For Leslie Cavazos, M.D., finding a job seems a little like playing a game of musical chairs. She hopes when the music stops and her residency as a physical medicine and rehabilitation specialist at the University of Kansas Medical Center comes to an end, she’ll be able to find a job.
But Cavazos doesn’t want just any job. She wants a position in her specialty and one that will put her in close proximity to Gladstone, Missouri, where her husband, Like He, M.D., a family practice physician, is working.
"His job is here, so I would prefer to find something here as well," she says.
There are no guarantees, of course, and therein lies a problem for physician couples. Though the job market is still a favorable one for physicians, finding jobs for two physicians - especially if one is in a hard-to-place specialty - can be more challenging.
More and more physicians today are facing this problem. Maybe that’s because physicians seem to be the marrying kind. A recent Medscape Physician Lifestyle Report found that more than 85 percent of male physicians who responded to the survey and 71 percent of female physicians are married - a number that exceeds the 51 percent of all Americans who are married.
But that’s not all. An increasing number of physicians are marrying other physicians. The annual 2013 Cejka Resident and Fellows Survey showed that physician-couple marriages were up 5 percent from 2012.
"It’s not surprising," says Scott Allen, M.D., an internist and associate dean of Academic Affairs at the University of California Riverside who is married to Emma Simmons, M.D. "Women make up nearly half of the workforce these days, and more are entering medicine." And think about it, he says. Medical trainees spend much of their time circulating with other physicians, so who else would you expect them to see socially?
"In general, physicians who marry physicians meet the criteria for successful marriages," says Monica Lypson, M.D., who is married to Andrew D. Campbell, M.D. "Physicians are typically older when they marry, so they’re likely to be more mature, and usually they’re financially secure. That means their marriages may last longer."
Lypson, an assistant dean at the University of Michigan, was one of several authors of a recent study of medical marriages. One key factor, the study found, is a reliance on each other for mutual support. "Physicians, especially those still pursuing training, can often find themselves located far from family and friends," Lypson says. That’s why, when a job search arises, it’s important for couples to support each other through the process, she adds.
It may not be easy, though. After all, job hunts can put a strain on any searcher. But throw in factors that are unique stressors for physician couples, and you may have the perfect storm for relationship issues.
One such stress is finding work that’s located in the same geographic area as the spouse.
Suzanne Anderson, associate director of medical staff recruitment at Duke Medicine, recalls one physician she had recruited. He and his wife were both physicians, and Duke had positions for both. "We were excited about recruiting them," she says. Unfortunately, although one spouse was happy with the position, facility and area, the other spouse apparently was not. "We lost them both," she says.
Geographic distance can be an issue for some physician couples as early as resident match. During training, for example, Lypson found a job she knew was perfect for her and she quickly accepted - even though it meant living and working miles away from her husband. "We had discussed this possibility during the couples match, so we were prepared and could have an open and honest discussion of the pros and cons," she says. Lypson made the move to Michigan. A short time later, her husband found a position nearby.
Another physician-couple stress factor can be family. Although starting and raising a family can be an issue for any couple looking for work, the physician couple with children (and double the medical debt) can be under tremendous pressure to find work quickly.
Abby Mozes, M.D., is an emergency physician who, for the past few years, has followed her husband, Josh Mozes, M.D., as he trains for his specialty in cardiac electrophysiology.
They have moved together from New York to New Mexico to Indiana, and now the two have landed in Boise, Idaho, where he works as an attending physician. Abby, however, is currently unemployed - a choice the pair made together. "I was in my ninth month of pregnancy with my third child when we moved to Boise," she says.
Financially, the Mozeses are in a position where it’s feasible for Abby to stay home with their two sons and new daughter, and she’s likely to do so for a while. But previously, she worked during all the moves made for Josh’s training.
"With family," she says, "there is pressure to work. Even if it was in a part-time capacity, I worked," she says. And, she adds, "I didn’t want to waste what I learned after years of training."
"Some facilities have nepotism policies," says Diane Safner, a senior search consultant for Cejka Search. John Heydt, M.D., who recruits physicians as CEO of the University of California Riverside Medical Group, says one of the university’s policy regulations prohibits employees from taking positions where one spouse reports to another. "It’s an issue we’ve dealt with as well," says Laura Blake, director of physician recruitment for WVU (West Virginia University) Healthcare. "We worked it out, but it’s something we watch now when we hire physician couples."
There are also some employers who may be wary of physician couples because they may want the same time off for vacations and holidays. "If the couple joins a large group or is in different groups at a hospital, it’s not so much an issue," says Blake. But small group practices may not be as flexible.
"Many physicians deal with sudden absences," says Anderson, "but small group practices may have a more difficult time with that than a larger practice." Adds Heydt: "The larger the practice, the less it becomes a problem."
Another challenge that couples must navigate is if one physician is in an unusual specialty or sub-specialty. "Due to the size of their market, equipment needed, demand for services, etc., they may not have that specialty position available" if the search area is narrow, says Blake.
Don’t rule out a location before having a conversation, however. "We worked with a gynecologist who was married to a psychiatrist," says Maureen Jamieson, a senior search consultant with Cejka. "The rural hospital wanted the gynecologist, so they created a psychiatry position for his wife."
That type of scenario can happen, but most experts agree that isn’t something you’ll want to count on. And that leads to perhaps one of the greatest stressors for physician couples looking for work: If both physicians are looking for work at the same time, whose job search should take priority? Which physician should take the lead?
There are two schools of thought here.
