When your partner is your partnerBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7129.2 (Published 07 February 1998) Cite this as: BMJ 1998;316:S2-7129
Job sharing GP Wayne Lewis discusses the pros and cons of working with your spouse
Marriages between clinical colleagues are not a new phenomenon. The stereotypical male doctor of the past pretty much expected to marry a nurse, who would invariably sacrifice her career the moment children appeared. This left the striving young doctor free to climb the greasy pole of the medical hierarchy unencumbered by parental responsibilities. With her understanding of the medical milieu, the ex-nurse could lend a comforting ear to the doctors moans and groans, without competing professionally. If this all sounds cosy and comfortable please return to the nineteenth century.
Medical marriages now take many forms. More than 50% of British medical graduates are female1 and many are married to another doctor. Myriad pairings between doctors and other paramedical professions are possible; marriage should no longer be assumed, and gay couples should not be forgotten. What can no longer be assumed is that doctors' careers should take precedence over those of their partners.
Increasingly, those who live together have to consider whether to work together. This decision is important for the spouses concerned and those employing them. So many of us will face this decision that it is likely to have a profound influence on medical staffing in the future. If more of us who are qualified to work together could be encouraged to do so, and thus share domestic duties also, we would be a much healthier profession.
Points to cover when applying for a job with your spouse
Can you work together? Be prepared to convince your employer that you can and if possible provide evidence, for example, time spent working together as locums
Show that you will not always take the same side. Counter fears of a voting block within the team by demonstrating independence of mind
Think through your individual domestic arrangements and have a plan ready for how you would deal with these and your working duties in an emergency
All employers are concerned about the effects of marital breakdown on a working couple. Accept this fear and demonstrate that you have considered it. Agreements that ensure all know where they stand should a relationship fail have much to recommend them
Accept that you will encounter irrational prejudice against you and counter it in a firm but good natured manner
Emphasise the benefits of a couple as good coworkers but be wary of giving away rights allowed to individuals, for example, voting rights. Ensure equitable holiday arrangements
Working with your spouse may be inevitable. If partners share a speciality there may be a limited number of employers available to them. With a move to a more integrated and cooperative health service even spouses who are widely dispersed geographically and in job description may end up working together, for example, in commissioning.
Benefits of sharing
Understanding the work of ones partner is a major benefit of the medical marriage3 and working together will enhance this effect. Your partner should (hopefully) be someone you could get along with as a colleague. It may be possible to share work so that domestic responsibilities can be dealt with more easily. In particular any jobsharing arrangements will necessitate working in the same workplace. Even mundane matters such as sharing transport can be a considerable advantage. There will be no shortage of pundits to draw attention to the possible disadvantages of working with your other half. The most often touted is that you will become unable to talk about any other topic than work. Clearly a person you live with may not always be as easy to work with, and there is potential for strain between working colleagues to become marital discord if you are co-workers. Doctors are generally highly obsessional and competitive. Jealousy arising between spouses may be particularly intense if they feel they are fighting over the same area of professional turf.1 A recurrent theme of what little research there is in this area is that men tend to behave selfishly in their career development.2,3 Working together may not ensure that both partners' careers are treated equally. Holidays can be another difficulty, particularly working in a small group, when losing two people at once can be a major stress.
The down side
Working in the same environment as your spouse may lead to difficulties in performing your duties. Identification problems may seem rather banal but having the same surname can be a drawback. It is not uncommon for other workers to expect you to perform your spouse's functions when they are absent, for example in covering his or her sick leave, in addition to sharing responsibility when others are away also. Patients may believe that you have vicarious knowledge of all they have divulged to your partner, and, indeed that you share your partner's special skills and interests. Employers may have legitimate concerns regarding a couple. It is easy to see how a conflict of interest between your role as a worker and a spouse may arise. In a small group, such as a general practice partnership, married workers may be considered a powerful subunit that will back up each other's interests regardless of the effect on others. There may be concerns over sharing of information, particularly where the couple occupy non-equivalent positions, for example, a GP partner and a practice nurse. A major fear is what the effects of marital breakdown could be on the working unit as a whole. The prospect of the workplace becoming the extension of a bitter divorce battle is clearly a nightmare.
Additional points for employers.
Don't be afraid to raise your fears. the couple should be expecting them and have answers. If you don't ask you may assume incorrectly.
