Secondary Logo

Recruitment of Dual-Career Academic Medicine Couples

Putnam, Charles W., MD; DiMarco, Judy, PhD; Cairns, Charles B., MD

doi: 10.1097/ACM.0000000000002084
Invited Commentaries

Today it is not uncommon to discover that a candidate for a faculty position has a partner or spouse who is also an academician, adding complexity to the recruitment process. Here, the authors address two practical obstacles to the recruitment of faculty who have an academic partner: dual recruitment and conflict of interest. The authors have found that tandem recruitment works best when suitable positions for both spouses are first identified so that recruitment can proceed synchronously. This approach decreases misperceptions of favoritism toward either’s candidacy. Managing conflict of interest, generated by the appointment of one spouse in a supervisory position over the other, requires a proactive, transparent, well-designed plan. After canvassing human resource policies and conducting interviews with national academic leaders, the authors have developed an administrative structure that places “key” decisions (hiring and retention; promotion and tenure; salary, bonuses, and benefits; performance evaluations; and disciplinary matters) regarding the supervised spouse in the jurisdiction of an alternative administrator or committee. The authors also offer suggestions both for mitigating misperceptions of bias in day-to-day decisions and for the support and mentoring of the supervised partner or spouse.

C.W. Putnam is professor emeritus, Department of Surgery, College of Medicine–Tucson, University of Arizona, Tucson, Arizona.

J. DiMarco is deputy dean, Administration, College of Medicine–Tucson, University of Arizona, Tucson, Arizona.

C.B. Cairns is dean, College of Medicine–Tucson, and professor, Department of Emergency Medicine, University of Arizona, Tucson, Arizona; ORCID:

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Charles B. Cairns, College of Medicine, University of Arizona Health Sciences, 1501 N. Campbell Ave., PO Box 245017, Tucson, AZ 85724; telephone: (520) 626-0998; e-mail:; Twitter: @ChuckCairns.

At our medical school (the University of Arizona), we recognize that recruiting the best faculty requires that we proactively mitigate obstacles to successful recruitment. Further, we recognize that the best candidates for open positions might be part of a dual-career academic couple—a situation that affects a substantial subgroup of women faculty.1 Here we address two specific, practical impediments we continually face in recruiting dual-career couples. The first—dual recruitment—pertains to searches at any academic level. The second formidable obstacle—conflict of interest—arises when candidates are considered for a leadership position that will place them in a supervisory role over their partner.

Back to Top | Article Outline

Dual-Career Hiring

A growing trend

Medical faculty members are commonly partnered with other academics.2–5 Girod and colleagues5 have noted that 32.2% of medical school faculty are partnered with another academic; that, not surprisingly, 69% of these academic partners are also medical school faculty; and that one-quarter of medical school faculty whose partners are also academics actually work in the same department as their partner. Thus, dual recruitment often becomes a sine qua non for hiring a new faculty member. Moreover, because evidence indicates that geographic mobility offers women advantages in career advancement,6 successful dual recruitments could help narrow the gender leadership gap.

Spousal hires have a long history in academic institutions, but in the past such hires often occurred in the context of securing the recruitment of a “leading spouse.” Consequently, the terms “spousal hire,” “trailing spouse,” or “following spouse” have acquired latent pejorative connotations. The current recruiting scene is quite different: About 1 in 5 academic couples were hired together or “dual hired” to their current positions.5 Faculty members with academic partners are also more likely to be applying for academic positions, perhaps because they have not yet found mutually desirable appointments.5 Furthermore, universities are increasingly under pressure to become more “family friendly,” especially to dual-career couples, in order to recruit and retain the best faculty; to address concerns about diversity and representation; to raise morale and increase productivity; and to create a more equitable workplace. Importantly, members of dual-career academic couples are more productive academically by quantitative measures (e.g., publications, grant funding).5

We understand that no matter how well a dual recruitment is managed, other stakeholders may take exception to the outcome. Some may argue that hiring the couple is per se unfair: Were it not for the partnership, one spouse or the other would not be considered, and consequently, another perhaps more qualified candidate is being passed over. Conversely, some may support the position that not to consider the candidacy of the second spouse is inherently unfair. Once under consideration, it is axiomatic that the spouse or partner candidate must receive the same scrutiny as would anyone else applying for the same or a similar position. Questions that hiring committees must address include the following7:

  • Is the candidate well qualified for the position?
  • Is the candidate a good fit for the position?
  • If a position is being created, does it align with the goals of the receiving unit?
  • Are the candidate’s potential colleagues excited about the possible hire?

Wolf-Wendel and colleagues7 caution that “successful accommodations, in which both members of the couple and the institution as a whole are completely satisfied, are rare and require some luck.” If a suitable position for one or the other spouse is not available or cannot be created in a way that benefits the institution, we have found that being honest with the couple and advising them to direct their search elsewhere is the best course of action.

