Doctor-doctor marriages: What makes them work?

Extra flexibility, compromise, and communication. Threecouples tell how they do it.

By Doreen Mangan, Senior Editor

FP Rebecca Strafford, (above) happily stayed home to raise the kidswhile husband, Craig (also above) pursued his ob/gyn career.

More and more doctors are exchanging wedding vows with other doctors.Such marriages are inevitable, now that women account for around 46 percentof medical students. Perhaps you know two-physician couples and wonder howthey cope. Or maybe you're in a medical marriage yourself.

A doctor-doctor match sounds ideal. Husband and wife understand the longhours and the stresses of medical practice. They speak each other's language.And, frequently, the income produced by two-doctor families can supporta comfortable lifestyle and make it easy to fund children's college educationsand the couple's retirement.

Another plus is that a physician spouse is a respected colleague who'salways on hand for consultation. "We have the luxury of asking completelyunguarded questions of our spouses, such as, 'Hey, what drug works bestfor such-and-such a condition?'" says Craig J. Strafford, an ob/gynin Gallipolis, OH. He's been married to FP Rebecca L.T. Strafford for 30years.

"Sharing professional and family life, and overcoming challengestogether, 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 ofany two-career marriage. Tightly packed schedules allow little time to dealwith sick children, no-show babysitters, or other crises. Which parent willcancel appointments or a lecture to attend a soccer game or cope with anoverflowing washing machine? And there's little time for husband and wifeto be alone together.

Each spouse may find the best career opportunity in a different partof 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 practiceslot 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 chiefof surgery at Penn's Presbyterian Medical Center.

Surgeons Joe Friedberg and Jo Buyske hold their year-and-a-half-oldtwins, Dashiel (left) and Gabriel. At the table are the 5-year-olds, Davidand Emilia.

The careers of physician spouses may follow different paths. One partnermay achieve great success, while the other may encounter failures. Romance-stiflingcompetition may arise. "Such couples are in danger of becoming TINS[two incomes, no sex] couples,' says Sotile, who co-authored The MedicalMarriage: A Couple's Survival Guide with his wife, Mary.

Medical marriages have additional stress when one partner is making life-and-deathdecisions daily, or both are.

To find out how medical unions survive, we talked with several coupleswho seem to have found the secret. Granted, each spouse apparently had thegood judgment to pick the right partner. But each pair tries hard to makesure love, intimacy, and plain old companionship don't suffer because ofthe constant demands of family and medical practice.

When two obsessive-compulsives tie the knot

Type A personality traits, found in many professionals, are endemic amongphysicians, according to Donald E. Rosen, a psychiatrist with Oregon HealthSciences University in Portland. "Perfectionism, compulsiveness, workaholism,and an exaggerated sense of responsibility make us good doctors but problematicspouses. We need to be in control," explains Rosen, who conducts seminarsfor medical couples. "We've been trained to deal from strength withpatients' weaknesses, without revealing our own. This can make us play aparental rather than an adult-to-adult role in marriage, making intimacydifficult."

Jo Buyske and her husband, Joe Friedberg, both 39, are lucky. Althougheach exhibits type A tendencies, those are channeled in different and complementarydirections. Friedberg's is directed toward his work. "He takes thebest care of his patients, and everyone else around him does, too, or paysthe price," Buyske says. "He just has to be the best. He neverstops, 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 atiny bit more driven in that I'm committed to doing research and clinicalstuff, so I end up being in the office longer overall."

Friedberg's compulsive tendency to work too much sometimes infuriateshis 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, whereshe admits to being a "control freak." To him, she's just extremelywell organized. For example, when the family moved to Philadelphia threeyears ago, she single-handedly oversaw the renovation of their 150-year-oldVictorian townhouse in Philadelphia's city center, while starting a newjob and supervising the care of their then 2-year-old twins. They now haveanother 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 suppressanger or other negative emotions that get in the way of our clinical effectiveness.This limits our capacity for expressing emotions and for enjoying or toleratingstrong feelings—positive as well as negative. That leads to difficultieswith closeness and intimacy."

Rosen's research has also found that inordinate time consumed by professionaldemands is more a symptom of marital problems than a cause. "The physicianwho works incredibly long hours," he explains, "may be doing soto avoid emotional closeness at home, where we lack the clear role boundariesof the professional doctor-patient relationship."

Stephanie M. Cohen, a Hackensack, NJ, plastic surgeon, and her child-psychiatristhusband, Peter J. Walsh, became aware of such dangers early in their marriage.The couple, who met in medical school, married right before they startedtheir residency training. "We realized that all we were talking aboutwas what was going on at the hospital," Walsh recalls. "So wemade an effort to discuss other things, including our needs and feelings.In this field, you're encouraged not to express your feelings. But that'sdetrimental to your relationship."

Topics can include their sex life, which was difficult to find time forduring 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 havea healthy emotional life, you need a healthy sex life."

These days, when Cohen or Walsh sense conflict, it tends to be aboutone of them neglecting the other and putting work pressures ahead of therelationship. 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 mostlyabout the fact that one or both of us is spending too long just zoning outwhen we're supposed to be having our time. It's easy to turn on the TV andturn 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 availableto absorb stress for the rushed and harried doctor. But how can you be supportiveof someone who's had an exhausting day with patients when your own day hasalso 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'ttake that.'"

Before they had kids, they were able to be a bit more supportive. "Weused to play a game we called 'being sick,'" Friedberg remembers. "Youcould pretend to be sick, but only for 20 minutes. The well person wouldhelp 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 overyou."

Nonetheless, this husband and wife don't neglect each other. They tryto have a dinner date every two weeks. Before their second set of twinsarrived, in July 1998, they had weekly dates.

