We met when were in medical training — Bryan was a nephrology fellow and Yolanda was a general surgical resident. So, it was natural for our careers to come up in conversation as part of our pre-marital counseling with our rabbi. Ultimately, he provided a template for thinking about what we wanted together. That was the start of formulating our approach as a couple working in different areas of the same profession. As a couple, we have created a shared philosophy on the importance of family, our own personal career objectives, integration of work and life, and plans for the future. As we build and maintain our relationship, we consider several core areas — or puzzle pieces: family, domestic help, finances, career, timing, integration, and the future.
As I (Bryan) was getting ready to board a plane at the Madison airport, my mobile phone reverberated the Champions League theme ringtone off the jet bridge. Walking behind a slow steady queue of fellow travelers heading to New York, I answered the call.
“Dr. Becker, this is Nancy Struthers, the nurse at West Middleton School. I’m calling because Anna has a bad bloody nose. I tried to get in touch with the other Dr. Becker, but she was not able to get to the phone. So, Anna suggested that I call you.”
“Thanks. How bad is it?”
I was now slinging my travel suitcase into the overhead bin.
“Well, she is still bleeding, but it has slowed down.”
“Thanks. How’d it happen?”
“She said she was accidentally hit in the face while her class was out on recess.”
“Okay. It’s gonna take me a few minutes to get there. Are you able to stay with her until I get there?”
“Yes. Do you have an idea of how long it will take?”
“I am at the airport, so probably about 30 minutes.”
“Great. We’ll be looking for you. Thanks so much.”
I grabbed my computer bag and suitcase and walked off the plane with a range of emotions that captured what it means to have a two-career, two-physician marriage:
Concern that our daughter was okay and that the nosebleed wasn’t more than just a nosebleed. After all, we’re physicians, and we think of all kinds of possibilities.
Understanding that my wife, Yolanda, who is a transplant surgeon, could not answer the phone because she likely was in the operating room.
Frustration that I needed to change plans to get to a meeting I was supposed to co-chair.
Recognition that often one, but not both of us can be available. This was one of those times.
Two Rules That Have Helped Us Manage
As a couple, we have created a shared philosophy on the importance of family, our own personal career objectives, integration of work and life, and plans for the future.
Two household rules keep us on course:
Do not panic.
Ask, “Will this really be important in 25 years?”
When we apply these rules, we rarely make bad choices for ourselves or our careers.
They provide perspective and reduce stress when we must make decisions.
1. Do Not Panic
Few situations require us to take immediate action unless someone is bleeding or dying (physician perspective is somewhat different here from that of parent). It’s important to take time to think through options. In the scenario described above, it was easy to figure out Bryan’s logical next steps: Call someone in the office to re-arrange travel and alert his co-chair of the change of plan for the scheduled conference.
2. Will This Matter?
The second rule is the “25-year rule.” We ask ourselves whether “this” will matter in 25 years. Realistically, few things truly stand up to that test of time. Although it might require some adjustments and possible inconveniences, being late or attending the meeting remotely would garner a negative response to “will this matter?” under the 25-year rule.
Jigsaw Puzzle Without the Side Pieces
We met when were in medical training — Bryan was a nephrology fellow and Yolanda was a general surgical resident. So, it was natural for our careers to come up in conversation as part of our pre-marital counseling with our rabbi. Ultimately, he provided a template for thinking about what we wanted together. That was the start of formulating our approach as a couple working in different areas of the same profession.
Two-career relationships among physicians now comprise nearly half of all physician marriages.(1) We describe ours as a “two-career, two-physician marriage” because our professional lives extend beyond taking care of patients. The opportunity to pursue other challenges, to change professional roles, or to shift career objectives are important and increasingly prominent aspects of our partnership.
Some of the work generated around two-career, two-physician marriages ignores or downplays some basic features of all marriages and partnerships. Do spouses and partners enjoy spending time with each other? Are they satisfied in their relationships?
There does appear to be a positive correlation between creating time to do things with a partner or spouse and satisfaction in two-physician marriages.(2-4) This finding aligns with the concept of linked lives: that in a two-career marriage, the life of each partner is influenced by the other.(5) Imagine putting together a jigsaw puzzle without any side pieces. Rather than placing the side pieces first and building from there, you must consider each piece from different perspectives as you find those that fit together.
As we build and maintain our relationship, we consider several core areas — or puzzle pieces: family, domestic help, finances, career, timing, integration, and the future.
Core Area: Family
We are fortunate to have two great children who enrich our lives in amazing ways. To build our family, we had to structure sharing childcare, parenting, and housekeeping.
