Physicians in Dual-Career Marriages

Abstract

The context of the lives of physicians has unique and challenging features for those in dual-career marriages. The empirical investigation of this phenomenon has remained relatively sparse. This study assesses dual-career couples that include a physician nurture marriage and family relationships while managing the heavy demands of their career. Using a sample of 15 dual-career couples with a key informant physician, a qualitative phenomenological lens investigated how these intimate relationships are nurtured as they manage the other demands of work and life. Two major themes evolved that were associated with intentionality to grow and maintain their relationship before having children and negotiating the demands of life and work after children come into the family. This study discusses important implications for theory, research, and practice as family counselors, therapists, and educators as they focus on adjustment to the unique experience of physicians in dual-career relationships.

Keywords

medical marriage physician marriages work–family issues dual-career marriages

The experience of managing two careers creates or intensifies stress between (or maybe we could say, “spouses and partners” instead of husband and wife, to capture a wider audience at this juncture) husband and wife. Sometimes, such a stressor can lead to intentional and inadvertent neglect of relationship nurture as well as decrease work productivity and personal well-being. By forging and strengthening marital bonds and creating an environment that fosters teamwork, openness, and caring, the marriage partnership can be a source of support and renewal amid the demands of a career. Some couples who find themselves in such a situation may realize that this tug-of-war between being a good spouse and being a good professional leaves them empty and feeling spent.

A number of studies focusing on dual-career marriages tend to discuss the gender division of household labor (Bohen & Viveros-Long, 1981; Gross, 1980; Leslie & Anderson, 1988; Skinner, 1980; Ten Brummelhuis & van der Lippe, 2010) and the impact of women entering the workforce (Voydanoff, 2004). Few studies have investigated how couples maintain their connection despite their busy schedules. While studies on work–family spillover discuss the reciprocal impact of work on family life (Frone, Russell, & Cooper, 1992; Gutek, Searke, & Klepa, 1991; Ten Brummelhuis & van der Lippe, 2010; Voydanoff, 2005), little attention has been paid to the maintenance of intimacy in dual-career marriages. This article uses a phenomenological qualitative approach to explore how physicians and their nonphysician spouses navigate their relationship.

An examination of the extant research on dual-career couples reveals at least important observations about the state of such marriages. The first is that dual-career couples struggle with establishing equality in their relationships (Bryson, Bryson, Licht, & Licht, 1976; Elman & Gilbert, 1984; Rapoport & Rapoport, 1969). Second, wives in dual-career couples shoulder more domestic responsibilities than husbands in such unions (Elman & Gilbert, 1984; Reinhart, 1984). Third, wives, rather than husbands, are more willing to sacrifice career advancement to reduce gender–role conflicts within their marriage (Elman & Gilbert, 1984; Poloma, 1972). Fourth, marital satisfaction is about the same in doctors' marriages as in other traditional marriages (Skinner, 1980; Yogev & Brett, 1985), although one would assume that dual-career couples experience more dissatisfaction. Fifth, satisfaction in marriage is heavily dependent upon the perception of equity rather than marital equality (Moravits, 1989; Rachlin & Hansen, 1985). Finally, and possibly most interesting, is that marital satisfaction increases when both spouses are emotionally supportive of each other’s career (Rapoport & Rapoport, 1971; Reinhart, 1984).

Rapoport and Rapoport’s (1971) work on dual-career couples explored the relationship between love and paid work. Their research led to a number of studies that have primarily looked at marital satisfaction among dual-career couples. One type of dual-career marriage that has been discussed in current literature is the medical marriage (Sotile & Sotile, 2000), in which one or both partners are physicians. Research conducted by Myers (2001) suggests that medical marriages experience difficulty in the area of intimacy, as traits that are often associated with a good physician, like control and perfection, often conflict with qualities that are considered important to maintain a marriage.

