The Single Most Important Decision a Physician Will Ever Make.

Essential conversations for Physicians and their partners. The one decision that a physician will make that weighs the most both personally and professionally is committing to a partner for marriage (or living common-law). This is relevant for most of us, since a Medscape survey in 2020 of 15,000 MDs in 29 specialties showed that 80% of MDs are married. Getting married or cohabitating is a transformative life event, but also comes with its own set of challenges. For physicians, marriage involves unique considerations given the demanding nature of the profession.

Before tying the knot, it’s crucial for the MD and their soon-to-be spouse to have honest conversations about various aspects of their lives, which we will explore in this post.
1. Work-life balance: Especially early in your training and career, work can be all-consuming. Even once MDs are established in practice, the average female physician works 48.1 hours per week, and the average male clocks in at 52.2 hours (Canadian Medical Association workforce survey 2017). Be transparent about the potential long hours and unpredictable schedule, including nights, weekends, and holidays.

2. Financial planning: Physicians often carry significant student loan debt and may face the pressure of high earning expectations. Discuss your financial situation openly, including your spending habits. Create a financial plan that aligns with your mutual goals, such as home ownership. Come up with a plan on how expenses should be shared if there is a substantial gap in income between you and your spouse. Although it is not the most romantic topic, discuss legal matters like pre-nuptial agreements, wills, and estate planning.

3. Life goals and values: You and your partner may already have similar values at work, such as patient care; in fact, an AMA Insurance Agency Inc survey of 5000 MDs in 2019 showed that 40% of physicians marry another physician or health care professional. More specifically, according to the 2020 Medscape survey, 1 in 4 female physicians are married to another MD (higher than the 16% of male MDs married to another physician). However, you must ensure that your non-career priorities in the home align as well, and you are willing to support each other’s goals. You may have to address potential compromises in incorporating each other’s cultural or religious traditions if you come from different backgrounds.

4. Parenting and family planning: If you plan on having children, discuss your expectations regarding family planning, parenting roles, and childcare responsibilities. These conversations should also encompass potential challenges like pregnancy during residency and fellowship. On the other end of the spectrum, more and more of us are in the ‘sandwich generation’, where we are taking care of both kids and aging parents. Talk about realistic strategies to care for both sets of parents as they get older.

5.Career transitions: The life of a physician may involve frequent relocations and long periods of training. Discuss how you both envision these transitions and the impact on your relationship and family. Planning for these career shifts can alleviate stress and uncertainty. Early on, you should also talk about what retirement means for both of you.

6. Quality time and self-care: Ensure that you have a plan for quality time together and individual “me time”. As we have discussed in other blog posts, physicians are at a higher risk for burnout, which can be accelerated by a lack of self-care. While having a spouse who understands ‘the medical business’ is helpful, it’s no guarantee; having a partner who is a non-physician health care professional increases the odds of burnout by 23% (AMA Insurance Agency Inc survey 2019). This is especially relevant for the 35% of male physicians who are married to an allied health care professional.

7. Professional boundaries: The health care field requires professional boundaries different from other professional disciplines. Make sure that your partner understands your ethical responsibilities to your patients. Explain that you may not be able to discuss your day in detail due to patient confidentiality. Some specialties require constant connectivity, particularly when on home call. Mutually establish boundaries to ensure that you have technology-free time together as a couple without the intrusion of work-related communications.

8. Community involvement: Many physicians have a strong desire to give back to their communities through volunteer work or medical missions. Ensure that your spouse is supportive and willing to participate in these activities if they align with their interests.

Open conversation is the cornerstone of a successful marriage, especially for physicians who face unique challenges due to the nature of the job. Addressing these key topics before getting married will help you both understand each other’s expectations and concerns. For complex or sensitive issues, seeking the guidance of a professional can help for relationship, legal, and financial matters. Statistics Canada data from 2018 state that 38% of marriages end in divorce; luckily, physicians have some of the lowest rates of divorce by profession, at only 21.8%. Remember that marriage is a journey, and the more you prepare and communicate now the better equipped you’ll be to navigate down the road together as physician and spouse.

Author: Dr. Krishna Sharma, Chief Medical Officer, Specialty Medical Partners