Physician Burnout and Divorce: When Work and Marriage Feel Hard

Work strain, relationship questions, and support without a ready-made verdict.

A car wash on a day off

Lakeisha is an illustrative composite, not a real client or a real physician. She’s 44, and she’s a hospitalist at a regional medical center. She’s just come off a run of shifts, and today is the first of three days off.

It’s a little after ten on a Thursday morning in late September, and she’s sitting in her car in the line for the automatic car wash at the gas station near her house. There are two cars ahead of her. The radio is on low. A parking stub from the hospital garage is still tucked in the cup holder next to a travel mug she forgot to wash.

She has a note open on her phone. She started it at some point last week and hasn’t told anyone about it. It has three lines: the schedule, us, and whether I’m just tired. She’s been reading those three lines for a while, as if they’ll sort themselves into the right order if she looks long enough.

If I could just figure out which one it is, she thinks, I’d know what to do about the other two. The car in front of her pulls forward into the tunnel. The green light comes on for her. She puts the phone face down on the passenger seat, rolls up the window, and eases forward onto the track.

If you’re a woman in medicine and some of that sounds familiar, this guide is for you. It’s for physicians who are worn down by work and who are also facing strain in their marriage, whether separation is a question you’re considering or something that’s already underway. It looks at how to tell different kinds of questions apart, what burnout does and doesn’t mean, why safety comes first, and what support can look like before and after a separation.

A note on where I’m coming from. I’m a licensed therapist, and I also coach executives. This article is general education. It isn’t therapy, coaching, or medical, legal, licensing or financial advice, and it can’t tell you what’s happening in your marriage, what caused it, or what you should decide. Lakeisha and the other physician in this guide are illustrations, not people.

Three kinds of questions that can arrive at once

When work exhaustion and marriage strain show up in the same season, they can feel like one enormous problem. Sometimes it helps to notice that you may be carrying several different kinds of questions, and that each kind belongs in a different place.

• Questions about work. How tired you are, how much of you the job is taking, how you feel about the schedule, the inbox and the documentation, and what, if anything, you want to change about your working life.
• Questions about the relationship. What’s happening between you and your partner, what you each want, whether you’re considering a separation, and how you feel about all of it.
• Questions about the practical side of a separation. If a separation is being considered or is underway, there may be legal, financial, housing, parenting and scheduling matters, and some of them come with deadlines.

These three can touch each other. A hard month at work can make it harder to think clearly about anything at home, and a hard month at home can follow you into the hospital. But touching isn’t the same as causing. This article can’t tell you whether your work caused what’s happening in your marriage, or the other way around, and I’d be cautious about any source that says it can.

Keeping the three apart isn’t a way of pretending they’re unrelated. It’s a way of giving each one its own attention, so the answer to one doesn’t get decided by accident while you’re trying to solve another.

What burnout means, and what the definition can’t tell you

If you’ve been using the word burnout for what’s happening at work, it’s worth knowing how the term is actually defined.

Three details in the WHO’s description matter here.

First, the WHO says burn-out isn’t classified as a medical condition. It sits in a chapter about factors that influence health status or lead people to contact health services. So even if the description fits your working life closely, it doesn’t tell you what, if anything, a clinician would find.

Second, the WHO says the term refers specifically to the occupational context and shouldn’t be applied to describe experiences in other areas of life. So the definition describes work, not relationships. It can describe how you feel about your job. On its own, it can’t establish why a particular relationship is having difficulties. That doesn’t mean strain at work never plays a part in what happens at home. It means a definition can’t tell you whether, or how, it does in yours.

Third, a definition can’t assess you. If you’re worried about how you’re feeling or functioning, a primary care provider or a licensed mental health professional can look at what’s going on. The National Institute of Mental Health notes that a primary care provider can do an initial mental health screening and refer you to a mental health professional.

If you’d like a fuller look at burnout itself, separate from any relationship question, my general guide to physician burnout covers how it can show up in a medical career and what support can look like.

The Systemic Lens: working conditions are real, and they aren’t a verdict on your marriage

If you’ve gotten used to pushing through, it can be easy to treat exhaustion as a personal failing. It can help to look at the conditions you work in, too.

The U.S. Surgeon General’s advisory on health worker burnout says workplace systems cause burnout among health workers. It points to a range of societal, cultural, structural and organizational factors, with examples like excessive workloads, administrative burdens, limited say in scheduling and a lack of organizational support. The CDC’s National Institute for Occupational Safety and Health describes similar conditions across health care, including long and often unpredictably scheduled hours, high administrative burdens and little control over schedules.