The demands placed on a physician are quite high (Bakker, Lieke, Prins, & van der Heijden, 2011). Empirical and anecdotal information suggests that the spouses of physicians report frequent moments of loneness, regardless of the profession of the nonphysician spouse (Bakker et al., 2011; Williams, 2014). While the same may be true of other individuals living in dual-career relationships, physician marriages are unique in that the physician is required to spend numerous hours charting, at conferences, at clinic, rounding, in board meetings, speaking with patients and their families, and being on call, to name a few of their responsibilities (Bakker et al., 2011; Jovanovic & Wallace, 2013). The number of hours spent outside of the home is significantly more than other professionals (Bakker et al., 2011), and this is likely to have an impact on their intimate relationships (Jovanovic & Wallace, 2013).

There is disagreement in the literature regarding the level of satisfaction and stability in doctors’ marriages (Isaac et al., 2013; Reinhart, 1984; Shanafelt et al., 2013; Sotile & Sotile, 2000; Williams, 2014). Some contend that the medical marriage of male physicians is not less satisfying than that of other professionals (Lewis, Barnhart, Nace & Carson, 1993; Weisman & Teitelbaum, 1987). Shanafelt et al. (2013) paint a more positive picture of the medical marriage in their study, which included 891 spouses of physicians. The aim of this study was to evaluate the physician relationships from the perspective of their partners and/or spouses. Of the sample, 503 were employed outside of the home and worked between 30 and 40 hr a week. Four hundred and forty-seven of these spouses were nonphysician professionals. Their findings suggest that partners/spouses of physicians have high levels of satisfaction, however, the number one factor that was associated with marital satisfaction was the amount of time that the couple was able to spend together each day.

Warde, Moonesinghe, Allen, and Gelberg (1999) compared marital satisfaction between male and female physicians with children. In their study, male physicians appeared to have greater marital satisfaction than female physicians. That is, high levels of marital satisfaction were associated with two primary factors, namely helpful and cooperative partner and the low levels of role (responsibility) conflict. Role conflict or “the perceived frustration resulting from the competing demands of career, marriage, and family” (Warde, Moonesinghe, Allen, & Gelberg, 1999, p. 162) was higher among female physicians than their male counterparts. Female physicians who are parents were more prone to experience role conflict than their male colleagues. This is primarily because the determinant variables are very long work hours, scheduling, work that exacts physical and psychological demands, disparity in division of home responsibilities, and challenges of caring for children (Warde et al., 1999). Overall, lower levels of role conflict have been shown to be positively associated with high levels of marital satisfaction for male physicians. Stamm and Buddeberg-Fischer (2011), in a study of 414 physicians and their partners/spouses that focused on gaining insight into the career arrangements of physicians and their partner/spouse, indicate that child care is a major source of stress.

Theoretical Framework

Symbolic interactionism formed the framework for the questions that were asked and served as a guide during the processes of analysis. Symbolic interactionism traces its roots in the pragmatist philosophers such as Peirce, Dewey, Cooley, and Mead (Blumer, 1969). Some of the characteristics of the symbolic interaction perspective are an emphasis on interactions among people, use of symbols in communication and interaction, interpretation as part of action, self as constructed by others through communication and interaction, and flexible, adjustable social processes (Boss, Doherty, LaRossa, Schumm, & Stinemetz, 1993). Meaning changes depending on the context of the individual.

Method

Overview of Research Design

The aim of the current research study is to explore relationship nurture strategies employed and developed by dual-career couples, in which one partner is a physician and the other works outside the home. The study utilized a detailed protocol that was administered to participants at a time and venue convenient for them. Audio files were then transcribed and coded.

Sample and Data Collection

The study employed recruitment methods including print advertisements in hospitals, clinics, and private practice offices in and around Southern California; word of mouth; and snowball sampling. The interviews lasted between 60 and 90 min and were conducted by an individual of a seven-member research team. For this in-depth qualitative study of physicians and their professional nonphysician spouses, both partners were required to be present for the interview, as we were interested in how the dyad makes time to nurture the relationship. Participants were called to schedule a time, date, and venue suitable for them. Following the administration of the protocol, audio files were transcribed and coded. The inclusion criteria for the study were that couple should be married for a minimum of 2 years, the physician should be out of residency for a minimum of 1 year, and the nonphysician spouse must be working full time.

