Hello all,

After scoping out the site for a while (hadn't visited since med school), I decided to post about what has become an ongoing concern for me.

Just a brief bit of introduction, I'm a traditional graduate, almost 1 year out of residency, and happily married. My husband and I are looking toward having and parenting a biological child (preferably before I hit my mid-thirties), which places us squarely in the "planning" stage. (Friends are having babies, though, and my clock has begun to tick in earnest.)

Here's the issue: I work in hospital medicine, with the kind of intensity and difficult (predictable, but anternating days/nights) scheduling that is typical. My husband has considered SAHD status, but we don't have any model for that in our personal sphere. I also have considered a stint of SAHM, but I don't know how long I would be happy at home and my husband maintains that that would be a net loss, as my earning power is greater than his in a non-medical field.

Has anyone tried to combine a hospitalist with pregnancy and infant/child-rearing? I am having a hard time visualizing how these 8-12 hour days will mesh with full-time parenthood.

Thanks in advance!

Hi 1MDforpeace -

Didn't respond at first since I'm still just in med school, far from attending status! But, since noone with a closer match has commented yet, I thought I'd at least share my thoughts.

I was pregnant during my 3rd year medical school rotations, which included long-hour Q4-call rotations as well as some easier ones. It was a little tiring, and I definitely relied on my husband being able to come through doing almost all housework during the tougher parts, but all in all it worked out pretty well for us. Everyone's pregnancy is different, of course, so it's good to know that if you HAD to, say, be on bedrest for 3 months, you wouldn't starve... but it seems like it works fine with hospitalist schedules the significant majority of the time.

Once the baby is born... it's another game. I had one month of actual, paid maternity leave, and then two months where I got to work flexible hours from home (which turned out to be a lot better than going back at that point, but far less idyllic than I'd pictured it in advance - I wish I'd just gotten a full 3 months of focus-on-baby time!). At the 3 month mark... I found I was excited to get back to some of my outside interests (like, medicine!)... but it was HARD to leave my baby for even the 60% time status I negotiated for the first month back. Then at 4 months, I was onto 12 hours days (but no weekends & no call, thankfully)... and, to be frank, I was miserable. I actually really liked what I was doing that month, but it was SO MUCH HARDER to be gone those long days than I'd expected. The older my baby got, the easier it got (or the more used to it I got?), but it still really helped me to at least have lighter periods mixed in. Honestly, I think if I'd gone back to what I understand to be normal hospitalist hours straight away at that point, and then continued on without breaks to reconnect a bit more, I would have been really unhappy. On the other hand, lots of people do it....

Looking back, if I had full freedom to set things up the way I'd like? Take 4 months off completely, although start going back to conferences and meetings and such some during that 4th month. Then start back at ~1/3 time for 2 months, and then 1/2-2/3 time for the rest of the year (or possibly longer). But, at the same time, given the constraints I had (I wanted to graduate so I could move back near family... and, honestly, I love my career, and think that it matters, so it has some priority in my decision making, too...)... I think I would do it the same way again.

Anyways, this probably doesn't add a huge amount to what you'd seen in other forums, & I'm sorry I'm not in a place to really give you quite the info you'd like to hear, but... these are my closest-to thoughts!

I think you could do it...especially if you have a little more "down" time in between shifts. Flexibility is key in parenting. IT will certainly be nice if there is someone at home providing a stable schedule for junior, either a SAHD or just a hubby with regular hours and free evenings. I have 4 kids, produced at various stages in my training, and I still work full time, but in an outpatient clinic. For a hospitalist, I think it would be best if you could negotiate working only days for a while when you go back, and I think 10 weeks of leave is a must if you can swing it. If you are planning to breastfeed, you will need to consider how that will fit in-- ie: will you have breaks every few hours to pump, or do you run around nonstop for 12 hours? Good luck and enjoy it!

I am a hospitalist. I work full time in an academic center. I had my first child my last year of residency and just had my second child during my second year as an attending. So I currently have a 2.5 year old and a 2.5 month old. As a hospitalist, I typically work 7 day stretches and average 12 days on service a month. My schedule is not predictable. When on service, I am at the hospital for 9-13 hours a day and available by phone 24/7. I do not spend nights at the hospital, but when on service I receive 0-5+ calls a night. My days are generally very busy at the hospital. When I'm off service it usually takes me at least a half day to finish up paperwork and tie lose ends. I also do other administrative and teaching duties which can take anywhere from 3-9 hours per week when off service. Hopefully, that gives you a flavor of where I am coming from as hospitalist work can really vary.

With both of my children, I have had healthy pregnancies. Towards the end, it is really tiring to work on your feet for such long days, but you just do it. With my first child I had 9 weeks of maternity leave and my husband then took paternity leave. Our daughter was briefly taken care of by a family friend until my husband finished out his year as a teacher. Once we had both taken care of our child and experienced being a parent, it was clear to us that we wanted our daughter to have one of us as her caregiver the majority of the time. We discussed options including both of us working part time or my husband working full time and me working part time, but the numbers and practicality seemed to make him being the stay at home parent the most obvious choice. I make about 3 times what he makes as a teacher. It also seemed that it would be much easier to work around one person's work schedule rather than two work schedules and also probably need to depend on outside childcare. My biggest concerns with him being the stay at home parent were 1) him not being fulfilled or not liking it, 2) me not feeling like I was getting to see my kids enough or spend enough time with them.

