Despite dramatic challenges to the institution, most doctors couldn't be happier in their relationships.
Despite dramatic challenges to the institution, most doctors couldn't be happier in their relationships.
Physician marriages have been the stuff of soap operas, featuring workaholic healers, neglected spouses, and late-night squabbles.
It's time to rewrite the script, however. Doctors in wedlock are smiling more in the year 2000. A majority of physicians (54 percent) say their marriages are terrific, according to our lifestyle survey. Only 7 percent rate their marriages "so-so" or lousy. Back in 1979, when we asked a similar question, only 43 percent of doctors checked the "terrific" box, while 13 percent were discontented.
"These numbers are astonishing," says psychiatrist Roy Menninger, chairman of the Menninger Clinic in Topeka, KS, and coauthor of Medical Marriages. "You hear so many complaints from physicians that it's hard to believe anything is improving."
Granted, our respondents may have overrated their marriagesthat's human nature. And if spouses had been questioned, their responses might be quite different. Still, some who counsel physician couples say the overall satisfaction level we report reflects changes they see in their clinical experience. Doctors, particularly men, are breaking away from the old "career-before-home" lifestyle.
"It's not enough for men just to be good providers anymore," says Wayne Sotile, a clinical psychologist in Winston-Salem, NC, and coauthor of The Medical Marriage. "The definition of a successful family man has changed."
For most Americans, marriage just doesn't inspire the same hopes it once did. But for most physicians who wear a wedding ring, life is surprisingly good.
"I believe my wife is as glad to see me at the end of the day as she was 39 years ago," says FP William Darwin in Little Rock, AR, who calls his marriage terrific. "And I'm just as glad to see her."
Ironically, some of the evidence for stronger physician marriages shows up in the problems doctors cite.
Heading the list is "I am not home enough," mentioned by 45 percent, almost double the percentage in our 1979 survey. Does that mean that happier-than-ever married physicians are spending more time at the office and hospital? That's not it. Physicians typically work about the same 60 hours per week that they have for many years, according to other Medical Economics surveys.
It's that physicians have a heightened awareness of the virtues of being a homebody, says psychiatrist Michael Myers in Vancouver, British Columbia, author of Doctors' Marriages. "When I was in medical school in the 1960s, men were told to marry strong women because medicine would be our first love, and our wives would have to do everything else," says Myers. "Now you hear doctors say, 'I don't want to give my whole life to medicine.' "
Wayne Sotile says men's expectations are higher. "In the last two decades, family has entered the hearts of men," he says. "We want to be present and hands-on in the lives of our children." And doctors of both sexes, he adds, are more willing to sacrifice income for the sake of spending more time with their families.
The second most commonly mentioned problem"failure to communicate"invites the same interpretation. The percentage of doctors who identify this as a marital pothole has risen from 18 percent in 1979 to 34 percent today. But again, experts say, it's not as if there's less talking. "We're just more enlightened," says Myers. "Twenty years ago, if I asked a doctor in marriage counseling, 'How are your communication skills?' he might have said, 'Huh?' "
The growing number of two-income households forces couples to talk, adds Denver clinical psychologist Scott Stanley, coauthor of Fighting for your Marriage. "These couples have more things to negotiatelike who's going to stay at home when a kid gets sick," says Stanley. "They don't assume the man's career takes precedence over the woman's."
The "failure to communicate" problem is consistent across all age groups. That pattern confirms Wayne Sotile's contention that it's not just young doctors who are earnest about building intimate, solid marriages. "A 60-year-old doctor today is more respectful of family issues than a 60-year-old doctor in 1980," he says. "And he's more likely to seek marriage counseling."
We asked physicians to identify the major strengths of their marriage from a list of six: children, similar interests, mutual respect, sexual compatibility, financial situation, and religious beliefs. Mutual respect leads the pack, cited by 79 percent of physicians, including William Duncan, a general surgeon in Martin, TN. How does this quality play out in his marriage? "My wife and I don't criticize each other in front of other people," replies Duncan.
Next on the list is children. Of course, you might expect this from couples where male doctors indeed spend more time changing diapers and driving car pools. Jaylynn Kao, a pediatrician in Fond du Lac, WI, enjoys such a marriage with her husband, radiologist Michael Milstein. "Splitting child care 50-50 gets a lot of lip service, but in our case, it's really true," says Kao.
Similar interests rank third as a major strength, beating out sexual compatibility 66 percent to 51 percent. Maybe it's more important to share a hobby than to make love. But then again, says psychiatrist Mike Myers, if couples pay attention to essentials like companionship and good communication, sex takes care of itself.
