Spouses and Relationships

[Raster]

The truth for many physicians is that their spouse can't afford to work.  Literally.  The incremental cost of working is less than the after tax pay.  Depending on your location, your husband may be subject to close to 70% taxes on his first dollar of income (Federal + State + Local + Pease phaseouts + self employment tax).  Work as a team.

 

[Benjamin]

DarrVao777,

That is very interesting that you bring up the nearby residency (in which field?) and forcing residents to do another year if they get pregnant. I'm a dude that is just starting my orthopaedic Surgery practice... I know and understand from experience that call issues can be a big deal for residents. However, I would think that program you mentioned could open itself up to litigation over the forced extra year, as it would clearly only apply to the women. The language we are using to discuss this topic almost sounds like we are talking about a prison sentence.

I really hope that the medical landscape can be more supportive of women having babies and also working in medicine.

[Zaphod]

Benjamin wrote:

DarrVao777,

That is very interesting that you bring up the nearby residency (in which field?) and forcing residents to do another year if they get pregnant. I’m a dude that is just starting my orthopaedic Surgery practice… I know and understand from experience that call issues can be a big deal for residents. However, I would think that program you mentioned could open itself up to litigation over the forced extra year, as it would clearly only apply to the women. The language we are using to discuss this topic almost sounds like we are talking about a prison sentence.

I really hope that the medical landscape can be more supportive of women having babies and also working in medicine.

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Um, no. Youre looking at it from an entirely biased point of view. One program and their likely "off the books" unwritten rule is not the same as all of medicine.

You sign a contract and are entering a residency that has rules and regulations. Part of those regulations are for how many months/weeks/hours one can miss and still be considered to have completed a residency. You dont just get to have a degree for 5 years of work for only 4. It may sound archaic, but it is handed down by the ACGME I believe (my friend had this exact issue and almost had to do extra months). Our program fought very hard to make sure this didnt happen.

Remember that many of these organizations missions is to protect the public and ensure competent physicians. This is where this comes about. Luckily, its all known up front and is 100% able to be planned accordingly. If you look at it from that stand point it makes perfectly reasonable and non discriminatory sense. Obviously it effects women more, but having a baby or even 2 wont normally trigger it, but you may be giving up vacation.

Its not prison like talk, this is the reality of pursuing a profession that requires a training period that was named after prison camps (internment), and how that doesnt work well with having a family simultaneously. Everyone who did a residency gave things up (like your 20s/early 30s!), but thats what we signed up for.

[Benjamin]

Zaphod,

I actually totally agree with you.  Residencies and training program need minimum requirements.  I just think that if someone wants to take time off after a baby, they should have to make up the time they missed, not a whole year.  It sounds like this one program mentioned is probably doing something off the books IMO.

While I also definitely agree that rigorous training and long hours are needed to train competent and even excellent physicians, I also feel the "that's what we signed up for" mentality can be a limitation to creating a better work environment for trainees.   I hope that in my academic practice that I will be able to help improve the medical education environment for trainees having babies and those not doing so.  It's definitely a touch situation.  We want to be the best and brightest, and also have a family too.  Very tough to balance both.

[Zaphod]

Benjamin wrote:

Zaphod,

I actually totally agree with you.  Residencies and training program need minimum requirements.  I just think that if someone wants to take time off after a baby, they should have to make up the time they missed, not a whole year.  It sounds like this one program mentioned is probably doing something off the books IMO.

While I also definitely agree that rigorous training and long hours are needed to train competent and even excellent physicians, I also feel the “that’s what we signed up for” mentality can be a limitation to creating a better work environment for trainees.   I hope that in my academic practice that I will be able to help improve the medical education environment for trainees having babies and those not doing so.  It’s definitely a touch situation.  We want to be the best and brightest, and also have a family too.  Very tough to balance both.

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I agree with your other assessments, just pointing out that these mandates dont necessarily come from the program, though yes, this particular one sounds archaic and punitive. Obviously, there are still quite a few boys' clubs out there and thats just generational and takes forever to change. My program had plenty of other issues to offset their work on this particular position.

Training (at least in surgery) is certainly not a good medical environment for learning, and dont think it will get much better as there is far too much pressure every year for attendings and thus extended to residents to produce income for the hospital. There is no way that leads to the most efficient training paradigm. It will never be perfect, but its certainly got a long ways to go. After a few years out, a far too large percentage of residency was not spent on anything meaningful as far as learning. Hospitals have their mandates which are sometimes at odds with training, its difficult to navigate for programs Im sure.

