More and more doctors are exchanging wedding vows with other doctors. Such marriages are inevitable, now that women account for around 46 percent of medical students. Perhaps you know two-physician couples and wonder how they cope. Or maybe you're in a medical marriage yourself. A doctor-doctor match sounds ideal. Husband and wife understand the long hours and the stresses of medical practice. They speak each other's language. And, frequently, the income produced by two-doctor families can support a comfortable lifestyle and make it easy to fund children's college educations and the couple's retirement. Another plus is that a physician spouse is a respected colleague who's always on hand for consultation. "We have the luxury of asking completely unguarded questions of our spouses, such as, 'Hey, what drug works best for such-and-such a condition?'" says Craig J. Strafford, an ob/gyn in Gallipolis, OH. He's been married to FP Rebecca L.T. Strafford for 30 years. "Sharing professional and family life, and overcoming challenges together, can strengthen the marriage," says psychologist Wayne M. Sotile, who has counseled many physicians having marital difficulties. Yet these seemingly well-matched people must cope with the problems of any two-career marriage. Tightly packed schedules allow little time to deal with sick children, no-show babysitters, or other crises. Which parent will cancel appointments or a lecture to attend a soccer game or cope with an overflowing washing machine? And there's little time for husband and wife to be alone together. Each spouse may find the best career opportunity in a different part of the country, so one or both must be flexible. General surgeon Jo Buyske, for example, gave up a job at a practice she loved in Boston when her husband, thoracic surgeon Joseph S. Friedberg, found the ideal research and practice slot as an assistant professor at the University of Pennsylvania in Philadelphia, where they're now both on staff. "Leaving was a personal sacrifice, but not a career sacrifice," says Buyske, who recently became chief of surgery at Penn's Presbyterian Medical Center. The careers of physician spouses may follow different paths. One partner may achieve great success, while the other may encounter failures. Romance-stifling competition may arise. "Such couples are in danger of becoming TINS [two incomes, no sex] couples,' says Sotile, who co-authored The Medical Marriage: A Couple's Survival Guide with his wife, Mary. Medical marriages have additional stress when one partner is making life-and-death decisions daily, or both are. To find out how medical unions survive, we talked with several couples who seem to have found the secret. Granted, each spouse apparently had the good judgment to pick the right partner. But each pair tries hard to make sure love, intimacy, and plain old companionship don't suffer because of the constant demands of family and medical practice. When two obsessive-compulsives tie the knot Type A personality traits, found in many professionals, are endemic among physicians, according to Donald E. Rosen, a psychiatrist with Oregon Health Sciences University in Portland. "Perfectionism, compulsiveness, workaholism, and an exaggerated sense of responsibility make us good doctors but problematic spouses. We need to be in control," explains Rosen, who conducts seminars for medical couples. "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." Jo Buyske and her husband, Joe Friedberg, both 39, are lucky. Although each exhibits type A tendencies, those are channeled in different and complementary directions. Friedberg's is directed toward his work. "He takes the best care of his patients, and everyone else around him does, too, or pays the price," Buyske says. "He just has to be the best. He never stops, and he'll never schedule a case for tomorrow if it can be done today." Friedberg concedes that "I probably work harder. I'm probably a tiny bit more driven in that I'm committed to doing research and clinical stuff, so I end up being in the office longer overall." Friedberg's compulsive tendency to work too much sometimes infuriates his wife: "I get mad, because I know he could control his life better. I often ask, 'Do you really have to schedule that case for today?'" Friedberg, though, welcomes Buyske's attention to the home front, where she admits to being a "control freak." To him, she's just extremely well organized. For example, when the family moved to Philadelphia three years ago, she single-handedly oversaw the renovation of their 150-year-old Victorian townhouse in Philadelphia's city center, while starting a new job and supervising the care of their then 2-year-old twins. They now have another set of twins, 17 months old. Of course, obsessive-compulsive behavior goes beyond scheduling talents. Says Rosen, "We have a deep commitment to our work, and we suppress anger or other negative emotions that get in the way of our clinical effectiveness. This limits our capacity for expressing emotions and for enjoying or tolerating strong feelings—positive as well as negative. That leads to difficulties with closeness and intimacy." Rosen's research has also found that inordinate time consumed by professional demands is more a symptom of marital problems than a cause. "The physician who works incredibly long hours," he explains, "may be doing so to avoid emotional closeness at home, where we lack the clear role boundaries of the professional doctor-patient relationship." Stephanie M. Cohen, a Hackensack, NJ, plastic surgeon, and her child-psychiatrist husband, Peter J. Walsh, became aware of such dangers early in their marriage. The couple, who met in medical school, married right before they started their residency training. "We realized that all we were talking about was what was going on at the hospital," Walsh recalls. "So we made an effort to discuss other things, including our needs and feelings. In this field, you're encouraged not to express your feelings. But that's detrimental to your relationship." Topics can include their sex life, which was difficult to find time for during residency, especially