Valentine’s Day: I am Not (but, Thank Goodness, My Husband is) a Romantic

From the 2/12/2021 newsletter

Director’s Corner

Valentine’s Day: I am Not (but, Thank Goodness, My Husband is) a Romantic

By Adina Kalet, MD MPH

In this week’s Director’s Corner, Dr. Kalet talks about the links between love at home and high quality, world-changing science at work. She highlights the importance of strong, egalitarian partnerships in creating a life of meaning, purpose, and flourishing …

COVID-19 has highlighted the importance of having clinician investigators “on the ground” to care for both patients and populations. This group is the most likely to detect emerging disease variants, run innovative therapeutic trials, and move new discoveries to the bedside and into the community. Translational scientists save lives. We need to nurture these clinician investigators as they fulfill their vital scientific and societal roles and provide them with the resources they need to stay healthy and train the next generation of physician scientists. 

Despite their importance, though, over 40% of well-trained physician scientists leave academic medicine, causing a serious shortage of physician researchers and a resulting in a huge loss to the health science workforce. Given how exciting and important their work is, why do so many step off the track? 

I believe they leave because of the constant and recurring challenges these individuals face trying to balance their own lives while attempting to pursue meaningful clinical and research careers. Without solid, deep, and meaningful support both at home and at work, the challenging lives of clinician scientists can become overwhelming. 

What does this have to do with Valentine’s Day? 

In our recent paper entitled “Challenges, Joys, and Career Satisfaction of Women Graduates of the Robert Wood Johnson Clinical Scholars Program 1973–2011,” our group, including Dr. Kathlyn Fletcher, reported on a long-term study of the women graduates of this highly successful fellowship aimed at training change agents in the transformation of American healthcare quality. Among many findings, we identified that - of all these remarkably successful and influential women - the most satisfied were likely to describe their work as “…deeply meaningful and have egalitarian spousal relationships.” The views of these well-trained women clinician scientists offer important lessons to those interested in repairing the leaky pipeline of clinical researchers.

Most of the program graduates in our study were in committed, dual career, personal partnerships. What did “egalitarian spousal relationships” mean to them? It was very complex. We asked the women, some younger and some close to retirement, to reflect on the course of their working lives. On one hand, successful respondents noted that culturally determined and structurally maintained “traditional” gender social roles became flexible and negotiated over time as the needs of the couple changed. A small number of the women in our study reported that, during the child rearing stage of their lives, their partners were the primary parents while they were the sole employed spouse. Most women, though, were constantly juggling home and work. While some respondents reported satisfying lives of “serial monogamy,” divorce was uniformly reported as disruptive to careers and life satisfaction. 

Even as they support early career clinical investigators and scientists, funders such as the National Institutes of Health, the Robert Wood Johnson Foundation, and the Doris Duke Charitable Foundation, have not explicitly and formally addresses how to create, maintain, and sustain “egalitarian spousal relationships” that might be associated with a thriving, impactful, and flourishing life in medicine and science. This might be an area for future study.

What would a relationship curriculum for clinician scientists (and others) cover? 

Love relationships, although universally seen as positive and important are, typically, firmly in the personal and private domain. Most of us learn how to make a life from our own families, our particular cultural groups, or our close peers. Career-focused women in my generation, facing lives very different from that of our parents, had to be creative. We talked “offline” with our peers, scanned our mentors’ offices for evidence of outside lives (e.g., family photos, children’s artwork, dry cleaning, grocery lists), and asked directly when it seemed safe: “How do you do it all?” “Who does the laundry?” “When the kids are sick, who stays home?” “When do the grants get written?” “How do you decide if it is right to relocate?” 

When I was raising my own children, I loved gently interrogating medical students and residents who had “working mothers.” I asked about their experiences and views, hoping to learn anything that would improve my chance of being a good mother. Since then, there has been an accumulation of material to read and discuss. Role models are more common. We can now think about what a structured curriculum might include. 

