Sunday, January 22, 2012

continuity of care



Let's talk, for a moment, about childcare.

It's a topic that I've meant to discuss for a while, and certainly I addressed it a little bit in my book, but as a family with two parents who work long variable hours outside of the home full-time, our childcare issues fall into a specific subset.  That is to say, without putting too fine a point on it, that we are utterly, utterly dependent on full-time, reliable childcare in order to function day-to-day.  Neither Joe nor I work part-time or any kind of variable/abbreviated hours.  We both work in the OR, which means we invariably leave home before sunrise, before the kids wake up.  We both take overnight call on a rotating basis.  This is not to be self-congratulatory or masochistic, and does not make us better or worse parents (though I'm sure there are those that would argue each side), it's just the life we lead and we've found a solution that works best for us.

However, before I get into the specifics of childcare, let me say first that none of this could work without an equal, fully-invested partner in parenting.  Joe and I had Cal early on in our medical residencies.  We were both at a critical point in our training, and both of us had responsibilities to our jobs and our patients that were equivalent and inarguably important.  So we've always, always, always viewed the division on parenting responsibility 50-50.  There were some minor variances here and there (for example: more difficult rotations month-to-month, the fact that Joe never got post-call days off but occasionally would get to leave for work later than I did, etc.) but on the whole, from the moment we first became parents, it's been right down the line.  We make sure one of us is always home every single night--if we need to, we'll trade call or make pre-emptive schedule requests to ensure that this is the case.  If I'm going to be home late, Joe tries to get out earlier.  If Joe has a journal article that he's getting ready to submit, I watch the kids.  We both have demanding jobs but this obviously doesn't make parenthood itself any less so, therefore when it comes to childcare, we've always been of the philosophy that "if you can't do it, I'll try to do it" and vice versa.

However, the fact is that both of us work all day on most days, and as such, we need to have a childcare solution to cover those working hours.  What we have, and what we have always had, is a full-time nanny.  I know this is a bad word for some people, and I can almost hear the squelching sound from the pile of shit that I am stepping in by telling you that I choose to practice medicine full-time and employ a nanny, but there it is.  We pay someone to watch our kids during the day so that we can go to work.

In residency, it was unavoidable.  We were in New York at the time, but having family members take care of the baby was not an option (both of my parents are also physicians that work full-time, and besides, they did not want nor should they have felt obligated to drop their practices in order to take care of their grandchild--they worked full time even while raising their own kids, after all; and Joe's parents, while both retired, live in Ohio).  We also had the kinds of jobs that were not amenable to a daycare-type solution.  I know that some dual-resident families make daycare work for them, but like I mentioned before, Joe and I both have OR-based specialties, and as such, we were both expected to be at work well before most daycare centers opened--and yes, this includes the hospital-based daycare at Columbia.  So we hired someone to come to our house, take care of the baby, and stay with him until one of us got home in the evenings.

As I've undoubtedly pointed out many times in the past for those in similar situations, finding a nanny, particularly as a medical trainee, is not simple.  First of all is the matter of the hours--it is difficult to say the least to find someone willing to show up at 5:45 every single morning, and for most nannies it's a dealbreaker.  The variability of the hours is also a problem--you have to understand that most nannies in New York (and certainly elsewhere) can find much more agreeable hours in basically in basically any other household.  A third issue is, obviously, the cost.  Childcare to this day is our number one largest household expense, but that's probably as it should be.  There was a period of time (before we finished residency) where our nanny was getting paid more than either Joe or I was for working at the hospital.  But this is the solution that has worked best for us--the only tenable solution really--and over the past six years, we've always had a full-time nanny.  Our current nanny has been with us for the past three and a half years, since we first moved to Atlanta.  She loves the kids, and they love her.  She's family.

Even now, that both of our kids are in school (Mack goes to preschool all day, three days a week), we still employ our nanny full-time, because Joe and I leave for work too early to drop off, and for the most part work too late to pick up from school.  And there are all the school holidays that are not hospital holidays.  Presidents Day and MLK Day and Teacher Planning Day (SO MANY DAYS FOR PLANNING) that we need someone to stay with the kids, to say nothing for the unexpected off days--snow days, ice days, sick days.  I know in the eyes of many Joe and I must be monsters for not taking off days from work when the kids are home sick from school, and who knows, maybe we are, especially since we are leaving our sick kids in order to go take care of sick strangers.  But the fact of it is that school aged kids get minor stay-home-from-school illnesses, like, all the time, and as long as I assess that they are OK--and by that I mean able to take and keep down fluids, making good urine, not stuporous--I make them chicken noodle soup the night before and stock up on juice and Motrin and keep in touch with our nanny throughout the day.  And then in the evenings, either Joe or I gets home--occasionally even both of us--and we'll take it from there.

In many ways, our childcare model is much like the practice of medicine.  It's about continuity of care.  The way our household works, no one can be with the kids all the time, around the clock every single day--but we have a team, and we have a system, and we make sure that handoffs are careful and that the time each of us does spend with the children is of the highest quality.  One could argue that abbreviating the work schedule of one or both parents might be better for our kids (oh, who am I kidding--no one ever thinks that of Joe, mostly people ask me, "So, do you think you'll eventually go part time?") and I think that, for each individual household, that can be difficult to say.  But I choose--choose--to work full-time.  I don't speak for anyone else, I'm certainly not telling anyone else what to do, but this is what works best for our family.

