There’s the toll stress can take on the doctor. The missed dinners and lost weekends. Single parenting and the frequent chirp of the pager at all hours of the night on a regular basis. When I’m on call, we both suffer.
One thing we don’t have to worry about is the impact on her career. Although she’s got a few degrees hanging on the wall, too, she chose to stay home and make raising our boys her full-time job.
I can only imagine life gets more difficult when the physician’s spouse is also navigating a career of his or her own. That’s the case for the Econ Dad, a Ph.D. economist married to a physician.
He’s written an insightful guest post for us, detailing how to best align one’s own career with that of a physician spouse. What does that mean, exactly? Read on!
Aligning Careers With Your Physician Spouse
Pursuing a career as a doctor has many great things going for it like meaningful work, high income, and good job stability. But, like many careers, there are also downsides and challenges, like low flexibility, long hours, and many years of training.
Here’s a question: What should you do if you’re married to a doctor? Or married to a doctor in training?
Let’s set aside whether that’s good or bad overall — that’s another question for another day! — and consider how you might design your own work to complement your spouse’s work. That is: How can you align careers with your physician spouse in order to raise a family and support his or her career, while at the same time making room for your own career?
Aligning Your Career
To start: what does it mean to align your career with your husband’s or wife’s career? Let’s think about this in terms of the economics of the household.
For context, I’m an economist and I’m married to a doctor. My wife is in her final year of residency, and it’s been a long road. We had our first son three months before my wife started medical school, and had three more children during her medical school and residency, so we now have four kids under 10 years old.
We both work full-time, and we’ve had every childcare situation you can imagine (including our share of childcare disasters). It hasn’t always been easy, but it’s been totally worth it.
Economically strong households have stable finances, reliable support, and the presence of both parents — especially if you’re raising children. This means structuring your collective work-life setup to maximize benefits and minimize risks. If you and your spouse both work, one of the biggest risks to your family’s success is one of you getting burned out, sick, or depressed. Those are devastating scenarios if you depend on two incomes.
Economic tenets of career alignment include diversifying collective risks, sharing work-life balance, and taking turns, where possible. It’s like having a diversified portfolio, where you keep your wealth in a variety of assets so that you can thrive in good times and bad. If you have a high-risk job, you should invest in low-risk assets, and vice versa.
If you’re married to a doctor, aligning careers means supporting your spouse’s stress points and alleviating your collective pain points, while at the same time taking advantage of the benefits provided by a physician career path.
Benefits of a Physician Career
In order to properly align careers, we need to go over the benefits and challenges of being a physician. These will be familiar to most doctors and doctor’s spouses (at times, maybe all too familiar!), so I won’t belabor them, other than to summarize what they are.
Here are some of the main benefits of a physician career path:
 Meaningful work. One of the best aspects of being a doctor is having meaningful work. Your work really matters. You may literally be saving lives on a daily basis. Helping others is your job. As many of us know, meaning is foundational to a thriving life.
 High income. Or, at least, pretty darn good income — well above the US average and typically in the top 5% of US households, depending on specialty. This creates a lot of opportunity for saving and healthy finances.
life insurance and disability insurance.
 Stable job. It’s rare for physicians to be fired. Once you find a good job, it’s usually pretty stable. Because of the high barriers to entry (think: a million years of training), there will always be strong demand for physicians. There are exceptions, of course, but overall job stability is high.
 Flat incomes outside of big cities. Physician labor markets are unusually flat across geography, so that salaries are similar whether or not you’re in a big city. This is known as geographic arbitrage, and can be a real sweet spot for physician families (here’s a related post where my wife and I just navigated this for her career opportunities):
Challenges of a Physician Career
Now, for the challenges. You didn’t think a physician career was all sunshine and roses, did you? Here are some of the main challenges of a physician career path:
 Low income for many years. Medical school is expensive, residency is low paying, and training takes many years to be a fully certified doctor. An added challenge is that these years often overlap with prime years for having kids. It can be difficult to raise a family when most or all of your residency income goes towards childcare.
 Long hours. Let’s face it: doctors work a ton. Working 50-60 hours a week is standard practice. Then, don’t forget notes at home in the evening. One doctor friend of mine said he works long hours, not because he wants to, but because “that’s just what is expected of him.” It’s a demanding career by the sheer volume of work.
 Low flexibility. One of the biggest challenges doctors face is that they can’t miss work. My wife gets emails from her hospital explaining that winter storm travel advisories don’t apply to her. She can’t call in sick to help a child at home. This is a real pain point for physicians with families.
 Limited financial upside. Physicians make good money, but have limited ability to be “rich” like an entrepreneur or finance wizard. But, because the income is high and predictable (as opposed to uncertain but possibly higher), it pays to pursue financial independence by working and saving. Heck, I bet you may even know a few Physicians on FIRE.