Emma Simmons, M.D., says the most marketable physician should take the lead. "As a strategy, it makes sense for the physician who can find work easily to lead. That way, the physician can bring in income while the spouse looks for work."
Others, including Mozes, say it’s best to let the physician with the more difficult-to-place specialty take the lead. "I let Josh take the lead because there aren’t many job openings in his sub-specialty," she says. And although she’s not currently working as an emergency physician, she says she usually finds work when she looks.
Blake is also inclined to let the physician with the hard-to-place specialty lead the search. "Even if the primary care physician finds work, there may not be a job for the sub-specialist, so they may have to leave the area anyway," she says.
"Figure out whose job is primary, whichever physician that may be, and start there," suggests Heydt.
And if you can’t find work immediately, there are options, says Cavazos. You can work locums or moonlight until the right job opens up, she says.
Or, you could open your own practice.
Opening an independent practice is harder now than it used to be, says Cavazos. "It’s scary but feasible if you’re in the right specialty."
Psychiatry is one of those feasible specialties, says Hy Gia Park, M.D., who, along with her husband, Charles, work together in their practice, Arahant Health Services in Denver, which offers help for addictive, behavioral and other psychiatric disorders. Unlike a primary care practice, she says, the initial capital to open a psychiatry practice isn’t as large.
But why open a practice at all when so many physicians are opting for employment?
Charles Park, M.D., explains that, following a variety of clinical experiences, he felt compelled to give voice to a holistic philosophy that was shaping his practice goals. "We picked the name Arahant for our clinic because it means ’one who is worthy’ in Sanskrit. We felt our patients needed to be reminded that they are worthy human beings because the label of ’addict’ caused them to forget this," he says.
"Charlie opened the practice in 2006, right after his fellowship," says Hy Gia Park. She joined his practice after leaving her own fellowship in 2013. "I looked for work, but my husband said he needed me in the practice."
Before considering opening a practice of your own, Hy Gia offers some advice: "Assess your family situation first," she advises. "In residency, you have steady pay and great health care coverage. You don’t have that initially with a practice, so make sure there is a stable income coming from somewhere before making the leap." Hy Gia says her family has always owned businesses, so she knew what to expect when she joined her husband’s practice. If you do decide this is the route for you, she also suggests you learn to love the business side. "You have to be involved with the business side. There’s no getting around that."
Still, it can be rewarding, says Charles Park. "If I have any advice for people coming out of residency and fellowship, it would be to embrace the freedom that is given to us by our field, and try on every role in their chosen specialty. See how their professional identities are shaped by these varied experiences, and see if any one organization can truly contain their growing voice."
If not, you may want to open your own practice, with or without your spouse.
Of course, if it’s employment you’re seeking, there are plenty of things you can do to help the job search along - whether the search is for you, your spouse or for both of you.
Your potential employer’s physician recruitment department can help.
Shelley Tudor, vice president of research with the Association of Staff Physician Recruiters (ASPR) and an in-house recruiter for a managed-care system, says she’s happy to work with physician couples. "When an organization has multiple positions available, working with two physicians is a welcomed benefit," she says.
Anderson also says she’s happy to work with couples. "It can be an advantage for us if we have two positions open, so physician couples can be an asset," she says.
However, Heydt says physicians who want to make a job decision based on whether or not their spouse can also find work is something they’ll want to factor into their negotiations. "We’re a large employer, so we’re likely to find a job for the spouse, but if we don’t have anything available in that specialty, we’ll work with our partners to see if others in the area might have a position open at their facility," he says.
Still, there are a few things you’ll want to do on your end before showing up for an interview.
First, sit down with your significant other and talk, says Lypson. "Be really honest with each other. Put everything on the table." Heydt agrees: "As a couple, you each need to decide what your needs are and what you want professionally."
Blake suggests that the couple brainstorm on their own, listing the areas that are deal-breakers and areas where they may be willing to compromise. "Then get together to discuss them," she says.
"It’s like looking for a house," says Simmons. "List your priorities and what you want, ideally. Talk about how much distance would be comfortable if you were to take jobs in different locations. Discuss different scenarios that might come up. Know what your deal-breakers are."
Allen and Simmons have been fortunate throughout their careers to find work as a couple. Allen says if an employer didn’t offer them both jobs or find work for his spouse, that would be a deal-breaker. But they were both upfront about that and let potential employers know that was the deal. "You have to know what your values are, what you will and won’t accept," says Allen. If you and your partner have different priorities, or disagree on deal-breakers, it’s better to discuss that before either of you start reaching out to recruiters - or appear before a potential employer for your first interview.
Once your priorities have been set, deal-breakers discussed and target locations determined, it’s time to start the search. Plan to be honest and open about what you want. And the sooner in the process you state your wants and needs, the better.
"If you’re looking for a job for your spouse, give us that information at the initial phone screening," says Tudor. Don’t bring it up when you’re ready to commit to a contract.
Overall, however, recruiters are happy to get your call. "I don’t see any disadvantages to physician couples," says Heydt. And most recruiters will work with you to meet as many of your needs as possible. "We don’t want to give good people a reason to look elsewhere," says Heydt. Adds Anderson: "Two for one is an advantage for us, and we’re willing to work with both of them. We realize that if one is unhappy, then two are unhappy, and that can lead to two vacancies." So as long as your expectations are reasonable, you can count on recruiters to do what they can to bring you on board - and keep you.
Karen Edwards is a frequent contributor to PracticeLink Magazine.