Dual physician couples and family planning

[SociableJimmy]

Was hoping anyone with similar experience could chime in. I"m a PGY-4 surgical resident, wife is an urban academic EM attending. We're hoping start having kids soon and are trying to get finances/child care sorted out. We are both unsure of how much needs to be set aside (both upfront and ongoing) for this process. We have no family in the area to help with child care and she commutes 45-90min each way to work, 14-18 shifts per month. My current surgical schedule unfortunately makes me pretty useless, and with my fellowship path this will continue for several more years. This means we will need to rely pretty heavily on daycare/nanny etc. How much of our salary can we reasonably expect to devote to this? I understand this will vary by location. I had initially thought of devoting my entire resident salary (minus loans) to child care and then putting her salary toward our other expenses as needed. Despite our combined income being near the top 5%, she's very concerned that we won't have enough as our anticipated child care costs will also be much much higher than the average non-physician couple with one parent who can stay home and who also has family around to help. I think hearing the real world experience of others in this situation would be helpful, thanks in advance.

---

Members don't see this ad.

 

[DrMetal]

Was hoping anyone with similar experience could chime in. I"m a PGY-4 surgical resident, wife is an urban academic EM attending. We're hoping start having kids soon and are trying to get finances/child care sorted out. We are both unsure of how much needs to be set aside (both upfront and ongoing) for this process. We have no family in the area to help with child care and she commutes 45-90min each way to work, 14-18 shifts per month. My current surgical schedule unfortunately makes me pretty useless, and with my fellowship path this will continue for several more years. This means we will need to rely pretty heavily on daycare/nanny etc. How much of our salary can we reasonably expect to devote to this? I understand this will vary by location. I had initially thought of devoting my entire resident salary (minus loans) to child care and then putting her salary toward our other expenses as needed. Despite our combined income being near the top 5%, she's very concerned that we won't have enough as our anticipated child care costs will also be much much higher than the average non-physician couple with one parent who can stay home and who also has family around to help. I think hearing the real world experience of others in this situation would be helpful, thanks in advance.

How old are you guys? If you're in your early 30s, I'd say wait until you're both done with training and settled somewhere. If you're in your early 40s, then I can understand some sense of urgency.

 

[SociableJimmy]

How old are you guys? If you're in your early 30s, I'd say wait until you're both done with training and settled somewhere. If you're in your early 40s, then I can understand some sense of urgency.

Early 30s. She is also somewhat concerned about maternal age & fertility risks if we wait much longer. I’m quite ignorant to how valid those concerns really are at her age, so I’m not sure how to address that.

 

[VA Hopeful Dr]

How old are you guys? If you're in your early 30s, I'd say wait until you're both done with training and settled somewhere. If you're in your early 40s, then I can understand some sense of urgency.

This is terrible advice. Planning on kids in your early 40s is a recipe for not having kids.

OP: planning to devote your resident salary is reasonable (and depending on where you live might even be overkill). Either do daycare with a backup nanny/babysitters or a flexible nanny with backup babysitters since y'all's schedules are going to be erratic.

 

[VA Hopeful Dr]

Early 30s. She is also somewhat concerned about maternal age & fertility risks if we wait much longer. I’m quite ignorant to how valid those concerns really are at her age, so I’m not sure how to address that.

Very valid concerns about fertility.

 

[dpmd]

Early 30s. She is also somewhat concerned about maternal age & fertility risks if we wait much longer. I’m quite ignorant to how valid those concerns really are at her age, so I’m not sure how to address that.

They are a lot more valid than people seems to believe. Fertility drops after age 30 and more drastically after 35 (and after 35 it is considered a geriatric pregnancy). It will be a challenge but then again it will never be the perfect time to do it.

 

[GoSpursGo]

Not a dual physician family, but concretely I would say that childcare winds up costing me about the same as my rent in an urban mid-Atlantic location.

Ultimately, it’s daunting but you just have to do the math. Add up your other fixed costs (taxes, rent/mortgage, gas to and from work, maybe a fund for you to interview for fellowship). Factor in your nominal tax breaks for having a kid. Then decide how much is an acceptable amount to put away for savings each year. The bottom line is, of course you CAN have a kid on your salaries, but you will save less and may need to compromise other aspects of your living (location, size of house, etc).

