How marriages between physicians negatively impact the female spouse’s career

By Yasmine S. Ali, MD, MSCI, FACC, FACP | Fact-checked by Barbara Bekiesz

Published December 14, 2023

Key Takeaways

Research shows that marriages between heterosexual couples who are both physicians have an unequal impact on the female spouse’s productivity and earnings.
Female physicians married to male physicians (MTPs) work fewer hours per week, are less likely to have on-call duties, and earn less money per year than female physicians not married to physicians.
The effect on productivity has been tied to the uneven gender distribution across medical specialties—which leads couples to decide that the lower earning (likely female) spouse should take on more domestic duties—along with inequitable social norms related to childcare and domestic chore load.

Much has been said about gender disparities when it comes to domestic chores, with women in every profession and of every background shouldering a vastly unequal share of domestic responsibilities.

It has also been noted that there is a high rate of physician marriages (physicians married to other physicians), and in heteronormative relationships, this may actually make domestic gender inequities worse.

The impact to female physicians' productivity

In a study that examined the effect of physician marriages by gender and rurality of work location, researchers publishing in Women’s Health Reports found a significant impact on female physicians’ productivity and earnings.^[]

Using a cross-sectional, multivariate analysis of survey data from nearly 80,000 respondents, the study authors found that, on average, a female physician who is married to a (male) physician (MTP) works 2.9 fewer hours per week than a female non-MTP physician. The same effect was not seen in male MTP physicians, whose weekly work hours were unchanged from those of male non-MTP physicians.

The study also found that female MTP physicians are less likely to have on-call work, and they earn $5,018 less per year than female non-MTP physicians. In contrast, male MTP physicians were more likely to have on-call work than their male non-MTP counterparts, and they earned $6,635 more per year.

Additionally, female MTP physicians were more likely than male MTP physicians to leave the labor market entirely or to work only part time.

Interestingly, but perhaps not surprisingly, this gender differential associated with physician marriages was found to be more prominent in rural areas than in urban ones.

Reasons for the differential

The Women’s Health Reports authors cite two primary reasons for this gender differential seen in physician marriages with respect to work hours.

First, it is possible that “uneven gender distribution across medical specialties may drive this discrepancy,” the authors note. As has been reported before, women are vastly underrepresented in the highest-paying medical specialties.

Thus, dual-physician households may decide that the lower paid partner, who is more likely to be the female spouse, should reduce their work hours in favor of more domestic responsibilities, such as childcare and household management.

Secondly, the researchers identify “inequitable social norms” as a potential reason why females in dual-physician marriages may leave the workforce or reduce their hours, regardless of income. This has been seen, for example, in female surgeons—a traditionally high-paid specialty—who have left the medical workforce entirely, or switched specialties due to the difficulty of balancing a procedure-based career with domestic tasks.^[]

"It may also be that on-call time—and the flexibility to be available for call—is better compensated than unavailability due to family or domestic responsibilities."

— Yasmine S. Ali, MD, MSCI, FACC, FACP

This may also account for the differences in annual salary, as well as weekly work hours.

Rural vs urban differences

The researchers postulate that, in rural areas, there are fewer job opportunities and thus less likelihood for female physicians to be able to find more flexible arrangements or other forms of fulfilling work, and this exacerbates the underlying gender differential seen in physician marriages.

Indeed, previous research has suggested that metropolitan areas are more attractive to highly skilled, dual-educated couples due to the greater breadth of opportunities in urban job markets.^[]

Far-reaching implications

This body of research demonstrates how myriad challenges faced differentially by women in medicine—from lower salaries, to specialty underrepresentation, to higher domestic chore load—combine to impact women physicians’ productivity when they are married to male physicians. The physician-to-physician marriage appears, in fact, to be a microcosm and a reflection of the broader issues faced by female physicians in the medical field at large.

What this means for you

Being aware of inequalities that may exist within physician marriages can help you have proactive conversations with your partner about balancing domestic duties and structuring your careers equitably. Addressing uneven expectations and being intentional when making life plans can help mitigate disproportionate impacts on the female spouse's career.