Physician work-life balance: child care

The MomMD work-life balance survey addressed questions of child care, specifically, which parent was the primary child care provider and how working mothers covered child care while at work.

The question of schools and education is taken up in the next story.

 

With respect to child care responsibilities 41.5% of responders identified the mom as the primary care provider, and another 41.5% split care equally among both parents. Only 17% identified the partner as primary childcare provider (Figure 1).

Somewhat surprisingly, women who are physicians were more likely to be the primary childcare provider in the family than were women who are not physicians. The physician group includes both attending physicians and resident physicians, while the non-physician group includes all other professions, including physician-track students (Figure 2). One caveat is that the non-physician group is small, consisting of 56 responses whereas the physician group consisted of 115 responses.

The trend was clearer when comparing attending physicians to physicians in training. Attending physicians were more than twice as likely to be the primary child care provider than were resident physicians. This is consistent with substantial difference in physician work hours between attendings and residents: only 15% of attending physicians work more than 50 hours/week, whereas 74% of resident physicians work more than 50 hours/week. However, even when working 50 to 80 hours a week, more than 80% of resident physicians either shared child care responsibilities equally or were the primary childcare providers.

One possible confound is that the children of attending physicians are older than the children of residents or students. The survey results show that on average attendings have more children than residents and their children are older than the children of residents. To eliminate the effect of the age of children on parenting roles, we next considered only survey responses in which the oldest child in the family was 5 or younger. Even in this group, moms who are attendings were twice as likely to be the primary child care provider than were moms who are residents (Figure 3).

Day care vs. Nanny

For child care coverage during the day responses were tabulated for all careers. In this analysis responses of “school” for child care coverage were not included. Coverage varied by family income, with parents at the highest incomes relying most on nannies or babysitters to cover care, shifting to a combination of daycare and family/friends at lower incomes (Figure 4).

Speculation

These results suggest a few qualitative conclusions. First, residency, especially for women, is a family affair. The woman resident works a tremendous number of hours in the hospital and carries a substantial additional load in child care responsibilities. During the residency years the partner or husband plays a larger supporting role in taking on more child care responsibilities than they will after mom has completed her training. Residency programs would be well advised to ensure support is available for both their resident and her family members, who are helping to make the residency successful.

Second, despite the partial shift in child care responsibilities to the partner or dad, moms in residency are still carrying a substantial amount of the child care responsibilities. While data does not exist on child care responsibilities when the dad is a resident, it is very likely that dad residents spend less time caring for children that do mom residents. In constructing residency schedules and programs, the resident’s dual role as physician and parent should be considered.

Discussion

The numbers are interesting, but don't tell the whole story - we hope that you will! Please tell us how you balance home and work on the MomMD doctor's forum.

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