I will also say that from personal experience doing a day care, with a dual physician family I think you would need a really good nanny. The problem with childcare when you’re a professional is that it absolutely, positively, never ever can fail. A child in daycare will contract on average ~8 viral infection each year (meaning yours could be the lucky one to get 12+). that’s a problem for parents even in non COVID times where you don’t suddenly have to drop everything on a Sunday afternoon to find COVID testing like I’m doing right now, or having the whole room shut down because one kid has a fever. Though hopefully by the time your kid is in care we will be past this point…? Beyond your nanny, you also need one or two backups, meaning drop in daycare or a backup nanny. And then lastly your wife having a group of other parents at her work who are willing to swap with each other on short notice as a last resort with the understanding that everyone is going to need this at some point. In a lot of ways, the logistics are a much bigger nightmare than the money!

 

[DrMetal]

This is terrible advice. Planning on kids in your early 40s is a recipe for not having kids.

To be fair, I hadn't really given any advice yet. I asked a question about their ages to get a better understanding of their mindset.

And no advice is really going to sway a person one way or another, in my opinion. When it comes to this decision, people basically do WTF they want. Much like in medicine and healthcare!

Early 30s. She is also somewhat concerned about maternal age & fertility risks if we wait much longer. I’m quite ignorant to how valid those concerns really are at her age, so I’m not sure how to address that.

Well, then go for it! Many folks are having kids in training (hell, I had mine in medical school . . .but I'm also a male, with a stay at home wife, and an active-duty Navy salary). Fly in your favorite grandparent to help out, or figure it out otherwise, it can be done.

 

[VA Hopeful Dr]

To be fair, I hadn't really given any advice yet. I asked a question about their ages to get a better understanding of their mindset.

Really?

How old are you guys? If you're in your early 30s, I'd say wait until you're both done with training and settled somewhere. If you're in your early 40s, then I can understand some sense of urgency.

 

[Raryn]

Was hoping anyone with similar experience could chime in. I"m a PGY-4 surgical resident, wife is an urban academic EM attending. We're hoping start having kids soon and are trying to get finances/child care sorted out. We are both unsure of how much needs to be set aside (both upfront and ongoing) for this process. We have no family in the area to help with child care and she commutes 45-90min each way to work, 14-18 shifts per month. My current surgical schedule unfortunately makes me pretty useless, and with my fellowship path this will continue for several more years. This means we will need to rely pretty heavily on daycare/nanny etc. How much of our salary can we reasonably expect to devote to this? I understand this will vary by location. I had initially thought of devoting my entire resident salary (minus loans) to child care and then putting her salary toward our other expenses as needed. Despite our combined income being near the top 5%, she's very concerned that we won't have enough as our anticipated child care costs will also be much much higher than the average non-physician couple with one parent who can stay home and who also has family around to help. I think hearing the real world experience of others in this situation would be helpful, thanks in advance.

With regards to cost:

As as attending+resident, you'll be able to afford it, though the specifics is going to depend on where you live.We had our first baby when my wife was in residency in a medium cost-of-living US city. My wife's program let her have 12 weeks maternity leave, of which she took 11 (since taking all of it would have meant she had no vacation time). My baby started daycare at 11 weeks. That ended up costing us right around $1000/month for a daycare where the kid was there from 7a-6p.

If you look it up, $1000/month is around the nationwide average for daycare, but that includes a lot of cheaper areas. We've since moved to a much higher COL area and are paying $2000/month for a very nice daycare (and it's now 830a-6p, but that's because my schedule is lighter). Could probably have found things $100-200 cheaper, but not by much unless it was quite far from where we live.

But you have a bigger problem than cost: Scheduling. The above worked for us because I have a M-F clinic schedule without call - so if my wife was on nights or on a 24-hour shift, I'd be able to take care of the baby. Obviously your own surgical residency schedule is totally wackadoodle, but your wife is in EM. Even in an academic setting, as far as I know people in EM still have to work periodic nights and weekends. What's going to happen when you both end up working on a Sunday? Or overnight? There's no daycare that's open at 3am on a Tuesday.