Back to Top | Article Outline

Tandem recruiting

When suitable positions are available (or can be created) and the spouses are highly qualified, we find that the recruitment works best if both hiring units engage in the process in synchrony. This synchrony includes coordinating visits when feasible, communicating with each other, and communicating with both spouses. Ideally, letters of offer should be presented simultaneously. These measures ensure that both spouses feel equally valued and that neither spouse is viewed by others as trailing, even though the initial contact is almost always with just one of the two partners.

Tandem recruiting may well be worth the extra effort. Indeed, hiring highly qualified partners makes good institutional sense. Attempting to recruit someone of equivalent talent might be outside the reach of a given university were it not for the attraction posed by the accommodation of both. Once on board, the couple likely poses less of a “flight risk” than other faculty members. The two partners may feel a special loyalty, engendered by the co-hiring, to the institution. Additionally, the couple may have learned that finding positions of high quality for both partners is no easy matter.

Back to Top | Article Outline

Proactively Managing Conflict of Interest

Given that both partners of medical school academic couples are medical school faculty (69%) and that over a quarter work in the same department as their partner,5 it is inevitable—as each member of the couple ascends the academic ranks—that candidates will be considered for a position that places them in a supervisory role over their partner. Recruitment of a spouse or partner supervisor may occur either synchronously or asynchronously—or as one spouse is promoted into a supervisory position. Regardless of its origins, one spouse or partner hiring or supervising the other constitutes a conflict of interest; however, to reflexively view the candidacy creating the conflict as tainted is neither fair to the couple nor wise for the institution. Proceeding with the recruitment—and then managing the conflict of interest after the hire—requires thoughtful consideration and a proactive, transparent, well-designed management plan.

Most academic institutions have written nepotism policies and explicit procedures for hiring relatives, including a spouse or partner. An extension of the formal process is that a spouse cannot participate in “key” decisions regarding a partner. Key decisions include hiring and retention; promotion and tenure; salary, bonuses, and benefits; performance evaluations; and disciplinary matters. By contrast, both partners may participate in day-to-day decisions (e.g., individual teaching, research, or clinical activities) that do not directly or indirectly benefit either of them.8

Back to Top | Article Outline

The alternative administrative body: Creating a transparent plan to manage key decisions

To address potential conflicts of interest regarding dual-career partners at our medical school, we sought to identify best practices. We performed an Internet search of university and medical school policies. We also interviewed our colleagues from the University of Arizona human resources and legal departments, as well as external academic medical and university leaders, including chairs, deans, and a college president (see Acknowledgments). We learned that because key decisions are readily identifiable, they are more easily managed. The solution practiced by many institutions is to assign key decisions to an alternative administrator or committee. The arrangement must be in writing, and it must be fair, workable, acceptable to both spouses, and, importantly, transparent to other faculty members and staff. Several experts noted that one work-around, sometimes chosen out of expediency, is simply to assign a “supervisor” outside of the customary chain of command to a spouse. Because of its contrived nature, such a work-around invariably generates mistrust among colleagues.

Based on the information we collected and our many discussions, our policy to address spousal conflicts of interest involves appointing an alternative administrator, typically a well-respected senior faculty member, preferably of higher rank or administrative appointment than the supervising spouse (or if that is impractical, of equal rank). For senior-level positions (e.g., departmental chair, dean), we developed an alternative administrative committee composed of three senior faculty members, at or above the administrative level of the supervising spouse. We believe that, for making key decisions regarding the supervised spouse, a committee is more likely to be perceived as objective and transparent. Moreover, an alternative administrative committee, once appointed, can oversee multiple spousal conflicts of interest, as is the current situation at our institution.

The alternative administrator or committee also serves as a watchdog for monitoring actual or perceived biases in decisions, actions, or behaviors outside of the key decision realm. It serves as a confidential sounding board for anyone perceiving bias and as a monitor of the perceptions of the faculty constituency (e.g., by conducting anonymous surveys). In these capacities, the committee reports to the responsible higher administrator (e.g., dean, provost, president).

Creating an alternative administrative structure cannot be a casual quick fix. The responsibilities and decision-making parameters, the faculty member(s) to be appointed, and the reporting requirements assigned to it should be reviewed not only by the institution’s chief human resources officer and chief counsel but also by both spouses. The written document, signed by both spouses and the appropriate administrative official(s), must be copied and placed in the personnel file of each spouse.

A primary objective inherent in the creation of an alternative administrative structure is to lend transparency to the hiring of the spouses and to subsequent key decisions affecting the supervised spouse; however, because the document itself is a personnel matter, its contents cannot be divulged to anyone beyond the need-to-know parties. What can and should be widely shared is the existence of a formal agreement, the broad parameters of the agreement (e.g., what constitutes a key decision), and the composition of the alternative administrative body. This transparency will signal to other faculty and staff that the implications of the hire are being carefully considered by the responsible administrators.

Back to Top | Article Outline

Managing day-to-day conflict

The success of a spousal hire which involves a discernible conflict of interest ultimately depends on the professionalism of both spouses. However, no one—especially either member of the couple—can ensure that all day-to-day decisions are consistently made without bias. Moreover, even with routine decisions (e.g., teaching or clinical schedules), other stakeholders may feel disadvantaged; they may interpret such decisions as representing spousal bias. Conversely, the supervising spouse cannot be paralyzed administratively for fear that a decision might be seen as evidence of bias.