Remember the pluses of a working team - particularly not just one but two good co-workers.
Be flexible. Would you rather work with an automaton who never considers their family?
Don't assume that one member of a couple speaks for both.
Before working with your spouse it is essential to consider and address the issues above. Good communication is essential, and you should not assume that your spouse views the arrangement in the same way as you do. You must ask yourselves how well you really would work together? A trial run, if at all possible, would be a good plan, perhaps in a locum appointment. Set limits on how the arrangement will affect your personal lifeÑyou may decide to ban on discussion of work topics on evenings and at weekends for example. The experience of those who already work together will be invaluable, and their advice should be sought if at all possible. Don't forget that those who work with a married team have valuable experience and may be able to highlight problems that couples themselves are unaware of. Equivalence of career opportunities should not just be assumed, but concrete arrangements agreed at the outset. Male selfishness has already been noted. Women should remember that this trait is likely to be present in their partner however much he seems to be an enlightened ‘New Man'. Work out who is going to deal with domestic crises before they arise, otherwise only one of you may literally end up holding the baby.1,3
Meet legitimate concerns
It is important to address employers' fears. It may seem inconceivable to you that your perfect marriage could end up in ruins, but so many do. An employer has a legitimate interest in the stability of your partnership if it will affect the working group. If you don't show you have considered this, and at least tried to work out what you would do if disaster struck, they may assess your suitability as a coworking couple in more intuitive and less reliable ways.
Consider an agreed course of action should there be marital strife. Some partnership agreements allow for the dissolution of a partnership should marital breakdown occur with one or both ex-spouses being readmitted only with general agreement. Fears of a voting block within the group are legitimate and displaying some independence of mind has much to recommend it. Reducing the power of the individuals in voting may be suggested but think carefully before giving away what should be your rights within a team. Holiday arrangements have to take account of the difficulty of losing two members of the working group, but this can usually be dealt with if there is good will and flexibility on all sides. Also ensure that your coworkers do not assume that the couple will always speak with one voice. It must be generally understood that both be consulted when agreement is sought.
There is a dearth of research in this area. Qualified doctors who are not engaged in work for whatever reason must be a crucial concern. Doctors sharing the same workplace can more easily cope with the demands of domestic life. Encouraging this working pattern may bring many back into at least part time employment, and will help prevent the erosion of skills caused by protracted periods completely away from work. Jobsharing arrangements in particular should be supported.
Sadly we remain a highly chauvinistic profession of obsessive workers systematically neglectful of our families.1 And if that doesn't encourage you to go out there and enlighten your fellow workers, by a wonderful working relationship with a partner you respect and treat as an equal, nothing will.
Thanks to Tessa Lewis for helpful advice and Hasina Shaikh at the BMA library.
Predicting the number of doctors required in 2020 is a tough job, but someone's got to do it. That someone is the Medical Workforce Standing Advisory Committee which has just published its third report. (Downloadable as a 247kB PDF file atwww.open.gov.uk/doh/medical/mwsca3.htm).
t concludes that 5 200 new doctors will be required each year to keep pace with demand and ‘wastage'. Four thousand graduate from British medical schools each year, so the balance must be filled by the return of temporary leavers, from immigration, and more graduates. To keep the quaintly named ‘home share' of the medical workforce at the current 76%, the committee estimates that around 1000 more graduates are required, though no new medical schools are planned. The committee also admits it has been optimistic in its estimates of retention, which in any case cannot be measured from routine NHS statistics.
The model is remarkably sensitive to changes in the ‘wastage rate' and growth in demand for doctors: no increase in medical school intakes would be required if wastage is 3.1% and growth in demand is 1.4%, but more than 2,500 more graduates would be required each year if wastage hits 3.5% and growth in demand is 2%.
Apologies to those who had difficulty getting hold of a handbook on working abroad, incompletely referenced in Career focus two weeks ago.(Kemple T. Taking a sabbatical in general practice. BMJ 1998;Classified suppl:24 Jan http://www.bmj.com/cgi/content/full/316/7127/S2-7127. The full citation is: Health professionals abroad: a directory of worldwide opportunities. Ryder T. Oxford: Vacation work, 1997. It is widely available, including from the BMJ bookshop (0171 383 6244).