[iglord]

My wife is a PGY-2 OB/GYN and I don't have a full time job. I have a bit of 1099 income from writing and receive a VA disability stipend. Aside from these income contributions, I take care of the typical stay-at-home dad duties. I do the groceries and household shopping, finances, auto and home maintenance, and most of the cooking. We just got back from a kid-free vacation paid almost entirely with points from my credit card churning hobby. My wife tends to do a lot more cleaning than me, and on top of her resident duties is also training to become the local mohel since our community doesn't have one.

[drcolleen]

To the original post- I'm full time, full spectrum rural FM and my husband is an adjunct college teacher.  I was military so he moved with me twice having to quit jobs at colleges he really liked when I had to PCS then separated.  He helped choose where we live now -- and I digress slightly by saying it was a mistake to move where we have absolutely no family support.  At this time we have 4 kids 7.5y/o and younger.  Husband works on campus 2 days/week and has a few online classes.  I do most of the childcare and house cleaning when I'm home but he certainly manages the kids when I'm at work so they only go to daycare 2 days most weeks, one day we both work the other he gets to be at home alone.  I do all the finances because I enjoy it, he doesn't like to think about it.  He does most the outdoor chores and is handy.  Our salaries are disparate but what he saves us in childcare expenses more than makes up for it at this point.  At this point we have settled into a balance and that balance is going to be different for each family and will, I expect, change as the phase of life changes.

 

To the point about intern babies- We had our 1st in feb when I was a PGY2.  I could not imagine having a newborn intern year; mothering a newborn is hard and internship is hard, combining the 2 seems like the mother of all mommy-guilt so I would not personally have planned that.  I think later in residency is easier since you can front load calls and more demanding rotations.  My humble opinion.

 

To the point about making up maternity leave- it's been a few years, but me and classmate both had babies our military PGY2 yr and there were talks of having us make up the 6 weeks of maternity leave until we did some math to point out how much time some of the guys took between their vacation, getting various military badges, etc.... then miraculously we graduated on time.

[Queue]

My wife is a military surgical intern and I am a stay at home dad. We started dating a few months before she was accepted to med school and got married in between MS1 and MS2. I worked as an engineer for a little while after college while she was in medical school, but it wasn't right for me, and we decided I would work what jobs were available in the area she did her rotations in, then be a stay at home dad for future kids. We found out my wife was pregnant a few months before she graduated from medical school. We were in disagreement about when to have children (she wanted them while we are still relatively young (I'm 27 and she's 28), but I wanted to wait until after residency). She ended up winning the argument of course. So my wife was pregnant for the first 5 months of her intern year. Our daughter is 4 months old now and just as previous posters have commented, it has indeed been quite the challenge for her. I've finally gotten the hang of taking care of Little One all day, but I know it kills her to be away at work for 13-14 hours nearly every day of the month, but it's what we signed up for. At this point we just take everything one day at a time (or hour at a time if things are really crazy/crappy) .

I do all of the cooking, finances, errands, laundry, and as much of the cleaning as possible, and we usually spend some time on her off day really doing a thorough cleaning. We are about to start having a babysitter come for a few hours during the day twice a week so I can get some time off and work on accruing flight hours as I'm working on my commercial pilot's license. I'll say that the decision to have children has to come with knowing there has to be a lot of give and take by both partners. My wife was a huge neat freak before having our daughter. I've always been MUCH more relaxed about the state of tidiness of the home and prefer to tackle cleaning in one huge fell swoop. Now we're trying to meet in the happy middle. Same thing goes with who gets to have time off if our daughter is still awake when she gets home from work. It's all about balance and never forgetting the sacrifice that the other is making in order to help your family realize your goals.

Since my wife is in the military, she decided to take all 12 weeks offered for her maternity leave. It was amazing having all 3 of us home for the first 3 months while getting used to being parents and not having to worry about our income. As far as making up the leave, 6 weeks of her leave does not have to be made up, while the extra 6 weeks does. So the end result is her having to postpone her flight surgery training by 2 months in order to squeeze in the extra 2 rotations.

Everyday is a challenge for sure, but we both think the sacrifices we're making now will pay off down the road.

[Anesthesia84]

I am in a dual MD relationship. I am an attending anesthesiologist and my husband is finishing his cardiology fellowship in June. We have 3 kids. Our first was 4 months old when we both started intern year and I would never do that again. We survived and are going on 10 years of marriage but that year almost broke me (and our relationship struggled).

