So, things have been so stressful for the last year. I started a child psych fellowship. That meant that I had to see my therapy patients after school (so there was no hope of getting home before 6pm), and I started taking call again (home call, but I typically don't leave the hospital until all of the kids go to bed). We also had a second child in November. DH's residency hasn't been getting any easier either, so he has been of minimal help at home. I frequently had to take my own babies to my parents house (2 hours away) or get someone to stay with us when I was on call.

So, I have decided that:

1) I am quitting my fellowship once I finish my inpatient rotations. I will take on more hours at two moonlighting jobs, amounting to about 15 hours a week. I will start looking for a more intellectually satisfying PT job after DH finishes his residency in July.

2) We are keeping our aupair because a) we like her, and b) we already paid the agency fee so it isn't any more expensive than hiring a sitter 20 hours a week.

3) We are also keeping our biweekly cleaning service. Because it is awesome.

So, very soon, I will be working part time with full-time live-in childcare. I am SO excited.

Oh Wow. You sound at peace with your decisions. I'm finishing up PGY5 psych child psych, so I'm very curious about how you arrived where you are. Feel free to ignore my post and bask in your PT work :-) To start, though, the 2 hours' drive time alone sounds overwhelming-- you've been doing a LOT.

Are you board eligible? Have you been moonlighting and doing fulltime fellowship and taking call? I'm curious whether you considered just taking leave and coming back after DH finishes (or transferring? yikes- - as I wrote that, I don't think I'd have the motivation to do THAT); or any part time fellowship options; or maybe you just decided the motivational energy to get up every day and leave your kids for this line of work just wasn't that great (in other words, child psych was not all you'd hoped it would be). We've thought about au pairs, but I don't really understand the limits -- why wasn't she able to watch the kids the nights you're on call?
Whatever your situation , however you got there, you sound pretty settled. Good luck.

Ohiomommd, thanks for responding. I have been thinking about a short version to answer a question that has taken me several months to figure out, and bottom line is that I miss my kids, I miss my husband, and I really want to spend more time being a mom and wife. I have been feeling this way for two years (since I went back from ML with my first), and I thought it would get better, but it just didn't. I don't think that coming to work and talking about parent-child relationships all day helps, but I don't think that is the extent of it.
I talked to my adult residency director, and I will be board eligible and have completed all of my adult training. It is a little bit of a problem with insurance right now (you have 3 years here and 1 year there? why?), but I should be able to get a completion certificate from my adult training program when I finish this year of child.
Our aupair work restrictions are 45 hours a week and no more than 10 hours a day. She has to have 1.5 days off every week, and she has to have off at least one weekend a month.
As far as PT residency options. I thought about it, talked with my RD about it, and I just don't think it would work for me. Mostly because I really want to work PT. I don't want to work 35 hours a week instead of 60. I want to work 15-20 hours a week. As far as taking a leave, I don't really see myself wanting to come back in 6 months, and I don't want to pretend I am going to. I also just don't think that my DH's job is going to be that much less stressful when he finishes residency. Especially his first year. I do think that I might come back and do the two years of child training (or maybe analytic training?) later in my life.

sorry for all of the sentence fragments

Good for you! A friend of mine just went back to do her pschi residency after taking off about 12 years with kids, she's tired, but happy with her decision and the kids are seeing a role model for a different way of becoming a momdoc.