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Medical couples are experts at delaying gratification. Medical school’s rigid, unpredictable, and demanding schedule forces couples to postpone vacations, outings, dinner plans, and relationship progress. Glen Gabbard and Roy Menninger, in their book Medical Marriages, call this common trend among single- and dual-physician couples “the psychology of postponement.” They explain that medical school and demanding attending physicians become “a convenient scapegoat” for couples looking to avoid living their lives or addressing certain relationship issues.

Wayne and Mary Sotile, authors of The Medical Marriage: A Couple’s Survival Guide, explain the phenomenon this way: “Postponement occurs when a medical couple grow accustomed to living a life of waiting. They pin their hopes of eventually getting around to enjoying their life and relationship upon the completion of the current quest.”

This mindset makes some sense: Medical school requires couples to adjust their expectations: We probably can’t go on vacation during our partner’s surgery rotation and yes, the nonmedical partner is likely to do a disproportionate amount of laundry during that period. It’s just the way things go during a particularly tough stretch of time. During those periods, it is healthy to remember that these situations are temporary and realize when circumstances interfere in an otherwise healthy relationship dynamic.

For some, however, postponement can become a philosophy and a crutch that allows each partner and the couple as a unit to avoid other uncomfortable conversations, ultimately leading to a destructive cycle of silence between partners. If adopted as a way of life, Sotile and Sotile note, postponement “allows people who are unhappy in their relationship to continue avoiding the anxiety that comes with trying to maintain closeness. They put off dealing with problems. They’re always ‘waiting until…’” In this way, an attitude of delayed gratification becomes an avoidance mechanism that drives a wedge between couples.

It may be that this attitude and coping strategy is adopted out of love, not malice or avoidance. I’ve spoken with many medical partners who explained that they postponed a relationship conversation because it never felt as urgent or important as the next test. They didn’t want to be the reason their partner was off their game or struggling in school. In these cases, the nonmedical partner takes on the burden of an issue to protect and support the medical partner. But even with altruistic motives, postponement fails to protect medical couples from relationship issues. Instead of achieving the goal of saving arguments for a convenient time (and when are arguments ever convenient?), it erodes the affection in the relationship by keeping issues unresolved and leaving one partner to shoulder that burden.

Ultimately, couples that survive medical school using a strategy of postponement will likely be disappointed when things don’t get easier after graduation. Most residency programs require more hours, not fewer, than medical school. And while some doctors eventually go on to work 9-to-5, many work weird shifts and are occasionally on call, leaving them with inconvenient and erratic schedules. Medicine will always be a part of our lives, and if we fail to recognize that truth, we run the risk of postponing forever. We don’t want to wake up in 10 years and realize we never took that vacation because we never made the time for it or that we left dozens of important conversations unspoken.

Instead of hoping for the day that life becomes more level, it is in the best interest of medical couples to learn to navigate that alternative lifestyle and start to figure out how to live with medical school, with medicine in our lives.

Sarah Epstein is a master’s candidate in couples and family therapy who blogs at Dating a Med Student.

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