The first is the exceptional work demands that come to physicians. Three times more physicians work 60-plus hours per week than any other professional group. Everybody thinks they work hard, but nobody works as hard for a lifetime as do physicians. This creates special challenges for physicians and their families. Medical couples understand early on that the doctor is going to be working hard, but they often become disillusioned with how many years this hard work pervades and affects their families.

The second factor is that both men and women these days are compelled to be more whole people when it comes to work and family. Women who were historically the support systems for physician families are now driven to do more outside the home, either with a career or with other non-family responsibilities. Secondly, in these past fifteen years, families have entered the hearts of men. The expectations that male physicians have of themselves at all stages of life regarding family have grown tremendously. The expectations of physicians' spouses and physicians' children and grandchildren have grown tremendously as well.

The third factor is that we do not have appropriate, realistic road maps of what it means to have a lifetime partnership and what it really means in the trenches to have a reasonable balance between work and family. It doesn’t seem to help young physicians to look at the “road maps” created by the lifestyles of prior generations. The right formula of work and family life in the past does not apply to today. And today’s generation of aging physicians faces a different set of external demands and a different set of expectations of how they are to successfully balance work and family. Oftentimes there is a script written by other folks--parents, grandparents, culture, the media--about what marriage is really like that truly is not applicable to real life.
II. What you can do about it.

Be realistic.
If you are going to do the job, accept the implicit demands in the job. Being married is tough, but it is the best thing we can do to ensure our health and happiness; we have definitive data about that. Like it or not--and all concerns about political correctness duly acknowledged--the truth is that spouses of physicians are happier when they accept that they will need to function in family life fairly independently of their physician-mate. This was one of the resounding messages we heard in our recent, national survey of physician spouses. You must also honor and facilitate medicine as a part of your family life rather than resenting its effects.
Love your work. Find support from loved ones for your work.
Life is about both love and work. Since the sixties, we have emphasized the love part of that equation and ignored the work part. If your family is not supportive of you in the hard work that you are doing, it can be very toxic to your emotional and physical health.

Protect your boundaries.
Physicians and other busy people married to physicians need to learn to say no to some of the opportunities and invitations that are an endless part of a successful career. Choose wisely how you deal with your most precious commodities: your attention and your energy.

Respect your own mind, body, and spirit.
You cannot have a healthy marriage unless you are healthy. Physicians spend their careers caring for others but often do not take fundamental care of themselves. This can result in misery at home and at work.

Nurture positive personal relationships.
Physicians who have the most positive personal relationships also tend to be the ones who promote positive collaboration and collegiality in the workplace. Incidentally, these same physicians get sued less frequently, are deemed to be better physicians by their patients, and have better adherence to the medical interventions they do. Remember, this is a two-sided coin: the quality of the workplace relationships on one side and the quality of the marriage relationship on the other.

Practice pleasure.
Physicians typically grow up as doers and achievers, getting a PhD, so to speak, in denying healthy pleasures, in learning to self-deny, go numb, and keep on going. To be open, responsive, and able to grow a relationship, you cannot be numb.

Implement and honor relationship rituals that allow friendship, communication, and intimacy.
We work with couples who have not had a date in years, who do not turn the television off when it is time to talk, who only speak when they are exhausted or angry or irritated. Bear in mind the number one cause people cite for getting a divorce is a loss of friendship. You can’t have friendship unless you spend time with a person and give them your good attention. For physicians who are extraordinarily into their career, I offer this wisdom: Beware the fatal flaw of every now and then, swooping into the family and being critical of the partner who is doing the bulk of the in-the-trenches work. That is the sin that is the hardest to forgive in medical families.
We need to understand that no couple is more challenged than a medical couple, no family is more challenged across the journey than medical families, members of no other profession are more challenged than physicians. To be resilient, you have to take care of business at home and in the workplace, and the most important requirement for that is caring connections. In order to promote that, I believe communities of physicians and their loved ones need to be rallied as emissaries of collaboration and collegiality. Getting along with each other is one of the greatest ways to ensure your own resilience and promote the creation of healthy medical marriages.