Work/childcare balance during training in a dual physician household

[Beginner MD]

Quick brief background: Husband and I are both in time-intensive fellowships (year 2 out of 3) and have a toddler at home that keep our hands full.  We have no support family-wise near us and although we have daycare during the week, both of us have to take turns watching the little one on the weekend when the other person is working.  On the rare occasion that one of us gets some time off and actually does something for themselves (e.g. go golfing with colleagues and drinks afterwards), it is hard for the other one to not feel resentful for not getting their own "personal" time as well.

Both of us are tired all the time and although we love our child immensely and want to have more in the future, I can't seem to see past the fact that we have no time for ourselves, especially if you have a list of chores to accomplish during the weekend.  It's starting to wear on our marriage and besides just hiring a babysitter every weekend, I'm curious how other people have dealt with it...  And I don't know if our lifestyles will be any better after fellowship is over because both our careers involve being on call frequently.  Need some encouragement or advice.

[Dr. Mom]

We used au pairs during our training.  We still remain very close to one of the au pairs who visited us recently and now has kids of her own.  The au pair lives with you.  The arrangement offers many benefits.  My favorite was having time with the kids in the mornings without the need to be rushing them to daycare.  The situation works best if you consider the au pair as a family member and not a hired employee.

[SValleyMD]

Well I have nothing to add other than the fact that I would be really, really careful what type of attd jobs you land as unfortunately it sounds like something will have to give -

My "time-intensive, high-call specialty" has led to a job that is busier than anything I experienced in a busy fellowship. So unless you're careful you can find yourself in a worse situation with no end in sight.

Sorry not meant to be Debbie downer but the reality is some of these high call jobs/specialties really suck.

[Beginner MD]

I have entertained the thought of an au pair when we were first looking into childcare, but it still seemed relatively expensive, although my daycare isn't exactly cheap either.  But the part that made it hard for me to get over was the fact of having someone live with us for a long time...more of an issue for my husband who likes his personal space.  And I have heard that you would need to bring them with you on vacations and such, so that would be paying for an extra person for flights and such as well, which would add up on the affordability of having an au pair.

[MPMD]

I 100% mean this to be supportive of a another forum member and not flippant but I would invest in some marriage counseling.

We are 2 MD couple with young child as well and constantly checking in w/ each other to make sure we're not experiencing this dynamic.

This is a stressful time but resentment of your partner is a big red flag. Really hope this improves steadily for you as your fellowship ends.

[MPMD]

Sorry I just saw that this was in the "Women's Issues" subforum, not trying to wade in where my opinion isn't wanted!

I think like most of us I just view all the threads and so don't notice where threads are posted.

[StarTrekDoc]

Daytime Nanny - We had nanny who was essentially the home assistant :  Childcare, laundry, light house cleaning and basic meal prep.   She was worth it.

You're dual income.  Personal time is precious and you want time playing with the kids and not the ADLs.

We were fortunate enough to have her for both kids and into elementary school years.

[Steven Podnos MD CFP]

We had three children in four years immediately following our residencies. We used a combination of live in and daytime help until the kids went to school.  Two things we did that helped immensely:

 

1) We looked at raising the children as a partnership, a loving "us vs them" issue. We understood that raising the children is friction to a marriage in some ways (less sex, more fatigue for example) and that we needed to compensate.

 

2) We did allow each other to have some personal time for exercise, etc.  But we also made a regular day for Date Night , or at least an afternoon together without the kids every week for many years.

[Dr. Mom]

Beginner MD wrote:

I have entertained the thought of an au pair when we were first looking into childcare, but it still seemed relatively expensive, although my daycare isn’t exactly cheap either.  But the part that made it hard for me to get over was the fact of having someone live with us for a long time…more of an issue for my husband who likes his personal space.  And I have heard that you would need to bring them with you on vacations and such, so that would be paying for an extra person for flights and such as well, which would add up on the affordability of having an au pair.