 Mental health challenges. Physician burnout is a major issue these days. I read articles about it all the time: Example 1, Example 2. Physicians work long hours at the bottom of the hierarchy for many years. Even at the top, it’s extremely demanding work. Physicians have high risk of depression, suicide, and other mental illnesses. Staying healthy is key.
Aligning Your Career
So, in light of these benefits and challenges: How can you best align your career with your physician spouse? Here are some strategies to consider:
 Take more risk AFTER your spouse is established. Once your spouse has established a stable, high-income job after residency, that’s when to take more risk with your career. Start that company or write that book you always wanted to. Since you’ve been working hard for the first leg of your spouse’s career, you’ve established skills that you can now bring to market independently, with a new safety net from your spouse that you once provided to him or her.
 Put high value on flexibility. Flexibility is key!! Your spouse can’t easily handle the morning routine or stay home with a sick child. He or she barely has time to make a dentist appointment. It’s worth a lot if you can pursue flexible work, because you balance out the lack of flexibility from your partner. I run two businesses, mostly from home. When I travel for work, our home situation can be quite difficult (that’s a much longer story), but most days I am home and my flexibility helps out tremendously.
 Prioritize your spouse’s mental and physical health. One of your highest priorities is to make sure that your spouse is feeling happy, healthy, and productive. The biggest risk to their long-term career success and earning power is that they become depressed, sick, and/or can’t work. Make sure they have time for physical wellness, even though they already work long hours. Make sure they feel like an integral part of the team in raising kids. Do whatever it takes to avoid burnout and depression. I call this Protecting Your Most Valuable Asset, and it’s critical for doctors.
 Hire support at home. The most practical way to maintain the mental strength of your physician spouse is to hire support at home. If you’re also working full-time, spend money to keep the house clean and have reliable childcare. Maybe even embrace the morning date. You’re spending up front to preserve your productivity. Even if you’re a stay-at-home spouse, consider hiring support at the margins to keep both of you happy, healthy, and engaged. That said, for stay-at-home spouses, you may have to carry more of the home burden personally until after residency is complete.
If you’re thinking about terminology (think: anatomy lab), you might call this trying to “decouple” or “uncorrelate” your career benefits and challenges with your spouse’s career. You’re flexible when they’re inflexible. You’re stable when they’re unstable. You zig while they zag. You’re the ying to their yang.
Bottom line: If you nudge your career towards uncorrelated benefits and challenges, your dual-career household will be more solid overall.
What About Two Working Physicians?
“That’s all fine and well, but what if my spouse and I are both doctors?”
Dual-physician households have become more common than ever as more partners pair off in medical school or residency — here’s a nice piece from the New York Times on the Economics of Power Couples. These households face unique challenges because two physician spouses can’t easily complement one another in the same way non-physician spouses can. You’re both working long, inflexible hours, with tons of debt for many years, until one day you suddenly have super-high combined household income (though, unfortunately, still inflexible and long hours).
For dual-physician households, you need to spend money to alleviate your greatest pain points. Pay extra for solid childcare. Pay more to live close to the hospital. Use your combined income to alleviate the challenges that a non-working or uncorrelated-career spouse might otherwise alleviate. If you can lean on extended family, all the better.
As long as you’re both in medicine, you don’t have much choice but to throw money at the problem. It’s a small price to pay to keep you both healthy and working. Try to keep your kids active and connected to the community, especially if you’re working long days. As my grandfather used to say: “Hey, it’s cheaper than rehab.”
There’s no one-size-fits-all strategy here. Take the above ideas for what they’re worth and develop the best set of principles that work for you and your family. Each family and career is unique, so use judgment and nuance to make your situation as good as possible.
Your spouse’s physician career shouldn’t necessarily take priority over yours — after all, you both have your own lives and dreams to pursue. That said, making simple adjustments to align careers with your physician spouse will work wonders for a healthy household. And remember: try not to get burned while staying on FIRE!
The author has a PhD in Economics, works in economic consulting, and writes about career and family at EconDad.com. His wife is a doctor, and they had their first child together three months before she started medical school. They’ve since had three more children during medical school and residency: now with four kids ages 9, 7, 5, and 1. Challenges exist, no doubt, but they’re doing their best to raise healthy and happy kids in a dual-career household.
Physician spouses, how have you adapted or aligned your career to coexist with your partner’s career? Any advice you can share? We’d love to hear from you in the comments.
14 thoughts on “Aligning Careers With Your Physician Spouse”
I really enjoyed this article. This is a topic that my husband and I were just discussing a few weeks ago. Your chart that shows how to align your careers at different points is great!
After completing my PhD in Sociology, I chose not to pursue an academic track for many reasons, but in part because it wouldn’t have meshed with aspects of my husband’s physician career, especially with our desire to start a family (two kids later, that was the right call for us!). I’ve made the ability to work from home and have a high degree of flexibility a requirement for any of my work pursuits. I claim it’s to offset my husband’s lack of flexibility, but grad school may have also turned me into a brat. I got used to working hard, but having the freedom to work when and where I wanted to. Maybe that influenced your path to work from home as well?