when Cohen was working 80- to 110-hour weeks. "Medicine isn't necessarily conducive to a healthy physical relationship," Walsh says. But it's something couples should talk about. "To have a healthy emotional life, you need a healthy sex life." These days, when Cohen or Walsh sense conflict, it tends to be about one of them neglecting the other and putting work pressures ahead of the relationship. So they fall back on their old habit of talking things out. And because they have a strict rule about an 8 pm bedtime for their daughters, ages 5 and 3, the evenings are their own. "When we argue, it's mostly about the fact that one or both of us is spending too long just zoning out when we're supposed to be having our time. It's easy to turn on the TV and turn your brain off when you're tired,' says Cohen. But more than intimacy can be missing in a union of two type A physicians. In traditional medical marriages, the nondoctor spouse is usually available to absorb stress for the rushed and harried doctor. But how can you be supportive of someone who's had an exhausting day with patients when your own day has also been shattering? "There's no stress absorber in our marriage," Jo Buyske says. "Joe wanted me to have lunch with him a few days ago. I was complaining about this and that. He said, 'Don't be depressed; I can't take that.'" Before they had kids, they were able to be a bit more supportive. "We used to play a game we called 'being sick,'" Friedberg remembers. "You could pretend to be sick, but only for 20 minutes. The well person would help the other one to the couch; hand the 'patient' the remote control, a pillow, and a blanket; and prepare tea. We don't play that game much anymore, though. These days, if you lie down on the couch, the kids climb all over you." Nonetheless, this husband and wife don't neglect each other. They try to have a dinner date every two weeks. Before their second set of twins arrived, in July 1998, they had weekly dates. Over the dinner table, they talk about work and family issues. And whoever appears to be more stressed is usually the focus of the conversation. Once, when Friedberg's father was ill, they discussed whether Joe should intervene in his dad's medical care. "Sometimes what we talk about is ancient history; we'll go into our childhoods," Buyske says. Neither of these doctors can imagine being married to a nonphysician. "When things go wrong with a patient, we both know how personally awful that is," Friedberg says. "I find that incredibly helpful." He adds: "We have tremendous respect for each other's clinical ability; we give each other good advice. I frequently ask Jo about a problem I'm having with one of my patients, to double-check my thinking. The patients benefit from it." Balancing home, kids, and work "Generally, two doctors who marry tend to strike an egalitarian arrangement," says Wayne Sotile. "They're responsive to each other's passion for their career during the early years of the relationship, particularly if the relationship began during training. Unfortunately, as careers progress, there tends to be a push in the marriage for a more traditional division of roles. And women assume the lion's share of running home, hearth, and parenting." Some do it by choice, though, including Jo Buyske. While a "super nanny" cares for the two sets of twins, Buyske runs the house, schedules the couple's social life, and pays bills. Her organizational skills really shine at home, her husband says. He concedes that around the house, "Jo ends up doing more work than I do. I try to pitch in where I can, but I botch it. I tried to do the laundry, but that was a mess." "He messes up on purpose," she teases. But she's serious about her domestic role. "I firmly believe you can control your job in such a way that you can do a good job and manage your home life," says Buyske, who married Friedberg nine years ago, while they were both residents. "It's very important for me to get home and see my kids. I'd leave my paperwork to do that. Joe will get done most of what's on his desk, or he'll bring it home." One parent, usually Buyske, is always home by 6:30 pm to relieve the nanny. Friedberg tends to arrive by 8. The younger twins are asleep by the time he gets home, but the 5-year-old girl and boy are still up. Friedberg spends extra time with the babies on weekends. The couple take call on the same weekends, "to get the misery out of the way at once," Buyske says. They take turns with the kids' doctors' appointments and other daytime family obligations. "Letting the nanny take them to the doctors would mean I'm a bad parent," says Buyske. Even this much equality was missing when Craig and Rebecca Strafford, both 53, became doctors. They say they're of the "in-between generation." Their parents assumed traditional roles—the husbands worked, and the wives ran things at home. When Craig and Becky graduated from medical school in 1971, it wasn't uncommon for women to have professional careers, although few doctors were female. But it was unusual for couples to share equally in household chores and child care. As a result, Becky made two sacrifices for her marriage. First, she switched specialties. The Straffords came to the Holzer Clinic in Gallipolis, OH, in 1975, because the clinic wanted her husband as an ob/gyn. Becky had trained as an anesthesiologist, but the clinic was using certified nurse anesthetists for the surgery in its affiliated hospital. No local opening existed in her specialty, so she became a family practitioner. Her second compromise was to quit the clinic for five years, while her three children were young. "We'd counted on being able to get good child care when we moved here," she says. But it's such a small town that not much was available. So she was the one to stay home with the kids. Becky admits that she was a little disappointed, though not resentful, that she couldn't develop her medical career while her husband's soared. "I was anxious about losing skills. But it never occurred to me not to do it. There didn't seem to be an alternative to make my professional hours more flexible. Craig and I had always done