Skip to content
  • About
  • Contact
  • Contribute
  • What Physicians Say
  • My Book
  • Careers
  • Podcast
  • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
  • About Kevin Pho, MD, Founder of KevinMD
  • Aging and dementia: what physicians say, in their own words
  • Artificial intelligence: what physicians say, in their own words
  • Be heard on social media’s leading physician voice
  • Cancer: what physicians say, in their own words
  • Children’s health: what pediatricians say, in their own words
  • Contact Kevin
  • COVID-19: what physicians wrote as it happened
  • Custom enhanced author page pricing
  • Diabetes and obesity: what physicians say, in their own words
  • Direct primary care: what physicians say, in their own words
  • DMCA Policy
  • End of life: what physicians say, in their own words
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words
  • Heart disease: what physicians say, in their own words
  • Immigration and medicine: what physicians say about immigrant doctors and immigrant patients, in their own words
  • KevinMD influencer opportunities
  • Medical errors: what physicians say, in their own words
  • Medical ethics: what physicians say, in their own words
  • Medical malpractice: what physicians say, in their own words
  • Medical school: what students and physicians say, in their own words
  • Mental health: what psychiatrists and physicians say, in their own words
  • Nursing: what nurses and physicians say, in their own words
  • Opinion and commentary by KevinMD
  • Opioids: what physicians and pain patients say, in their own words
  • Physician burnout speakers to keynote your conference
  • Physician burnout: what physicians say, in their own words
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician personal finance: what physicians say about their own money, in their own words
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Physician suicide: what physicians say, in their own words
  • Physicians and administrators: what physicians say about who runs medicine, in their own words
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Primary care: what physicians say, in their own words
  • Prior authorization: what physicians say, in their own words
  • Privacy Policy
  • Private equity and corporate medicine: what physicians say, in their own words
  • Race and medicine: what physicians say, in their own words
  • Recommended services by KevinMD
  • Residency: what residents and attendings say, in their own words
  • Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words
  • Subscribe to the KevinMD enhanced author page
  • Subscribe to the newsletter
  • Surgeons and surgery: what surgeons say, in their own words
  • Take-home messages: what physicians say when asked to leave one
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • The electronic health record: what physicians say, in their own words
  • Vaccines: what physicians say, in their own words
  • Violence against health care workers: what physicians and nurses say, in their own words
  • What physicians say: the KevinMD records
  • Women in medicine: what women physicians say, in their own words
  • Women’s health: what physicians say, in their own words

The conundrum of dual physician households

Smart Money, MD
Physician Finance
July 10, 2019
Share
Tweet
Share

Two incomes are better than one, right?  As we all know, the answer isn’t clear cut.  If we have to actively “work” to generate income, we have to balance exchanging time for money.  Nothing comes for free.  When you throw in a tax system to convolute matters, certain households are actually punished for going into the workforce.  There is a delicate balance between each income-earning member and what each profession entails.  Some households are hit harder financially than others due to the income situations of each spouse, but hey, we don’t choose our partners based on their incomes right?

This conundrum isn’t limited to doctor households or families with a high-income earner.  One of my neighbors is a financial analyst with a stay-at-home wife and two kids.  The wife opted to resign from her previous job as a teacher because her entire income would have gone towards childcare.  That’s just how life plays out sometimes.

The tax man punishes disproportionate incomes

The U.S. tax system almost always “punishes” the spouse with a lower income.  Two main reasons:

1. The tax system is progressive, just like how the jackpot in those slot machines keep on growing.  The higher your income, the more likely you will get pushed toward a higher marginal tax bracket.  Suppose a dual income household has a physician earning $350,000 a year and an IT customer support specialist earning $60,000 a year.  The physician income alone puts the family in the 32% marginal tax bracket.  If the IT professional were single, he’d only be in the 22% bracket. If he were the sole breadwinner in the family, they’d be in the 12% marginal bracket.  Instead, the family will be in the 35% marginal bracket.  This means that a good portion of his income will be taxed at 32% (until the family income reaches the 35% threshold) and the rest at 35%! Perhaps that is the penalty one pays for being in a high-income household.  For some households, giving up 35 cents for every dollar you earn on a $60,000 might not be worth it.

2. Social Security and Medicare taxes get taken out “twice” in a dual working household.  This is a system that you pay into while working and will receive some repayment in retirement.  But one could argue that it’s still potentially less money in your pocket.  A family with spouses earning $350,000 and $60,000 a year will potentially take home less than another family with a single earner with a $410,000 income.

