Residency and Parenting Are Incompatible

By EMILY JOHNSON 

Being a parent during residency requires one or more of the following:

●     Family and/or friends nearby who are willing and able to provide free childcare

●     A stay-at-home spouse/co-parent

●     A spouse/co-parent who is willing to let their own career to be a distant second priority beneath family responsibilities and the resident’s career

●     Significant amounts of generational wealth that allow you to outsource household and childcare obligations with money you didn’t personally earn

●     High levels of financial risk tolerance and willingness to incur extraordinary levels of debt above and beyond average medical school debt ($234k!). 

Because medical residency in the United States is incompatible with being a parent.

It is a Sunday evening, and I am writing this as I wait for my husband to get back from the hospital. He was “on call” today, which, in lay terms means his work hours were “all day.” He was out the door before I woke up, and it is now 9:30pm and Find My shows that he is still at the hospital. So that means he’s on hour 15 or 16 of his workday, and he could be leaving in a few minutes, or he could be there for another few hours (and I have no idea which).

I do know he got at least a 15-minute break today, because our toddler and I went to the hospital today to have lunch with him. Why interrupt his workday, drag a toddler across town right before nap time (thereby risking the loss of my cherished mid-day downtime because of the dreaded car nap), and pay for parking and mediocre cafeteria food on a Sunday? Because if I hadn’t, I truly don’t know when my son would have seen his dad next.

This pattern – out before the family wakes up, back after bedtime- is the rule, not the exception. An “early” day might mean he gets out before 7pm – but that doesn’t guarantee that he’ll see our toddler, who goes to bed between 7 and 7:30pm.  

As a medical spouse with a young child, of the most infuriating comments I ever hear is among the lines of “but don’t they cap work hours now?” Or even worse – the occasional insinuation that perhaps today’s residents have it “too easy” because of work hour restrictions. Because the answer is yes – work hours are technically capped at 80 hours/week – but let’s talk about that: 

First, here’s what an 80 hour/week schedule looks like, in case you haven’t worked one lately:

Second, from a caregiving perspective, an 80/hour week cap is laughable, because you can still miss 100% of a toddler’s waking hours most days of the week on an 80 hour/week schedule.

And third, the fine print on work-hour restrictions for residents is that it is averaged over a 4-week period, so they could’ve kept him there even longer if there were a few lighter days sometime over the next few weeks. 

There are several challenges of being a parent in residency, but the most fundamental one is just the math. No day care centers are open 24/7, so if you don’t have family nearby, a stay-at-home spouse, or a spouse working a different and much more flexible career, your only childcare option would be finding a nanny who can align their work hours with yours. 

The rate in our area for a nanny with experience is at least $20/hour, before taxes. Let’s bump that up to at least $25/hour, because you will need to find a nanny who is willing to align with your schedule, meaning they will oftentimes not know their schedule until a few weeks beforehand, do not know when their shift will end each day, and are willing to work any day of the week and any hour of the day, as well as weekends and holidays. Ha! Just bear with me. 

In Minnesota, you are required to pay nannies hourly and required to pay overtime for any hours worked over 40. So, you’re either looking at shelling out significant amounts of overtime pay or hiring (and coordinating!) two nannies to split coverage.

The first-year salary for a resident at the University of Minnesota where my husband works is about $69,000. At an average of 60 hours/week (which is conservative), that’s about $22/hour, before taxes. There is no overtime, no overnight pay differentials, and no holiday pay. 

You do the math. It’s not possible to make this work unless you have local family, a spouse with a different and secondary career, inherited wealth, or the willingness to incur extraordinary levels of debt. And even if you do have one or more of those things, it can still be a nightmare. 

You might think: just wait until you’re done with residency to have kids. 

Most medical schools are 4 years, and residency ranges from 3-7 years depending on which specialty you choose. The average age of medical school matriculants is 24. So residents are typically finishing their training between ages 31-35 (later if they took any gap years for research or completed a fellowship). The American Academy of Obstetricians and Gynecologists says that fertility begins to decline around age 32. 

So for many doctors, waiting until after residency isn’t just a personal sacrifice – it may be biologically risky or impossible.

But here’s the kicker: not only does my husband love being a dad, it has also made him better at his job. He has told me this on numerous occasions, citing specific examples each time. 

We went through the ringer with pregnancy, delivery, and postpartum, which educated him about the process and experience of creating and birthing human life in ways well beyond what his textbooks and OBGYN rotation could offer. 

He now understands much more about child behavior, child development, and what it is like to be a caregiver, rather than a physician, in a clinic setting. 

And most crucially, he now understands what it is like to be a parent, which is an experience shared by nearly 70% of US adults – helping him empathize and develop rapport more easily with the patients he works with and cares for every day.  

Until recently I have been embarrassed to admit how much we are struggling, because we’re some of the lucky ones:

●     My parents are retired, live 5 minutes away, and provide an immense level of (free) help

●     I have a flexible job that allows me to step away for every pediatrician’s appointment or sudden illness. I can work from home if we have a blizzard or a -20 degree day that disrupts our childcare arrangements.

●     We both come from upper-middle-class families that have given us a huge financial leg-up, most notably the lack of undergrad student loans to tack onto our medical school loans. 

What right do we have to complain, when so many other resident families have it much, much worse? I’m looking at you, two-resident couples.

But I’ve come to realize that’s precisely the reason I do need to say this out loud: even with all that support, we are still struggling mightily to make this arrangement work. And “making it work” is a generous way to put it when our toddler spends much of his time asking about daddy, pretending to go see daddy at work via his Cozy Coupe, and possessively screaming “No! My daddy! MY DADDY!!!!” whenever someone else interacts with my husband on his singular day off each week.

If we want physicians in this country to have children, and to actually see those children, the system needs to be designed to make that possible.

Right now, it isn’t.

Emily Johnson, MHA, is a healthcare strategist exploring the fine line between personal experience and professional responsibility in the world of healthcare leadership.