I now work 4 days per week and will likely cut back more once he starts his attending job because I enjoy the household management and kid stuff. It's also fallen more to me over the years since I am more organized and have usually been the one working fewer hours. We didn't define our roles in traditional gender based ways but it is just how the cards fell. We have friends where the husband stays home or is the primary household manager and while they do sometimes get some judgement, they don't care.

Do what works for your family! And know that it might change over time as your family changes

[ENT Doc]

Don't underestimate what effect having a child will have on your relationship, your work, your lifestyle, and your finances.  The first child is a wake up call with less marginal effect with additional children.  For the relationship, you need to set aside time for yourselves.  I actually disagree with the intern year being the hardest to navigate in this regard.  For many surgical specialties the 2nd year and chief year are the hardest.  The first is when you're really getting indoctrinated into the specialty and are working your butt off (the intern year was likely spread out over other rotations, including your own specialty).  The chief year is where you are running a service, always on call (although not primary call) and always needing to make sure you are running a tight ship.  My wife and I have had to completely modify our daily routine to have time for ourselves (both personal time and she/I time).  We get up at 4am now, have a few hours for ourselves, I leave for work as she takes care of the little ones, I spend more time with them when I get back, they are to bed by 7:30pm and we've got another 1.5 hours for random stuff and she/I time.  Less exhaustion at the end of the day and we feel more satisfied (time to read, work out, etc).

Having a kid is expensive, not only in direct costs (USDA estimated $245k a few years ago, not including college) but in indirect costs (spouse working less, even past the point of financial efficiency because we don't want a stranger raising our kids).  As far as work is concerned, there is no free lunch.  Someone is going to cut down, or you're going to fork over income to a daycare.  The effect of having a child in a high stress environment is worth mentioning.  I've seen women handle this gracefully and have seen it break others to where they quit residency.  The latter is a shame on several levels.  My only suggestion here is to make sure your life is fulfilling before having a child, that despite the hard work you're actually still enjoying what you're doing, and have appropriate plans in place to address the above issues.  Teamwork is key.

[YSH]

ENT Doc wrote:

Don’t underestimate what effect having a child will have on your relationship, your work, your lifestyle, and your finances.  The first child is a wake up call with less marginal effect with additional children.  For the relationship, you need to set aside time for yourselves.  I actually disagree with the intern year being the hardest to navigate in this regard.  For many surgical specialties the 2nd year and chief year are the hardest.  The first is when you’re really getting indoctrinated into the specialty and are working your butt off (the intern year was likely spread out over other rotations, including your own specialty).  The chief year is where you are running a service, always on call (although not primary call) and always needing to make sure you are running a tight ship.  My wife and I have had to completely modify our daily routine to have time for ourselves (both personal time and she/I time).  We get up at 4am now, have a few hours for ourselves, I leave for work as she takes care of the little ones, I spend more time with them when I get back, they are to bed by 7:30pm and we’ve got another 1.5 hours for random stuff and she/I time.  Less exhaustion at the end of the day and we feel more satisfied (time to read, work out, etc).

Having a kid is expensive, not only in direct costs (USDA estimated $245k a few years ago, not including college) but in indirect costs (spouse working less, even past the point of financial efficiency because we don’t want a stranger raising our kids).  As far as work is concerned, there is no free lunch.  Someone is going to cut down, or you’re going to fork over income to a daycare.  The effect of having a child in a high stress environment is worth mentioning.  I’ve seen women handle this gracefully and have seen it break others to where they quit residency.  The latter is a shame on several levels.  My only suggestion here is to make sure your life is fulfilling before having a child, that despite the hard work you’re actually still enjoying what you’re doing, and have appropriate plans in place to address the above issues.  Teamwork is key.

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I can not agree with this response enough.  People throw in big drama about the 40 weeks of pregnancy, X amount of parental leave, and hardship of the first few months of newborn years. But the truth is, having a child will create a permanent long lasting effect on one's career, marriage and life.  You think you just have to make it through the first X years, but honestly, you and your spouse will never be back to the way it was ever again (financially, mentally and otherwise).

This is not to say marriage and kids are not worth it.