So while daycare is the *cheaper* option, it's likely going to be unworkable at least part of the time due to scheduling issues if your wife's shifts coincide with yours. If her group is flexible, then maybe you could pull it off, but you need to be pretty sure of that.

So where does that leave you? Well, nannies. But given the very variable schedule of needs, you might have trouble covering everything with just one. It sounds like your wife works 3-4 shifts a week and has an ungodly commute on top - lets pretend they're 8 hour shifts plus 2 hours of commuting (and she gets out on time) - that's going to be at least a solid 40 hours on weeks where your wife's shifts all overlap your work schedule. Average nanny nationwide makes just over $15/hr, so that's around $30k a year, but there's taxes and things that will bring that up to at least $35k. And you probably won't be able to get a nanny with a schedule like that making just $15/hr - not to mention you might not want the cheapest option. But even if you're double that, a two physician household where one is an attending can definitely afford it. Even if you have to hire two separate nannies and coordinate schedules between them.

One thing you may want to look into is au-pairs, which some of my colleagues have had good luck with. They're live-in nannies that are somewhat of a cultural exchange program with other countries, and you can ask them to work nights and weekends or anything else as long as you don't exceed 45 hrs/week. Total cost is around $20k plus you have to provide them a room to stay in, food to eat, and some form of transportation - but you get a fair bit of flexibility from there.

 

[DrMetal]

Really?

Touché. I guess that is advice. And it's pretty good advice, coming from a man who's seen many marriages fall apart in medicine. (Not mine though, it's a joy to be married to me.)

 

[gutonc]

With your intense and her somewhat random schedule (with a long commute), daycare is pretty much a a non-starter.

So you’re down to a nanny or an au pair (if those still exist in pandemic world). If you have room in your house for an au pair, that’s the route I’d suggest. Cost is variable of course, but probably in the $1500-2500/month range depending on the organization you use and the location. But you have much more flexibility with an au pair than a nanny (assuming you’re doing it all aboveboard) which is what you really need.

 

[DrMetal]

With your intense and her somewhat random schedule (with a long commute), daycare is pretty much a a non-starter.

So you’re down to a nanny or an au pair (if those still exist in pandemic world). If you have room in your house for an au pair, that’s the route I’d suggest. Cost is variable of course, but probably in the $1500-2500/month range depending on the organization you use and the location. But you have much more flexibility with an au pair than a nanny (assuming you’re doing it all aboveboard) which is what you really need.

Not to mention the strain you'll bring down on your marriage during those first 2-3 years, and the guilt you'll feel for missing the first 2-3 years of your kid's life (it's a guilt I bear).

OP: If you're close to both being attendings in 1-2 years, I'd elect to wait. It'll be less stressful for all of you and more enjoyable. Fertility issues? I dunno, that's hard to predict.

 

[Franzd'Epinay]

OP, I agree with the others that given your personal circumstances, a nanny is the way to go.

I would be very selective if you're going with an au pair, especially when the kids are infants. I've never used an au pair, but I met a fair number of them while traveling abroad when I was younger. They were overall lovely people, but they were like me--young kids who just wanted to see the world. Them being an au pair does not in any way guarantee that they are good with kids, that they have experience with kids, or that they even like kids. That coupled with the extra responsibilities you owe them (housing them, feeding them, etc.) always made me shy away from even looking into the process. I have met many people that have had great experiences while using au pairs, but they have always had older kids (4 and up).

 

[gutonc]

Not to mention the strain you'll bring down on your marriage during those first 2-3 years, and the guilt you'll feel for missing the first 2-3 years of your kid's life (it's a guilt I bear).

OP: If you're close to both being attendings in 1-2 years, I'd elect to wait. It'll be less stressful for all of you and more enjoyable. Fertility issues? I dunno, that's hard to predict.

You must be fun at parties.

