Spouses and Relationships

[The White Coat Investor]

Like the FB meme when you are shorthanded it's a failure of administration to staff adequately for known and expected and likely surprise shortages. And it isn't something you should fix by working harder and longer overtime, but us docs are working stiffs without the protections many laborers have. Except when you are the owners; in which case hope you like the cross coverage policies you created both when you are out and when your colleague is out- and if you don't, vote for a change.

It's interesting to deal with this from the owner's perspective. Our group of partners is generally really good at stepping up for short term issues but dropped the ball on a couple of them recently. So we readdressed the issue in our last meeting. We could solve this problem by either paying someone to be on call (and then taking that call) or by hiring more people so we're a little fat instead of a little thin on staffing. We decided we didn't want to be on call and that we didn't want to hire more (we'd rather make more money) so we decided that we're just going to do a better job of picking up the slack when something bad happens to a partner.

People who have never been owners often don't realize that there is a downside to every policy. Take parental leave, for instance. We can have paid parental leave if we want. We've chosen not to because the downside is that we all make less the rest of the time in order to have that benefit. In reality, in the long run those of us with fewer kids are just subsidizing those who have more kids. So we just comply with federal parental leave laws (i.e. 3 months of non-paid parental leave). Nobody likes it when they have a kid, but they do for the rest of their careers.

This stuff is always much more interesting when you can see both sides of it. Kind of like the recent discussion about non-competes.

[MPMD]

It's interesting to deal with this from the owner's perspective. Our group of partners is generally really good at stepping up for short term issues but dropped the ball on a couple of them recently. So we readdressed the issue in our last meeting. We could solve this problem by either paying someone to be on call (and then taking that call) or by hiring more people so we're a little fat instead of a little thin on staffing. We decided we didn't want to be on call and that we didn't want to hire more (we'd rather make more money) so we decided that we're just going to do a better job of picking up the slack when something bad happens to a partner.

People who have never been owners often don't realize that there is a downside to every policy. Take parental leave, for instance. We can have paid parental leave if we want. We've chosen not to because the downside is that we all make less the rest of the time in order to have that benefit. In reality, in the long run those of us with fewer kids are just subsidizing those who have more kids. So we just comply with federal parental leave laws (i.e. 3 months of non-paid parental leave). Nobody likes it when they have a kid, but they do for the rest of their careers.

This stuff is always much more interesting when you can see both sides of it. Kind of like the recent discussion about non-competes.

it's remarkable how much easier these situations become when you have normal people trying to do the right thing most of the time.

your example is a good one and you made decisions that have positive and negative consequences.

i fully realize this is a very different issue for small groups of specialists and maybe a bit worse for proceduralists, but i reject the idea that pregnancy is the main issue here. pregnancy and mat leave are time-limited and generally predictable. if you have a group of 3 general surgeons taking q3 call and basically working every other weekend you have elected (or maybe just found yourself) to be in a very unstable and precarious situation. if one of them has a bad hand cellulitis and another is puking their brains out from a GI bug you are down to one doc. a group like this is always going to be intensely vulnerable to unpredictable life events -- which i would point out are inevitable.

i'm not saying it's wrong to be in a group like that or wrong to be frustrated when the inevitable happens, but i wouldn't say that a female partner deciding to start a family is your real deep risk here.

i know a medium sized group of docs who had a situation where a later career guy had an injury that was ?maybe disabling but unclear with sort of a stop and start recovery. out with no clear return date known or possible but a deep financial need to return to work if at all possible even with accommodation. my guess is they would have gladly traded that for a planned pregnancy w/ 3 months mat leave.

[Jenn]

...we just comply with federal parental leave laws (i.e. 3 months of non-paid parental leave). Nobody likes it when they have a kid, but they do for the rest of their careers...

And your website helps docs plan for those months of unpaid leave, as many (and as many times), as they choose or need to take (for any reason including unplanned events- pregnancies or not). Kudos.

This might be another 'emergency fund' (truly a 'budgeting allotment' though) issue to stress for younger docs- better to delay repaying student loans than HAVE TO be back at work 4 days postpartum or eating mostly ramen when breastfeeding. Can't give you credit- I opted to (try to) do this before you were in med school- but as 2 doc couples I noted one of us might want to stay home with kids, so we trialed living on one salary, and saved the other salary for retirement or earlier gaps in the budget. A great deterrent to lifestyle creep- budgeting for (having) babies- can cover work leaves as wel as infertility expenses. We have friends whose families I wish were practicing living on an after retirement budget since it looks like their spending will have to drop 80% WHEN not if they stop working.

[The White Coat Investor]

And your website helps docs plan for those months of unpaid leave, as many (and as many times), as they choose or need to take (for any reason including unplanned events- pregnancies or not). Kudos.

This might be another 'emergency fund' (truly a 'budgeting allotment' though) issue to stress for younger docs- better to delay repaying student loans than HAVE TO be back at work 4 days postpartum or eating mostly ramen when breastfeeding. Can't give you credit- I opted to (try to) do this before you were in med school- but as 2 doc couples I noted one of us might want to stay home with kids, so we trialed living on one salary, and saved the other salary for retirement or earlier gaps in the budget. A great deterrent to lifestyle creep- budgeting for (having) babies- can cover work leaves as wel as infertility expenses. We have friends whose families I wish were practicing living on an after retirement budget since it looks like their spending will have to drop 80% WHEN not if they stop working.

