For Dr. Adam Brown and Dr. Steven Farmer, marriage came with a few extra challenges

When emergency physician N. Adam Brown, MD, MBA, FACEP, met Steven Farmer, MD, while the two were training as physicians, he knew he’d met the person he wanted to spend his life with. However, in the era when the Defense of Marriage Act (DOMA) was still in effect, getting married as a gay couple—and making sure that marriage would be recognized—involved complications that heterosexual couples didn’t encounter. The two overcame those hurdles to build a life together as a two-physician couple.

Dr. Brown is currently senior vice president–mid-Atlantic at Envision Physician Services and system chief of emergency medicine at Sentara Northern Virginia Medical Center in Woodbridge. Dr. Farmer is a cardiologist at George Washington University in Washington, D.C.

The couple recently sat down with ACEP Now Medical Editor-in-Chief Kevin Klauer, DO, EJD, FACEP, to discuss the challenges of getting married as a gay couple before it was legal nationwide in the United States and of being in a two-physician marriage.

KK: Tell us about yourselves.

AB: I’m from North Carolina, born and raised. I went to medical school at East Carolina University in Greenville and then did residency at Thomas Jefferson University in Philadelphia. That’s where Steve and I met. I started working for EmCare at the time; now I work for Envision Healthcare. I work clinically at a hospital here in northern Virginia, but most of my time is spent working administratively.

SF: I was born in London in the United Kingdom and lived in multiple cities around the world, domestically and internationally. I attended medical school back east at Yale, and then I did my residency and fellowship all at the University of Pennsylvania in Philadelphia. I also have a PhD in health policy.

KK: How did you two meet, and when did you get married?

AB: I was in my last year of residency at Jefferson, and Steve was in his first year of fellowship at Penn. Our first date was at The Continental in downtown Philly. After that date, there was really no question this was the person I was going to be with; that was 11 years ago. We got married seven years ago on July 9 in Montreal, Canada.

With Steve being a dual citizen, we wanted to make sure that our marriage would be recognized in the United Kingdom. The United States, at that point, did not have marriage equality across the country, and while we had considered getting married in a place like Massachusetts or Washington, D.C., where marriage was legal, it was not recognized in the United Kingdom, but a marriage in Canada would be recognized. They would recognize international gay marriages, which is kind of an odd way to choose your marriage destination, but that was a calculation we had to make.

SF: It wasn’t that we could have gotten married in Chicago, Massachusetts, or some other location that allowed gay marriage, but if you got married in one of those places and then you moved from that place to another state, they may not have the same technical definition of a gay marriage, and you would have to get divorced in the first state and then remarried in the second. This is all pre-DOMA, the Defense of Marriage Act, being revoked.

Although we got married in Montreal, we essentially became incorporated when we moved to Chicago. We became this very complicated legal entity, which established many but not all of the equivalencies of marriage through legal contract.

AB: There are a lot of challenges that I don’t think that most people recognize. Those were some of the hoops that we needed to jump through to make sure that we were fully recognized as a married couple. We flew back to Chicago after Montreal and then eventually we moved to DC. Marriage equality hadn’t passed, and so our marriage was valid in the District, however, as soon as we crossed the Potomac River into Virginia, the marriage wasn’t valid.

In 2015 when the Defense of Marriage Act was overturned by the Supreme Court, that was a big day for us.

KK: In some conversations with you, Adam, I’ve gained some understanding of the complexities of being a gay man in health care. What challenges and obstacles have you encountered?

AB: I think one of the biggest challenges is the implicit bias, or the assumptions that are made, if someone doesn’t know that I’m gay. Something that actually happened recently was I was doing a promo video for our company. I was sitting at a desk, and the assumption by the people that were doing the video was that I would have a wife and kids. They had a picture on the desk of my face superimposed on the picture that was what they envisioned my family would look like. I was with a wife, two kids, and a white fluffy dog. I questioned them, “Where did you get this picture because my face is superimposed over the male picture, and secondly, I don’t have a white dog. My dog is gray, and of course, I don’t have kids either.”

Dr. Farmer (left) and Dr. Brown.

Dr. Brown and Dr. Farmer on a recent vacation in Barcelona.
Adam Brown and Steve Farmer

That was illustrative of some of the biases that take place. I know that happens with other minority groups. Once I actually do tell people that I’m gay, then there is the immediate worry or fear that people will think of me in a different light. Will they see me as a certain stereotype? Will they think of me in a sexualized manner? Once you tell someone you’re gay, you’re telling them what you like sexually. That is something that I think in a heterosexual or heteronormative environment does not happen.

Every time I have a conversation with someone about my family, I’m having a “coming out” type of moment if someone didn’t see me in that light. That can be difficult because I have to guess if that person is going to be supportive. Are they going to turn away? Are they going to think of me in a negative fashion?

KK: Steve, did you see the picture of Adam’s alternative family?

SF: I did see it, and I had some real questions for Adam when I got home.

It did prompt a lot of conversation. Lots of other people saw that nationally, and they know Adam. People did question if something had changed.

KK: Steve, what about your experiences?

SF: Well, I think in residency and fellowship as a cardiologist, it’s much more conservative than emergency medicine. I had a real concern because I didn’t know any other people nationally who were gay and a cardiologist.

Adam Brown and Steve Farmer

I was very careful about not revealing my sexuality while in training because I didn’t want it to prevent my getting a fellowship at Penn and I didn’t want it to impact my job search. When I did apply for jobs, I was very explicit that I was gay because I didn’t ever want to be in a situation where I joined a group that was in any way uncomfortable with it.

It frequently happens that patients will speak with me and make assumptions about my being married because they see my ring or for other reasons. In DC, I have a lot of African American patients, and maybe I’m coming back at them with my own biases, but my sense is that gay men are less acceptable in the African American culture than they are in some other groups. I usually deflect the question or ignore it. It’s kind of awkward, clinically speaking, because I never really say who I am, which I think is an impediment to being authentic with patients.

KK: What are some of the challenges and struggles you go through together as a couple with your busy schedules and your relationship?

AB: I think we consciously have to work hard not to allow for constant shop talk. With both of us being very interested in health policy and both of us working as physicians, we have the tendency to bring a lot of our work home. Luckily, we are in different specialties; that has helped.

We have done a lot of planning for going on trips together. We go to the gym together, exercise together, etc., and that has made a huge difference toward ensuring that we keep some level of balance and reality to the world that we live in.

KK: Steve, what are some of the unique characteristics, positive or negative, of being married to an emergency physician?

SF: Well, the first thing I would say is that a noninvasive cardiologist and an emergency physician are pretty much the opposite extremes of the decision-making processes. Adam makes decisions very quickly with limited information, and that’s the nature of his personality and his job. As a cardiologist, nearly every decision that I make is a decade-long decision, where I’m trying to optimize long-term outcomes, which is the complete opposite mindset.

I’ve found that Adam’s and my decision-making styles complement each other tremendously. We both benefit from joint decision making because I will bring in more considerations into some decisions that we make together, and he pushes me to make a decision.

KK: Do you have any words of advice for emergency physicians or their significant others or life partners about how to make relationships work?

SF: You have to compromise, and you have to talk. Sometimes, you have to give, and other times, you get the benefit of support from your partner. I think those are features of any solid relationship.

AB: Understanding that everything that Steve does, whether I agree with it or disagree with it, I know he loves me and he loves our relationship. I know that he wants what’s best for me, and he knows that I want what’s best for him, and we want what’s best for us. That’s so important.

KK: Adam and Steve, I really appreciate your time, and thank you for your openness.