As with many two-career, two-physician marriages, this structure was affected by our choice of specialties, our practices, and what we added into that mix. Because of our specialty choices, it was apparent that one of us had a higher likelihood of being away at odd hours, often working with a different sleep-wake cycle. This had the potential to cause friction when it seemed as if one parent attended school functions and activities and the other one did not. Over time, work-related travel conflicted with our children’s events.
Suffice it to say, one of us became technically expert at discretely transmitting entire school musical performances using FaceTime and texting moment-by-moment action from a soccer match.
What started as dividing up daily childcare tasks, such as dropping both kids off at activities or playdates, morphed into deciding who was going to teach our kids to drive and who was going to get them set up at college.
Over time, we learned a variety of lessons that have allowed us to enjoy being a family.
Although we didn’t get to do as much as a couple as we wanted to, we gave ourselves space to say that was okay. We worked hard to ensure that at least one of us could get to scheduled events. Color-coding the Google calendar became an all-important tool for everyone to see where we needed to be and when.
Not everything got done in the way we might have wanted. Whether it was completing chores or shopping on the weekend or ensuring someone got to a birthday party on time, we tried and sometimes failed. Again, this is where the 25-year rule was helpful, although it did not placate an anxious child.
We got over our independent streak and allowed ourselves to ask for help (see below).
Communication between parents and between parents and kids is essential. Conveyed expectations to each other and to our children have become bi-directional: including kids to us. The expectations have not always been met with great enthusiasm, but this approach has fostered open dialogue and transparency.
Core Area: Domestic Help
When deciding when and where to look for help, we are mindful of extended family and finances. Our quests have ranged from finding a nanny for our kids when they were little to hiring someone for snow removal, to accessing expertise for various home projects.
We’ve also considered what we could afford when deciding whether to outsource or do something ourselves. While that has changed over time, we have always been mindful of asking the question, “Do we really need help, support, certain services, etc.?”
Communicating and agreeing about what is necessary versus what is accessory has helped allay potential problems, control expenses, and guide us to get help when and how we have needed it. We have done this in two ways. First, in off-hand conversations one of us has raised thoughts about what would be helpful at a particular juncture. Second, we have shared responsibility for assessment and decision making for discrete tasks or assets, such as finding help for snow removal or managing our bank account.
Core Area: Career
We have been fortunate in our careers to have individually filled a number of successful and satisfying roles. One of us persevered as an academic surgeon, with forays into education and policy to round out career accomplishments. The other started down a traditional “triple-threat” academic route as a clinician, investigator, and educator and over time has self-re-invented on several occasions. Some change was a pragmatic solution to integrate time and family, and some of it was driven by personal interests and goals. Some was simply the availability of employment at that moment in time.
It has not always been easy. We both have felt symptoms of burnout at various points in our careers. We also have endured harassment, uncomfortable professional situations, failure, and the inability to land positions at institutions or locations that could accommodate both of us, meaning one of us couldn’t take the role that he or she wanted.
Five features have characterized our ability to craft careers for ourselves; two reflect traits that Petriglieri identified in successful two-career couples: a bi-directional attachment structure and blending professional identities.(6)
Our secure attachment to each other has allowed us to undertake a variety of roles and duties.
We have been able to apply new skills that one of us has honed to address our problems. This might manifest in how we handle meetings to get to an objective conclusion or how to ask questions to get the best variety of responses and outcomes from the team.
We share pride in each other’s accomplishments. Each feels a mix of pride, joy, and excitement when the other does something special.
We are grateful for the candor and advice that the other one has provided along the way.
We have allowed ourselves to actively share experiences by bringing work home and including each other in work events when possible.(7) This arrangement has the benefit of our most trusted adviser weighing in when it really matters.
Core Area: Timing
If we had to synchronize every step in our lives and careers with what would be optimal timing, nothing would happen. There is never the perfect time for anything. Some moments are good for change and others are not, and those good times do not always dovetail with opportunities that either of you might want to pursue. Moreover, circumstances beyond our control have often dictated how we addressed something different or new in our lives together, whether it was family or job.
We have used several criteria as a prism through which to view the timing of some career decisions. Those criteria include family (both immediate and distant) disruption, location, travel, and personal. Looking at opportunities with all of these variables in mind has helped us think about timing.
One of us assumed a new role as an associate dean in a political environment at a medical school. Within six months (and after three major leadership changes), the new dean wanted to make another change that eliminated the associate dean position. This happened less than six months after we had located to a new city. It would have been disruptive to uproot everyone again. We considered the 25-year rule criteria, which led to an expansive search for new opportunities and a lot of discussion at home about how to reduce the likelihood of such problems in the future.