To enhance rigor during the early stages of the interview process, the research group met for debriefing and critiquing of the protocol as well as the process of analysis. The analysis process also used many checks and balances to enhance the rigor and credibility of findings, including the use of multiple coders, audit trails, member checks, and critical case analyses (Strauss & Corbin, 1998).

Analysis

The study employed a multisystemic interpretive approach (Strauss & Corbin, 1998), beginning with inductive open coding of the first few interviews in a research team. This approach involved multiple reads of the transcripts, coding without the use of a start list of codes (Strauss & Corbin, 1998). A final coding scheme was developed using a reflexive process similar to constant comparison (Strauss & Corbin, 1998). This process included scrutinizing codes by searching for exceptions and disconfirming evidence and conducting member checks by the continuation of interviews even when it appeared that saturation had been reached. Codes were refined, changed, combined, or omitted accordingly. These multiple stages generated a final list of codes that the researcher considers to be descriptive as well as conceptual. This was done while constantly keeping the participant’s words in context.

Participants

Fifteen couples who have been married for an average of 7.5 years comprised the sample for this study. Participants were from varying ethnic backgrounds, such as White, Black, and Asian, and consisted mostly of physicians whose specialties were family medicine or obstetrics and gynecology. Fourteen of the couples had children residing in the home, and many of these children were high school aged or younger. Participants conveyed both the advantages and disadvantages of being part of a dual-career couple. They frequently used words such as not enough time or managing time to describe one disadvantage of being part of such a dyad. On the other hand, words such as teamwork were used to express the way that some couples functioned. The professions of spouses include allied health professionals, nurses, businesspersons, and information specialists. Both partners were employed outside the home and worked an average of 40 hr per week.

Findings

Analysis of the data produced two categories, namely intentionally prioritizing couple relationship and scheduling time to nurture the couple relationship that allowed for an understanding of how couples nurture their relationship.

Intentionally Prioritizing Couple Relationship

All couples in this study were aware that after marriage, both partners would be involved in the paid workforce, so many of them consciously and unconsciously prepared for the demands of such a lifestyle. The data show that once couples spent time together, developing a sense of “us,” they were better equipped to navigate the challenges of a dual-career lifestyle as well as make time to nurture their relationship. As a female emergency physician and her accountant husband noted:

We didn’t feel it would have been advantageous to have the kids during medical school and residency with all its demands; that was not a good time. And then after residency we took 2 years just for us…When she finished her residency, she didn’t start working for 9 months. She took 9 months for rest and relaxation.

This couple, along with others, implied that having time to bond was effective in forming a strong connection. When asked about their decision to have children, a female pediatrician and her husband who holds a graduate degree in business stated:

We discussed that (money and children) before we got married. It had to be something that had to be addressed because you can be in love and have all the chemistry but if you can’t manage a life together. We had pre engagement counseling…I always knew I wanted to have three kids. But my wife didn’t want to have children.

To this, his wife responded:

I had been in school all my life. I felt, “man I don’t want to come home to this, I just want to be done and relax. I want to be pampered for a change. I just want to live my life.” My thought process was I’m not having kids. So we were able to spend time, just the two of us, before we had children and this made our relationship strong.

In this sense, this couple was able to make time for their relationship and create a bond so that if or when children were introduced they would know that they had a foundation that was built on quality time together. It must be understood that not all couples mentioned this as a part of their relationship. Couples who did not spend this time prioritizing the marriage were not unsuccessful in nurturing the relationship; however, when asked about time with the couple, they tended to talk about time together as a family, rather than giving a description of time that the couple spent together. An orthopedic surgeon and his wife who works as a physiotherapist voiced their struggle prior to marriage:

I would say we probably didn’t talk about life after to…get to the bottom of things…I think we were less interacting personally, less intimately, and less depth (because of our careers) and the reason being…we were not fundamentally agreeing on issues…all the time.