I'll tell you something that I've noticed in particular.  Whenever the discussion comes up about work-life balance and the choices that we (mostly women) make, the discussion essentially gets boiled down an issue of financial burden versus parental responsibility, and it invariably seems that the sentiment is that if parents (mothers) have the option to work part-time or opt out of working outside the home, they should, for the good of the children.  That choosing to work outside the home full-time is either born of financial necessity ("we can't afford to get by on less than two full incomes") or selfishness, abdicating the responsibility of caring for ones own children in favor of escaping the drudgery of the homestead and having more disposable income for your minks and Rolexes and Lego Star Wars sets or what have you.  To this, I would like to present a third viewpoint.  The fact of it is: I like working.  Not because I feel indebted to the medical machine, not because I have to, I just like what I do.  I like being a doctor, I like practicing anesthesia.  I trained for almost a decade to take care of patients, I want to do it more than part-time, and I want to do it well.  This does not mean that doctors who work part-time (men or women) don't like medicine, or are worse/lesser doctors, or cheating the system.  It also does not mean those who choose to spend the working day apart from their children care any less about the well-being or upbringing of those children.  I can only speak for myself, but I honestly enjoy my responsibilities outside the home too, and my choice is to work full-time.

Are there weeks that I spend a little too much time at work and miss my kids?  Certainly.  Are there weeks that I wish I had an extra day or two outside of the hospital to just catch up with them, with myself, with anything?  No doubt.  Are there things that I miss for work that I wish I didn't have to--performances, class parties, sports days?  Oh lord, almost every month.  But no one said adulthood was easy, and parenthood is almost certainly less so.  One thing it is about is adaptation and compromise, and finding your niche in balancing parenthood and career, perhaps in some cases deciding to choose one over the other entirely.  And I feel fortunate in many respects to be in a profession fulfilling enough that the decision of how I want to divide my time between work and home is, indeed, a difficult one.

Thanks to the commenter in the last entry for bringing up the topic, and reminding me that it's one I've long wanted to talk about.  There are lots of niches, lots of solutions, we found the one that, for now, works best for us.  What about you?  Other working parents, what's your niche, and what adaptations and compromises have you found that work best for you?  (Everyone be nice please.)

*          *          *

Oh, and here's one for you, pregnancy enthusiasts/perverts.  Me and Thing 3 at 15 weeks.  Unlike with Cal, I didn't take many expanding midsection pictures the last time around (until it got, like, crazy), but this time I am acutely aware that this is almost certainly the last time I will go through this particular fascinating biological process so I'm trying to savor it in all its bloaty, body-snatcher-y glory.  I took this picture inside my closet but cropped out the edges because no one needs to see that many pairs of scrubs and long sleeved T-shirts, NO ONE.




(If you work with me, I apologize--please try to unsee these pictures by the time we run into each other in OR or in the doctor's lounge while pretend not to be fighting over who gets to the coffee machine first.)

64 comments:

  1. Anonymous9:44 PM

    Congrats on your pregnancy! I'm an MS1 and my husband is a PGY1 and we have 2 year old twins. Fortunately he has a very humane residency schedule (in path), and during the day we get by with preschool, grandma, and occasional fill-in family and babysitters. It's working pretty well but my husband does way more childcare on the evenings/weekends than me and I do miss the kiddos a lot when I'm studying. By the end of this year I *really* hope to be more productive in my studies so we can do more activities as a family...

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  2. I recently had to leave my job because we couldn't make childcare work. My husband's a resident, but my salary wasn't high enough for us to find a reliable full-time nanny. (We went through 3 in just a few months.) We couldn't find a daycare that worked for us between cost and my son's therapy that he gets every day.

    It sucks to be the spouse of the resident with the more disposable job. You can't go 50/50 and you find the sacrifices always go to you. It's no fun, but I've accepted the fact that as long as the kids aren't in school I'm going to have to make sacrifices because it's easier for me to be the one making them.

    Oh, and I am not going to mention the fact that you cannot be 15 weeks because I was bigger than that back at 12 weeks. Oh sorry I totally just mentioned it. Whoops!
    https://lh6.googleusercontent.com/-s75nW9joTFQ/TkQuOymixbI/AAAAAAAACEg/1l5jtB85FQ0/s512/2011-08-11_15-31-23_454.jpg

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  3. Anonymous10:00 PM

    I'm in my last year of fellowship now, and am due to give birth soon. EVERY SINGLE DAY I get asked, 'So, are you coming back to work after the baby?' by various people in the hospital (nurses, patients, other doctors). My physician husband gets asked the same question by his patients/staff: 'So, is your wife going back to work after the baby?'

    The only answer I can give (not that I actually know what I'll be doing after fellowship anyway) that doesn't elicit 'tsktsk-ing' or some other kind of obnoxious statement is "Oh, I'll finish up my training for sure and then I'll probably take 6 months off to be with the baby and take my boards before I go back to working part time." This shuts most people up, as if it were anyone's business besides mine and my family's what I do with my career, and as if there were such a thing as "part time" in my field.

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  4. Hi--I just want to thank you for this blog. I've been out of fellowship for three years now, and I love hearing your perspective.

    Congratulations on finding a child care solution that works for you.