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I couldn't imagine doing your schedules without in-home help of some kind.  Au pairs were the least expensive of in-home options for us but that was over 20 years ago.  Our home had a separate bedroom and bath apart from ours and the kids, so she had her own space.  We treated her like a family member, so she was welcome on vacations.  If I recall though, some of our vacations she preferred to travel with some of her friends.  By having live in help, she was super flexible with our changing hours.  We viewed raising the kids at that point in our lives as a team of three instead of two.  My entire residency salary went to childcare and a cleaning service.  But, it was a gift to myself and our relationship which has paid out far more in time than many other investments.

You guys sound like you are at a breaking point. Don't be scared of change. As I tell my twenty-somethings, change is the only constant in life so make friends with it.  I'd recommend trying some type of in home care. If you don't like it, go back to daycare.  We have used live out, live in, and au pair caregivers over the years  Au pair was by far the best for us during the residency years.  YMMV.  Best wishes!

[q-school]

i'm not trying to be negative, so hopefully you can take this in the helpful spirit it is intended.

kid sick days are the worst for two career minded physicians with busy call schedule.

if you can't take them to day care and you don't have family nearby (that was us), it is extremely stressful to figure out at the last minute who is going to take time off.  lots of places have a 24hour no fever policy, so it means two days off if you get a call during the day.

we tried day care but my oldest was extremely prone to ear infections, so every single week we were either in ed, f/u at primary doctor, convenient care or somewhere else until he had tubes placed.  he was miserable and also didn't walk or talk until after 18 months.  that was stressful.

it doesn't necessarily get better as attending, especially if both don't want to be the one.

it is also hard to find mutually satisfying jobs, it is hard to change jobs, it is hard to develop professionally while being a good spouse, good parent, good citizen, and good physicians both.

we've seen lots of dual career couples eventually realize they had to compromise, and one or both had to decide they couldn't be everything.  we've seen a nephrologist go part time back to primary care.  we've seen lots of those families have one person retire completely from medicine.  we've seen a lot of divorces.  i encourage you to start thinking about how you want to face the challenges that are coming and talk openly with each other.  i don't think there is one right answer, but i am sure that the challenges are just starting.  more babies, if that is the plan, will really only make things worse.  kid activities is a time suck like nothing else, and if neither of you have family that can help, and neither knows what time you can be relied on to get home, then i strongly urge you to consider spending money (that it seems like you don't have) to get help.  the money will be there in a few years.

we eventually had a nanny.  i wasn't allowed to talk to the nanny, because my wife did some research and the number one reason nannies quit is because they are asked to do other household chores, i was told.  she knows i think that if the kid is taking a nap, i think the nanny could do dishes or put the garbage out, or whatever.   so i wasn't allowed to talk to the nanny.     we still keep in touch with all the nannies, i think they all really loved the kids but you probably only need them like ten years or so.  it's not a forever expense.

we decided we didn't feel right having nanny live with us.  we actually had to have a backup nanny in case the first nanny got sick, which happened occasionally.  it just took a lot of money to craft a system that was almost bulletproof in terms of letting us both work.  ymmv.  i hope you find a solution that works for you.  we offered to take them on vacation with us, but they never wanted to.  they were happy to take their own vacations.  we paid taxes and health insurance for them, if that was a follow up question.

your limiting resource is already time, not money.  its just that money is more easily quantifiable.  protect/develop/grow your relationship with your spouse, kid, etc.

best wishes, been there.

she's still my first wife!  i'm still her first husband!

 

[MrsIMDoc]

1. See if you can have a colleague add you to Physician Mom Group on facebook.  It has over 65,000 physician moms going through similar things.

2. Try to avoid another kid until out of residency/fellowship.  One kid childcare is expensive and two kids is more. Obvious I know but I feel like some people choose to have the second kid when they are already in misery but it can make things worse.

3. If you can afford in home care then do it. The commute time to daycare can be reclaimed. I disagree with above that a nanny can't do housework.  It depends on your market.  HCOL cities where nannies make $60,000/year can demand no housework.  Where we live nannies do help around the house (basics like children's laundry, basic meal prep, cleaning kitchen)

4. When it comes to looking for your jobs after fellowship, look to live in areas that have lower COL and lower commute times.  You already said you do not have family close by, so you should be free to live anywhere.

5. Look for jobs that offer the most flexibility.  I am working a job I do not love because it is so amazingly flexible with having a child.