Creating time for the relationship allowed partners to bond and form a foundation that assisted them in being able to cope with the stressors of their chosen lifestyle. The development of this foundation required a conscious effort to create sufficient time on the part of the couple.

Once the couple was able to create this foundation, transitioning to becoming a parent was easier. Couples in this study who chose to delay becoming parents did this for at least two reasons; first, they had a desire to strengthen their relationship and second, when they looked at their careers, they realized that having children at a certain point could leave them with parenting or professional regrets. We see here that couples in this study were intentional in ensuring that they allowed time to grow as a unit before children were introduced.

Scheduling Time to Nurture the Couple Relationship

Although many of these couples had access to child care, children, rather than career appeared to be the number one reason for couples not being able to spend impromptu time together, and their experiences took varying forms. A female pediatrician explained:

I would love for us to spend more time together. A lot of the time that we are together physically, the kids are also here physically as well. So there’s not that much communication about each other, but mostly communication about the kids, so you don’t get a lot of personal communication. And about the time we would do that we are both falling asleep because we are both so tired. So we are finding that you can miss out on certain things if you don’t touch basis and communicate. It still works but it would be wonderful if we could have more time.

Her husband further stated:

It’s a struggle to maintain steady worship (together) because things get in the way. But we try to touch base every evening. That’s why we keep a schedule because if you don’t have a time things get in the way.

Planning was necessary when young children were present. The presence of children in the family certainly had an impact on the frequency of time that partners were able to spend together. A female gastroenterologist and a software specialist who have a 1-year-old daughter noted their challenge:

Our life is in such a way that we have to have everything planned…Since our daughter was born we’ve had maybe 6 months (without couple time).

A male internal medicine specialist married to a physical therapist, and parents of two school-aged children, shared their reality:

There hasn’t been much time (for the two of us), not after the kids. It does take planning…After you put them to bed and hope they stay asleep.

The importance of having a bed time for the children as a way of ensuring that there were a few minutes for the couple to spend together were further echoed by a nurse and her husband who practices preventive medicine.

When they go to bed late at night, that’s our time. It doesn’t always work. If they get to bed after nine the whole night’s shot. Living in the same house, eating at the same table, sleeping in the same bed is not couple time. That’s like saying because I’m in the building I work in, I’m working. No. You really have to set that time away. We like listening to different programs on enriching marriage and reading books. And being a couple you have to be intentional in the things that you do to help strengthen that because anything that you plan if it’s not caretaking it eventually dies and you don’t notice the death until you want something from it.

Some couples really tried to make an effort to make time for each other; time that did not involve the children. A female pediatrician, and mother of two, and her husband who holds a business degree state:

Sure, you know we have two children and it is difficult to be by ourselves. So we just understand that it’s life so we make an effort to as often as we can, maybe we can pick that up a bit, that we can spend more time with each other. It’s just a matter of childcare, and planning. And as you know we are pregnant so it’s going to be, as this third one comes in I don’t know how many people are going to want to take care of three. So we will just have to be creative here. I would love for us to spend more time together.

Other couples felt that couple time could take a backseat to raising children since their children would not always be with them. This sentiment of putting the children first for the time being, and considering the structure of their lives, was shared by a male cardiologist and his wife who is a nurse:

When the kids are gone to bed she and I can do some things together, but right now this is a limited time not many more years, so I think we will prioritize them for now.

When asked how they finally found time to nurture their relationship and what they did to connect, couples mentioned a variety of rituals that they engage in. Most of these rituals required consistent planning and a concerted effort on the part of both partners. A male anesthesiologist married to physical therapist found a way to spend time together while giving back to the community:

A lot of the time that we spend together is doing ministry stuff. I think I struggle with (our personal time), because I think that we need more time with each other. It’s a balance that you have to have. We’re still working on it.