There is much to learn about finding love, building healthy relationships, and negotiating lives of meaning while not driving each other crazy! When I was starting out, it would have been great to have access to “paired” autobiographies, such as Michele Obama’s Becoming and Barak Obama’s A Promised Land, to gain insight from each partner’s point of view into how hard, but inspiring, it is to maintain a loving relationship under the pressures of “dueling” careers. We can learn from others as they cope with the types of accumulated, complex life experiences that author Nikos Kazantzakis had his protagonist, Zorba the Greek, lament when he said, “I'm a man, so I'm married. Wife, children, house--everything. The full catastrophe."

Ah, yes. The “full catastrophe.” 

A curriculum on creating egalitarian relationships might include exercises on how to determine if each partner shares values and a common view of the future. Children: yes or no? Bedroom window: open or closed? How important it is to “fight” fairly and forgive often? But in the end, it is not those issues alone that make a relationship work for the long haul. 

What might men in egalitarian relationships report? I suspect it would be very provocative but reassuring. To understand how best to create lives full of meaning, we must think deeply about how both people contribute to nurturing, sustained, and flexible loving partnerships. 

Let me tell you about my Valentine … 

My husband has received many “kudos” for playing nontraditional roles, yet when we both switched to four-day work weeks after the birth of our first child, colleagues were supportive of my choice but warned that it would “ruin his career.” (Today we are both tenured full professors.) When we share that he does most of the cooking, he gets showered with praise yet my years of boiling the water for pasta or broiling the fish still go unacknowledged. Thus, as my experience exemplifies, egalitarian relationships are better for both partners but still require different sorts of internal and external negotiations for men. Attention to this, with a reliable evidence base could lead to greater flourishing for all of us. 

Here comes my Valentine’s Day theme. I have had the benefit of such an “egalitarian” loving partnership, and it has made all the difference. I met Mark in July 1984 when we were the interns on the 16 East medical team at Bellevue Hospital. Needless to say, we became very interdependent that summer, meeting regularly in the ICU to replace central lines or draw blood cultures, writing progress notes side-by-side well into the wee hours. I suspect there are few ways to get to better know a person’s character than sharing a 2:00 a.m. cup of cold “food truck” coffee. That summer, well before we became a couple, we were partners.  

Mark recalls that time with much more “romance” than do I.  He has always been the cornier one. I am the “realist,” skeptical that romantic love even exists. I have been free with my feminist critique of all that life has thrown at us. He is the one who still believes in magic. 

Over thirty-three years of marriage, there has been lots of tension and compromise.  There were certainly many ways it could have - and almost did - go wrong. We have challenged assumptions, gained self-awareness, believed in and pushed each other, experimented, and occasionally jumped off the deep end.  We never seem to get it exactly right, but we have gotten better at getting it close enough. We have made a home, raised children, and had our share of adventures. Our egalitarian relationship is a perpetual work in progress, more of a constant juggle than a harmonious balance. We are both better people because of it and, I might add, we have both found rewarding roles as clinician scientists and administrators.

So, is this just good luck? Maybe. I certainly feel lucky. I know many of our junior colleagues think of us as a “dynamic duo.” My response when I hear this is “Forget the Marvel Comics version and come to dinner, see our messy but warm home, meet our kids and the cats, and watch us work it out.”    

For further reading:

Kalet, A, Lusk, P, Rockfeld, J, Schwartz, K, Fletcher, KE, Deng, R, & Bickell, NA (2020). The Challenges, Joys, and Career Satisfaction of Women Graduates of the Robert Wood Johnson Clinical Scholars Program 1973–2011. Journal of General internal Medicine, 35, 2258–2265.

Kalet, AL, Fletcher, KE, Ferdman, DJ, & Bickell, NA (2006). Defining, navigating, and negotiating success. Journal of General Internal Medicine, 21(9), 920-925.

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.