"Show me a doctor whose wife is happy," an old cartoon caption goes, "and I'll show you a man who's neglecting his practice." The joke assumes that the norm for physician marriages is unhappiness and that physicians are "medical men," as they were called in a less liberated day. A new study published online in Mayo Clinic Proceedings last month turns the joke on its head in several ways. It reports that 86.8% of physicians' spouses and partners said in a national survey that they were satisfied — and 55.4% extremely so — with their relationship with their stethoscoped other. Furthermore, 27.1% of these spouses and partners were men. In addition, neglecting a medical practice is not the formula for keeping a physician's mate happy, it turns out. A multivariate analysis of the survey findings shows that the number of work hours logged by a physician per week is not a factor associated with extremely satisfied spouses and partners. Rather, the best predictor of the strongest relationships is the number of waking minutes the couples spend together. The only other factor associated with extremely satisfied spouses and partners is the number of nights per week the physician is on call. The study is not the first to challenge the stereotype of the troubled medical marriage. It cites a single study in which 90% of married adults rated their relationship as favorable, and another in which 88% said they were either satisfied or completely satisfied. All in all, physicians and their mates fare about as well as everyone else in domestic matters: Their satisfaction level roughly matches that for all married US adults in several surveys. Few Physicians See Their Mate More Than 2 Hours Daily The study authors identified physicians' partners and spouses for their line of questioning by asking physicians in an earlier survey to supply the email addresses of their mates if they were willing to be surveyed about relationship satisfaction. The researchers obtained email addresses for 1644 spouses and partners; of these, 891 sent back a completed questionnaire. The median age of the responding spouses and partners was 51 years compared with 55 years for the physician. About 57% of physicians' mates worked outside the home, and almost 87% had children. Their demographic picture was consistent with that of the physicians, which suggests that survey participants were representative of physician mates as a whole, according to lead author Tait Shanafelt, MD, a hematologist at the Mayo Clinic in Rochester, Minnesota, and coauthors. In these pairings, physicians worked a median 55 hours a week, whereas mates working outside the home put in a median of 40 hours (30 for women and 40 for men). Good relationships need face time, the study suggests. Among couples who were together fewer than 20 minutes a day, slightly more than 20% of physician spouses and partners reported that they were extremely satisfied. This percentage exceeded 70% for mates who were with their physician partner more than 120 minutes each day. Dr. Shanafelt and colleagues write that the study does not establish a causal link between minutes logged and satisfaction and allows for the possibility that happy couples are inclined to hang out more and unhappy couples less. Nevertheless, "the dose-response relationship between time spent together and satisfaction is notable," the authors write, adding that previous studies of physician marriages uncovered the same pattern. "These data underscore that creating and protecting time together may be one critical ingredient for healthy relationships with physicians and that achieving it can mitigate many of the negative effects of excessive work hours and a demanding professional life," write Dr. Shanafelt, director of the Mayo Clinic Department of Medicine Program on Physician Well-being, and colleagues. The study delved into some of the negatives of a medical marriage. The authors report that at least several times a week, when physicians came home, 34.1% were irritable, 43.5% were too tired to engage in family activities, and 46% still had their minds on that day's patients. Slightly more than 1 in 10 spouses and partners of physicians had seriously considered divorce in the previous 12 months. Still, 80.9% said they would choose a physician for a life partner again. Dr. Shanafelt and coauthors acknowledge that survey results may skew to the sunny side because physicians who enjoy happy relationships may be more likely to put researchers in touch with their mates. However, one finding weakens that argument, they write: The percentage of physicians who said they had contemplated divorce in the last 12 months was 11.0%, which is remarkably close to the percentage of spouses and partners who had divorce on their minds. That similarity "would suggest that both satisfied and dissatisfied physicians provided contact information for their spouses/partners." In an accompanying editorial, lead author Mary Warner, MD, from the Department of Anesthesiology, Mayo Clinic, Rochester, and coauthors write that Dr. Shanafelt's study "provides evidence that physicians and their spouses or partners make pretty good couples, with relationships...that are as stable and satisfying or better than those of the general population." However, there is more about these relationships to explore, Dr. Warner and coauthors point out. Of the physician spouses and partners surveyed, 10.2% were physicians themselves and another 30.7% were some other kind of healthcare professional. Does relationship satisfaction differ among these groups? In addition, the study does not parse out what percentage of physicians are in same-sex relationships, which raises even more questions about who is feeling what — questions that few researchers asked in the days of medical men and their long-suffering wives.