[resident_1]

Two physician household here. I'm practicing wife is finishing up fellowship. Had first kid fourth year of med school, second kid end of intern year, third in pgy4.
It is stressful. I was specialties allow for jobs that are all outpatient without call (this gets rid of any call scheduling issues, can lign up vacations ,etc)
I think what is not been mentioned is utilizing your family for support. We have my in-laws living with us right now and helping out. We are also utilizing an Au Pair because it is actually less money if you have multiple kids.

Then there are other things we do to make more free time.
We started ordering grocery shopping online and picking it up which is very helpful. We hire someone to do yardwork. We hire someone to do deep cleaning of the house.
We still do cooking and light cleaning. Will consider hiring someone to cook bulk meals for the week as family is so big it takes a lot of effort to cook for everyone (and these kids eat more and more every year).

My opinion is that both spouses should keep working. At least one spouse doing part time if full time is too much. I think both spouses need to maintain their professional skills.

[resident_1]

Another aspect that I think has not been mentioned is combined student loans. My spouse and I have $500 K combined. Working part time would mean that entire salary is going to student loans. This is more depressing than having entire salary go to childcare. So in our situation we have to work full-time because of student loans. Also if you are taking advantage of PSLFyou need to have full-time employment.

[Miss Bonnie MD]

loeffy wrote:

I’m just curious as to what others’ husbands do and the dynamics of your relationship. It seems that this topic doesn’t get discussed often (female physician’s husbands) but I’m curious as to others experiences of being in a demanding high-income role, a role that was traditionally the husband’s.  Looking at my own situation, I feel that I’m in the minority, as my husband and I have taken the traditional husband/wife roles and flipped them completely.  However, talking with my female colleagues, most of their husbands are physicians, finance, business, etc.  It seems that most women have made compromises in their career choices for their husband and when we talk about kids, it seems a majority of the women docs are likely to take care of the childcare duties (either go part-time or less demanding job duties).  I know there is no right or wrong answer, every relationship is different.  However, even these days with gender equality and changes in traditional social norms, for me there is often an uncomfortable moment when people ask my husband what he does or what our relationship dynamics are like.  What’s your relationship like?  What have your experiences been?  What are your plans for the future?

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Loeffy, are you on facebook? If so, consider joining the doc moms personal finance group, I am one of the admins, PM me.

[Doc Spouse]

I'm a small business owner (online websites) and my wife recently started her cards fellowship.  I'm often asked by other husbands and single friends if it bothers me that she'll be making more than I do, but that's never really mattered to me.  Part of it may be because I'm older (39) and have already "been there and done that" professionally.  For the first few years of our marriage and while she was doing residency, I was pulling in 200k+ between my actual 9-5 job and online.  I think that does have a calming effect on that innate male desire to "provide" for the family as I've proven to my ego that I can provide if necessary.  I'm an IT geek, not a psychiatrist; so you should probably take that self-analysis with a grain of salt.  

When we moved for her fellowship, it was to an area that no longer supported my career; so my income dropped to around 50k with the websites and I'm currently doing that full-time.  With her fellowship salary, she is now the official breadwinner in our house and we had a small party to celebrate. Our combined income is more than enough for us to live on as we're both financially responsible.  I handle pretty much all of the bills and finances as she has little interest in the managing of it, but we share everything in joint accounts, have budget talks regularly and discuss all large purchases. There has never been "my money" and "her money" which I do think is important. We're both fans of Dave Ramsey for savings and WCI for investing.  We have no debt aside from a mortgage and we'll have the house paid off in the next 3 years.  Again, I think this is important for our relationship dynamics.  If money isn't a huge looming factor, does it really matter where it comes from?

In terms of housework, I'm pretty much responsible for all of it.  I work out of the house and do the usual cleaning/laundry/yard and house maintenance during the day whenever I need a break from the computer.  My main concern is just making it easy for my wife when she gets home, as her days are long and full enough of stress as it is.  She does do the cooking on her one day off because she enjoys making enough for the entire week.  She comes from a pretty conservative culture when it comes to gender roles; so I think that cooking is her way of contributing as well.  Or maybe it's because I suck at cooking?   We go out and do something fun every few weeks, but her idea of a perfect day off is relaxing at home which I enjoy as well.

We have no children at the moment, but we'll be trying very soon.  That will undoubtedly throw a large wrench into our comfortable and orderly life, but she's now 32 and tired of putting it off due to her career.  I also want to be able to semi-ambulatory when the kids are going to college; so time is ticking!  Provided we're lucky enough to have our first child in the next two years, I'll likely be a SAHD while she finishes up her fellowship.  I guess we'll see how it goes...  best laid plans and all that.