    --female neonatologist + big fan

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  5. My mother stayed home with me and my older brother until I was a teenager and she went back to college to get a degree in accounting. It drove me nuts to have her studying all the time and not available to me, and I remember thinking how unfair it was. Going through medical school, I often thought of her sitting in front of the dining room table with a stack of books, studying for hours on end, and I was grateful that she had modeled this for me. When I had my first child, I went insane trying to stay home and actually picked up a moonlighting shift on Christmas Eve when my son was only four weeks old because I was so desperate for the cerebral stimulation. I quickly realized that I would be a terrible stay-at-home mom, even though I had been so grateful to have one myself. But, like Michelle, I really like to work. I feel like the balance of working, while sometimes missing my son, and then getting to come and feel like being with him is a treat, is my best mix of having a life that is sustainably interesting and rewarding on both the parenting and the working fronts.

    Part of me feels the mommy guilt that I should want to stay home full-time, and I know that if I had to pick between being a doctor or being a mom, I'd choose my kids. As long as I can keep all these balls in the air, though, that seems to be what works best for all of us. We also have a nanny, but as an ER doctor who works nights and a fair number of weekends, we are able to get away with only about 20-30 hours of nanny care every week. My husband definitely has to pitch in more than he would if I stayed home, and I think that it has been good for our son (and, eventually, our current 18 week old fetus) to spend so much time with his father. My father worked a lot, and come to think of it, I remember not spending much time with my dad until my mom went back to school. It took us awhile to build a meaningful relationship. I don't think there is a right answer to how to do the child/work thing. You just do the best you can.

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  6. I had my first two during my PhD years, and I'm about to have my third child any day now during my fourth year of med school, and I have been asked multiple times each pregnancy whether I plan to stay home. Yes, I felt like getting 10 years of postgraduate education for fun... And the thing is, my husband is (mercifully) not in medicine, does all the daycare dropoff/pickup, and would go part time if we could afford it--but no one ever asks him about being a stay at home dad. Such is life, I guess. Everyone does what they think is best for their unique situation, but it sure seems like the working mom is the parent that catches the most veal for it.

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  7. Catches the most crap...stupid autocorrect...

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  8. I enjoyed the entry, but I wish you didn't have to make so many caveats and preemptors. As a long-time follower of your blog that has seen some of the nasty comment-storms arising from some of the honest, personal stories you have shared, I can understand why. But it is a shame that you have to be defensive about decisions that are obviously the best for you and your family. Your posts (and others on doctor/mother blogs) sharing your particular struggles and perspectives (even the ones I disagree with) have helped me as I try to navigate my own way through being a committed resident physician and committed mother. I think that, by large majority, that is the case with many of your readers.

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    1. This is the first time I've read this blog. Personally, I appreciated the caveats, particularly so since my choices have been so very different than Michelle's. I'm mom to many and have been their primary care-provider since they were created.

      I sometimes think a different path might have been better, who can predict the future? My youngest is in 6th grade and I've been working as a writer since he was three years old. But my office is in the dining room so never did use any childcare.

      We are blessed to have choices. Not everyone does.

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  9. I really enjoyed this post.

    What worked for us as a GP and MSI4/PhD?

    Childcare is a combo of full-time daycare across from the hospital and grandparents on the floor below us. It works for us as (1) no OR specialties for us, thankfully and (2) we choose condo/city living instead of suburbs/detached home to avoid adding commutes to the already long days.

    Work - I'm trying out 3.5 days a week right now as a locum and love it. I work about 40 hrs if I add in charting, referral, and checking labs -- plus a night a week of home call (rarely called). I left an internal medicine residency 2 years ago and am much happier with work/life balance and yet am still intellectually fulfilled in family med. Main draw back now is our debt repayment has slowed so I'll likely start working a bit more in the future but for THIS MONTH it works as hubby is currently away doing the CaRMS residency tour right now.

    This work/life balance thing is very fluid - we seem to be trying new things every few months as schedules change.

    I find that most of the people asking me what we're doing for childcare are other working moms who are also trying to find a way to make this work!

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  10. Anonymous12:32 AM

    Congrats on Baby #3! How exciting! That is the beauty of parenting: You get to decide what is right for your family!

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  11. I have a theory after watching my sister (physician) and her husband (full time worker as well) handle this: 2 people can only work 80 hours between the two of them before you need more than daycare. That is, if you both have 40 hour a week jobs and not terrible commutes (I think 1/2 hour each way) you can do daycare with a big of flextime. If you have someone working 50 hours and the other working 30, you can do it. but if you have one person working 50 and the other working 40...all of a sudden daycare is impossible and you need more help. for you guys, you probably work 100 hours a week. A full time nanny isn't a luxury. its essential. Good on you and thanks for saying it. You think Sheryl Sandberg, famous Facebook exec who tells women to stay in the workforce doesn't employ at least 2 full time people? I think its great. Good for you. Thank you for your service! And Cal and Mack are going to think you are an awesome mom and have lots of love in their hearts from loving their nanny. (note: I am a full time working parent with a full time working partner: but my hours are very normal business hours with a bit at night...I can do daycare!)

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  12. Anonymous2:29 AM

    Michelle, can you talk a little about your experience as the daughter of 2 physicians? Was it just normal for you that they both worked full-time (and you didn't think of it much at the time)? How did your parents make it work? Has the fantastic outcome (you and your very impressive sisters) made you more comfy with doing the same in your family?