 

[Crayola227]

With regards to cost:

As as attending+resident, you'll be able to afford it, though the specifics is going to depend on where you live.We had our first baby when my wife was in residency in a medium cost-of-living US city. My wife's program let her have 12 weeks maternity leave, of which she took 11 (since taking all of it would have meant she had no vacation time). My baby started daycare at 11 weeks. That ended up costing us right around $1000/month for a daycare where the kid was there from 7a-6p.

If you look it up, $1000/month is around the nationwide average for daycare, but that includes a lot of cheaper areas. We've since moved to a much higher COL area and are paying $2000/month for a very nice daycare (and it's now 830a-6p, but that's because my schedule is lighter). Could probably have found things $100-200 cheaper, but not by much unless it was quite far from where we live.

But you have a bigger problem than cost: Scheduling. The above worked for us because I have a M-F clinic schedule without call - so if my wife was on nights or on a 24-hour shift, I'd be able to take care of the baby. Obviously your own surgical residency schedule is totally wackadoodle, but your wife is in EM. Even in an academic setting, as far as I know people in EM still have to work periodic nights and weekends. What's going to happen when you both end up working on a Sunday? Or overnight? There's no daycare that's open at 3am on a Tuesday.

So while daycare is the *cheaper* option, it's likely going to be unworkable at least part of the time due to scheduling issues if your wife's shifts coincide with yours. If her group is flexible, then maybe you could pull it off, but you need to be pretty sure of that.

So where does that leave you? Well, nannies. But given the very variable schedule of needs, you might have trouble covering everything with just one. It sounds like your wife works 3-4 shifts a week and has an ungodly commute on top - lets pretend they're 8 hour shifts plus 2 hours of commuting (and she gets out on time) - that's going to be at least a solid 40 hours on weeks where your wife's shifts all overlap your work schedule. Average nanny nationwide makes just over $15/hr, so that's around $30k a year, but there's taxes and things that will bring that up to at least $35k. And you probably won't be able to get a nanny with a schedule like that making just $15/hr - not to mention you might not want the cheapest option. But even if you're double that, a two physician household where one is an attending can definitely afford it. Even if you have to hire two separate nannies and coordinate schedules between them.

One thing you may want to look into is au-pairs, which some of my colleagues have had good luck with. They're live-in nannies that are somewhat of a cultural exchange program with other countries, and you can ask them to work nights and weekends or anything else as long as you don't exceed 45 hrs/week. Total cost is around $20k plus you have to provide them a room to stay in, food to eat, and some form of transportation - but you get a fair bit of flexibility from there.

One of my relatives' situation was one EM resident and one EM attending, and they have done an au pair from the start with 2 young boys. It seems ideal. One was from Peru and another from Europe. They were amazing.

However it was closer to $50K a year, and this was years ago.

The program they had at least, the au pair only serves for a year or two at a time. Many use the time to save up money for educational pursuits and improve their English.

 

[Crayola227]

Not to mention the strain you'll bring down on your marriage during those first 2-3 years, and the guilt you'll feel for missing the first 2-3 years of your kid's life (it's a guilt I bear).

OP: If you're close to both being attendings in 1-2 years, I'd elect to wait. It'll be less stressful for all of you and more enjoyable. Fertility issues? I dunno, that's hard to predict.

Infertility also takes a large toll on many marriages. Some don't survive it.

This is often true (not surviving or a large toll) even when a couple struggling with infertility do end up having the children they want, whether by assistive reproductive technologies or adoption.

The toll can leave deep scars on a marriage, issues that can linger for years or never fully resolve.

I don't mean to make it sound like doom and gloom, couples also come through it well, strong, make peace with not having any kids, bio kids, or a smaller family, but even the ones with what they consider a happy ending often still tell you it came at a significant struggle.

No offense but when it comes to time and fertility, men and women seem to often feel very differently. And it is different.

Too often we tell people not to endure the struggle of childbearing and career, but it has to be weighed against the possible struggle of infertility, a struggle that doesn't always have a happy ending, even assuming one succeeds in having kids that way! People have a very unrealistic view of both the odds of success, and even what succeeding can mean for a family.

Also, if your choice is to spend money on childcare or infertility treatments.... both are quite expensive but I have a feeling which parents prefer spending on. It's a different kind of stress, daycare arrangements vs fertility treatments, the stress of not knowing, and the treatments themselves can be very uncomfortable.