Another couple, a family practice physician and her husband who teaches middle school, discovered that while they need to be more involved in the process of making time for each other, they were doing the best they could, given their schedule.

We sit on the couch together, maybe watch a TV program, but yeah, we both probably know we need to invest more in the relationship because we are probably on the periphery right now. But it’s a good marriage. In my opinion, I’m very happy being married to him, he’s a wonderful support and he’s a great father and I enjoy being with him.

A male anesthesiologist married to a physical therapist did share the struggles involved in making time to nurture their relationship. Like other couples in this sample, they spent time doing things like exercising, reading, and engaging in spiritual activities alone as a way to center themselves. Allocating time to regroup as a couple required more planning:

I think that’s where my concern was is that we were still doing all these things individually but we need to get back to doing it together because I think that adds to the relationship.

When children were introduced into the family, the couples had to become more proactive in regard to scheduling time to nurture their relationship. The couples seemed to understand that life would not always be like this and were willing to do what they could to connect with each other.

In addition to the two categories that emerged, and as referenced earlier, couples in this study certainly saw themselves as a team. An emergency physician and her husband who is an accountant shared this experience:

… if something isn’t coked I will pick up and cook if I can. We cross over roles…In general, there is nothing really stated; we don’t state “oh you’re going to do XYZ.” If I’m off and there is laundry to be done, like ironing for example then I will just start ironing. I don’t say well it’s his job and I’m going to leave it for him.

This speaks to the partnership that is part of the dyads in this study.

Discussion

The purpose of this study was to explore the ways in which dual-career couples nurture their relationship. The sentiment shared by many of the couples is that couple time doesn’t happen automatically. Couples state that they had to make a concerted effort to reconnect at the end of the day and had to be committed to finding downtime. Based on the stories of the participants, the way they sought to nurture their relationship was impacted by the presence of children. Even with two careers, vacations and impromptu adventures were more frequent. However, as children were introduced, their meaning of time together changed from occasional romantic get-aways, to a few minutes alone in their home. The couples, although not necessarily happy about this, realized that this change was necessary to function as a professional, parent, and partner. Couples in this study had to be organized and proactive in regard to managing their chosen careers, and these organization characteristics were also seen in their efforts to nurture their marriage. The experiences of these couples highlight some of the challenges faced by dual-career couples as they juggle the demands of work, family, and home. While most of the couples reported career success, the major strategy that they employed for nurturing their relationship could have the potential of becoming another job. Time, unlike the other resources that the couples have access to, is a constant in many ways. Couples could not get more time within each day so they had to prioritize how much time they would be willing to give to the various demands placed on them.

While conducting exploratory discussions with these couples, several concepts emerged that could be worth exploring in future research. Expectations and socialization of gender and changing sex roles, clarifying values of each couple, finding new support systems congruent with the dual-career lifestyle, reestablishing dependency needs and needs for nurturing within the marriage, aside from the external gratification they both receive from their work, working with conflicts related to power and competition, and helping the couple make educated decisions regarding occupational mobility as some of the areas that family life educators and other mental health professionals should address.

Symbolic interactionism is the framework chosen through which to view the current research. Based on the stories of the participants, the meaning attached to nurturing their relationship was impacted by the presence of children. Even with two careers, vacations and impromptu adventures were more frequent. However, as children were introduced, the meaning given to time together changed from occasional romantic get-aways, to a few minutes alone in their home. The couples, although not necessarily happy about this, realized that this change was necessary to function as professional, parent, and partner. As family scholars, it may be necessary for us to engage our public in discussion regarding family planning, rather than assuming that due to their level of education they are aware of the impact that children will have on a marriage.

The couples in this study had to be organized and proactive in regard to managing their chosen careers, and these characteristics were also seen in the efforts they put into nurturing their marriage. Future research might consider accessing if there is a connection between how couples tell the story of their relationship and how this impacts their creating time to nurture the dyad. In addition, studies could include a more detailed measure of marital satisfaction to access how couples feel about the current relationship. Having an awareness of what the processes involved in creating time to nurture the dyad may be directly related to how satisfied partners feel in their marriage.