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  13. Thanks for the post Michelle. I've always thought the Nanny option ideal - if you can afford it. So much easier with no daycare drop-offs, provied your Nanny is reliable.

    BTW - my first thought on your belly photos.... they look like the "after" photos of "before and after weight loss". Sigh.... I'm not pregnant and would be delighted with such a lovely figure :-)

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  14. Actually, I envy those women who have a Nanny and are at home - even more ideal. I know one whose husband is a corporate/merchant banker work-around-the-clock type, and she works part time running her own yoga classes, and they had a full time Nanny, which is ideal. I wouldn't object to a housekeeper either (maybe I've been watching too much Downton Abbey...)

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  15. Dear Michelle,

    Thanks for posting this. Selfishly, it couldn't come at a better time for me! I'm a resident in paed surgery (not on the program yet - in Aust you can't apply until PGY3) and pregnant (10 wks) with our first child. Both my partner and I are pursuing a career in paed surgery, which is tricky for several reasons - it's v competitive and obviously hours are long. Training is 7 years and during that time we can expect to be sent to different cities. There is nothing that either of us want to do (how I wish I loved anaesthetics!) I am in the process of talking myself out of my dream career because I think it will just be too hard. The whole idea of changing tack is frustrating and disappointing to me. I can't believe that after hundreds of years of feminism I still feel that I have to chose between family and career! (Of course I could do paeds, or emergency, or teach, but I want to do surgery!)
    Anyway, your post reminded me that we can make our own choices, and child care is a real option. And the kids will be fine.

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  16. Anonymous7:55 AM

    Does your nanny stay in with you guys?
    If not, how do you handle situations like for example, Joe is stuck in the OT and you are called?

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  17. Anonymous9:13 AM

    Thanks for posting!

    Your pants are really cute- where did you get them?

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  18. Anonymous at 4:55am: Our nanny is not live-in, but she will stay with the kids until either Joe or I get home, whatever time that is. If we know ahead of time that we will be especially late, we let her know in advance, and of course on the days that we get out of work early (post-call, etc.) we try to get her out early too. It works out pretty well.

    Anonymous 6:13: Gap maternity! Much better fit in their pants that Old Navy maternity, which tends to run HUGE. I gave away all my maternity clothes in the Spring too, so these are relatively new--they're still being sold on the Gap website, I think, the "sexy bootcut jeans" (blergh, the names they give their clothing).

    This is all really interesting everyone, fascinating to see what everyone's work/home situation is, since every household works a little differently.

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  19. I don't see what the big problem is about having a full-time nanny. In my country, most people have live-in nannies that also do the housekeeping, and that's even for stay-at-home moms, mind you. I had a live-in nanny all throughout my life up until I was 16 years old, and turned out perfectly fine. In fact, I loved it, and will definitely do it for my own children, if I can afford it. The whole idea of working mothers not being good enough for their kids (you know what I mean...) is complete and utter nonsense. Do what's best for you and your family, and don't listen to what other people have to advise or say because, hey, they're not in your house and don't know what your family's needs are.

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    1. I agree! We have full-time nannies in my countries as well. We call them maids, or domestic helpers, and actually, most of them aren't even trained to take care of children. They're only trained to do housework, but since they usually come from families with many kids, most of them know how to take care of babies and toddlers. My caretakers would change about once every 2 years, because their contracts would last that long; they usually wanted to return to their home countries afterwards and take a break.

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  20. Thank you for posting this. Both my husband and I are residents right now (me- gensurg, him- neurology) and we keep running into this issue of how in the world we're going to care for children some day. It's so helpful to hear about how other dual physician households are dealing with this issue, as we're going to have to figure out how it'll work for us in the future as well!!!

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  21. Hi Michelle, I'm totally with you in that I LOVE my job and would be a very unhappy person if I didn't get to do it. I'm doing a residency in veterinary emergency and critical care, which in general is less total hours per week than physicians do in their residency, but requires a shit ton of reading (on average of 30 hours a week), so even when I am at home, I'm still working.

    My husband and I were always 50:50 prior to me getting into vet school, but since I've started this career, he is shouldering 75% of the burden. He knows that when I'm done in 2.5 years, we'll go back to 50:50, and while it bites for him, we are dedicated to making sure our kids are okay. We're lucky in that his work hours are flexible, so we haven't had to employ a nanny beyond my first year of school.

    I am glad you wrote about this challenge, because in my field, which is predominantly women nowadays, people still ask you what you're going to do about the kids.

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  22. dr.mama12:38 PM

    Thanks so much Michelle for posting on this topic! We have just had our second baby and also just started our full-time, live-in nanny. I will admit that I was apprehensive at first (having been raised by a stay-at-home mom, there is a bit of a guilt factor from her), but it is amazing! Even though I'm still off on maternity leave, the nanny has been a lifesaver...she does everything (childcare/housework/etc) and I've had so much more time for both kids than I thought I would. While it currently seems like a bit of a luxury (ie. her and I both at home), when I'm back to work in a couple of months I think the balance will be great.