I will say it is hard to be away from them as much as I am at times. By day 5 we are all ready for my work week to be over. They are usually really missing me. However, it has been wonderful to have my husband so involved in their lives. It is also very nice not to have to take kids to daycare, pick them up, or worry about how our children are being cared for. I breastfed my first child until she was 23 months and am currently breastfeeding my second child. Pumping isn't fun, but I'm happy to provide them with breast milk. It is hard to fit pumping in to crazy days at work, but I just make time for it even if it means I'm at the hospital a little longer. I don't have to work nights at the hospital, but my nights are disturbed by calls at home. I did work some nights as a resident with my first child, and I am glad not to be away at night now. I really like to be there for bedtime. I have considered taking a different job with nights though, so it may be a part of my life with kids at some point (just to say I would consider doing it). The toughest nights for me are when I alternate between caring for my infant and taking calls from work. There are definitely nights where I barely get sleep between the two. That's probably an advantage to being in the hospital for shifts and not taking call from home.

For our family, I believe this is the best arrangement. My kids are really close to their father and me. Another perk I hadn't anticipated to him staying at home is all of us being able to be together as a family, when I'm not working. I will say that it is sometimes hard to carve out time to focus on work when I'm not on service, since I really just want to spend all my time with my kids. It is part of my job and part of promotion, so I make time for it. It's just hard to do. The academic center I work at is family friendly. It's also nice to work from home and be able to breastfeed or take a break and play. I wouldn't have that benefit, if my kids were in daycare. Figuring out the work and personal life balance is an ongoing process.

I really enjoy my clinical work and teaching. I think doing a job you like/love will help balance the difficult aspects of being a hospitalist and parent. Most people change jobs during their career. I am open to doing outpatient or private practice, if that's what I want for my career or need for my family life. I have heard that hospitalist work is actually more difficult once your children are school aged. Right now any time I'm off I can see them. I can see how it will be harder to juggle school events and activities with my untraditional schedule as they get older. Once our kids are in school, my husband will probably work full time and I may work 3/4 or part time.

I hope this helps. If there are any other questions you have or things I didn't address that you are curious about, please let me know here or send me a message. I wish you the best.

I agree, that once they are school aged it actually becomes harder to work long days! There is after school care of course, but there is also homework and projects and many evening activities (sports, band concerts, other school or social events). Whereas when they are babies or preschoolers, there is full day care available then you are able to go home together and enjoy your evenings at home (assuming you don't have to work, that is!) I am not a hospitalist currently although I have worked as one in the past. Currently I work part time in a large private practice (outpatient) and am able to work half days so I can be home during the after school hours. My husband makes more than I do so him cutting back at work or staying home was never really something we discussed. I feel fortunate to have flexibility in my career so I am able to be home with my family when I need to be. Best of luck!

I wholeheatedly agree that the hours they need you are different when they are school aged! I feel like my little ones need me in the mornings and the older one needs me from 3pm on! I need to work like 11-3 every day LOL...

Docmom, if you find that job give them my name.

Actually the best job share arrangement would probably be a mom of school aged kids (work in the mornings) and mom of babies or toddlers (work in the afternoon, when they are napping!) I remember when mine were little, the mornings when they were rested and playful were the best hours of the day.

Thanks to everyone, especially AmmaMD and mohm for the input.

I think what has me so uneasy is that no *woman* in my group has/wants kids.

My take-home, I guess, is that it's do-able with a little extra flexibility and a bit of luck (healthy pregnancy, amiable colleagues/boss, average-needs baby and kid).

momd, your situation closely parallels mine (i.e. husband is a teacher, long hours when at work) and your concerns from the trenches are exactly my own ("what if my husband's not happy or feels frustrated as a SAHD", "what if I don't feel like I'm doing enough as a parent"). I can't thank you enough for laying out how parenting early in your career as a hospitalist and how a stay-at-home father arrangement has worked for your family. As things progress, I may have more questions for you; please feel free to PM me.

As hospital medicine becomes even more commonplace and, like all areas of medicine, integrates increasing numbers of female physicians, hopefully the answer to this puzzle will become clearer. I prefer the practice of inpatient medicine and feel that it is a necessary correlate to good outpatient care. I don't feel that I should have to choose between practicing medicine in my desired field and raising a family. We'll see how much my colleagues are willing/able to concede (I liked AmmaMD's suggestion about the graduated start-back after maternity leave) once the time comes.

1MD-I did a graduated start back after having all three of my children. I added in what I felt my colleagues needed most-in our case, OB call and coverage-they covered me while I was on leave and I was more than happy to come back just for acll a few weeks before my leave was officially up, then added in office hours gradually over a month or two. It worked great b/c to the partners, I 'was back' but it was a much easier transition for me and the kiddos....

I just want to add a plug for hospital medicine. I recently made the switch from office practice with inpatient peds and delivery attendance to pediatric hospitalist medicine. I feel like a huge weight has been lifted off my shoulders. Due to staffing issues we are only covering nights right now - will be 24/7 by summer - but it is working great for me. I work two 12 hour shifts per week (and do an additional 12 administrative) I have four kids age 10 down to 1 year, my husband is a full-time FP, and admittedly we hit the babysitter jackpot, but I don't really have extended family support around. The nights can occasionally be rough and it takes me longer to recover now than it did when I was younger (if I am up all night long) but I have so much more time at home now. I am able to make dinner at dinner time (instead of in the morning before work (crockpot) or the night before, or on the weekend before, or rushing to do it when I got home from work - stressful!). I have been able to go to all three of my school-aged kids schools here and there to pitch in. I am semi-caught up with laundry - 4 kids! no such thing as really caught up! I too preferred hospital medicine to the office (all along) so I think that's where some of the relief is coming from. I made the change after 9 years so even if your first choice doesn't work - you can do something else!