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Wednesday Oct 08, 2014

Culture Shock: Practice Transitions Impact Our Loved Ones

We all know how difficult residency and the transition to practice can be for physicians. But what often gets overlooked is that this also can be a tough time for our loved ones -- spouses, children, significant others, friends and other family members.

Nearly half of U.S. marriages end in divorce, and the divorce rate is even higher among physicians than it is in the general population. But does it have to be that way?

My wife and I have three children. Because of my packed schedule as a student and a resident, my wife struggled with the feeling that she was "doing it alone" when it came to raising our family. Now that my schedule is more flexible and I am more available, she and I are adapting to changing roles. Not only did residency and entering practice change me as a person, but it changed my family as well, and sometimes it's hard to go back to "normal," or even to define what that is now for us.

Open communication has been the key to ensuring our relationship has stayed healthy. My wife says it has been difficult for her to know how to provide emotional support as I have advanced in my career. Although I am grateful for her support, I know she is sometimes unsure how to help me deal with experiences such as taking on new leadership roles, becoming increasingly accountable to my patients and medical decision-making, and going through a malpractice case.

And she certainly isn't the only one who has found the transition disorienting. As we start practice and get established in our profession, many of us move to a new area. Many take on the added responsibility of buying a house. While we struggle with professional responsibilities, our families often struggle with transitioning to a new place and trying to find a new support network. This can also include new jobs for our loved ones, which can be just as stressful for them as our own transition is for us.

Children, meanwhile, sometimes struggle with attending new schools and trying to make new friends and can feel neglected during this experience if we fail to show them special attention.

Perhaps somewhat counterintuitively, the sudden increase in income that comes with transitioning to practice also can cause significant stress on families. Many of us who traversed the difficult financial times of medical school and residency act as if heavy shackles have been removed and we can now live the lifestyle that we expect physicians to live. But the realities of loan repayment; the need for life, disability, and malpractice insurance plans; the desire to build up a prudent amount of savings; and the need to begin looking toward the financial health of our retirement can put a large dent in those financial expectations. This stress can be alleviated somewhat by open communication about expectations, budgeting and proactively managing finances instead of incurring further debt to change our lifestyle.

The increase in free time that often accompanies this transition can also be problematic. My family expects more of my time now, but I'm also interested in hobbies that I had to put aside during medical training. Devoting ample time to my family and friends is crucial to them and to me, although it can oftentimes mean my other interests have to take a back seat.

My family means everything to me. But I realize that as I have gone through the difficulties and changes inherent in medical training, I have sometimes failed to take into account how these stresses affect them. In my case, healthy communication and appropriate expectations have been the keys to managing these tensions, and I would just offer this advice: As we go through our unique experiences in becoming physicians and establishing our careers, it is crucial that we not neglect those who mean the most to us.

Kyle Jones, M.D., is a faculty member at the University of Utah Family Medicine Residency Program in Salt Lake City. He is the director of primary care at the Neurobehavior HOME Program, a patient-centered medical home for those with developmental disabilities. You can follow him on Twitter @kbjones11.

Posted at 04:00PM Oct 08, 2014 by Kyle Jones, M.D.

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