    I work "part-time" (40-50 hours/week) as a Family Doc doing only obstetrics (we're lucky to get to do that in Canada!) and my schedule is a bit erratic given the nature of babies. My husband is a lawyer, and while his hours are more routine than mine they're still not flexible enough for daycare to be an option for us. We used a combination of grandparent babysitting with our first baby (she's now 2) as I was a resident at the time; but 2 kids (toddler and newborn) is more than we're willing to ask a grandma to manage. I am often asked why both of us are working with young kids....but I truly love my job and believe that I am a better mother when I'm also working as a doctor as the time I spend with my girls is more engaging for me if I also have my work time. But that's just what works in our house!

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  23. Anonymous2:11 PM

    Bravo! And you never know about thing #4. Once you're rolling in a minivan, why not?

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  24. Thank you. Thank you, thank you, thank you. My favorite part was the reference to the fact you have trained 10+ years at this point and would like to do the job well. I feel exactly the same.

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  25. Anonymous5:31 PM

    Michelle,

    Your blog is so fabulous. It is the only blog I have read consistently, well, ever. I have read it since I started applying to medical school back in 2003.

    I am also someone who has been both (at different times) a stay-at-home mom and a mom-as-resident-physician. Both have been wonderful, terrible, great, and painful experiences for different reasons.

    I am going to offer you one piece of unsolicited advice: STOP APOLOGIZING FOR HAVING A NANNY. The jerks online who judge you are not worth paying attention to. If you are happy and professionally fulfilled and your kids are happy then having a nanny is clearly part of helping you be the family you want to be.

    Americans--especially conservative ones--are a weird bunch. Collectively, they dislike people who don't work (witness the hatred for programs that support low-income families like welfare and SNAP/WIC/foodstamps). At the same time, they fetishize "traditional" families where mom stays home with the kids and dedicates her life to her kids and does not bring in income. It's wildly hypocritical, especially in the current economy.

    You may have guilt about leaving your kids (most parents do in some form or another). That's a personal guilt and a normal reaction. But you should not feel guilty about using different forms of childcare (including a nanny) to support the professional and family life that you have built. Unless you abuse your nanny and lock her in a closet at night and feed her stale bread and water. Then you can feel guilty. Until then, STOP APOLOGIZING.

    Emily

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  26. I'm one of those women who was fortunate enough to have the option of stopping work outside the home when I had my kids, even though our income was modest at the time. It felt even more fortunate to me because I really didn't like my job; I was exhausted and burned out and happy to quit. Michelle, I think it's great that you have a job you feel called to do and that you love. If I'd been in your shoes, my decision would have been far more difficult and perhaps different. And I admire the way you and Joe have made things work for your family. Don't ever feel like you have to apologize to anyone for that.

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  27. Holly8:03 PM

    An hour ago I was in the car stuck in in traffic in the pouring rain with my toddler, who was in her car seat essentially eating a dinner of cheerios, organic fruit squeeze pouches, a cheese stick, and whatever else I could hand her -- I felt like I was running a buffet out of the front seat of the car. We got home at the precise moment she needed to be put in bed, so we hustled through the bedtime routine, read a few books, gulped some milk, kissed goodnight and off to sleep she went. Then I trudged downstairs, made her lunch for tmrw, packed up her daycare bag and shoved some food down my own gullet. I'm not a clinician and I definitely don't work a schedule like one, but I work in PR for a top academic hospital and my work life is pretty much always chaotic and unpredictable. My husband is an Air Force pilot and is frequently out of town, and we commute in opposite directions, so I do all the daycare pick up and dropoff myself (our daughter is at the excellent on-campus daycare that I am STILL not sure how we managed to get a spot off the wait list for) and owing to the aforementioned travel, I frequently juggle the at-home responsibilities solo, too. Daycare is open 7 to 7, which is a great safety net and totally sufficient for the rare times when she needs to be there that long -- there are many kiddos of dual-physician families there, and one of the babies in her infant room was the child of a couple who were both interns. I have no idea how they did it last year, but their little girl is sweet and happy and appears well-adjusted, and so is mine and so are all the other kiddos there whose parents are probably all twisting themselves up in knots about not some aspect of their situation being suboptimal. I nearly went crazy from boredom during my maternity leave and despite the inherent drawbacks of my job, realized quickly that working is ESSENTIAL for me to be a good mom. It's so worth the stress, and honestly, I'm pretty sure that my husband and I are the only ones feeling the stress, because our daughter loves going to school and couldn't possibly be a happier child. I would have NO IDEA what to do with her if I stayed home with her, and I really respect the people who have made their life's work caring for and educating young children. My mother had a big job while I was growing up, but she had basically no commute, and three grandparents living near by to pitch on sick days and school vacation days, and I realize now (having a long commute and no family at all nearby) how valuable those things were to making it all work. But the upshot remains the same -- somehow, she made it all look easy (even though I'm sure it often wasn't), and rewarding and worth it and important, and I hope I can someday say I've managed to show that same scenario to my own daughter.

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  28. Anonymous8:36 PM

    I like to work much more than I like to be home with my toddler. I have found that I am not a stay at home Mom and never will be. I love him, but he is SO MUCH better off at day care/preschool where he can finger paint, eat sand, play with trucks and trains and be safe in a fun, social environment. I work regular hours so day care works perfectly for us. I imagine after spending years in med school and residency that no one is eager to give up all those years of training to stay at home.

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  29. Anonymous10:29 PM

    Michelle, you're my hero!

