For better or worse, women in medical training face unique challenges in finding suitable childcare.
Residency is famous for its punishing work schedule. Because of the nature of medical training, a mother’s work schedule may be erratic, for example, changing from inpatient to outpatient service, or from days to nights, on biweekly or monthly schedules. Finding a childcare solution that meets this changing schedule is critical, but it isn’t easy.
In addition, the hours per week required for childcare can be staggering. The regulating body for most medical residencies, ACGME, requires limiting weekly duty hours (on average) to 80 hours or fewer. This is an improvement from years prior. And yet for a physician mother, 80 hours of work (which does not include commuting or time spent studying medicine) represents a costly challenge.
After having two children during residency and fellowship and speaking with numerous parents who are resident, I have learned that many physician households are obliged to use a patchwork of solutions to meet childcare demands. I have described these options and their benefits and drawbacks below.
Physician Childcare Option 1: The Stay-at-home spouse
For thoroughness, I will include this here. I trained with a couple of guys whose wives stayed home with their children. The 80 hours they might have worked on MICU and stroke service did take them away from their children, but ultimately the children were well-cared for by their (other) loving parent.
When children became old enough, the stay-at-home spouse has the option to enroll the children into part-time preschool or daycare.
The upside of this is low cost and high flexibility. The downside for some spouses is the sacrifice (if they view it as such) of leaving satisfying career work to function as sole parent most of the day.
Physician Childcare Option 2: Enlist the help of local family
This solution isn’t for all residents. But if family lives near where you are training, it is an excellent childcare solution. One of my friends who was raising her young children during residency benefited from her mother’s help. Her mother lived in their home, cared for the children and took them to preschool. My friend compensated her mother for her time.
This is the ideal solution, but as I discussed above, is not available to everyone. This adherence to a matched location for medical trainees (for years!) is one of the least family-friendly aspects of medical training.
The NRMP match system (in which nearly all doctors who want to train to practice their profession are obliged to participate) chooses where residents go for residency. As a result, they may be obliged to train somewhere far away from home. Very few deeply-indebted medical students risk ranking only a few local programs for fear of not matching.
What if an unexpected pregnancy arises? This very thing happened to me, but the NRMP told me I should have understood the chance that I might become pregnant before ranking (an excellent) residency program so far from home.
Physician Childcare Option 3: Nannies and babysitters
Nannies can be hired with relative ease by advertising on websites like care.com or sittercity.com.
Nannies fall into several categories
1) Live-out nannies
2) Live-in nannies
3) As-needed babysitters
Live-out nannies normally come to your home before you are destined to leave for work and remain until family returns home. Live-in nannies are provided room and board (and sometimes other benefits such as tuition reimbursement) in exchange for less expensive hourly wages. And babysitters fill in gaps such as sick-days for children, the gap between daycare and parents returning home, or the other nanny’s vacation time.
While not everyone will have a nanny, I think it is important for all residents with children to have a few trusted babysitters in their portfolio at all times. This may seem unnecessary if you work mostly outpatient hours, however sometimes unexpected difficulties arise with your usual form of childcare.
For example, after 3 months at a corporate daycare center, my oldest son began biting other children and was expelled from the daycare. Just like that, my husband and I (both residents requiring >80 hours of childcare due to long commutes) needed a fast alternative. Don’t get caught in trouble. Always have a backup sitter.
Benefits and drawbacks of babysitters and nannies
The pros of nannies are their incredible flexibility. Children benefit from the close one-on-one interactions. Normally (before global pandemics!) small childhood illnesses such as pink eyes do not preclude the nanny from caring for the child, which can be a godsend for residents to avoid missing work.
The biggest downside to having a nanny is the cost. It would be difficult to find a nanny willing to work very long hours for a bargain price. In large metropolitan areas, average wage for good nannies is easily double minimum wage. And across the country, minimum wages are rising. The other large drawback of having a nanny is the dependence created on that caregiver. Nannies may quit for all kinds of reasons including schedule, wages, and even personal life changes.
If you can afford it, I suggest hiring one or two nannies to cover childcare. Finding a good nanny is life-changing.
Physician Childcare Option 4: Daycare
Finally, there’s out-of-home daycare. Typically, parents pack food for their children (such as breastmilk in bottles, formula, or snacks), drive to daycare, and drop off their children during the workday and retrieve them when they return.
I used to think that there were only corporate daycares, until my son did his biting thing and was expelled.
I would actually say there are two kinds of daycare:
1) corporate daycare (such as Kindercare or Bright Horizons); this category also includes preschools and montessori preschools.
2) family-owned daycares, which can also be montessori style
Corporate daycares benefit from large infrastructure and may be larger and better equipped than family daycares. The downside to corporate daycares is the utter absence of flexibility.
Family-owned daycares, on the other hand, benefit from the warmth of the owner. My one-year-old biting baby thrived under the particular love and attention of the owner of his daycare. She also helped me by allowing me additional time beyond the close of school hours for my son to remain, for a fee. While she originally did not offer this service, she noticed that I hired a nanny to pick up the children and knew that I was not home until well after school ended at 6pm.
Benefits and drawbacks of daycare
One upside to daycares is affordability. Daycare is much easier on the wallet than hiring a nanny, but the price is paid in inconvenience. With a nanny, I only have to keep my own home well stocked for my children.
Another benefit of daycare is its unavoidable social atmosphere. Children will mingle and make friends, and so too will you as the parent. However children in daycares may acquire more infections than children with nannies, which might lead to workplace absenteeism for the working parent.
Daycare has other downsides. I have never encountered a daycare that remained open on a weekend day. There’s the struggle for the food and the dropping off
Physician Childcare: The bottom line
The most practical approach to this is to determine your budget on a monthly basis. From there, determine if you can afford to hire a good nanny. If you can’t, you’ll need to use a combination of daycare and babysitters.
Even if you can afford a nanny, consider the benefits to having a daycare solution. When working nights, my young son was playing with his friends at the family daycare while I slept during the day. If he had been home in our small apartment, it would have interrupted my rest time before my call. I might even have felt too guilty to rest and tried to spend more time with him.
Nowadays as an attending, we have a live-in nanny. This has been my favorite childcare solution ever. We have an excellent nanny who has worked for us for years, feels like family, and cares about our children. And, if I am working from home, I can see my kids all day long. We have flexibility in the hours she works.
Our childcare solution
We had two iterations before we determined our childcare solutions for my 6ish years of medical training:
1) Primary corporate daycare, live-out nanny (for picking him up, for weekends)
2) Primary family daycare, as-needed babysitters
Nowadays we only have trusted live-in nanny and two as-needed babysitters. This is costly to us, but worthwhile in reducing our average daily stress.
That’s all folks! I hope you found that review helpful.