 

[qwerty89]

The voices of women physicians with infertility

If you're a physician suffering from infertility and want someone to talk to, please let me know. You are not alone.

www.kevinmd.com

“I work outpatient family medicine. I’m expected to give 90 days’ notice for more than two consecutive days off and 30 days’ notice for one day off. Often impossible to do and resulted in a write-up in my annual review for ‘unplanned absences.'”

That's terrible. I'm in radiology and I haven't even put in my Q1 2022 vacation requests for my 2 weeks of vacation per quarter. One of the downsides of being patient facing I guess.

 

[VA Hopeful Dr]

The voices of women physicians with infertility

If you're a physician suffering from infertility and want someone to talk to, please let me know. You are not alone.

www.kevinmd.com

“I work outpatient family medicine. I’m expected to give 90 days’ notice for more than two consecutive days off and 30 days’ notice for one day off. Often impossible to do and resulted in a write-up in my annual review for ‘unplanned absences.'”

That's terrible. I'm in radiology and I haven't even put in my Q1 2022 vacation requests for my 2 weeks of vacation per quarter. One of the downsides of being patient facing I guess.

I'm outpatient FM and that's not even close to universal.

 

[DrMetal]

Infertility also takes a large toll on many marriages. Some don't survive it.

Oh I don't doubt it. But if you've already waited until age 31, would there be that great of a difference (with respect to infertility) at age 32.5, or 33? I'm no expert on the matter . . my REI friends say they never make any predictions in their business. If the OP and his wife could wait 18 months, get settled in a new city, perhaps closer to home, maybe utilize a grandparent instead of a 'au pair' (jesus, I had no idea these existed), wouldn't that be better?

There's no hard advice here to give . . .it can all be done in many ways. Again, I had mine in medical school, probably the worst time to have kids. They're teenagers now, all they remember of me during their young years is me studying!

 

[VA Hopeful Dr]

Oh I don't doubt it. But if you've already waited until age 31, would there be that great of a difference (with respect to infertility) at age 32.5, or 33? I'm no expert on the matter . . my REI friends say they never make any predictions in their business. If the OP and his wife could wait 18 months, get settled in a new city, perhaps closer to home, maybe utilize a grandparent instead of a 'au pair' (jesus, I had no idea these existed), wouldn't that be better?

There's no hard advice here to give . . .it can all be done in many ways. Again, I had mine in medical school, probably the worst time to have kids. They're teenagers now, all they remember of me during their young years is me studying!

Figure 3: Age-specific fertility rates for the five calendar years...

Download scientific diagram | Age-specific fertility rates for the five calendar years preceding the survey, Cambodia 2010 DHS (computation using tfr2) from publication: A Stata module for computing fertility rates and TFRs from birth histories: tfr2 | Background: Since the 1970s, birth history...

www.researchgate.net

 

[mvenus929]

I'm outpatient FM and that's not even close to universal.

I'm not FM, but we're expected to give 9 weeks notice for time off impacting clinic days (we don't have clinic every day) so as to minimally impact patient scheduling. We also recognize that things come up and have a backup system in place and sometimes patients are canceled day of, but trying to figure out when those patient will be seen again in follow-up gets more complicated the heavier your clinical schedule is.

 

[Raryn]

One of my relatives' situation was one EM resident and one EM attending, and they have done an au pair from the start with 2 young boys. It seems ideal. One was from Peru and another from Europe. They were amazing.

However it was closer to $50K a year, and this was years ago.

The program they had at least, the au pair only serves for a year or two at a time. Many use the time to save up money for educational pursuits and improve their English.

Perhaps you're thinking of all-in costs, because it's definitely not $50k in payment - these things are standardized by agencies, and you pay the Au Pair something like $200/week plus you pay the agency ~$10k, which comes out to about $20k total for the year. But on top of that you must provide them room, board, and transportation - so if you add those in it might be $50k or so, particularly if you provide them with a car.

And yes, it's a maximum of 2 years and you're required to provide them time to take a college class or two, but it's still fairly flexible.

