(MONEY Magazine) – Tim McElroy had had enough. A nurse anesthetist in Pittsburgh, McElroy was about to bathe his 2½-year-old daughter Sean when she fell into a fit of hysteria over a missing stuffed animal named Birdy. Father and daughter had just returned from dinner at a local family restaurant, and he thought about calling there in search of the toy. But somehow this small task had grown into a symbol of his domestic frustration. He just couldn't do it.

Instead he phoned his wife Sue, an anesthesiologist at a nearby hospital, who at the moment her cell phone rang was wheeling a head-wound victim into surgery. She managed to duck out of the operating room and call the restaurant. Birdy was found, order restored. But the incident, which happened a couple of years ago, has become emblematic of the household's nontraditional gender dynamic: Sue has several times Tim's earning power, so Tim--reluctantly--has scaled back his career to care for Sean. "I have Birdy moments all of the time," Tim says. "They just remind me that my life is dictated by the fact that Sue is the breadwinner. I love my daughter more than anything, but this is not what I wanted. This is not what I thought life would be."

Indeed, although a third of married women who work now outearn their husbands, the emotional and financial issues dredged up by this reversal of traditional gender roles takes many couples by surprise. They face all the usual identity problems and power imbalances that arise in any marriage in which one spouse makes far more than the other. But when the woman is the primary earner, ingrained social expectations can inflame the situation--even in our supposedly enlightened era.

• THE ROLE REVERSAL Tim, 43, and Sue, 45, met in an operating room in 1993. He was a seasoned nurse anesthetist, she a resident in training. At first Tim was reluctant to date a doctor. "Tim's background is very conservative," says Sue, "and the lesson that he learned was that the man is the breadwinner." He gradually reconciled himself to always being overshadowed by Sue in the hierarchical world of medicine. They began dating in 1997, a year after Sue finished her residency. She moved into his townhouse in 1999, and in September 2000 they married.

During their first years together, Tim's earnings kept pace with Sue's. Even when they began to diverge--in 1999 she made $175,000, he $100,000--the couple split living costs. To the extent that there was tension early on, it was less about money than status. "When I met Tim, he knew far more about anesthesia than I did," says Sue. "Suddenly I finished my training, and I'm the one giving orders." Lighthearted comments from friends and colleagues sometimes got under his skin. "Even today," he says, "when I run into people that I haven't seen in years, I get remarks like 'Boy, you've got it made.'"

• THE PRESSURE POINT Only after Sue and Tim adopted Sean in April 2001 did the disparity of their earning power lead to serious problems. Sue was made a partner at Western Pennsylvania Anesthesia Associates (WPAA) during her maternity leave; afterward she returned to work full time, often spending 24 consecutive hours on call at the hospital. The couple agreed they wanted one of them at home with Sean, at least part time. And given Sue's earning power, Tim cut back his work schedule. The gap in their incomes soon became a gulf: He'd been making $140,000 to her $200,000, but his earnings now fell to about $60,000 a year as hers rose above $300,000.

Suddenly issues that had been simmering came to a boil. Both acknowledge that part of the problem was that Sue had been the prime mover behind having a child yet Tim ended up making most of the sacrifices. He loved his time with Sean, but inevitably his resentment leaked out. Sue tiptoed around conversational land mines but meanwhile was frequently losing her temper, and sought out a church counselor for help controlling it. In short, they were fighting a lot--so much so that Sue sometimes felt reluctant to go home after work.

• THE STRATEGY The situation had to change, and by fits and starts it did. To allow Tim to regain part of his professional identity, they found a part-time babysitter so Tim could take on independent contracting work. But because he couldn't accept jobs that kept him away overnight, his options were limited.

Then, in the spring of 2004, they tried a more dramatic approach. Sue accepted a job in Hilton Head, S.C., where they'd purchased a vacation house a couple of years before. The position paid 25% less than what she'd been making but required far less on-call duty. The transition didn't go well for Tim, however. Professional opportunities he'd been promised never materialized, and he felt more isolated at home than before. "I was miserable," he says. "We had no family down there, no support system. I told Sue I had to do something other than being a mother."

They returned to Pittsburgh in December 2004, but the time in Hilton Head had been a watershed. When Sue went back to work at WPAA, she accepted a position with a lower salary and no on-call duties. Tim signed on there as well, part time, and currently he works three days a week while Sean, now four, is with a sitter and in day care. He still wants to get back to full-time work. "I love my family," he says, "but I resent the fact that this is going to be my life for a while. I'm not hardwired for the life I have right now, but I'm making it work."

• THE ADVICE The experts MONEY contacted offer these suggestions:

Make him CFO. It's crucial for both spouses to feel they're making a financial contribution, but earning isn't the only way to do it. Happily, Tim long ago took on the role of family money manager. He should continue to carve out a meaningful and discrete financial role. Ruth Hayden, author of For Richer, Not Poorer: A Money Guide for Couples, likes the fact that Tim is actively contributing to Sean's college fund, for example.

Keep her involved. Sue shouldn't bow out of financial decision-making altogether just to empower Tim. Why? For one thing, in any marriage the less involved spouse should be able to take over the finances in case of emergency. Also, any sense of financial inadequacy Tim might feel would be compounded if he made a big investing misstep on his own.

Rethink their roles. With two strong earners (Tim was making $140,000 a year before scaling back) and a prodigious amount of savings (see the box on page 42), the McElroys do have the luxury of flexibility. They could spend for more child care. Or they could trade roles for a while. It would be healthy if Tim felt that Sue's sacrifice equaled his. It might even make his own seem less burdensome.