Thomas and Gabriella Miller, MDs, of Chesapeake, Va. have the kind of schedule most two-physician couples dream about. She sees their three kids—ages 8 to 11—off on the bus every morning and is home when school lets out in the afternoon. He works several days in a row, but is off for weeklong stretches that allow him to volunteer at the children's school and attend their sports practices. They even take two-week vacations together as a family.
This is certainly not the case for many doctor couples, whose numbers are growing as more women have entered medicine in recent years, said Lawrence Smith, FACP, chief medical officer of the North Shore-LIJ Health System in Long Island. Oncall hours and the unpredictability of many medical specialties can leave married physicians as ships passing in the night—or the front hallway—with the spouse whose practice is more scheduled taking much of the responsibility for home life and child-rearing.
Yet by working as hospitalists in the same practice, the Millers and others like them have been able to set fixed hours so they can take care of their kids and spend quality time together. “One of the key things about a hospitalist career is the fixed hours,” said Douglas Paauw, FACP, professor and head of general internal medicine at the University of Washington Medical Center. “(Often) people in primary care get home and have to do all their chart notes from the day, bring the computer home, get the kids fed, do homework, and then work on daily charting after the kids are asleep. A well-done hospitalist program avoids that, and that's a positive for both partners.”
Experts aren't sure whether or not more married physicians are turning toward becoming hospitalist couples like the Millers, but the arrangement clearly has unique advantages … as well as unique challenges.
“If you have young children at home, it may be nice to always have someone home and not need child care,” said Dr. Paauw. “On the other hand, if you are working opposite shifts, you are not together very much.”
Making it work
It took awhile for the Millers to figure out the schedule that worked best for them. After having three children in quick succession during residency, Dr. Gabriella Miller went into urgent care with the military, while Dr. Thomas Miller joined a brand new, four-member hospitalist practice, Chesapeake Hospitalists at Chesapeake Regional Medical Center in Virginia. But Dr. Gabriella Miller said she eventually found the 12-hour shifts and long commute wearing, and difficult to balance with her role as mother.
“When the kids were younger we had sitters and nannies, but as they got a little older, we really needed to be there for school things and so on,” she said. “And with (my former job), even though it was shift work, when I was gone, I was gone.”
Dr. Thomas Miller had been trying for years to recruit his wife to his practice, which was looking for someone to manage the hospital's inpatient geriatric psychiatric unit. After a particularly bad day fighting traffic on the highway three years ago, Dr. Gabriella Miller agreed to do it.
Now the couple can easily balance their schedule so someone is always home when the children are, and never miss class plays and sporting events. As a general hospitalist, Dr. Thomas Miller practices the traditional block schedule, five or six days on and five or six days off, while Dr. Gabriella Miller works part time, tending to her patients around the kids' school schedule.
“I can see all the patients on my unit in three to six hours,” Dr. Gabriella Miller said. “And then I can work from home—running lists, checking orders and labs, printing notes, and so on.” And while Dr. Thomas Miller may “disappear” for a few days when he is on clinical shifts, he then has multiple days in a row when he can participate in the children's activities. “From a father's perspective, I really like it,” he says. “A lot of times you don't see fathers able to attend those kinds of things on a regular basis, and I'm able to do that, which is great.”
Working together as hospitalists has also made it easier for the Millers to keep the romance in their marriage.
Like most hospitalists, weekends aren't as meaningful to us. So we might not go out on Saturday night, but some days when the kids are in school, we will go for a matinee and a nice walk,” said Dr. Gabriella Miller. “So we have much more time together as a married couple, both with and without kids, than a lot of other couples do.”
Partners in research and life
Vineet Arora, FACP, and David Meltzer, ACP Member, are married research hospitalists at the University of Chicago's Pritzker School of Medicine. Dr. Meltzer is chief of the hospital medicine section, created in October 2008, and Dr. Arora works within the General Internal Medicine section as an academic hospitalist. While the couple's research interests are distinct, they are often complimentary, which means they can work together on research projects, attend conferences together and generally inspire one another, Dr. Arora said.
“We bounce ideas off each other all the time; we write papers together,” Dr. Arora said. “We collaborate.” One successful collaboration combines Dr. Arora's interest in medical education with Dr. Meltzer's interest in patient outcomes and health care costs. The pair wrote and received a grant to expose Chicago public high school students to health research careers by training them to work on one of Dr. Meltzer's large research projects dealing with costs and outcomes.
“We've been running this program for the last five years,” Dr. Arora said. “I'm in charge of the high school program, but the students work on the project he runs, so he is their mentor.” Working for the same employer not only makes it easier to collaborate on such projects, it allows the couple to match their schedules—including clinical service—so they can spend more time together.
“What's nice is, when we're not on service, we can dictate when we're here and when we're not,” said Dr. Meltzer. And if the pair has kids, they will have the ability to adapt their schedules accordingly, Dr. Arora added.
“Right now, we try to pick the same month to be on service,” she said. “I can't imagine doing that if we had kids!”
Of course, being a two-hospitalist couple isn't perfect. Coordinating two schedules doesn't always work out as well as it has for the Millers and for Drs. Arora and Meltzer, for example. “If your shifts are off by six hours, you may not get to see each other much,” Dr. Paauw noted.
Those who work together also say they are sometimes tempted to bring the job home.
“You have to work to avoid being drawn into that,” said Dr. Gabriella Miller. “It's an easy habit to get into.”
Drs. Arora and Meltzer take deliberate steps to ensure they enjoy time together without bringing work into the mix, such as going on a “no-email” vacation to a foreign country.
“We definitely reserve time to not talk about work. We have a summer house in Michigan where we try to do things that are non work-related,” Dr. Arora said. “At the same time, though, it is convenient to have (my husband) right there if something does come up.”
Workplaces that take steps to appeal to married hospitalists— like offering on-site child care and flexible schedules—can give themselves a competitive advantage in a market where there still aren't enough hospitalists to go around, experts noted. “Hospitals that make family life easier for their physicians are going to have the edge—even more so with two-physician couples,” said Dr. Paauw.
And keeping employees happy, with incentives to stay put, is a big plus for hospitals, said Dr. Smith.
“If you have two halves of a couple working for you, with a good balance that's making it work for their own lives and for their patients, that's always good,” Dr. Smith said.