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Why I Still Work (Even Though My Physician Husband Out-Earns Me)

Sarah Hart Unger

Dr. Sarah Hart-Unger is a busy woman who wears many figurative hats. She’s a pediatric endocrinologist, residency program director, wife, mother of three, blogger, and podcaster.

Just the thought of all of that wears me out. I cut out the practice of medicine, don’t have a podcast, have one fewer child, and I still wonder where the time goes!

To learn more about who Dr. Hart-Unger is and what she’s up to, check out her website, The SHU Box, which she has maintained since 2004, and her Best of Both Worlds podcast with Laura Vanderkam.

Today’s guest author and I communicated after Dr. Brent Lacey shared the story of his wife leaving medicine to raise her family. Like many other readers, Dr. Hart-Unger was hoping to hear Dr. Catherine Lacey’s side of the story, and I’m glad we were able to deliver. I’m also happy to share a counterpoint, and I thank Dr. Hart-Unger for today’s contribution.

The following article was written in response to This Decision Cost Us 13 Million Dollars, But Was it a Financial Mistake? It was written before I had received or published the followup, Why One Mother Left Her GI Fellowship to Raise a Family.


Why I Still Work (Even Though My Physician Husband Out-Earns Me)


First of all, a confession. I am not a FIRE diehard. I am intrigued by the movement, but I hadn’t even heard of it until about a year ago. Physician on FIRE was one of the first FI/FIRE bloggers that I came across, and I definitely felt awakened to new possibilities by reading his musings (and others, like The Physician Philosopher and Choose FI).

In fact, I would not consider myself a particularly frugal person, though interestingly the more money we have, the less I am attracted to flashy showy things (paradox?). I do very much enjoy using my “life energy” to purchase amazing experiences that do not always come cheap, whether they are a meal at French Laundry (worth every penny) or a stay at the Ritz (actually, NOT recommended with a toddler #neveragain).


we celebrated our 10th anniversary there in 2016. Worth every penny!

So how will this nonsense get you to FI?


While I have not always exercised such discretion around spending, the most pro-FI action I have taken is to stay in my career. I am a pediatric endocrinologist, which is the second to worst paid specialty (average of $201K/yr according to Doximity — I guess we’re undervalued!).

I am married to a vascular surgeon which has a salary average of more than twice that, landing it in the top 5 of all physician specialties. We have 3 children, ages 2, 6, and almost 8. I had my first beautiful baby girl while I was in the second year of my fellowship, and the other two children as an attending.

To be clear, I haven’t always loved everything about my career path, and in fact have pivoted a couple of times. When pure clinical work felt a little monotonous, I embraced GME and leadership, and am currently serving as program director of the pediatrics residency program in an increasingly academic health system.

I technically work 0.9FTE. I initially cut my hours a bit to have some extra flexibility & time with my children, but also ended up following my passion and launching a podcast about (wait for it!) working motherhood.


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While I’ve played with the specifics of my working life, I have never once even considered quitting. Why?


  • Because I want to continue to grow and learn professionally. I love learning and gaining new skills, whether they are clinical or related to my GME role. It’s truly fun for me!
  • Because I want to take care of patients (and help train the next generation of pediatrician to do this well, too!). I find this gratifying, meaningful, and even enjoyable most of the time. Admittedly, I DO hate being woken up at night and someday would like to buy my way out of call entirely.
  • Because I have a REALLY good job, from an objective standpoint. My hours are reasonable. I have enough flexibility. And while I am not going to reveal my exact salary, the midpoint pedi endo according to Doximity — while on the low end for physicians — is still at the 97th percentile according to this calculator. I may not earn as much as my physician husband, but my contribution is still significant. I could support our family if it was necessary. I can provide a buffer so that we can enjoy luxurious things sometimes, and still save. And importantly for this audience, it should be noted that I can help us reach FI significantly earlier!


What Will We Use Our $13 Million For?