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  30. Anonymous10:48 PM

    I worked part-time from when the child was age 2 through college freshman; then, I became a fulltime college professor. My husband worked unusual, long hours and left the house at 4 AM. I appreciated being able to wake up, get the child off to school, and so on.

    Michelle, I agree with those who say there is no need to justify your choice: if the kids are cared for, then it's all good!

    Best,

    Beth in Texas

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  31. Anonymous10:52 PM

    Michelle, congrats on the baby!!

    I know you must be very busy, but I would love to see your cartoons get formally published at some point! Also, I just bought your book and I can't put it down! I love it!

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  32. Thank you. Really, thank you so much for your honesty. My boyfriend is a PGY2 and I return to med school as an M1 in August. We've had a lot of talks about how we plan to do medicine and a family, and they always conclude with your situation. I'm relieved (and happy for you, Joe and your kids) that two physicians can make use of their 10+ years of training and maintain a healthy home life. Thanks for sharing! And congrats on your 15 month bump :)

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  33. Anonymous11:03 AM

    Love your post! I grew up with a few friends who had both parents working full time as doctors, and though I can't remember the specifics of their day-to-day care situation, they all were happy, healthy, smart, and sociable. Having your fabulous nanny simply means there is one more person in your kids' lives who loves them! And given your unpredictable work schedules, having one nanny who coordinates everything seems like it would be less chaotic than trying to balance daycare and the hours before and after.

    What bugs me about the "stay-at-home" versus "working" mom arguments is the idea that a stay at home mom does everything with and for her kids. My mom stayed home with my brother and I, but she didn't attend every cross-country meet, or make brownies for every class party. Despite her constant presence with us at home, we were still expected to learn self-sufficiency, and to take care of ourselves and problem-solve. Scraped your knee? You know where the band-aids are! And we *gasp* even hung out with the neighbor kids without supervision after school! Just like a kid with working parents! The horror!

    I just wish as parents we could feel comfortable making our own decisions up an down the spectrum without the need to apologize.

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  34. Anonymous4:48 PM

    Thank you for sharing this, although really it is none of my business, I find the discussion of work/life balance between all parents fascinating. I have a friend from college who (also lives in ATL -- I should put y'all in touch) is an OB/GYN and her husband is a cardiologist. They have 3 young children (6, 3, and 1)and I'm constantly marveled at their balancing act.

    I don't have children, not a doctor, not married, but have a plethora of health issues. Medical doctors have helped me IMMENSELY. I try to thank them genuinely after each visit/surgery but just in case no know one else thanks you, I say thank you for the help you provide patients.

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  35. Emily5:25 PM

    I don't see any need at all for you to apologize for having a nanny. I think that we are so influenced by expectations we are surrounded with, other people we come in contact with on a daily basis, as well as our own (subconscious?) insecurities that we forget that there are no "absolutes", no rights/wrongs. Everything is relative. In my social circle, all the families have full-time, live-in nannies. And housekeepers. And the wives do not work outside the home. So who should apologize, the woman that leaves her children with a nanny while she goes off to work, or the one who leaves them to go to the spa/yoga studio/shopping mall? Frankly, noone needs to apologize for anything if they are truly at peace with their decisions.

    And just to put in my 2 cents, I'm a practicing physician, 27 weeks pregnant, and you can bet I will drop my career like a bad habit if this baby comes and I decide I can't leave her during the day. No apologies here.

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  36. Anonymous5:47 PM

    does the nanny cook/clean/etc when the kids are away at school?

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  37. Anonymous7:39 PM

    Also on my 3rd child, in practice now (as a pediatrician) and get asked by my patients all the time about what we do for childcare (I think more in the spirit of curiosity since most of my patients have dual working parents). We did daycare, then switched to a nanny when #2 came along. Here's the funny thing: my mother in law is so opposed to my working that she comments on it constantly, even when my husband was unemployed (and thus a stay at home dad) for over a year. You just can't win with some people. So don't apologize.

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  38. I had every intention of going back to CCU 4days/week after my first kid, but went per diem instead. I now work one day a week, (every other weekend) and have done that for 5 years.

    I always get a tiny bit irritated when people say (still, after 5 YEARS) "Oh, so you only work one day a week then? Must be nice."

    No, I work all the days. I raise 2 kids during the week and I work as a nurse on the weekend.

    I also get asked, "So does your husband take care of the kids on the weekend while you are at work? Does he do okay with that?" Well, yes. He does just fine.

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  39. Anonymous7:30 AM

    I'm a PGY3 and my husband has stayed home with the kids since birth (when I was an MS3). We are both doing what we are happiest, most fulfilled, and best suited to do and it works for us. But I could fill a book with the stupid things that people have said about our set up, not to mention all the issues he has had trying to get the kids in mom run playgroups!

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  40. Anonymous1:10 PM

    Wow! You are in excellent shape for someone who is on Thing 3! What's the secret? haha. Congrats again!

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  41. Anonymous4:20 PM

    I don't think male parents get asked about childcare, but I also don't think it's men doing the asking. It seems to me that it's women asking about other women's situations. And for better or worse, men aren't that vocal about it, or don't care enough to make it an issue. Thoughts?