Sex, in fourth place, apparently is getting better for married physicians. In 1979, 18 percent said unsatisfactory sexual relations were a problem. Only 12 percent report that difficulty today.
After sex comes religious beliefs, a marital strength for 47 percent of doctors. A slew of studies these days claim that faith is good for your health. By and large, it's good for physician marriages, too. Except for Islamic doctors, physicians professing no religion are the least likely to say their marriages were terrific, and they also are the most likely to be divorced. Hindus, in contrast, are at the other end of the bliss scale; almost 59 percent report terrific marriages. They're followed closely by Catholics and Protestants.
Financial circumstances are cited as a strength by 38 percent of doctors. On the other hand, the proportion of doctors who say conflict over money rocks their marriage has risen from 11 percent in 1979 to almost 16 percent in 2000. "Virtually all the physicians I counsel assume their income will drop soon, if it hasn't already," says Wayne Sotile. "In response, many doctors take the attitude, 'I'm going to make as much money while I can and put off getting involved with my family.'
"Or the spouse doesn't endorse the doctor's fears and tells him, 'Stop complaining. Suzy's husband doesn't bring all this worry home. Why do you?' These things stress out a marriage."
Only 5 percent of survey respondents are divorced (and not remarried or living with a mate). Still, if doctors don't fix the leaks in their marriages, they risk going under. James Hanley III, a pediatrician in Lebanon, TN, says his first marriage lasted only two years, partly because he saw very little of his wife. At the time, he was logging 90 to 100 hours a week in a rural Florida community. To make matters worse, his ex-wife, a nurse, worked while he was off duty.
"One day she just packed up and moved in with her mother," says Hanley. To make his second marriage succeed, he joined another pediatrician in Lebanon and cut back his schedule to a less punishing 70 hours a week.
"Failure to communicate" helped doom the 16-year marriage of ob/gyn Joanne Bulley of Keene, NH. "My ex-husband was too introverted," says Bulley. "The communication was all one way." Almost 17 percent of doctors say their marriages are marred by conflicts over how to spend leisure time. Byron Faber, a radiologist in Silverdale, WA, says his first marriage of 24 years suffered that way. "After we were married, my wife developed a fear of flying," says Faber. "So we couldn't go anywhere together. When I went to CME meetings in Hawaii, I'd go alone or with my son."
He remarried immediately, only to get another divorce two years later. "My friends told me to slow down and choose my second wife more carefully, but I was used to living with someone," says Faber. "I convinced myself I could make it work. Now I've learned I can be single and happy."
Internists are the most likely to report that they have terrific marriages, while ophthalmologists are the least likely, according to our survey. This divide between primary care doctors and specialists generally plays out across the board.
"Maybe that's because primary care doctors spend more time talking to their patients so, presumably, they know how to communicate better," says psychologist Wayne Sotile. "But what do you make of psychiatrists?"
Psychiatrists complain the least about communication problems, but they're in the middle of the pack when it came to marital satisfaction. Plus, they appear to display the greatest marital angst. Psychiatry has the highest percentage of divorced doctors, and the highest percentage reporting bad sex.
"Maybe they're more demanding of relationships than the average doctor," says Sotile. Or maybe it's that psychiatry attracts more than its share of troubled individuals, add Myers and Menninger.
Ob/gyns produce an interesting blip on the radar screen. After psychiatrists, they complain the most about unsatisfactory sex. Similarly, they're the least likely, along with pediatricians, to say that sex is a major strength. "Is the bar raised for them?" asks Sotile. "Maybe they know so much about sexual function that they're not satisfied with average performance."
Doctors in solo practice who want to improve their marriages should consider joining a group. At least that's what our survey suggests. Some 49 percent of solo doctors report terrific marriages, compared with 57 percent of group-practice counterparts. And a higher percentage of soloists are divorced.
Conventional wisdom might attribute the difference to an easier schedule for group-practice doctors. However, they work a median five more hours a week than soloists, according to another Medical Economics survey. "I am not home enough" is a bigger complaint for them. Perhaps those longer hours explains why group-practice doctors earn 25 to 54 percent more than soloists (depending on whether they belong to single-specialty or multispecialty groups). Not surprisingly, finance shows up as less of a marital stumbling block for group practice doctors than for soloists.
As an American institution, marriage has taken its knocks lately. True, the divorce rate is nudging downward, but so is the marriage rate. And the number of unmarried couples who live together has increased 167 percent between 1980 and 1998, according to the US Census Bureau. Clearly, society has less faith in matrimony.
So what's in store for the institution of marriage? Sotile points to the course that intimacy normally takes through a relationship.