 

[VA Hopeful Dr]

I'm not FM, but we're expected to give 9 weeks notice for time off impacting clinic days (we don't have clinic every day) so as to minimally impact patient scheduling. We also recognize that things come up and have a backup system in place and sometimes patients are canceled day of, but trying to figure out when those patient will be seen again in follow-up gets more complicated the heavier your clinical schedule is.

You need a new job. I try to give as much notice as possible (usually >6M for planned trips) but if I can't then I still get the days off I need. Just text the office manager and it gets done.

 

[RangerBob]

I’d probably recommend the au pair/live in nanny route too to preserve both your sanity. Transport to/from daycare, finding sick care, finding coverage when they’re closed is all a lain. Plus if your wife is EM and you’re a surgeon, you’re likely going to need off-hours daycare.

I’m sure it’s expensive, but you just have to think of all these as a part of the cost of being a doctor and having a family. It’ll payoff in the end—if it allows both of you to work and keeps you two happily married, then it’s a win. And if you’re less stressed then your kid(s) will be happier to.

One of the perks of being a physician is we make a lot of money. And what’s the point of money if we’re not using it to increase our/our loved ones’ or others’ (charity) happiness and well being?

 

[GoSpursGo]

You need a new job. I try to give as much notice as possible (usually >6M for planned trips) but if I can't then I still get the days off I need. Just text the office manager and it gets done.

It's a little easier said than done for those of us like @mvenus929 who are in academic ped subspecialty--not exactly a ton of options out there for us

Back to the OP's questions, I believe they said they are fellowship-bound. So 18-24 month wait probably doesn't help much. And of course, the first few years of attending-hood isn't exactly a walk in the park either. The bottom line is it's always going to be a hit to one's pocketbook and sanity when you decide to have kids.

 

[Crayola227]

I’d probably recommend the au pair/live in nanny route too to preserve both your sanity. Transport to/from daycare, finding sick care, finding coverage when they’re closed is all a lain. Plus if your wife is EM and you’re a surgeon, you’re likely going to need off-hours daycare.

I’m sure it’s expensive, but you just have to think of all these as a part of the cost of being a doctor and having a family. It’ll payoff in the end—if it allows both of you to work and keeps you two happily married, then it’s a win. And if you’re less stressed then your kid(s) will be happier to.

One of the perks of being a physician is we make a lot of money. And what’s the point of money if we’re not using it to increase our/our loved ones’ or others’ (charity) happiness and well being?

Exactly. You might not get to have as nice of vacations, international getaways, may need a more modest house with a kitchen that needs a remodel, used cars, less eating out, maybe you have to work longer before paying off loans or retirement, but if you actually live like say blue collar working class people do but in a house big enough for an au pair, feed the kids some mac n cheese, the resident and attending salary together can usually afford the space and the live in au pair to make having kids and two careers possible.

Once both of you are full time attendings, you will be able to afford some upgrades, and eventually the kids will not need intensive daycare arrangements.

Way I look at it, the salary allows you to afford the flexibility of an au pair more than it does a lavish physician lifestyle.

It depends on how important kids are to you. If you're the types that would seriously consider eventually dropping like $60k on multiple rounds of IVF for a few years, honestly you're better off just trying to live poor now and put money to daycare and have kids the old fashioned way.

 

[Raryn]

It's a little easier said than done for those of us like @mvenus929 who are in academic ped subspecialty--not exactly a ton of options out there for us

Back to the OP's questions, I believe they said they are fellowship-bound. So 18-24 month wait probably doesn't help much. And of course, the first few years of attending-hood isn't exactly a walk in the park either. The bottom line is it's always going to be a hit to one's pocketbook and sanity when you decide to have kids.

There's no good time to have kids as a doctor.

Not as a med student, not as a resident, not as a fellow, not as a new attending, and not as an established attending. There's issues with education, training, coverage, and money with any of the options - just have to weigh them against each other. At some point you just have to bite the bullet and do it.

(I'll also point out this article from earlier this week about infertility in female physicians - The voices of women physicians with infertility )

 

[Crayola227]

I'm outpatient FM and that's not even close to universal.