Over the dinner table, they talk about work and family issues. And whoeverappears to be more stressed is usually the focus of the conversation. Once,when Friedberg's father was ill, they discussed whether Joe should intervenein his dad's medical care. "Sometimes what we talk about is ancienthistory; 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 personallyawful 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'mhaving with one of my patients, to double-check my thinking. The patientsbenefit from it."

(Above) Psychiatrist Peter Walsh holds Sydney, 5, while plastic surgeonStephanie Cohen carries Chloe, 3. (The family horse was named Delayed Gratification,shortened to "Doc.")

Balancing home, kids, and work

"Generally, two doctors who marry tend to strike an egalitarianarrangement," says Wayne Sotile. "They're responsive to each other'spassion for their career during the early years of the relationship, particularlyif the relationship began during training. Unfortunately, as careers progress,there tends to be a push in the marriage for a more traditional divisionof roles. And women assume the lion's share of running home, hearth, andparenting."

Some do it by choice, though, including Jo Buyske. While a "supernanny" cares for the two sets of twins, Buyske runs the house, schedulesthe couple's social life, and pays bills. Her organizational skills reallyshine at home, her husband says. He concedes that around the house, "Joends up doing more work than I do. I try to pitch in where I can, but Ibotch it. I tried to do the laundry, but that was a mess." "Hemesses up on purpose," she teases.

But she's serious about her domestic role. "I firmly believe youcan control your job in such a way that you can do a good job and manageyour home life," says Buyske, who married Friedberg nine years ago,while they were both residents. "It's very important for me to gethome and see my kids. I'd leave my paperwork to do that. Joe will get donemost 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 thenanny. Friedberg tends to arrive by 8. The younger twins are asleep by thetime he gets home, but the 5-year-old girl and boy are still up. Friedbergspends extra time with the babies on weekends. The couple take call on thesame weekends, "to get the misery out of the way at once," Buyskesays.

They take turns with the kids' doctors' appointments and other daytimefamily obligations. "Letting the nanny take them to the doctors wouldmean 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 wivesran things at home. When Craig and Becky graduated from medical school in1971, it wasn't uncommon for women to have professional careers, althoughfew doctors were female. But it was unusual for couples to share equallyin household chores and child care.

As a result, Becky made two sacrifices for her marriage. First, she switchedspecialties. The Straffords came to the Holzer Clinic in Gallipolis, OH,in 1975, because the clinic wanted her husband as an ob/gyn. Becky had trainedas an anesthesiologist, but the clinic was using certified nurse anesthetistsfor the surgery in its affiliated hospital. No local opening existed inher specialty, so she became a family practitioner.

Her second compromise was to quit the clinic for five years, while herthree children were young. "We'd counted on being able to get goodchild care when we moved here," she says. But it's such a small townthat 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 notto do it. There didn't seem to be an alternative to make my professionalhours more flexible. Craig and I had always done the same thing throughcollege, medical school, and residency. This was the first time we weretaking separate paths. That was a strain for both of us."

Says Craig: "That was a time when I felt inadequate. We did everythingequally, until our first child arrived." Craig, at that time, was ajunior member of the clinic's ob/gyn department. "In retrospect,"he says, "it was one of the darker parts of our relationship, becauseI was overwhelmed with trying to keep up with a very active practice andmanaging 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, andnot just with the kids. She still managed to work, doing peer review—whichshe could do at home—and taking care of nursing home patients. She alsodesigned the house they built, planned an orchard, and oversaw bee coloniesand 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 Cohenand Walsh enjoy today was, no doubt, unusual. From the day Cohen and Walshleft medical school in 1991, their careers began to diverge sharply. Shewas beginning seven grueling years of training, first in general surgery,and later plastic surgery; he, four years of a psychiatric residency. Asa result of their specialty choices, their roles at home began to change,especially with the arrival of their children, who were born in 1994 and1996, 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 badshe felt when one child would call out for "Daddy" in the middleof the night. "But then I realized I was being offended by the emotionsof a 3-year-old who didn't know any better," Cohen says. "Sheyelled 'Daddy' first, because he was the one who was there for the firstthree 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 complainthat a child wasn't yelling for him in the middle of the night."

Now that Cohen is building her Hackensack, NJ, practice, she still workslonger 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 attheir school events. Walsh also shops and pays the bills. A housekeepercleans and does laundry. Cohen cheerfully admits that she does nothing aroundthe house. She devotes a lot of her free time to her children, whom she'steaching 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 bothare satisfied with their own accomplishments.

Take the Straffords. Craig has won national and local recognition forhis 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 mytime and effort into the children. I feel much stronger about that thanI would in those other roles."

And although the Cohen-Walsh role reversal is evident professionallyas well as at home, Peter Walsh seems unfazed. "Medicine is still avery 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 consideredless prestigious, and child psychiatry is considered a women's field. Whenwe're introduced at a party, people assume I'm the surgeon."

But, he says, "That was never an issue between us. I've never succumbedto role stereotypes. I'm happy that Stephanie is doing something she reallyloves. I was so glad when she decided to have a family and not allow residencyto totally dominate our lives."

Now that Buyske has been promoted and is in a higher, better-paying positionthan her husband, has that caused problems? "Not at all," Friedbergsays. First, Buyske is in a different subspecialty. And, she says, "Wetake great delight in each other's successes."

Despite the stresses and strains of coping with another doctor as yourspouse, when such a marriage works, it's wonderful, says Craig Strafford."I feel as positive about our relationship as I did 30 years ago, whenwe decided to get married. It has been divinely wonderful to have someoneto share so much with."

How to keep a two-doctor marriage healthy and happy

Donald E. Rosen of Oregon Health Sciences University in Portland offersthese 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.

. Doctor-doctor marriages: What makes them work?.

Medical Economics

1999;24:54.