Emergency Medicine is a 24/7 field and parenting is a 24/7 job. Integrating these roles poses a challenge with many potential solutions and no “one size fits all” answer. Understandably, what works for one family will often be sub-optimal for another. Whether an Emergency Physician (EP) depends on family, individualized household help or a formal childcare environment, the most important thing is to find a solution that works for you. Below is a discussion of some factors that might go into such a consideration:
Stay-at-home Spouse: Although traditionally, the stay at home spouse was presumed to be the mother, the “Mr. Mom” lifestyle has become popular in recent years. The advantages of a stay-at-home parent are obvious: Childcare is provided by a parent and with no additional financial cost to the family; hours of childcare are both flexible and virtually unlimited; and extraordinarily tight bonds are often developed between children and the primary caregiver. On the downside, there is an overall financial hit to the family with only one partner working outside the home; there may be some resentment or guilt between the parents, which often becomes more pronounced as the roles drift farther and farther from traditional gender and cultural expectations.
Organized Scheduling: Two working parents who organize their schedules around each other will be the most cost-effective of all the child-care options. This requires no additional out of pocket expense and protects both parents’ income streams and careers. It guarantees that all childcare is provided by a parent, which is ideal to a lot of people. Unfortunately, this option is often easier on paper than in reality. Flexibility in scheduling and the ability to capitalize on “non 9-5” shifts are crucial to this option being a possibility. The main disadvantage to this often emerges over time. When alternating between working and primary childcare, frequently the only time parents see each other is a “childcare sign off”. Parental communication and relationship prioritization is key to making this lifestyle work long term.
Extended Family: Using extended family as your primary source of childcare may feel like the next best thing to a parent. If both parents work full-time, knowing your baby is with grandma can often assuage the anxiety of not being there yourself. Clearly this option is only viable if you have a family member (usually a retired parent, but possibly an aunt or cousin) who is both agile enough to care for a child, geographically proximate and able to work around your schedule. While the advantages are clear: trustworthy caregiver, flexible hours and tight familial bonds; the disadvantages may not be as obvious. If grandma quits her job to take care of Junior, she functionally becomes your employee, which may mean providing her with health insurance or an hourly livable wage. Differences of opinions regarding discipline and scheduling or financial concerns can lead to family conflict. This is one of the circumstances where a clear parent-caregiver agreement at the outset is beneficial to all parties.
INDIVIDUALIZED HOUSEHOLD HELP: This section is devoted to the caregiver that is hired to take care of your child in your home.
Babysitter: A babysitter is like a “freelance” caregiver. They come to your house to provide childcare but you do not have a full time employment agreement with them. They can be viewed as “fill-in” childcare and often complement another source of care. The hourly costs for babysitting vary, with different “going rates” in different areas of the country. Babysitters frequently charge a higher hourly rate than their nanny counterparts since they do not have a full time salary guarantee and may be less likely to commit to regular household chores.
Nanny: A nanny is a regularly employed childcare provider who comes to your home. A “live out” nanny arrives at a set time and leaves 8 or 10 hours later. Nannies tend to work 40-50 hours a week and should be paid “on the books” with regular employment benefits and taxes. The advantages to a nanny are most apparent when children are young or household change occurs frequently. A great nanny keeps the house organized, food in the fridge and the laundry washed. A nanny who takes wonderful loving care of your child while still facilitating strong parental-child bond is important in this childcare arrangement. Many EPs develop extraordinary long-term employment relationships with nannies who can roll with the irregularity of our shift work. Nannies can “live-in” as well, providing a more flexible schedule to parents. Nanny care is often expensive and can become harder to justify as children start school or become more independent.
Au Pair: An au pair is a foreign exchange student who is matched with a host family for one year through a state department work visa program. The family agrees to provide room, board, stipend and “cultural exposure”. In exchange s/he works as a childcare provider. It is a governmentally sponsered program so taxes and benefits are taken care of but there are strict work hour regulations. On the upside, these hours do not need to be consecutive and s/he can often work late into the evening or on the weekend without any “overtime costs”. The disadvantage is requiring orientation of a new, non-family member into your home each year.
FORMAL CHILDCARE ENVIRONMENT
Drop-off daycare center: Working parents all over the country depend on day care centers while they are earning a paycheck. Whether a small family-owned center or larger established setting, drop-off daycare centers are open from early in the morning until late evening and provide a safe, regulated, educational environment. These centers often have many children of varying ages allowing for socialization prior to school. The out of pocket costs will vary greatly (and may be pricier than expected) but can often be offset by tax advantages through a dependant care account or child-care tax deduction. Day care centers frequently have very strict rules for illness and little flexibility for extended hours, both of which can be prohibitive to EPs schedules. Some medical centers provide on-site childcare for employees but the hours, locations and services provided vary widely.
From our own personal experiences and the non-formalized research we did for this article, most academic EPs frequently create their own childcare solutions with a combination of options described. The best way to be truly successful and happy as a parent and partner and academic EP is to constantly re-evaluate what your true needs are and makes sure those needs are being met.
This piece was originally published in AWAEM Awareness April-May, 2014. Wendy Woolley, DO contributed significantly to this article.