"Couples start off enjoying the first blush of love," says Sotile. "Then they reach a stage where they feel snowed under by child-rearing and professional and financial concerns. The romance lessens, but couples in healthy marriages learn to be better friends and collaborators. Their motto is, 'It isn't perfect, but we'll make it work.' "
Physician marriages travel this path, too, as evidenced by our survey results, says Sotile. Satisfaction is at its highest for younger doctors62 percent call their marriages terrific. From age 40 onward, terrific marriages plateau at 52 percent, but the percentage of good ones steadily rises. Other positive indicators rise, as well. Except for a dip in the 40s age bracket, doctors increasingly rank mutual respect as a marital strength as they age. And they treasure sexual compatibility more and more, too. "If you hang in there, sex gets better," says Sotile.
To psychologist Scott Stanley, "hanging in there" means consistently setting aside time for those activitiesconversations, hikes, skiing, and of course, sexthat bond couples. "Otherwise, your marriage will experience a slow erosion, even though you consider yourself happy on any given day," says Stanley. "And then bad times hit you like a California mudslide." In other words, take the complaint of "I am not home enough" seriously.
Psychiatrist Michael Myers advises physicians to take stock of their communication skills as they go the distance. "Doctors often pride themselves on their ability to talk with patients or other doctors," says Myers. "They're amazed, though, that they can't talk to their spouse about the weather without getting into a fight. But in an intimate relationship, where you're vulnerable, you need a different set of communication skills. I tell doctors, 'If you're having problems talking, it's okay. You're human. Just get help.' "
Twenty percent of married doctors, in fact, have made trips with their spouses to the marriage counselor. A primary care doctor in the Midwest says therapy for her and her husband improved not only their ability to hash out differences, but their acceptance of each other's personality. "I understand that there are things about my husband that I can't change," says the doctor.
Combine that kind of realism with a sense of humor, and you have what it takes for a lasting, loving union. Dermatologist Marvin Engel of Walnut Creek, CA, for example, says his marriage is indeed terrific. But he can't resist adding, "On what day?"
While physician marriages are stronger these days, the picture is less rosy for women practitioners.
Some 51 percent rate their marriages as terrific, compared with 54 percent for men. And a higher percentage of women doctors call their marriages so-so or lousy.
In addition, almost 10 percent of women physicians are divorced, compared with 4 percent of their male counterparts. This statistic says more about excessive household responsibilities for women than anything else. Consider this: 33 percent of female doctors say that they're the primary caretaker for their children, while only 3 percent of male doctors can say that about themselves.
"The male doctor whose wife is a full-time homemaker has a buffer against stress," says clinical psychologist Wayne Sotile from Winston-Salem, NC. "But the woman doctor is almost always married to someone working outside the home. She can't count on her spouse to bear the brunt of household responsibilities. Instead, she usually assumes the lion's share. That puts a lot of wear and tear on intimacy."
New Hampshire ob/gyn Joanne Bulley says unequal domestic duties contributed to her divorce. "For seven years, my husband was unemployed and at home, but I still did most of the child-rearing and chores," says Bulley, a 45-year-old mother of two.
Plenty of female colleagues in her age group also saw their marriages disintegrate, says Bulley, who earned her MD in 1981, when women constituted only 12 percent of all physicians.
"The men we had to choose from when we were in our 20s were limited," says Bulley. "We were pretty strong women, and many men couldn't tolerate that. The men we could get along with were too passive. They weren't able to speak up and be themselves. Plus, there were zero role models for men back then when it came to doing their share of household duties."
However, wedlock for women physicians is improving. The proportion that call their marriages terrific or good has increased from 77 percent in 1979 to 89 percent today. And in 1979, the percentage of women physicians divorced or separated was six times as high as that of male colleagues. In 2000, the ratio is only 2 to 1.
Denver ob/gyn Patricia Vigder is proof of better times. Her husband, Scott, is a stay-at-home and hands-on father of their 2-year-old son, Louis. He also works out of the home as an entrepreneur who's developing intelligence-boosting baby-crib decorations. And the Vigders know how to communicate.
"We don't have any hidden agendas," says Pat. "What we say may not come out smoothly, but all the issues get on the table. We deal with them and then we move on."
On rare occasions, their arguments escalate into a classic battle of the sexesshe'll yell, and he'll leave the room. "But in a few hours, my voice is back to normal, and he's ready to deal with the situation," says Vigder.
"The longer we're married, the less these blow-ups happen. That's why our marriage is truly terrific," she says.
Robert Lowes. Marriages: Stronger than ever. Medical Economics 2000;19:47.