the same thing through college, medical school, and residency. This was the first time we were taking separate paths. That was a strain for both of us." Says Craig: "That was a time when I felt inadequate. We did everything equally, until our first child arrived." Craig, at that time, was a junior member of the clinic's ob/gyn department. "In retrospect," he says, "it was one of the darker parts of our relationship, because I was overwhelmed with trying to keep up with a very active practice and managing night call. I was working 80 to 90 hours a week." But he was also making strides professionally and developing other roles, such as board memberships and trustee positions. Becky, too, was busy, and not just with the kids. She still managed to work, doing peer review—which she could do at home—and taking care of nursing home patients. She also designed the house they built, planned an orchard, and oversaw bee colonies and their small dairy-goat herd. When the children were older, Becky went back to the clinic part time. Today, she's medical director at a regional medical center. When the Straffords began their careers, the role reversal that Cohen and Walsh enjoy today was, no doubt, unusual. From the day Cohen and Walsh left medical school in 1991, their careers began to diverge sharply. She was beginning seven grueling years of training, first in general surgery, and later plastic surgery; he, four years of a psychiatric residency. As a result of their specialty choices, their roles at home began to change, especially with the arrival of their children, who were born in 1994 and 1996, during Cohen's residency. Because his residency hours were shorter and more predictable than Cohen's, Walsh had more time to spend with their daughters. Cohen recalls how bad she felt when one child would call out for "Daddy" in the middle of the night. "But then I realized I was being offended by the emotions of a 3-year-old who didn't know any better," Cohen says. "She yelled 'Daddy' first, because he was the one who was there for the first three years, and she was scared. It doesn't mean she loves me any less." Comments Walsh, "I don't think the average male surgeon would complain that a child wasn't yelling for him in the middle of the night." Now that Cohen is building her Hackensack, NJ, practice, she still works longer hours than Walsh, who practices child psychiatry in New York City. So Walsh is usually the one who takes the kids to school and shows up at their school events. Walsh also shops and pays the bills. A housekeeper cleans and does laundry. Cohen cheerfully admits that she does nothing around the house. She devotes a lot of her free time to her children, whom she's teaching to ride horseback. Keeping competition out of the marriage When one spouse in a two-doctor marriage earns more or forges ahead faster, that can take a toll on the relationship. But not, apparently, when both are satisfied with their own accomplishments. Take the Straffords. Craig has won national and local recognition for his contributions to organizations such as the American Medical Group Association. "I could be jealous of that," Becky says. "But then I think, 'Would I want to be spending my time that way?' I've preferred putting my time and effort into the children. I feel much stronger about that than I would in those other roles." And although the Cohen-Walsh role reversal is evident professionally as well as at home, Peter Walsh seems unfazed. "Medicine is still a very male-dominated profession, philosophically if not in actuality," he says. "As a plastic surgeon, Stephanie is in a masculine field. Down the road, her earnings will be much more than mine. Psychiatry is considered less prestigious, and child psychiatry is considered a women's field. When we're introduced at a party, people assume I'm the surgeon." But, he says, "That was never an issue between us. I've never succumbed to role stereotypes. I'm happy that Stephanie is doing something she really loves. I was so glad when she decided to have a family and not allow residency to totally dominate our lives." Now that Buyske has been promoted and is in a higher, better-paying position than her husband, has that caused problems? "Not at all," Friedberg says. First, Buyske is in a different subspecialty. And, she says, "We take great delight in each other's successes." Despite the stresses and strains of coping with another doctor as your spouse, when such a marriage works, it's wonderful, says Craig Strafford. "I feel as positive about our relationship as I did 30 years ago, when we decided to get married. It has been divinely wonderful to have someone to share so much with." How to keep a two-doctor marriage healthy and happy Donald E. Rosen of Oregon Health Sciences University in Portland offers these pointers on how to avoid and handle conflict in medical marriages: Define and clarify problems. Know what you want to change. Remember, some people have a heavy investment in suffering. Accept that no solution will be perfect. It's impossible to balance work and family life in a way that pleases everyone all the time, so be prepared to lower your expectations. Make time to talk, even if it's just for 15 minutes a day. Couples who talk more need marital therapy less. Some people need to learn, or relearn, how to talk. Don't rely on mind reading. Carve out time for the two of you, away from the kids, to pursue a common interest, and don't feel guilty taking time for yourselves. In a traditional marriage, it's important for the woman to establish her own identity. In a two-profession marriage, the partners should have a clear and explicit discussion and negotiate shared responsibilities for home and children. Make time for a sexual relationship. If there's no time for sex, it's symptomatic of more basic problems. Avoiding sex must be discussed before it becomes chronic. Read Also: Top 5 Fun Careers In Medicine And Their Salaries What Personality Characteristics Should A Doctor Have? Doctor-Doctor Marriages – Are They a Good Idea? Your Guide To A Perfect Life As A Doctor Is It Too Late To Be A Doctor? How Doctors Stay Alert Source
