MARCH 15, 2006


Doctors and D-I-V-O-R-C-E

Medical marriage is stressful. Don't become a statistic

Tips to keep your medical marriage on track

1. Create a context "Let's be realistic," says Dr Sotile, "you're a medical family." That means facing facts and accepting that a marriage with a physician comes with relentlessly difficult circumstances and 60-plus working hours a week.

2. Be humble Even though your circumstances are exceptional, says Dr Sotile, "You can't be an exception to the rules that apply to all couples."

3. Take a leap of faith All couples report multiple periods of rocky times, notes Dr Sotile. "Becoming disillusioned is part of the journey of marriage," he says. It's essential that physicians make the decision to slow down and drop back to fundamentals. Don't lose faith and remember that little things can make the biggest difference.

4. Honour and cherish Dr Sotile urges you to remember you married an exceptional high-achiever ("doctors aren't attracted to knuckleheads"). Honour them whether they're a neurosurgeon or a stay-at-home-parent. And don't forget to hold hands and be nice. "Everybody needs a honeypie," stresses Dr Sotile.

5. Leave work at work It's natural for doctors to carry the burden of their stressful days back home. But what you've got to remember is that many of the qualities that make you a great doc — multitasking, hyper-vigilance, perfectionism, competitiveness — don't work at home.

6. Don't "wait until" Marriages ending after the 30th anniversary have tripled in the last decade. The last generation of physicians fell prey to the "wait until" lifestyle, but Dr Sotile urges today's docs: "Fix your marriage now!"

"I wish that we could stop this
D-I-V-O-R-C-E," sang Tammy Wynette plaintively back in 1968. An increasing number of unhappy physicians living through a break-up are singing the same tune.

All marriages are a lot of work — high levels of stress about money, kids and careers come part and parcel. Throw a doctor in the mix and long hours, job-related stress and often unrealistic expectations can mean instant big trouble almost before the honeymoon's over.

Divorce rates in Canada peaked at 44% in 1987 and have since fallen back to the current rate of 37% but are slowly on the rise. Despite their extra-large stress burden, there are no reliable statistics to suggest that rates among physicians differ.

"The fact that MDs don't have astronomical divorce rates," says Dr Wayne Sotile, PhD, a clinical psychologist in Winston-Salem, NC, "attests that they're extraordinary people, with a work ethic comparable to none." Dr Sotile and his wife Mary, have written numerous articles and books on the subject and in 30 years of practice have counted more than 3,000 physicians as clients.

Over the years they've discovered that medical marriages don't break down for the reason you'd assume. "More than the hours worked, what determines levels of stress is the physician's mood when they get home," says Dr Sotile emphatically. "Are they too tired to participate in family life? Are they irritated or worried about work?" He says many doctors make the fatal mistake of "wearing the sack cloth and ashes all the time," but not showing compassion to their own families. "They'll say, 'I'm dealing with life or death issues here — of course I can't go to Joe's baseball game.'"

A growing number of studies have delved into physician divorce. There are wide variations depending on sex and speciality. According to a 1997 US study, psychiatrists have the highest rate at around 50%; surgeons are next at 33%; the profession as a whole has a divorce rate of 29%. The study found an elevated divorce rate among female physicians and those who married while still in med school.

A 2003 study by Dr Gail Robinson of the Toronto General Hospital into stresses faced by women doctors found that "rates of successful suicide and divorce are much higher" than in the general public.

Dr Sotile's clinical experience bears this out. He doesn't blame the women though, he blames their families."The burnout and divorce rate for women MDs is higher and it only has to do with them getting slaughtered by their young husbands," he says. "Their families are always busting their chops about what they're missing." But ironically he notes that the 'feminization of the profession' has led to an increase in similar work/life conflict for male physicians, who now expect a better balance.

Dr Sotile says easily the most angry and disgruntled group he's encountered is young men married to physicians. "This was a real surprise to us," he says. "We're still dealing with old horrid wiring about sex roles." The message he hears over and over from these young men is "if my masculinity's not being honoured, I get angry." Take this angry post on the website from Matt, a SAHD (stay-at-home dad) married to a pediatrician: "So, DW [dear wife] is now off on her third conference. The boys and I get to stay at home. She's 'roughing it' in the Colorado Mtns. She had to go and get the required CME credits, but please.... she's going on a sleigh ride, pulled by draft horses to a secluded cabin in the resort, fed a magnificent meal, FREE DRINKS, and hot chocolate.... how romantic." Wives on the site express these sentiments too but are much more resigned.

Just as surprising, says Dr Sotile, is that many women docs have the same outmoded expectations. He describes the case of one of his physician clients whose husband got downsized. They decided he'd stay home with the kids, but she confessed to Dr Sotile that she felt ashamed her husband didn't go out to work: "My daddy would have found a job flipping burgers," she said.

A 1999 survey of US docs found 22% of male physicians were married to another working physician. A 2002 study looking at dual physician marriages found they have a relatively low divorce rate of 11%. "They're a happily married cohort," says Dr Sotile. "They're more compassionate about the passion for the career — they understand the calling because they share it."

Nevertheless, every medical marriage has to have a stress absorber. Usually this role is filled by the non-physician in the marriage. "One MD might have to choose not to take their first choice speciality," he says. "This is tough — they'll get no support from their families, so these marriages can start off with strain." On the upside, two-physician marriages tend to learn to be more flexible, and Dr Sotile found docs married to docs tend to work slightly shorter hours.

For more, visit the Sotiles' website:




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