a doctor whose wife is happy, and I’ll show you a man who’s neglecting his practice.” While the roles of doctor-husband and unhappy wife are reversed in half of healthcare marriages these days, the stereotype still holds: doctors must often care for patients to the detriment of their marriages.
As with all popular opinion, a kernel of truth is in the stereotype. Consider what makes a good doctor and how those qualities impact a marriage. Dedication to and empathy for patients, control in the face of crisis, perfectionism, attention to detail, confidence and decisiveness are qualities we all want in our physicians, but they are generally not qualities that build a healthy marriage. “Perfectionism, compulsiveness, workaholism, and an exaggerated sense of responsibility make us good doctors but problematic spouses. We need to be in control,” says psychiatrist Donald Rosen. “We’ve been trained to deal from strength with patients’ weaknesses, without revealing our own. This can make us play a parental rather than an adult-to-adult role in marriage, making intimacy difficult.”
But do these challenges truly create the bleak picture that is the stereotypical healthcare marriage? The long-held belief that doctors are bound for divorce in disproportionate numbers was never based on data. Ly and colleagues recognized this in 2015: “There are many reasons to question whether previous estimates of divorce among U.S. physicians are pertinent, given the limited sample sizes of most studies, the changes in demographics, work hours, and earnings among U.S. physicians, and the fact that overall divorce rates in the United States have fallen dramatically since the time of these studies (from 5.2 per 1,000 Americans in 1980 to 3.6 per 1,000 in 2011).”
Their response? Conduct a retrospective analysis of U.S. census data. The study had surprising results: physicians had a lower divorce prevalence (rate of ever having divorced) and divorce incidence (rate of divorcing within the prior year) than those of non-healthcare workers and several health professions. What?? How did conventional wisdom get this so wrong?
There are, of course, limitations to this single study. While it had a huge sample size, thereby overcoming the major limitation of prior studies on physician marriage, the census data was not able to differentiate among physician specialties. A prior study showed significant differences in divorce among medical specialties, perhaps identifying the driver of the common perception of physician marriages. In addition, this study could not estimate the prevalence of divorce among dual-physician couples because the occupation of the divorced physician’s ex-spouse could not be identified. This limitation is particularly important in light of the significant difference in divorce incidence and prevalence between male and female physicians. If, as this study shows, female physicians are significantly more likely to divorce, and if female physicians are more likely to be in a dual-physician marriage, divorce among dual-physician couples is an important topic for further investigation.
The most important limitation of this study, in my opinion, is that “divorce is an imperfect measure of marital satisfaction, the latter which (the study was) unable to directly assess.” Divorce is tragic. I once read that “each divorce is the death of a small civilization,” a poignant description of the far-reaching effects of divorce on many people beyond just the two ex-spouses. However, divorce does not occur without warning, divorce is not the entirety of the problem and divorce is not the best stage for intervention. Divorce is the result, not the cause, of the dissolution of a marriage. Just as a civilization is already dead—or at least terminally ill—when the government is overthrown, the marriage crumbles long before the parties divorce. So, while physician divorce rates are illuminating, the health of physician marriages is a much more useful thing to understand. When marriages are unhealthy, interventions can aid healing. When marriages are in their death throes, interventions are likely not to succeed.
Further understanding of marital satisfaction in physician marriages is important as a broad question. But the partners in each physician marriage already know the answer, at least as it relates to their own marriage. While additional research will assist in changes to the profession to improve work-life balance, individual physicians and spouses don’t need data to support the civilizations within their homes. They need resources to recognize problems, improve communication and increase the intimacy and vulnerability that can be inherently challenging for the typical physician’s personality. And as the data mounts on the long-term impacts of divorce on children, the urgency of intervention in troubled marriages increases.
Resources are available, and the reasons to access them are myriad. Counseling and therapy, both marital and personal, are effective tools, as is medication, when indicated. Supportive relationships with pastors, physicians and friends can encourage continued work toward a healthier marriage. Self-help books abound on the topic, as do marriage retreat weekends. And, as Christian physicians, CMDA’s Marriage Enrichment Weekends are available to us several times per year, with some specifically focusing on female physicians and their spouses, addressing the issues unique to the physician-wife-mom dynamic.
As a profession, we need to understand how we are caring for our members and their spouses, as well as how we can better support their marriages. As individual physicians, and particularly as Christians, we need to understand how our own marriages are doing and how we are impacting our spouses. If we, through overwork, undue emotional commitment to patients or inability to be intimate and vulnerable with our chosen life-mates are detracting from the health of our marriages, the onus is on us to change. Overall, physician marriages in this country are healthier than we thought they were. Though I have no data, I want to believe that Christian healthcare marriages surpass even this new data. And as Christians in healthcare, I challenge you and myself to pursue our marriages with the same intensity and wholeheartedness we pursued our training…to give our marriages more energy and commitment than we give our practices…to care more about our spouses’ challenges than we do about those of our patients.