6. For " On the rare occasion that one of us gets some time off and actually does something for themselves (e.g. go golfing with colleagues and drinks afterwards), it is hard for the other one to not feel resentful for not getting their own “personal” time as well," My husband and I rarely have time for ourselves.  If we were residents we would absolutely not have any personal time. If we have time off we spend it together.

[jhwkr542]

We have both sets of parents close to help with marital stress like this. Move closer to family after training? My wife also went to 0.8 FTE to be at home more. This is pretty clearly a work-life balance issue. Fortunately, you're almost done with training. Make it a priority to emphasize the life portion when looking for jobs. Trust me, people in private practice will identify with your plight... You just have to find the right practice settings for both you and your spouse.

[Beginner MD]

Thank you all for the constructive feedback, positive and negative, to give me a good sense of reality.  Fortunately (or unfortunately), I have already experienced a lot of the negatives already within my child's first year- getting a rash or fever that forces them out of daycare and needs to stay out of daycare for 24 hours (it felt like it occurred every month!), an urgent admission to the hospital for a severe rash so having to take the day off as well as a couple subsequent days, both husband and I having weekend call on the same days, etc.  Looking back, I'm surprised how we made it through the busiest year of fellowship with all of these things that have occurred.  I will have to say, despite being in a time-intensive specialty, my fellowship program has been the most forgiving when it came to these last minute childcare issues.  They've tried to coordinate with my husband and I's call schedules from 2 different specialities and have decent amount of back-up coverage overall, which has definitely helped.

It sounds like the consensus is to look for some type of au pair or nanny for the first couple of years until the kid goes off to school!  I've already made the decision to focus more on a research career pathway in academics after finishing fellowship, hoping that it allows me to have more flexible hours, especially if something urgent comes up.  We've already outsourced a lot of ADLs - lawn care, house maintenance, meal prep subscriptions, dog walking, etc, to try to give us some more time, but there always seems to be more things that need to be done.

It's just been a hard bullet to swallow thinking that one of our paychecks (as a fellow) may potentially go straight to childcare.  I've been maximizing our retirement accounts that are available because my goal is to be financially independent by my 50s and paying for a full time nanny seems like it will slow it down some.  But I think I just need to remind myself that the bigger paycheck is in the horizon that it won't feel as bad spending a significant percentage of our income on childcare and our sanity and health is more important. Once both my husband and I are full attending-status dual physician household, I'm sure this expense won't feel AS significant.

Addendum: I already live in a relatively low to medium COL part of the country.  My family actually lives in HCOL area, so unfortunately, I don't see myself moving closer to them to get help with childcare.  (Husband's parents are too elderly and unable to watch their grandchild for a long time.)  My own mother helps where she can, but as a first generation immigrant, she left me with my grandparents to raise until age 3, so she feels very apprehensive about doing a lot of basic childcare stuff.  We have, however, found 2 wonderful babysitters who we use intermittently when we need it.  Due to this thread, I've already offered one of them to consider being a part-time nanny for us to work mostly on the weekends.

[Dr. Mom]

Beginner MD wrote:

my goal is to be financially independent by my 50s and paying for a full time nanny seems like it will slow it down some

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"Life is what happens to you while you're busy making other plans."-John Lennon.

Pay for the nanny.  I saw it as a choosing time over money decision.  We have never regretted it.  Best wishes!

[neurosa]

You need childcare. Like yesterday. I second the notion of aupair's. they are great, your child will get to learn an entire different language/culture. Don't treat them like little slaves though. Know that they are in a vulnerable position in which they don't get paid that much to work 45/50 hours a week and are stuck in your house. Make sure to review their contract what you have to provide them and do that without hassle. I worked as an au pair in the past and have many friends who worked as an aupair and who your host family is really determines how you like the job. The best host families were the ones that treated their au pairs like a family member and made them a part of the parenting team. The worst were the ones that counted the amount of toilet paper or tea bags were used. My friend worked for two plastic surgeons who would micromanage what she was allowed to eat in terms of cost. Everyone else was allowed to eat eggs and croissant for breakfast but she was only allowed rice crackers, cheap peanut butter and off brand tea with her name on it.