I’m definitely going to check out your blog!
Hi, which career path did you end up choosing? We’re also considering a work-from-home, flexible career for my wife.
I really liked this perspective you brought. It reframes the fundamental family unit as the family and not the individuals in it and that in order for the family to thrive the individuals must make compromises and work together to achieve a common goal.
It is a welcome difference in opinion. Thank you for sharing it!
Hey thanks! I hadn’t thought of it in those terms, but you’re exactly right. We think about the family as the fundamental optimizing unit. It’s very much in line with Gary Becker’s work (Nobel-prize winning economist) on specialization in household economics.
We are stronger as a unit if we work together to balance each other out. In the end, we both benefit individually from the collective effort.
Thanks so much!
Economics would never have garnered the nickname, “the dismal science” if there were more like you.
I returned from a shift where I intubated a catastrophic bleed, admitted an MI and disempacted a nonegenarian to find my distressed physician spouse at home pleading, “I know you’ve been working your a** off, but I’ve had the kids all day – please help!” So I did.
Excellent, reliable childcare is a must for a dual physician household. Our guiding premise has been that we won’t miss the lost money, but we’ll never regain the lost sanity.
Ha!! That’s funny. I try to be more positive than dismal, as best I can, but I must admit I do have a tendency towards logic over emotion, sometimes too far (think: Spock from Star Trek).
Agreed 100% on reliable childcare. When I’m traveling for work, reliable care while my wife is at the hospital is so critical. We’ve had disasters in this regard, and it’s not fun. You’ve got to bite the bullet and pay for reliability for those pain points to support two careers.
You make many good points and I will gladly check out your blog.
I would not be able to do what I do without my wife’s support at home. She is also a professional and I know her career suffered for the good of the family. I tell her this all the time but this is a good reminder to double my efforts!
The other excellent point you made was the graph of the geoarbitrage. Rural america is always in need of doctors. Most people grow up and live in cities and never would consider otherwise. The small town jobs sometimes even paid more then the city jobs. I live 3 miles from my office and it takes me 4-5 minutes to get there. My cost of living is at least half that of the people living in the suburbs of the small cities and 1/4 that of the people living in the large city of my state. The disadvantages are few and easy to work around.
Yes, definitely show extra gratitude to your wife if she’s helping to support the family — we can’t do enough of this (though it’s easy to forget!).
Geoarbitrage is so interesting for doctors because it’s one of the few professions where you can actually do it consistently and successfully. We are moving to North Carolina after my wife’s residency, in part, for this reason. See related article here: https://econdad.com/a-tale-of-two-cities-an-economic-story-and-a-hard-choice/
Thanks for the thoughts!
It is a bit counterintuitive but dual physician households typically have a lower divorce rate than the general public. So although it is far more challenging in terms of both working long hours and lower flexibility, the shared bond of medicine may be a pretty strong glue holding them together.
A lot of physician households also delay having kids because of the intense commitment during training. I chose to have my daughter only after I became an attending. Of course there are those that have kids in medical school or even have kids prior to medical school and make it work but it certainly adds a lot more complications to an already stressful period. An understanding spouse is key.
Then you hear of those stories when one spouse has given up his or her own career supporting a doc in training who then promptly divorces as soon as he or she becomes an attending and makes the big bucks. That would infuriate me (luckily most courts recognize this and compensate the non-physician spouse)
That’s interesting about dual-physician divorce rates. If you’re working hard in similar pursuits, that’s definitely a common bond!!
I do think it’s too bad that many doctors feel forced to wait so long to have kids. I totally get why it’s advantageous to wait while training, it’s just unfortunate. Having kids later in life means less overlap with them. Kids have been one of the most meaningful parts of my life, and any delay for career reasons strikes me as an unfortunate side effect of an intense profession.
Thanks for reading!
A timely post for my wife and me. We both work full-time. Finding balance can be challenging!
We have certainly considered outsourcing some things to make it easier (lawn care, cleaning, etc). While that money spent won’t go towards our taxable/brokerage account… it is likely money well spent in terms of burnout prevention. Fortunately, it has been winter here in NC and the lawn hasn’t required a lot of maintenance and we have learned that a cluttered house can wait til the weekend sometimes, but it is coming soon… and we will definitely be paying.
Another way to find this balance is to cut back to part-time work for one or both spouses once a financial trajectory has been created that will achieve your goals by your desired time-line. This is another thing that I am considering as things on the side pick up and my wife and I look to design the ideal balance we’d both like to see in our lives.
P.S. I love the graphs!
Glad you liked it! I resonate with this part of your comment: “Another way to find this balance is to cut back to part-time work for one or both spouses once a financial trajectory has been created that will achieve your goals by your desired time-line.”
I couldn’t agree more. Especially if you’re able to swing it as a physician, this seems like a great way to keep relatively high income but have more reasonable work-life balance, especially for two docs.
Good luck with everything!!