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The demands inherent in certain practice specialties are popularly believed to contribute to the risk of divorce among physicians.1 ,2 Several demographic and personal factors thought to affect the risk of divorce may also influence medical students' choice of specialty and therefore confound the relation between medical specialty and divorce.3 ,4 To characterize the risk of divorce associated with medical specialty, we examined data from the Johns Hopkins Precursors Study. We found that the cumulative incidence of divorce among 1118 married physicians was 29 percent after 30 years of marriage and that the choice of specialty was independently associated with the risk of divorce among physicians.
Methods
Study Population
The Johns Hopkins Precursors Study is a longitudinal cohort study of 1337 persons who entered the Johns Hopkins University School of Medicine from 1944 through 1960.5 Our analysis was confined to the 1248 persons who graduated. Marital information was available for 1222 (98 percent) of these graduates, of whom 1164 (95 percent) ever married; of those, 46 were excluded because of missing dates of marriage or divorce, leaving 1118 physicians for analysis.
Measurements
Information on demographic and psychological characteristics, membership in the Alpha Omega Alpha (AOA) honor society, parental occupation, and marital status was gathered before graduation. Included among the measurements were the students' assessments of their levels of anger, anxiety, and depression, measured by the self-administered Habits of Nervous Tension Questionnaire,6 and of perceived emotional closeness to parents, measured by the Closeness-to-Parents Scale.7 Scores on these scales were grouped according to quartiles for analysis. Marital history was specifically assessed by questionnaires administered while participants were in medical school, 10 and 25 years after graduation, and in 1987.
Physicians' specialties were determined from information on the mailed questionnaires, the Johns Hopkins Alumni Directory, 8 the American Board of Medical Specialties Compendium of Certified Medical Specialists, 9 and career information submitted by the participants. Specialists and subspecialists were classified according to their primary field as practicing internal medicine, surgery, pathology, pediatrics, or psychiatry. For example, thoracic surgeons, obstetrician-gynecologists, and orthopedists were grouped in the "surgery" category, whereas cardiologists, rheumatologists, and general internists were placed in the "internal medicine" category. Those who could not be classified as falling into one of the five categories were listed in...