In his post, Dr. Lacey calculated that his wife’s career-ending decision was a ~13 million dollar loss for their family, looking at potential savings/earnings of his wife’s potential salary invested fully in the market. In reality, I’m not sure if the amount of difference is quite that high (childcare does cost something!). But, based on pure math, I can say that my working will allow us to:

  • Reach FI faster. According to Mustachecalc, with a conservative estimate of $80K more saved yearly, our “time to FI” decreases by a non-trivial 10 years!!
  • More easily save for / pay for college. I know that covering kids’ college costs is a controversial topic in the FI/RE world, but we are aiming to provide at least 4 years of college expenses (public or private) for each of our 3 children. Which is $$$!!! My husband and I are grateful our parents did this for us, and I want to pay the gift forward. My contributions help our 529 plans grow faster.
  • Live with a little more freedom and ease, saying “yes” to our kids more often. Quite honestly, I’d like to give my children more wiggle room than I enjoyed growing up. Being a dual-income couple means that we will be able to do that (big family trips, yes please!) and still save.
  • Outsource more! We employ a full-time nanny (who also feels like a 6th family member; she has been with us for more than 6 years now!) and she helps us with cooking, laundry, and much more. I don’t spend my weekends buried in housework; I’m generally free to spend quality time with family.



But is this a worthwhile tradeoff?


To be clear: if staying in the workforce meant that something negative would be likely to befall my children, I would leave. Or perhaps I’d see if my husband and I could each work at 50%. And maybe some people do believe that my choice to work is harmful to my children.

In this vein, there was language in the recent post that stung a little bit, language that suggested that by working, I am not providing the best environment for my children to grow and thrive.

In communicating with Dr. Lacey since he posted, I don’t think this is what he meant or intended. And I’m glad to hear that! The language that particularly struck me was in this section in which he write, regarding his wife:

“She’s involved in their lives in so many great ways! She volunteers at their school and finds great community activities for them. She teaches them reading, arts/crafts, sports, social interactions, and so much more.

Her approach to being a stay-at-home mother is the same as her approach to medicine was: total focus on being the best.”

When I read this, I will admit that I initially read these words as a personal affront. Did “the best” mean better than all of those others who work, either because they choose to, or because they need to? Does her “best” mean that I am “worst”?

Thankfully, I don’t think this is what he meant, and I also believe it my heart that it is not true. I am sure that I have fewer face to face hours with my children than she does. But — for the record — I still have quite a few!

Just like Dr. Lacey’s wife, I also volunteer at school sometimes (in the last year: 2 class events + career day!), and so does my husband. When it comes to reading, sports, and the other areas mentioned, I haven’t noticed my kids falling behind. They enjoy plenty of fun activities both in and outside the home, and we read together almost every night.



A Few Final Thoughts


First, I think it is important to remember there just isn’t data to support the concept that working does an automatic disservice to one’s offspring (and honestly, studies on this particular topic often seem quite fraught as the number of potential confounders are nearly infinite).

Second, I have seen models of both kinds of families with outcomes that vary widely, both in my patient populations and real life. There are clearly variables more important than “whether mom works” at play. Parental life satisfaction, a strong marital bond, and financial stability are just a few potential ones.

Third — well, it’s early, I know. But my 3 seem to be doing okay. And I know my children love me and are bonded to me, just as they are to my husband.


In summary . . . it’s all okay.


I hope I did not come off as expressing sour grapes in this counterpoint. I am glad that Dr. Lacey and his wife have found a life together that they love, and have found way of making it work (while still pursuing FI — impressive!). I just took initial issue with the article because it was less clear that this was a choice she made because of what she truly wanted, rather than one that was “best” based on some very antiquated traditions of what family life should be.

Perhaps she also found medicine disappointing in some way — which is absolutely valid — and I’d love to hear more about that, too. Notably, my husband read the post and wondered how people would feel if gender roles were reversed; i.e. if it were written by a woman whose physician husband decided to leave the workforce with one year of fellowship remaining. It seems far fetched to even imagine, which means there are biases at play whether we are conscious of them or not.

All that said, I am going to continue doing what I am doing, nanny and all. I believe we can have happiness, love, and health within our dual career family. I think that what I do makes a positive impact — on the world AND on our children — and I am proud that my kids will point out that “my mommy is a doctor for kids and my daddy is a doctor for grownups!”.