Whether the lower income producing spouse remains in the workforce ultimately depends on what is most important to the family.  Interestingly, most of my colleagues in this situation made their decisions based on finances.  Essentially all of the lower income spouses ended up leaving the workforce to care for their children until the kids became old enough to enter school.  Some of the spouses re-entered the workforce.  One wife of a couple I know actually worked side gigs with Instacart and Rover while the kids were in school!

Spouses with similar incomes fare better

Our tax system tends to be more forgiving when each member of a dual income household has similar incomes. Each member still needs to pay into Social Security and Medicare separately, but they would have been required to do so even if they were unmarried.  These households are undoubtedly more equipped to reach their financial goals more quickly, but are also susceptible to overextending their earnings because they have higher earnings.

Most of my experience with dual income households is with dual doctor households.  Since medicine is a relatively time-demanding profession, I find that most dual doctor households are obligated to outsource many tasks.  Instances include:

  • Utilization of grocery delivery services or grocery pick-up services.
  • Utilization of Uber Eats, Seamless, or other restaurant delivery services.
  • Utilization of dry cleaning services with pick-up services.
  • Nanny or Montessori schooling for young children.  Some nannies command salaries in the $70k range, more than what most medical residents earn!  I once knew a doctor household who kept their nanny until the kids were well into high school!
  • Utilization of lawn and home cleaning services.

There is no end to what you can outsource.  While the income levels of dual doctor households may be higher, their taxes are higher, and the expenditures tend to be higher as well.  Are these families actually better off financially than single doctor households?  I would suspect that the split is actually more even than we would expect.  There are a handful of dual doctor families I’ve seen that completely outspend their earnings. Shocking? Not anymore.

How to be a winner

There isn’t a single best answer to handle the finance implications of dual income households.  The bottom line is that some of us are going to get the short end of the U.S. tax system.  We might not have a choice in the matter.  What we do have control over is how much we save and invest.

“Smart Money, MD” is an ophthalmologist who blogs at the self-titled site, Smart Money MD.

ADVERTISEMENT

Image credit: Shutterstock.com

Prev

Before starting your own practice, do these 3 things first

July 10, 2019 Kevin 4
…
Next

The art of off-label prescribing

July 10, 2019 Kevin 0
…

Tagged as: Practice Management

< Previous Post
Before starting your own practice, do these 3 things first
Next Post >
The art of off-label prescribing

 

ADVERTISEMENT

More by Smart Money, MD

  • Is passive income a lie?

    Smart Money, MD
  • What to do financially when you’re a doctor getting a divorce

    Smart Money, MD
  • Doctors in tech cities are losing the rat race

    Smart Money, MD

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • How a physician keynote can highlight your conference

    Kevin Pho, MD
  • Chasing numbers contributes to physician burnout

    DrizzleMD
  • The black physician’s burden

    Naomi Tweyo Nkinsi
  • Why this physician supports Medicare for all

    Thad Salmon, MD
  • Embrace the teamwork involved in becoming a physician

    Nathaniel Fleming

More in Physician Finance

  • Paid for twice

    Physicians paid for G2211 twice. Most never bill it.

    Michael Duben, MD
  • Why physician financial freedom matters more than salary

    Arthur Lazarus, MD, MBA
  • Charitable giving for physicians: 7 strategies for 2026

    Logan Foltz, MD
  • The sweet spot before physician financial independence

    Stanley Liu, MD
  • Negotiating physician compensation works better in groups

    Contract Diagnostics
  • How doctors lose money investing: 6 failure modes

    Harsha Moole, MD
  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • 4 fibromyalgia myths the current evidence doesn’t support

      Kayvan Haddadan, MD | Conditions and Diseases
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI governance in health care has to reach the exam room

      Amanda Heidemann, MD | Health Technology
    • The Pennsylvania measles outbreak and the cost of forgetting

      Christine King, CRNA | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • 4 fibromyalgia myths the current evidence doesn’t support

      Kayvan Haddadan, MD | Conditions and Diseases
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI governance in health care has to reach the exam room

      Amanda Heidemann, MD | Health Technology
    • The Pennsylvania measles outbreak and the cost of forgetting

      Christine King, CRNA | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use Agreement
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The conundrum of dual physician households
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...