Forty years of marriage, dermatology, inequities, and gratitude

By Warren R. Heymann, MD, FAAD
Aug. 10, 2022
Vol. 4, No. 32

We have all been affected by the COVID-19 pandemic. There have been more than one million fatalities in the United States. Additionally, the associated sequelae of COVID — long-COVID in survivors, compounded by emotional, financial, and scholastic stresses have been devastating. A few weeks ago it was my turn, with a flu-like illness followed by a Paxlovid rebound. (I am now 100% fine.)

In this new phase of the pandemic, many patients who have not been seen since 2019 have returned to the office. I ask everyone how COVID has affected them, their family, and friends. Their eyes peering above the mask reveal the degree of difficulty the virus has wrought, or, as an offshoot of resilience and resignation, improved life. The gamut ranges from the death of a spouse to the positive effects of having grown children return home during the peak of the pandemic.

Two common themes prevail: 1) the difficulty of balancing work responsibilities from home while having school-aged children remotely educated at home; 2) the strain of not being able to see elderly parents who were in nursing homes or other facilities, especially if they were infirmed.

The cliché that “timing in life is everything” reinforced my gratitude that my children are adults and that the passing of my mother and mother-in-law was in 2018 and 2019, respectively. I’m sure my wife and I would have done what countless families had to do in order to endure both situations — I’m grateful that we did not have to.

How often do you take a moment to be grateful for the positive aspects of your life?

How often do you attribute your success to inequities?

Forty is a number with biblical implications — it took a generation for the Israelites to reach the Promised Land from Egypt. My wife and I took our vows on August 14, 1982 — I was a chief resident in dermatology and Ronnie was in her second year of pediatric residency en route to becoming a geneticist. It was an autumnally crisp summer evening on Manhattan’s Upper West Side. In the Jewish tradition, I recall the “pop” of stomping on the glass (actually a light bulb wrapped in cloth) once we were pronounced as a married couple, reflecting on life’s fragility. (A more cynical interpretation of this tradition is that it is the last time the husband will put his foot down.)

Forty years has confirmed life’s fragility on many levels. The tribulations of COVID remind me of how fortunate I am to have married this marvelous human being. Although I have tried to be a decent husband and father, Ronnie has borne the brunt of the domestic and parental duties. In two-physician households, she is not alone. COVID may have exacerbated these tendencies. According to the AMA, 25% of women physicians are married to doctors, and 16% of male doctors are married to physicians. (1)

The professional inequities between the genders and married physicians are real. In a study using the Association of American Medical Colleges (AAMC) 2019 National Sample Survey of Physicians (n = 6,000) and the American Community Survey data 2006–2017 (n = 72,900), Hu and Dill conducted cross-sectional, multivariate analysis with interaction terms between married to a physician (MTP), gender, and rurality, controlling for various work and personal characteristics. The authors found that female MTP physician works 2.9 fewer hours (p = 0.000) per week than a female non-MTP physician, while a male MTP physician’s weekly work hours are not significantly different from a male non-MTP physician’s. Compared to non-MTP counterparts, male MTP physicians are more likely to have on-call work, and female MTP physicians are much less likely to have on-call work; male MTP physicians earn $6,635 more (p = 0.010) per year, while female MTP female physicians earn $5,018 less (0.083). (2)

Ha et al, performed systematic review and meta-analysis found that women had lower publication productivity than men based on the h-index (a metric to quantify the amount and impact of one’s publications). When productivity was evaluated by specialty, women had lower productivity than men in all specialties except for plastic surgery; when productivity was organized by rank, women had lower productivity than men at the ranks of assistant professor, associate professor, and professor. (3) In a cross-sectional analysis data from the Association of American Medical Colleges Faculty Roster, Xierali et al report that the number of full-time U.S. dermatology department faculty increased from 167 in 1970 to 1464 in 2018. The number of female faculty increased from 18 (10.8%) in 1970 to 749 (51.2%) in 2018; the number of underrepresented-in-medicine (URM) faculty grew from 8 (4.8%) in 1970 to 109 (7.4%) in 2018. Proportions of female and white dermatology department faculty were similar to the U.S. population in 2018; however, like other clinical departments, the proportion of URM faculty was lower than in the general population. (4)