I don’t think that having an additional loving (paid) caregiver will compromise our family, or our children’s future. And I wouldn’t be sad to get to FI earlier, either.


Dr Sarah Hart-Unger is a pediatric endocrinologist and residency program director.  She has been blogging at theshubox.com for over 15 years and cohosts a podcast, Best of Both Worlds, with time management expert Laura Vanderkam.



Do you have a one-income or two-income household? What were the biggest factors in making that decision? Would you change anything if you could? Comment below.

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6 thoughts on “Why I Still Work (Even Though My Physician Husband Out-Earns Me)”

  1. I think the often many view their career as something where they trade time for money. For many work is more than just about the dollars but also about personal satisfaction. Also, I think like many things in life having 1 working spouse vs. 2 is a choice. There are many kids who grew up with 2 working parents and and other who grew up with one. I think the choice is personal and you cannot unilaterally say that one is better than the other.

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  3. I enjoyed reading the contrasting posts written by Drs. Lacey and Hart-Unger. We’re a few years ahead of these families (3 adult children), but definitely have some parallel experiences. We are a two-doc couple (primary care and academic surgical subspecialist), similar to Dr. Hart-Unger. I too have been a residency program director! We grappled with similar issues, but we fall somewhere in between. My wife has worked about 0.5-0.8 FTE for most of her career, with the goal of avoiding a live-in or day-time nanny. You see, she also grew up in a two doctor household, and her memories of that grumpy old nanny were not that pleasant. Good for Dr. Hart-Unger that she was able to find Mary Poppins, but a lot of parents and kids are not that lucky.

  4. I always like to point out a few things when I read posts about work and parenting.
    1) Parents today are way more involved with their children than in past generations.
    2) Staying at home can also mean more time for chores, housework, and personal time. Its not all about the kids.
    3) My mom had to work when I was about 6. She did have to miss school activities and was probably more tired than she let on. However she was a great mom due to her patience, kind nature and big heart. Today she is an amazing grandmother.

  5. I really appreciate you noting that “it seems unfathomable” for a physician husband to try to stay home as recognition that there are biases at play. I think the issue isn’t so much that some families choose a stay at home parent and some don’t – it’s that it’s automatically assumed it will be the woman, and once a pregnancy is announced you’ll be asked directly “are you coming back?” (even if you’re the breadwinner), and god forbid if the husband stays home that just upends everything.

    On a personal note, my Mom worked and always told me to “be able to write my own checks.” She’s been married for almost 45 years to my Dad, but I’m convinced her confidence and ability to stand on her own two feet made their marriage better. (Don’t read this to say a working wife is necessary for a long and happy marriage, but instead as another potential positive for continuing to work that hasn’t been stated clearly stated).

    • Sara, your mother’s advice mirrors my own. My mom initially was a traditional stay at home mother. My father kept a tight grip on the purse strings and used money to control her. Their marriage went south and she found herself forced back into the work place with little experience and a 13+ year employment gap. Her Bachelor’s in psychology wasn’t very marketable either.

      She quickly found out that relegated her to poorly paid positions and unstable employment. For a while we were on food stamps, which back then was totally humiliating. When I was maybe 15 or 16 she advised me to always be able to support myself rather than be dependent on a man. I took that to heart.

      You are right about that bias concerning pregnancy and coming back to work. Men don’t ever get asked this. I once actually had a job interview for a professional position where the interviewer spent half of our session quizzing me about my future marriage, reproductive, and work-after-babies plans. I am quite certain no man has been subjected to that.

  6. There is certain gender bias for sure. My husband faced it when he took on augmenting his career and business around my hours to care for our kids during the day. Some of the women that stayed at home considered him an anomoly and he never felt like he could fit in there. Even though he was a Realtor and worked part-time over nights a few nights a week, people assumed he didn’t contribute to our household. Overtime, he was able to gain momentum in another career that allowed flexibility and benefits, we flexed our schedule to work as a team. That’s what it is all about, being flexible to gain the life in which you are content. A job doesn’t define us, roles don’t either but we do.


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