In this study of married physicians with children, we evaluated two important aspects of a physician’s life, marriage and parenthood. Our study is one of a few examining the effect of work and home life on marital satisfaction of physicians and the first to examine parental satisfaction of physicians.
Approximately half of the physicians in our sample were extremely or very satisfied with their marriages. Similar ratings were found among a group of Texas physicians. In that same sample of physicians, those who reported high levels of marital satisfaction also had higher levels of work satisfaction, lower levels of work stress, and higher levels of family competence.15
The links between marital satisfaction and work life issues suggest that maintaining a healthy balance is good for professional life as well as family life.
High marital satisfaction was associated with two factors: a supportive spouse and lower levels of role conflict. These results are similar to what is found in other research studies of marital satisfaction among physician and non-physician groups.7, 16, 17
The perception of a spouse’s ability to give and receive support has been shown to predict marital quality for both partners in a marriage.18
In this study role conflict is defined as “the perceived frustration resulting from the competing demands of career, marriage, and family.” We found role conflict to affect marital satisfaction in an inverse relation: i.e., lower levels of role conflict strongly predicted higher levels of marital satisfaction. However, we did not find physician work hours to influence marital satisfaction. Although this may seem contrary to expectations, others have also found that it is not the number of hours worked that affects satisfaction with marriage,9
but rather the role conflict experienced by the physician.8
In a group of practicing physicians, Gabbard et al. found no difference in marital satisfaction between physicians who worked 40 to 50 hours per week and those who worked 60 or more hours. However, the group working longer hours more frequently complained about “the lack of time for fun, family, and self.”8
We hypothesize that role conflict is an intervening variable between marital satisfaction and many other factors related to gender, age, work, and home life. These numerous factors appear to affect the level of role conflict experienced by a working parent. In other studies we and others have found that women are more likely to experience role conflict than men,19–25
and younger male physicians are more likely to do so than older male physicians.25
Role conflict in working parents has been associated with excessive hours at work, scheduling, physically or psychologically demanding work, housework inequality, and child care difficulty.2, 22, 26, 27
Interventions in the workplace that decrease role conflict such as vacation time, flexible work hours, and equitable part-time employment opportunities will assist physicians who are struggling to combine work and family. Many studies of physician and nonphysician working parents have shown that reasonable work hours and a work environment flexible to family responsibilities improve not only family life satisfaction, but also mental health, job satisfaction, and work productivity.2, 22, 26–28
Health services administrators should make these options available for physicians as they seek to improve productivity and retain qualified personnel. It is a win-win situation for administrators as well as for physicians and their families.
The physicians in our sample tended to be less satisfied with their roles as parents than with their marriages. Because childrearing requires continuous parental attention as children develop physically and emotionally, for many couples, raising children may be more complex and demanding than maintaining their marital relationship. Again we found lower role conflict and a supportive spouse were strongly related to parental satisfaction. These results place even more emphasis on the importance of making family-friendly work options viable for physicians.
The location and type of medical practice also appear to affect a physician’s relationship with his or her children. Physicians in salaried positions, such as in staff-model HMO and Veterans Administration hospital settings, more frequently reported high parental satisfaction than did physicians in private fee-for-service practice. This may be because hours, call schedules, and income associated with salaried positions are more predictable. Some women physicians prefer working arrangements such as part-time and salaried positions so that they can spend more time with their children.29–31
Of note, the predominant concept of HMO when this survey was conducted was the staff model and not the more contemporary concept of “HMO without walls.”
This study also indicates that the occupation of a physician’s spouse may make a difference in parental satisfaction. Physicians married to a professional parent more commonly experienced high parental satisfaction than did physicians whose spouses worked at nonprofessional jobs. For the dual-career couple, the financial needs of a family are often better accommodated by two incomes than by one. The psychological burden of being the “sole breadwinner” may be eased, thereby freeing up emotional energy for the children. In addition, the professional spouse may be more intellectually satisfied than the nonprofessional and more apt to enrich the home environment with new ideas and unique experiences.32
Physicians who were married to a stay-at-home parent more commonly experienced high parental satisfaction than did physicians whose spouses worked at nonprofessional jobs. For those physicians whose spouse is a homemaker, improved parental satisfaction may result from the parents having their separate, well-defined roles. However, as only 1% of our female sample was married to homemakers, our results may not accurately represent this group.
It is noteworthy that we did not find specialty related to marital or parental satisfaction. This may be because both men and women medical students choose specialties with family considerations in mind,33
thereby minimizing the effect of specialty on marital or parental satisfaction of working physicians.
In the intervening time between when the study was conducted and this publication, managed care has become more prevalent in most parts of the country and the proportion of practicing physicians who are women has increased. Early results from the Physician Worklife Study in l997 indicate that with managed care has come more time pressure and less job satisfaction.34
Women in particular report more job stress, lower perceived wellness, and more burnout than men. Insufficient organizational attention paid to personal time was found to be a key explanatory variable for these findings.35
We expect that these issues would increase role conflict, our major predictor variable. These data suggest that repeating our study today could result in even lower levels of both marital and parental satisfaction, especially in women physicians, owing to the added time pressure and job stress of the current medical environment.
As in all studies that utilize questionnaires or interviews, our study is limited to data obtained from physicians’ self-reports. Self-report bias might have especially affected reports of perceptions (e.g., regarding marital and parental satisfaction, frustration with role conflict, and spouse support for career). We suspect that because of social response bias, physicians would have reported higher marital and parental satisfaction than might have actually been.
Our study is limited in its ability to make causal inferences by its cross-sectional design. We also did not evaluate the marital and parental satisfaction of physicians’ spouses, but prior research indicates that marital satisfaction scores of physicians and their spouses are highly correlated.9
Other limitations of this study center on issues of generalizability. Because the study group included only married physicians with children, results can only be applied to a similar group. Although this represents the majority of physicians (three quarters of male physicians and half of female physicians), our sample excludes single, widowed, and currently divorced parents because our independent and dependent variables examined three interrelated domains: career, marriage, and family. Our sample was from one county and was not selected randomly, although it was selected in an unbiased manner. The similarity in demographic characteristics between our sample and the AMA physician database shows that our data should be representative of married physicians with children who live outside Southern California (see ). It is possible that selection bias was created by the nonresponders and nonreceivers. We believe the higher than expected nonreceiver rate was due to the inaccurate mailing addresses from our original list. The younger age of the nonreceiver group may indicate that many of these are young physicians in training who move frequently. The study area included a medical school and major university teaching hospital.
In conclusion, it appears that once the choice of medical specialty is made, minimizing the level of role conflict and having a supportive spouse are the two most important factors influencing marital and parental satisfaction among physicians. Among working physicians with children, role conflict appears to be the intervening factor between both marital and parental satisfaction and conditions at work and home, such as work hours, child care, and household responsibilities. Furthermore, working in a salaried medical position may benefit parental satisfaction. Our findings support the growing body of literature that family-friendly work options are good for working parents, their families, and their employers.