Those are descriptions of work. They cover health workers broadly, and they don’t say anything about any one physician’s marriage. They don’t show that a demanding job ends relationships, and they don’t show that it doesn’t. What they can do is widen the frame. If you’ve been treating your exhaustion as proof that something is wrong with you, the advisory is a reminder that the system you work in carries part of the weight.

That matters in two directions. It can soften the self-blame about work. And it can keep you from placing the whole explanation for your marriage on the job, or on yourself, before you’ve had a chance to look at the relationship on its own terms.

NIOSH also describes a strong and historical stigma around healthcare workers seeking care for mental health concerns. If part of what’s kept you from getting support is worry about what it could mean professionally, that worry is worth taking seriously, and there’s more on those questions further down.

Before anything else: is it safe to disagree?

Before you think about any conversation with your partner about the future, or about seeing someone together, there’s a question that comes first. Is it safe for you to disagree with your partner, openly, without fear of what happens afterward?

If you’re worried about abuse, threats, intimidation or control, the suggestions in this article about talking together aren’t intended for your situation. If you’re not sure whether that describes your relationship, start with individual contact with a Hotline advocate or a qualified clinician of your own, not a modified version of a joint conversation. The National Domestic Violence Hotline says it doesn’t encourage anyone in an abusive relationship to seek counseling with their partner, and it says abuse isn’t a relationship problem. It explains that relationship counseling can’t fix the unequal power at the center of an abusive relationship, and that an abusive partner may later use what’s said in therapy against the other person.

What can help instead is individual support. That might be a conversation with a Hotline advocate, using a safer device or method if someone else has access to your phone or computer. It might also be a clinician of your own who understands abuse. The Hotline describes a personal safety plan as personalized and practical, meant to improve your safety while you’re experiencing abuse, preparing to leave, or after you leave. Its advocates can help you think through a plan that fits your situation. There isn’t one right order of steps that fits everyone.

You don’t have to wait until something happens again, or until you’re sure it has a name, before you contact a Hotline advocate. And not feeling afraid right now doesn’t settle the question on its own. If something about your partner’s behavior worries you, it’s reasonable to talk it through with an advocate even if you’re not sure it counts.

If you’re still weighing what comes next

If a separation is something you’re considering, rather than something either of you has decided, the weeks can feel strange. You may be doing ordinary things side by side while the biggest question in your life goes unanswered.

I won’t tell you whether to stay or to separate. That decision is yours, and it may take longer than you’d like. I also won’t tell you to change your hours, take leave or leave medicine as a way of settling the question. Those are real options for some people, and they’re decisions with their own consequences, for you, for your patients and for your career. They deserve their own consideration, not a place in a formula.

If it’s safe for the two of you to disagree, a few questions may help you get your bearings:

• What’s actually been said? It can help to hold what you know apart from what you fear it might mean.
• What are you hoping for? You might want different things on different days. That’s information, not failure.
• What would make a conversation possible? Some couples can talk at home. Others need a set time, a neutral place or a professional in the room.

If, and only if, it’s safe for each of you to disagree openly, including in front of a third person and without fear of what happens once you’re home, seeing someone together is one option some couples think about. Whether it’s a good fit for your situation is something a qualified clinician who provides couples work can assess. If abuse, threats or control are part of the picture, the Hotline’s caution in the section above applies, and individual support comes first.

It’s also all right not to know yet. Not knowing isn’t the same as avoiding the question. Sometimes it’s the honest answer for a while.

A laundromat on a Sunday morning

Shawna is an illustrative composite too, not a real client or a real physician. She’s 51, and she’s an anesthesiologist. She and her husband have been living separately since June. She’s renting a small apartment across town, and it doesn’t have a washer.

It’s a gray Sunday morning in October, a little before nine, and she’s at the laundromat two blocks from the apartment. She’s the only one there except for a man reading a paperback by the dryers. She’s folding towels on the long counter under the fluorescent lights. They’re the good towels, the thick ones. She took them when she moved and still isn’t sure she was supposed to.

Her phone is next to the stack. There’s an email from the office handling the separation paperwork, asking her to confirm a date for a meeting, and under it a text from a colleague asking whether she can trade call weekends next month. She reads both twice.

I can do the call weekend, she thinks. I’ve always been able to do the call weekend. And then, more quietly: I don’t know what I’m supposed to feel about the other one. She folds another towel, squares the corners, and sets it on the pile. Then she picks up the phone, opens the calendar, and closes it again without typing anything.

If you’re already living apart

If a separation is underway, or a divorce is in progress, some questions change shape. The practical side may be moving on its own schedule, even while your feelings about the relationship are still unsettled. And medicine keeps its schedule, too.