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  42. Anonymous1:06 AM

    To answer your question: I get asked all the time. My wife and I are in a similar situation with both of us in residency (me ophtho, her rad's) with two children (2, 5mos) and childcare is by far one of our largest expenses. We currently do a combo: daycare and then picked up by our babysitter who brings them home until one of us can get home. Back to the original question, I am constantly asked how we do child care when people find out my wife is also a resident and we have two young children. I don't get the "are you going to quit" question though.

    As an aside, what service/program do y'all use to keep track of your nanny's pay and tax issues? I currently use an online program, but it seems to be more expensive with a monthly recurring charge than I'd like to pay.

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  43. I wish wish wish I had ever looked that cute during any of my pregnancies!

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  44. Anonymous12:41 PM

    Hey Michele, congrats on expecting and here is a message about something you probably stopped thinking about ages ago -- the minor brouhaha over promoting a nice vacation spot on your blog in connection to getting a big rebate off your own vacation. I was one of the MDs who expressed "doubts" about whether that was kosher. Guess what? I think I was an ass about it. Really sorry. Someting else was going on in my own life. It seems so trivial now. Good luck and hope that helps make even a teeny memory of that bump fade.

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  45. I am a medical student trying to determine what specialty to pick and plan for kids in the near future. I appreciate your honesty and candid discussion of the pros and cons of being a full-time doctor and mom. At the very least, there is comfort in knowing that other people have done it and continue to love their job.

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  46. Anonymous7:38 PM

    I'm a full-time outpatient internist, in my second year out of residency. We have a crazy wonderful 1 year-old boy. My husband is not in medicine but has a long commute (1 hr each way minimum). What works for us at this very second is: baby in daycare near my work/our home, I drop off and pick up. I do notes/paperwork pretty much nightly after baby goes to bed. Sick baby = chaos. I have to pick him up from daycare, although my work culture has a "can do" attitude about rearranging patients should I be called out, I still hate doing it, but what can you do, I'm the one closest to sick one. Husband's benefits better than mine, able to stay at home with sick baby if does not go to daycare. My parents live an hour away in the same direction as husband's work, can pinch hit when my husband cannot take off of work to take care of little one. We have not established a relationship with an emergency baby-sitter. Oh, and we have two dogs, who pee/poo in the house if we pay too much attention to sick baby. Argh. Life is funny, the worse it is at home, the better it is at work, and vice versa. Can't get poo-ed on 100% of the time, but 50% is just about average. Being a doctor is hard, being a mother is hard, being a good wife, daughter, friend, sister is hard, but I try my hardest daily to find the little joys here and there, and struggle to maintain my relationships here and there, for the sake of my son, and my sanity. Michelle, have you had time to check out momastery? I like her concept of kairos, chronos on her "don't carpe diem" post. Sorry for the stream of consciousness post...oh, yeah, that's how we do child care. :)

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  47. Anonymous7:44 PM

    Anon 10:06- Good to know men get asked about parenting as well. I think that's a sign of changing times, in a good way. When I was in med school our chapter of AMWA would always hold a Moms in Medicine panel where moms would talk about balancing medicine and kids and it always made me think that they were actually doing more harm than good by pegging the balancing act as a mom's issue not a parent's issue. I had plenty of male classmates that were thinking about how they were going to do medicine and raise kids (and have a wife that was also career oriented).

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  48. Anonymous8:09 PM

    We (my partner and I) are full-time university professors- so our schedules are more flexible. BUT, when we transitioned from a nanny to daycare, we found we were both working far fewer hours than we wanted (like 40ish hours/week) which is not tenable for tenure or running large research labs. And now we're going to have two more. Our best option - and the only one that is economically viable (our first's daycare costs $24k for full-time care -- 8 to 4:45) - is an au pair. We will welcome the flexibility it will bring to caring for our brood (you're allowed to call it that when you have more than 2) and it does not cost as much as a nanny or daycare. I hope it will work for us.

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  49. Anonymous8:41 PM

    Hi Michelle! Long time reader/lurker, first time poster. This is a subject near and dear to my heart. I'm a (part time) pediatrician and my husband is a (full time plus) ICU doc. We lucked in to a fantastic daycare for our infant daughter when I went back to work at 6 months, and initially I thought part time physician = part time daycare. That is, until I realized I was getting up at 0400 to round on inpatients 5-7 days a week. Only my clinic was part time...I'm still doing a full call contribution. Oops. My decision to work part time in clinic was complicated, personal and didn't take into account the consulting work I've started to do on the side for family practice teams as well as hospital based outpatients clinics.

    The irony is that other physicians ask me why I'm not hiring a nanny and working full time and non-physicians (parents of patients, coworkers, friends) ask me why I'm not taking more time off with my daughter. Most days I feel like I'm losing on both fronts, eg I'm a substandard mother and physician. I'm really hoping it will get better, but to be honest, I struggle a lot. It helps to know I'm not alone!

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  50. Really informative topic you are discussing, I like the way you expressed your thoughts! keep it Up!
    modalert

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  51. Anonymous2:05 PM

    Thank you so much for posting this. My husband is a IM resident and I will be starting my Psychiatry Residency this July. (fingers crossed!) We have a 1 yr old daughter and will be starting to spawn another shortly due to age constraints on my end. I self flagellate constantly over whether or not I am a "bad mommy" because I look forward to working full time again. Society does a good amount of guilting women (while simultaneously lauding itself on women's right to choose her own destiny) when we decide that we can be moms as well as full time employees.