Consequently, both spouses must be proactively aware of decisions that, by their very nature, might be misconstrued as manifesting bias. A supervisor can often render that concern mute by increasing the transparency of the decision-making process by, for example, broadening participation in discussions; when a larger group reaches consensus, bias becomes less plausible. Consensus building, however, is less convincing if the faculty involved are all members of either spouse’s unit or are more junior to the supervisor.

It is self-evident that neither spouse, especially the supervisor, will know whether the spousal or partner arrangement is in fact working; other faculty are unlikely to complain directly to either spouse! The alternative administrative body can and should be available to the couple’s colleagues to hear their concerns and to proactively seek input from the supervisor’s constituency.

Back to Top | Article Outline

Remember the supervised partner or spouse

The supervisor’s partner merits no less attention. First, despite the institution’s best efforts during recruitment, the supervised spouse may be viewed by some as a “trailing spouse.” This perception may be even more likely if the institution did not undertake a competitive search for the partner’s positions—the so-called search “with an n of one.”7 More concretely, the supervised spouse may miss out on mentoring opportunities ordinarily afforded by the supervising spouse. Assigning the supervised spouse a mentor from outside the department or division can be of great benefit. Another helpful step is to assign a highly regarded senior faculty member from outside the department as an advisor to both spouses.

Back to Top | Article Outline

Closing Thoughts

In making the case for a “new nepotism” construct, we emphasize that recruitment or internal promotion involving partners or spouses must be scrutinized case-by-case. Critical questions that must be addressed before any decision is made include the following: Will the dual hire or new promotion benefit the institution? Is one unit being coerced into an unwanted hire? Do the partners or spouses have the awareness, professionalism, and commitment to make their situation work? Are individuals or parties who have concerns about the recruitment being heard, and are their objections being addressed?

Then, once a committee makes a decision to hire a dual-career couple or promote one spouse into a supervisory decision over a partner, the work is not done. As with any new hire, a formal reporting structure and continuing support, mentoring, coaching, and critiquing of each spouse are essential for long-term success. We have developed this system of alternative administration to enhance acceptance by faculty and staff, to provide guidance and mentorship to both partners, and to facilitate both key decision making and day-to-day operations.

Back to Top | Article Outline


Many of the ideas and concepts expressed in this Commentary emanated directly from discussions with academics who generously offered their views of spousal recruiting and conflicts of interest, either by phone or e-mail. The authors gratefully acknowledge their contributions: Margaret M. Dunn, MD, MBA, dean of the Boonshoft School of Medicine (Wright State University, Dayton, Ohio); Timothy J. Eberlein, MD, Bixby Professor and chairman of surgery, Spencer T. and Ann W. Olin Distinguished Professor, and director, Alvin J. Siteman Cancer Center (Washington University School of Medicine, St. Louis, Missouri); Julie A. Freischlag, MD, vice chancellor for human health sciences and dean, School of Medicine (University of California, Davis Health System, Sacramento, California); K. Craig Kent, MD, dean, Ohio State University College of Medicine and Leslie H. and Abigail S. Wexner Dean’s Chair in Medicine (Ohio State University, Columbus, Ohio); Joan Hinde Stewart, PhD (president emeritus, Hamilton College, Clinton, New York); and Stephen G. Swisher, MD, division head, surgery (University of Texas MD Anderson Cancer Center, Houston, Texas).

Back to Top | Article Outline


1. Schrager S, Kolan A, Dottl SL. Is that your pager or mine: A survey of women academic family physicians in dual physician families. WMJ. 2007;106:251–255.
2. Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Freischlag J. Physicians married or partnered to physicians: A comparative study in the American College of Surgeons. J Am Coll Surg. 2010;211:663–671.
3. Tesch BJ, Osborne J, Simpson DE, Murray SF, Spiro J. Women physicians in dual-physician relationships compared with those in other dual-career relationships. Acad Med. 1992;67:542–544.
4. Sobecks NW, Justice AC, Hinze S, et al. When doctors marry doctors: A survey exploring the professional and family lives of young physicians. Ann Intern Med. 1999;130(4 pt 1):312–319.
5. Girod S, Gilmartin SK, Valantine H, Schiebinger L. Academic couples: Implications for medical school faculty recruitment and retention. J Am Coll Surg. 2011;212:310–319.
6. McLean MR, Morahan PS, Dannels SA, McDade SA. Geographic mobility advances careers: Study of the Executive Leadership in Academic Medicine (ELAM) program for women. Acad Med. 2013;88:1700–1706.
7. Wolf-Wendel L, Twombly SB, Rice S. The Two-Body Problem: Dual-Career-Couple Hiring Practices in Higher Education. 2003.Baltimore, MD: Johns Hopkins University Press.
8. Arizona State University. SPP 205: Nepotism. In: Arizona Board of Regents Manual 6-704. Revised July 1995. Accessed October 30, 2017.
© 2018 by the Association of American Medical Colleges