The following is the abstract from Treister-Goltzman and Peleg’s article about the work-family conflict and female physicians: There has been a dramatic increase in the number of female physicians in all fields and specializations of medicine, but this increase has not resulted in a redistribution of domestic tasks and responsibilities. Reviewing the literature of the last two decades (April 1994 to April 2014) on how female physicians cope with the challenge of balancing their family and professional lives for the duration of their professional careers revealed that they suffer from the work-family conflict more than other professionals and that it has a more negative effect on women than on men. Women physicians consider work-family balance significantly when making career choices. These considerations affect their career success, their productivity as faculty members, their marital life, and parenthood. Having a supportive spouse at home and a facilitating mentor at work are important for a positive work-family balance among female physicians. Special career-supporting measures, such as flexible work schedules and expanded support for childcare over the course of work and when taking part in academic activities, are critical for female physicians. (5)

I have made two wonderful decisions in my life — to marry Ronnie and in choosing dermatology as a career. Despite the inequities mentioned, Ronnie has had a spectacular career working very full-time to the rank of Professor of Pediatrics and Head of the Division of Genetics at Cooper Medical School of Rowan University. This year will encompass my fortieth anniversary for both. I am truly blessed — I suppose I could have been a more equitable husband, but I could not have had a better wife. Should we ever have grandchildren, I hope that they will only learn of inequities in a historical context.

Point to Remember: Two-physician households are commonplace. Inequities exist both at home and the workplace. A concerted effort should be made in both arenas to level the playing field.

Our expert’s viewpoint

Danielle M. DeHoratius, MD, FAAD

I am thrilled to read yet another excellent column by Dr Heymann and privileged to author the Expert’s viewpoint. I can also confidently say that I agree with the statement that he is lucky to have married Ronnie, but I think Ronnie is pretty lucky too! I am coming from a dual physician household as well and I agree with the discrepancies wholeheartedly. It is unfortunate that a disproportionate distribution of domestic tasks remains, even in 2022. It would be interesting to study the numbers of hours of sleep acquired by each partner in dual physician households. Some days I refer to it as work-life balance, other days I think of it as survival. That said, I know it takes a village. Navigating a pandemic, conquering the unchartered territory of telemedicine, and homeschooling four kids was not easy. Kevin and I could not have done it without the support of various family, friends, colleagues, and a nanny or two along the way. It is important to take a moment and have gratitude for those people in your life who help you to be the physician that you desire to be. I also like to think about silver linings in every situation. While I would not go back to homeschooling four children, it was wonderful that we were home every night for dinner. Now we find ourselves in the rat race of running from soccer, to track, to baseball with a little math in between. While my 16 years of marriage pale in comparison to 40, I am grateful I have someone to weather the storm in, both the good and bad, all while being able to practice dermatology, a specialty that I love.

1. https://www.ama-assn.org/residents-students/resident-student-health/why-doctors-marry-doctors-exploring-medical-marriages (accessed May 1, 2022)

2. Hu X, Dill M. When Physicians Marry Physicians: Gender Inequities in Work Hours and Income. Womens Health Rep (New Rochelle). 2021 Sep 22;2(1):422-429. doi: 10.1089/whr.2021.0048. PMID: 34671763; PMCID: PMC8524735.

3. Ha GL, Lehrer EJ, Wang M, Holliday E, Jagsi R, Zaorsky NG. Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine: A Systematic Review and Meta-analysis. JAMA Netw Open. 2021;4(6):e2112404. doi:10.1001/jamanetworkopen.2021.12404

4. Xierali IM, Nivet MA, Pandya AG. US Dermatology Department Faculty Diversity Trends by Sex and Underrepresented-in-Medicine Status, 1970 to 2018. JAMA Dermatol. 2020 Mar 1;156(3):280-287. doi: 10.1001/jamadermatol.2019.4297. PMID: 31913403; PMCID: PMC6990830.

5. Treister-Goltzman Y, Peleg R. Female Physicians and the Work-Family Conflict. Isr Med Assoc J. 2016 May;18(5):261-6. PMID: 27430080.

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