Doctors and divorceBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h791 (Published 19 February 2015) Cite this as: BMJ 2015;350:h791
- Amanda Howe, professor of primary care
In The BMJ this week a study (doi:10.1136/bmj.h706) by Ly and colleagues shows that doctors in the United States have a comparable or lower risk of divorce than other health related professionals, and the general population.1 The researchers, however, admit the limitations of this large cross sectional study—as with many such studies there is no qualitative component to help explore the reasons for these figures; no data on the quality of the marriage, which might explain the findings; and no data on medical specialties or whether divorces are more common when both partners are medical doctors. The authors did find that divorce is more likely among female doctors than among male doctors, and that for women, the risks increased with hours worked.
Behind each of these statistics lies a human story, which in the case of divorce is usually one of broken dreams, personal damage (including to children), and material loss. One in four doctors’ marriages ends in divorce, which is hardly a cause for celebration; and nurses fare even worse, at one in three failed marriages.
Societal changes may have reduced the resilience of doctors’ marriages—the end of the “stay at home spouse” in favour of two working partners trying to juggle home and professional commitments, and with more female doctors in the workplace competing under the same pressures.
There are practical challenges too. Ly and colleagues’ study does not deal with job mobility, although it is known that couples can struggle to find compatible working lives, and split-site working, weekend only relationships, and long commutes may all put a strain on relationships, especially where children are involved.
And there are psychological challenges. Medicine is a high demand, high responsibility, high risk job, which is associated with higher rates of mental health problems and substance misuse than other professional careers.2 The tensions of trying to deliver a high quality service in an unpredictable environment while keeping commitments to patients, colleagues, and families must put a strain on doctors’ marriages, even if this is no “worse” than for other professional groups in society.
The finding that women doctors have higher rates of divorce with longer working hours is again unexplained by the study methods. Other literature and intelligent speculation can help to explore this further. The feminisation of the workforce is a recent phenomenon and society has different expectations of women at home and at work. The two sets of expectations require a different emotional balance and distinct coping strategies. The stereotype of woman is as a carer and homemaker, and there may be both personal and interpersonal subconscious pressures of guilt and anxiety when this role cannot be adequately balanced with professional commitments.3 Women may have a less supportive work environment and still be facing the “macho” culture of having to prove themselves “as good as the next man,” or subtle differences in collegial support or the ability to discuss one’s own work-life challenges. Evidence is emerging of an increase in the prevalence of mental health problems among younger women doctors.4 Some of the sex specific findings in Ly and colleagues’ study therefore deserve closer scrutiny and further research.
Finally, there may be value in research that uses a psychodynamic framework to look at both dependency and resilience.5 In psychological terms, humans look to their life partners for safety and intimacy and to meet their dependency needs. When day jobs demand big brave heroes or complex emotional interactions in relationships with patients, the ability to let these roles go at home may be a challenge rarely admitted to or named by doctors.
All transitions carry risks—of emotional adjustment, of identity, of self worth—and the transition from work to home where different demands and needs are at play is no exception. Factors discussed by Ly and colleagues such as “time spent awake with partner in a week” may be vital, as is the quality of that time; and the extent to which the unacknowledged emotional burden of work can be dispersed without damage to others during time at home.
Doctors are not trained to acknowledge or discuss their inner doubts and fears; although good insight and self management could assist the difficult transition between work and home. Contrast doctors who have had a terrible shift and come home, have a large drink, shout at the kids, and shut themselves in their study (perhaps a woman doctor who has kept her end up at work against a tough day and a patronising boss, then comes home to a house in chaos and an atmosphere of “mommy wasn’t here when we wanted her”) with doctors who come home, sit on the floor with their children, acknowledge the bad day, play games and snuggle up, then have a good offload to an attentive partner when the children have gone to bed.
Perhaps the couples who make it have found a language to talk about managing work-life tensions in a constructive way and to avoid mutual blame when work commitments impact adversely. Ly and colleagues’ study should start another important professional conversation about risk factors for divorce and how to minimise the impact of these on doctors’ lives. Some marriages need to end, but probably fewer than one in four.
Cite this as: BMJ 2015;350:h791
Competing interests: I have read and understood the BMJ policy on declaration of interests and declare the following: I am an employee of the University of East Anglia, an officer of the Royal College of General Practitioners, and an executive member of the World Organization of Family Doctors.
Provenance and peer review: Commissioned; not externally peer reviewed.
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