Background of Researchers

The researchers are trained family scientists who have spent considerable time in a medical environment interacting with physicians and others, some of whom, may actually be involved in intimate relationships with medical professionals. In addition, the researchers are trained counsels, therapists, and educators who have had the opportunity to work with a variety of couples as they navigate marital struggles and hence come to this experience with some level of awareness of the dynamics of couple relationships. Finally, there is an appropriate gender mix that may bring varying perspectives in regard to issues associated with gender drama that is frequently seen in couples.

Limitations and Implications

The findings of this study of dual-career couples have been able to shed light on how couples in this ecology nurture their marriage relationship while managing the other demands of paid work. While this qualitative study used a sample of doctors in dual-career relationship, the sample had a larger number of African Americans than those in the Asian and Hispanic groupings. While the study did not focus on race or ethnic issues, it is possible that physicians in that category may have some unique features that may be exacerbated by the challenges of discrimination in the professional context. Future research may need to assess the effects of race and ethnicity on complicating the demands of work and family life for physicians in dual-career marriages.

The limitations of this current study and the need for further research are clear. Information regarding physician families has been provided. However, it might be important to know more about the role of culture as couples nurture their relationships. Another area of exploration for further study is the similarities or differences that homosexual couples have as they manage the demands in various areas of their lives. These issues were not explored in this present study, and future studies that consider these issues would help to advance the current research.

The present study has important implications for practice in the fields of counseling and marital and family therapy. Counselors and marital and family therapists need to be sensitized to relationship dynamics in which a professional woman or professional physician in a marriage with another professional challenges the typical gender roles and symbiosis, and these couple may need more coaching and support as they venture into unfamiliar territory and one that has fewer role models that they can emulate. As well, couples in the premarriage context need to be prepared well for the challenges and demands that are associated with dual-career marriages and deliberate attempts must be made to engage them in thoughtful consideration of these matters. Counselors and therapists need to be aware of the issues of race, class, and socioeconomic status in relationships and how these factors may influence the social organization of these families.

Altogether, this present study was an important contribution to the present empirical literature on physician marriages and families and highlighted how these couples cope with their reality. Because dual-career relationships are on the rise, the present research is made much more significant at the present time.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Bakker

A. B.

Lieke

Prins

J. T.

van der Heijden

F. M.

(2011). Applying the job demands–resources model to the work–home interface: A study among medical residents and their partners. Journal of Vocational Behavior, 79, 170–180.

Blumer

(1969). Symbolic interactionism: Perspective and method. Berkeley, CA: University of California Press.

Bohen

H. H.

Viveros-Long

(1981). Balancing jobs and family life. Philadelphia, PA: The Free Press.

Boss

P. G.

Doherty

W. J.

LaRossa

Schumm

W. R.

Steinmetz

S. K.

(Eds.) (1993). Sourcebook of family theories and methods: A contextual approach. New York, NY: Plenum.

Bryson

R. B.

Bryson

J. B.

Licht

M. H.

Licht

B. G.

(1976). The professional pair: Husband and wife psychologists. American Psychologist, 31, 10.

Elman

M. R.

Gilbert

L. A.

(1984). Coping strategies for role conflict in married professional women with children. Family Relations, 33, 317–327.

Frone

M. R.

Russell

Cooper

M. L.

(1992). Antecedents and outcomes of work-family conflict: Testing a model of the work-family interface. Journal of Applied Psychology, 77, 65.

Gross

(1980). Dual career couples who live apart: Two types. Journal of Marriage and the Family, 42, 567–576

Gutek

B. A.

Searle

Klepa

(1991). Rational versus gender role explanations for work-family conflict. Journal of Applied Psychology, 76, 560.

10.