Yes, too many employees don't understand that it's all one pot of money. You can get paid more or you can get more benefits. Katie and I had this discussion last week about possibly adding a group disability plan for WCI employees. In the end we decided to just ask them if they'd rather have that benefit or just have a larger salary. Forcing them to take the benefit is pretty paternalistic. We're already forcing them to take some of their compensation as health insurance and 401(k) math. Most employees would love to have a parental leave benefit, but how many would be willing to get paid less to get it? Not so many. But it's one pot of money.

[Jenn]

So parental leave benefits ultimately are just an incentive (without longer term, annual costs as in salary) to get younger/ female employees likely to start a family to take a position. Just as health and pension (where above minimum requirements for similar jobs) plans are. It's paternalistic as you note to decrease compensation for any benefit- sometimes to enable it for owners or other employees who want that benefit for themselves- and an additional decider for offering them is if there's any chance the firm/ owners would feel compelled to assist disabled or injured or retiring employees if they had no such plan. (I can only translate to my relatives and health insurance: when my kids age out of Tricare I will buy health insurance for them since I'd live out of my car and/or give them a kidney plus all their transplant expenses if they needed one, so insurance is a cover to try to keep my assets and help them in need if ever. But I won't do the same for my sister, sorry Sis.)

[Larry Ragman]

So parental leave benefits ultimately are just an incentive (without longer term, annual costs as in salary) to get younger/ female employees likely to start a family to take a position. Just as health and pension (where above minimum requirements for similar jobs) plans are. It's paternalistic as you note to decrease compensation for any benefit- sometimes to enable it for owners or other employees who want that benefit for themselves- and an additional decider for offering them is if there's any chance the firm/ owners would feel compelled to assist disabled or injured or retiring employees if they had no such plan. (I can only translate to my relatives and health insurance: when my kids age out of Tricare I will buy health insurance for them since I'd live out of my car and/or give them a kidney plus all their transplant expenses if they needed one, so insurance is a cover to try to keep my assets and help them in need if ever. But I won't do the same for my sister, sorry Sis.)

Speaking as someone who has to pay for staff benefits, I can tell you that parental leave is no longer just an issue for female employees. In general, the younger generation want it be offered to fathers as well. There are practical consequences. To double the population covered by paid parental leave we have restrict the number of weeks offered to any one staff member. (They can take more unpaid.) But overall, yes, benefits are in competition with pay. We spend a fair amount of time benchmarking and trying to find the right balance.

[wideopenspaces]

Really? Parents have both kid duties and the usual missed days that everyone else has. The signletons only have the missed days that everyone else has (all of this is on the aggregate average)...

In my class of 5 residents, 4 were parents. Guess who was the ONLY person who needed significant time off during residency, that we all had to cover?

[Tim]

Speaking as someone who has to pay for staff benefits, I can tell you that parental leave is no longer just an issue for female employees. In general, the younger generation want it be offered to fathers as well. There are practical consequences. To double the population covered by paid parental leave we have restrict the number of weeks offered to any one staff member. (They can take more unpaid.) But overall, yes, benefits are in competition with pay. We spend a fair amount of time benchmarking and trying to find the right balance.

“It's paternalistic as you note to decrease compensation for any benefit”
Cost/benefit. One way out is use a cafeteria plan for elective benefits. A fixed dollar amount that the employee must spend on benefits (no cash option).
Which health insurance plan? Required to pick one.
Anything else? Choose.
You can have any thing you want, but not everything.
Oh, you can have everything, but the excess comes out of your paycheck.

Some want a fat benefits package (think low deductible family healthcare plan) + dental + eye and term life.
Others want healthcare on spouse’s plan.

Group LT disability , optional. Group ST disability company paid mandatory (mostly protecting the company). Not out of the employee bucket.

The difficult part is finding decent benefits without having an actual enrollment census.

[Dogtor]

Responding to OP -
Dual veterinarian household here. Husband works ER - works out to 3.5 shifts per week but they’re long and tend to run well over scheduled shift times. I work management and locum shifts, management gives me flexibility for kids and then I pick up the extra shifts when my husband is off. Due to my job’s flexibility I take on the majority of the childcare and household responsibilities, although I work significantly more hours.

We currently make close to the same income, but I did receive a big windfall from three years of work with my start up, which would effectively double my total take home for those years if you wanted to look at it that way. When I have to travel for work my husband picks up the slack with the kids, but mostly just regarding actual childcare. As far as groceries and maintaining the house goes, when I’m gone that typically goes by the wayside.

[F0017S0]

In my class of 5 residents, 4 were parents. Guess who was the ONLY person who needed significant time off during residency, that we all had to cover?

That resident had better have had a good excuse. A serious health problem or something like that. Because that is not okay to be a slacker...

[wideopenspaces]

That resident had better have had a good excuse. A serious health problem or something like that. Because that is not okay to be a slacker...

Does having a personality disorder count? I believe the time off was spent painting a bathroom at home.

[F0017S0]

Does having a personality disorder count? I believe the time off was spent painting a bathroom at home.

We ought to implement Intelligence Community-style personnel reliability screening for medical students, if indeed what you report is true. Unbelievable...

Sorry you guys got stuck with the extra duty.

[wideopenspaces]

We ought to implement Intelligence Community-style personnel reliability screening for medical students, if indeed what you report is true. Unbelievable...

Sorry you guys got stuck with the extra duty.

That wasn't even the worst thing that happened in residency 😆 Just go in expecting to do all the work all the time and you'll never be disappointed.

[F0017S0]

That wasn't even the worst thing that happened in residency 😆 Just go in expecting to do all the work all the time and you'll never be disappointed.

That's applicable to most any endeavor, haha.