Continuing to consider the 25-year rule influenced our timing to include our kids’ ages, as we did not want to disrupt high school; the health of our parents and extended family; the logic of the position in our individual career progression; and the desire of one spouse to continue with their current role and work.
Core Area: Integration
The idealized work-life balance that we crave rarely exists; consequently, it makes sense to work toward integrating work and life — participating in activities that are important but not career-related. Integration focuses on nurturing people and relationships. For us, this has meant taking time away from work to attend an event or go out to dinner and return to work.
For us, integrating work and life also includes integrating our professional skills with our kids’ activities. One of us became the team chaperone for our daughter’s nationally competing skating team. The translation of organizational skills from medicine to another activity, with a foundation of analysis and action as well as the clinical knowledge for the occasional first aid needs, was core to success in this role.
Integration also includes creating time for self through exercise and hobbies and sharing that time with your partner. It means finding causes to support or participating in community activities that have personal appeal and doing so with or without your spouse. At various times for us, this has been exemplified by participating in nonprofit and charitable organizations and serving on their boards.
Core Area: The Future
One of the most significant features that we believe portends success for two-career, two-physician marriages is planning for the future. Planning includes contemplating options, planning for potential contingencies, discussing each other’s expectations, and establishing strategies for meeting those expectations.
This process is essential to fulfilling the vision. Imagine the future that you want to create and how it could happen. As you mature in your marriage or partnership, your careers and your practices, that vision of the future changes for each of you; consequently, updating it regularly so you are together in that vision makes sense.
As you talk about your future, plan for a variety of aspects. Some aspects can be straightforward, such as college funding for kids. Some can be indefinite, such as identifying what part of the country or world you would like to live in for a period of time. Discuss how you can work together to make plans reality. These discussions can range from how to address finances to each partner’s pursuit of career choices.
Consider success and the future from a broader perspective. Identify the two-career, two-physician marriages or partnerships within your organization and discover what is fostering success for these individuals personally and career-wise. With such information, it may be possible to develop insight programs and career guides for aspiring two-career, two-physician marriages or partnerships as well as counseling services, toolkits, and information sessions that support these individuals. Such resources based on data and evidence could support and sustain these individuals promoting personal and professional engagement and fulfillment during stressful times that could be essential to growth that would guarantee their retention in the organization.
We never forget how fortunate we are to be able to consider our choices and our circumstances. Our parents lived through a depression, experienced world war and civil war, moved to countries where they did not speak the language, and entered their marriages with nothing.
The challenges of a two-career, two-physician marriage today are different, but still confounding and exasperating at times. During those times, our two rules have anchored thoughts, actions, and decisions on common principles. While your principles may not be the same as ours, the two-rule concept can provide perspective as you encounter challenges to your two-career, two-physician marriage or partnership.
It’s like picking up a jigsaw puzzle piece and looking at it a different way or twisting it a different direction. If you are willing to do that, you can see how that it does indeed fit with another.
Coda: The nosebleed resolved.
Financial disclosures: Bryan N. Becker owns DaVita stock.
- Ferrante L, Mody L. Dual-Physician Households: Strategies for the 21st Century. JAMA. 2019; 321:2161–2. doi:10.1001/jama.2019.4413. PMID: 31074762.
- Shanafelt TD, Boone DL, Dyrbye LN, Oreskovich MR, Tan L, West CP, et al. The Medical Marriage: A National Survey of the Spouses/Partners of US Physicians. Mayo Clin Proc. 2013; 88: 216–25, doi:10.1016/j.mayocp.2012.11.021.Epub 2013 Feb 27. PMID: 23489448.
- Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Freischlag J. Physicians Married or Partnered to Physicians: A Comparative Study in the American College of Surgeons. J Am Coll Surg. 2010; 211:663–71. doi:10.1016/j.jamcollsurg.2010.03.032. PMID: 21035046.
- Hager JP. Conceptualizing a Medical Relationship. Physician Family. 2015; Winter: 6–7.
- Abele AE, Volmer J. Dual Career Couples: Specific Challenges for Work-Life Integration. In Creating Balance? S. Kaiser et al. (eds.) doi 10.1007/978-3-642-16199-5_10. Berlin Heidelberg: Springer-Verlag; 2011, p. 173–89.
- Petriglieri JL, Obadaru O. Secure-base Relationships as Drivers of Professional Identity Development in Dual-career Couples. Admin Sci Quart. 2018; 64: 694–736.
- Coleman J, Coleman J. How Two-Career Couples Stay Happy. Harvard Business Review. July 27, 2012. https://hbr.org/2012/07/how-two-career-couples-stay-ha. Accessed January 17, 2021.