Isaac

Petrashek

Steiner

Manwell

L. B.

Byars-Winston

Carnes

(2013). Male spouses of women physicians: Communication, compromise, and carving out time. Qualitative Report, 18, 1–12.

11.

Jovanovic

Wallace

J. E.

(2013). Lean on me: An exploratory study of the spousal support received by physicians. Psychology, Health & Medicine, 18, 543–551.

12.

Leslie

L. A.

Anderson

E. A.

(1988). Men’s and women’s participation in domestic roles: Impact on quality of life and marital adjustment. Journal of Family Psychology, 2, 212–226.

13.

Lewis

J. M.

Barnhart

F. D.

Nace

E. P.

Carson

D. I.

(1993). Marital satisfaction in the lives of physicians. Bulletin of the Menninger Clinic, 57, 458–465.

14.

Moravits

M. E.

(1989). The relationship of equity and gender to intimacy and marital adjustment in members of dual-career couples (Doctoral dissertation). Indiana State University, Terre Haute, IN.

15.

Myers

M. F.

(2001). Topics in review: The well-being of physician relationships. Western Journal of Medicine, 174, 30.

16.

Poloma

M. M.

(1972). Role conflict and the married professional woman. In Safilios-Rothschild

(Ed.), Toward a Sociology of Women (pp. 187–198). Lexington, MA: Xerox College.

17.

Rachlin

V. C.

Hansen

J. C.

(1985). The impact of equity or egalitarianism on dual-career couples. Family Therapy, 12, 151–164.

18.

Rapoport

R. N.

(1969). The dual career family: A variant pattern and social change. Human Relations; Human Relations, 22, 3–30.

19.

Rapoport

R. N.

(1971). Dual career families. Harmondsworth, England: Penguin.

20.

Reinhart

T. W.

(1984). A study of the factors contributing to the degree of marital satisfaction achieved by dual career couples (Doctoral dissertation). Retrieved from https://www.worldcat.org .

21.

Shanafelt

T. D.

Boone

S. L.

Dyrbye

L. N.

Oreskovich

M. R.

Tan

West

C. P.

… Sotile

W. M.

(2013, March). The medical marriage: A national survey of the spouses/partners of US physicians. Mayo Clinic Proceedings, 88, 216–225.

22.

Skinner

(1980). Dual career family stress and coping: A literature review. Family Relations, 29, 473–480.

23.

Sotile

W. M.

Sotile

M. O.

(2000). The medical marriage: Sustaining healthy relationships for physicians and their families. revised ed. Chicago, IL: American Medical Association.

24.

Stamm

Buddeberg-Fischer

(2011). How do physicians and their partners coordinate their careers and private lives? Swiss Medical Weekly, 141, w13179. doi:10.4414/smw.2011.13179

25.

Strauss

Corbin

(1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage.

26.

ten Brummelhuis

L. L.

van der Lippe

(2010). Effective work-life balance support for various household structures. Human Resource Management, 49(2), 173–193.

27.

Voydanoff

(2004). The effects of work demands and resources on work-to-family conflict and facilitation. Journal of Marriage and Family, 66, 398−412.

28.

Voydanoff

(2005). Toward a conceptualization of perceived work–family fit and balance: A demands and resources approach. Journal of Marriage and Family, 67, 822−836.

29.

Warde

C. M.

Moonesinghe

Allen

Gelberg

(1999). Marital and parental satisfaction of married physicians with children. Journal of general internal medicine, 14, 157–165.

30.

Weisman

C. S.

Teitelbaum

M. A.

(1987). The work-family role system and physician productivity. Journal of Health and Social Behavior, 28, 247–257.

31.

Williams

(2014). Physician wellness and remediation. In A

Kalet

Chou

(Eds.), Remediation in medical education (pp. 185–203). New York, NY: Springer.

32.

Yogev

Brett

(1985). Perceptions of the division of housework and child care and marital satisfaction. Journal of Marriage and the Family, 47, 609–618.