    Reading this post has encouraged me to continue to follow my path. We are also looking into a full time Nanny and hope we can find someone who will fit as well as your nanny has.

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  52. Anonymous8:12 PM

    I am also an anesthesiologist, and my husband is a neurosurgeon. Our older child was born when we were both in residency, and we found after much trial and error that we needed 2 part-time nannies as no single person wanted to work all of our hours (including the occasional nights when we both had call). Now our son is in preschool and we have (somewhat) better hours as attendings, so we have switched to one FT nanny.
    I had many a few resident or other coworker asked me why I couldn't just use daycare, even though they worked the same hours as me! And neither my husband nor I have taken a "sick day" for our son, for like you said it's always just a mild fever or respiratory infection.
    I'm working PT now, having just returned to work after maternity leave #2. In some ways I do feel like quite the slacker as there are few PT members of my practice. But our daughter has some minor health issues that make us worry that it would stress a nanny to have her FT. But man did I miss work on this last maternity leave, I can't imagine staying home full time.
    Good luck with baby#3. I came across your blog a few years back and enjoy reading for tips from another 2 physicians-in-the-OR couple perspective.

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  53. Anonymous9:52 AM

    I really needed to read this. It brings to my eyes to hear a similar perspective. Thank-you......

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  54. Anonymous12:59 AM

    I love this blog! I'm an anesthesiologist who was married to another physician and is now a single parent. I'll be nice but just say I didn't have a partner so I had to work part time and I also have a nanny. I was told once by some very wise female physician colleages that a woman's happiness at work is directly proportional to the reliability of her childcare. I have an older nanny (51 years old) and it has been the best thing ever!! Anyway, love the blog and the comics and I need to check out the book. Thanks for putting our life into words!

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  55. I can't even tell you how grateful I am for this post. You have basically vindicated my future. I'm currently a 3rd year medical student and I love surgery more than is probably healthy - on multiple occasions I have had my chiefs kick me out of the hospital after scrubbing on cases s/p 24 hour call (they're my patients, so technically it's not a duty hour violation). Whenever I express my love for surgery, specifically neurosurgery, I get all of the "what about lifestyle, don't you want kids?" comments like it's something I care about at all right now (I'm 24yrs old). I have explained ad nauseam that my goal is to do something that I love, that will stimulate me intellectually for the rest of my life, and be awesome at it - everything else will just have to be fit in later. My parents think this is absolutely criminal as they have hinted that kids should be the veritable definition of my existence (they have a very conservative viewpoint). The SO doesn't much mind, even though he wants kids more than I do at this point - right now I just view kids as a deranged social/embryology experiment that happens to vomit at inconvenient times. Interestingly, his dad is a neurosurgeon and he is completely ok with the long work hours in case we do have a family (I made sure of this before things got serious).

    I cannot give you enough props for the awesome job you're doing - it's practically inspirational!

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  56. My mother had me while she was completing her MBA and gave birth to my sister four days after she walked for her PhD. As the child of a mother who not only worked more than 40 hours a week but traveled all over the world, sometimes for a month at a time, I have to say that while I missed her, and was sad when she missed a ballet recital or when we had to "reschedule" birthdays, I am so so so grateful to be the daughter of a working mother. We also had full time nannies, and while my dad also worked full time, his hours were kinder and he was able to serve as primary care giver in the evenings. It was amazing to have such a strong female role model in my life, and I attribute my sense of independence and drive to my mother's example. I am currently finishing up grad school, applying to medical school, and am recently engaged so children during training is a bit of an inevitability. You all provide something for your children that you wouldn't necessarily be able to do as stay at home mothers, and as the child of a working mother, I think they are extremely fortunate.

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  57. Thanks so much for posting this. My husband is in his first year of PICU fellowship, and I'm a full-time pediatric hospitalist doing 12-hour shifts on a mix of days and nights. We currently have a 2 year old (the Weasel), and our second is due in September. Our current daycare is a mix of daycare across from the hospital for the 2 year old, and because our 12+ hour work days don't jive with the daycare schedule, we have an evening/weekend nanny. Working would be impossible without the nanny; it's not like my husband can just take a day off from the PICU or call out early to come pick up the Weasel from daycare. We initially had a hard time finding a nanny who understood our highly variable schedule (or lack of schedule), and she's been fantastic. It's always good to hear about other physicians' search for childcare. It sounds like you've found something that works for your family and that's something to be cherished. Congrats on #3! I'm significantly bigger than you at 15 weeks, but oh well.

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  58. Anonymous7:15 PM

    In my experience live in nannies worked very well untill el;ementary school picked up and assignemnts became serious. Easily A student in 1 grade my child became and remains a load of work. I am blessed that circumstances worked out at that particular moment that my husbund was transfered to another town and I found 8 to 5 government job. I am able to couch my kids through homework and give then extra assignements. No way nannies would have cared that much or were able to teach them very different ethnic math curriculum from my country. They are both 2-3 years above ther peers in math now. Their summer time college student-nanny with GPA 4.5 could not solve math work I left for my kids to do during the day. Nanny used calculator to check it, my kids used their heads. And it was only 2nd grade by my country's standards !!!! I am happy I can influence and educate my kids this way. This would not have happpened with my previous 60 hour + weekends + overnight page call-job.

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