There isn’t a right way to feel here. Some people feel grief. Some feel relief. Some feel guilt, anger or numbness, or several of those in one morning, the way Shawna does at the laundromat. None of that tells you whether you made the right choice, and none of it needs to be resolved before you can get support.

A few things tend to matter in this season:

• Some matters are time-sensitive. Legal deadlines, custody arrangements, financial obligations and safety concerns may need prompt attention, and it’s reasonable to get qualified help with them quickly. Waiting until you feel steadier isn’t always an option.
• Each question has its own right person. A therapist can help you sort out your feelings and your priorities. A therapist can’t decide your custody arrangement, your finances or your legal strategy. Those belong with the appropriate legal and financial professionals, and with you.
• Professional obligations don’t pause. If you’re worried about how you’re functioning at work, or whether you’re able to work safely, that’s a question for your own clinician and for the appropriate people where you practice. An article can’t decide your clinical fitness, your contract obligations or what you owe your employer, and some of those questions may need a prompt answer.

Living apart doesn’t automatically end safety concerns. If you’re worried about your safety now, the Hotline’s personal safety plan is written for after you leave, too, and its advocates are available by phone, text or chat.

If your feelings are making it hard to sleep, eat, take care of your family or do your work, that’s a good reason to talk with a primary care provider or a licensed mental health professional, who can assess what’s going on.

What individual therapy can and can’t address

If you’re thinking about support for yourself, individual therapy is one option. It helps to be clear about what it is.

The NIMH lists severe or long-term stress from a job or family situation, and relationship or family problems, among the reasons people seek psychotherapy. It describes the general goals as relief from symptoms, maintaining or improving daily functioning, and improving quality of life. It also says the right treatment plan depends on a person’s individual needs and medical situation, and should be chosen under the guidance of a mental health professional.

In practice, individual therapy can be a place to:

• Sort out which questions belong to work, which belong to the relationship, and which belong to the practical side of a separation.
• Think about what you want, without anyone deciding for you.
• Have room for grief, relief, anger or confusion, without needing to manage those feelings for your patients, your colleagues or your family.
• Prepare for conversations you’re dreading, if it’s safe to have them.

And it has limits:

• It doesn’t itself change your schedule, your staffing or your employer’s policies.
• It can’t tell you whether to stay married, separate or divorce.
• It isn’t legal, financial, custody, licensing or contract advice.
• It can’t guarantee any particular outcome, for you or for your marriage.
• It doesn’t replace crisis services or safety planning if you’re in danger.

Individual therapy isn’t the same as couples work. If the two of you are considering seeing someone together, and it’s safe to disagree, that’s a separate conversation with a clinician who provides couples work.

Finding a good fit matters. The NIMH says rapport and trust are essential, and suggests that a preliminary conversation can help you understand how treatment will proceed and whether you feel comfortable with the therapist.

If you’re worried about what seeking care could mean for records, credentialing or a license, that concern may come before any of this. I can’t tell you how the rules apply where you practice. If that’s what’s holding you back, my piece on privacy, records and licensing questions physicians can raise before starting therapy walks through questions to ask, without assuming any particular answer.

Both/And: you can be worn down by medicine and still be deciding about your marriage on its own terms

One of the hardest parts of this season can be the pull toward a single story. If work weren’t like this, we’d be fine. Or the reverse: If things were fine at home, I could handle work. Either story can feel like relief, because it gives you one thing to fix.

A Both/And frame lets more than one thing be true without deciding in advance how they fit together:

• You can be exhausted by your work and still take your feelings about your marriage seriously on their own.
• You can see the system’s part in your exhaustion and still want to look at your own part in the relationship.
• You can love parts of your life together and still be considering a separation.
• You can feel relief about living apart and still grieve what you had.
• You can care deeply about your work and still not know what you want at home.

None of these pairs is a contradiction you have to resolve before you’re allowed to get support. They’re just what it can be like to carry two hard things at once.

Where they are now

Lakeisha is still in the car wash tunnel. The brushes are working their way over the windshield, and her phone, still open to the note with its three lines, is face down on the passenger seat. She hasn’t decided which line comes first, or whether they need an order at all.

Shawna is still at the laundromat. The towels are folded. The email is unanswered, and so is the text about the call weekend. She’s thinking about which one to answer first.

Neither of them knows yet how the next year will go. Some of what’s in front of them won’t wait, and some of it can take the time it takes.

If you recognize yourself somewhere in this, it may be enough for now to notice which questions you’re carrying and where each one belongs. If it’s more than you want to carry alone, a primary care provider, a therapist of your own, or, if safety is a concern, a Hotline advocate is one place to start.

Warmly,
Annie.