I think the real point was quoting people directly to establish examples of to just what extent trying to schedule fertility treatments can be an exercise in last minute challenges and unknowns, and how difficult that can be for various types of physicians and their specific practices. I think no matter what our individual practice is we can all understand that on average it would be challenge for most.

 

[VA Hopeful Dr]

I think the real point was quoting people directly to establish examples of to just what extent trying to schedule fertility treatments can be an exercise in last minute challenges and unknowns, and how difficult that can be for various types of physicians and their specific practices. I think no matter what our individual practice is we can all understand that on average it would be challenge for most.

Oh absolutely. When my wife and I were getting ready to go to NJ for our 2nd round of IVF I asked my job at the time for the 8 days off I needed for the trip. They refused.

I told them I was going and they could fire me if they wanted.

They did not (though looking back that job was so bad I kinda wish they had).

 

[mvenus929]

You need a new job. I try to give as much notice as possible (usually >6M for planned trips) but if I can't then I still get the days off I need. Just text the office manager and it gets done.

Actually, my job is incredibly supportive. When I broke my ankle, there wasn't even discussion about how to reschedule my patients, people just stepped up and took care of them. When my colleague got called for a spur of the moment adoption, he was able to take 12 weeks of paternity leave with about 3 days notice. Kids get sick and people need to take time off--those aren't necessarily included in the 9 week rule, but if you know you're going to need time off ('elective' time off requests), you're expected to give 9 weeks notice bc patients have to be rescheduled and some people take time off to be able to travel to see us. It's not fair to them to reschedule two days in advance bc you decided you wanted to go on a weekend trip and wanted to take Friday afternoon off.

 

[VA Hopeful Dr]

Actually, my job is incredibly supportive. When I broke my ankle, there wasn't even discussion about how to reschedule my patients, people just stepped up and took care of them. When my colleague got called for a spur of the moment adoption, he was able to take 12 weeks of paternity leave with about 3 days notice. Kids get sick and people need to take time off--those aren't necessarily included in the 9 week rule, but if you know you're going to need time off ('elective' time off requests), you're expected to give 9 weeks notice bc patients have to be rescheduled and some people take time off to be able to travel to see us. It's not fair to them to reschedule two days in advance bc you decided you wanted to go on a weekend trip and wanted to take Friday afternoon off.

Okay that sounds much more reasonable.

 

[Dr.LeoSpaceman]

Was hoping anyone with similar experience could chime in. I"m a PGY-4 surgical resident, wife is an urban academic EM attending. We're hoping start having kids soon and are trying to get finances/child care sorted out. We are both unsure of how much needs to be set aside (both upfront and ongoing) for this process. We have no family in the area to help with child care and she commutes 45-90min each way to work, 14-18 shifts per month. My current surgical schedule unfortunately makes me pretty useless, and with my fellowship path this will continue for several more years. This means we will need to rely pretty heavily on daycare/nanny etc. How much of our salary can we reasonably expect to devote to this? I understand this will vary by location. I had initially thought of devoting my entire resident salary (minus loans) to child care and then putting her salary toward our other expenses as needed. Despite our combined income being near the top 5%, she's very concerned that we won't have enough as our anticipated child care costs will also be much much higher than the average non-physician couple with one parent who can stay home and who also has family around to help. I think hearing the real world experience of others in this situation would be helpful, thanks in advance.

There is no "good" time. Wait two years, and there will be a whole different set of considerations that aren't necessarily "easier". But you'll be 2 years older.

Our first kid came when I was a PGY4 surgery resident. Second when I was a second year fellow. In the end, timing has worked out well. My schedule sucked for the first couple years, but now that I'm attending I'm around at the point where my oldest actually knows what's going on.

Monetarily, you can make it work. My wife had a job that paid much less than an EM attending, and it was "fine" with one in daycare. Yes, we had to budget, but it wasn't unmanageable.

I had friends that had kids around the same time, one who had a wife who was also an attending. They did have a nanny, but they also had a lot more financial flexibility.

 

[mistafab]

I came in to say pretty much the same thing as @Dr.LeoSpaceman

There is never a perfect time. You can afford it if you need to.