Thursday, April 16, 2015

MiM Mail: Having children with both parents in training

Hi Mothers in Medicine,

I am a longtime reader of the MIM blog, and really appreciate being able to read your stories. You are inspiring! I am writing to request advice, especially from those who had children during medical training with a medical spouse (or spouse with a very demanding career).

I am nearing the end of my 1st year of med school, and my husband is a resident in a surgical subspecialty, with 4 more years to go. We would love to have a large family (4-5 kids), and are a bit older than the average med student/resident so waiting to have kids until after training isn’t realistic. We are ready to start our family, but I am a little nervous about being the primary caregiver (with outside help) as a medical student. I know that my husband will make a wonderful father, but given his 80 hr weeks at the hospital he won’t be able to contribute as much time-wise. Having kids is super important to us, and some days I question whether medicine was the right choice for me, but I am doing well academically and I think I am on the right path.

Our tentative plan (acknowledging things don’t always go as planned!) is as follows, and I would love to hear your thoughts about pros/cons, other ideas and tips on how to make it work! We are considering aiming for baby #1 at the end of 3rd year. I would like to take a semester of maternity leave, then complete my year of elective rotations (daycare or a visiting Grandma for childcare), have baby #2 and take another semester off for maternity leave before starting residency. Has anyone tried to/ succeeding in taking 2 separate semesters off rather than a year at once for maternity leave? Is completing 80% of my clinical rotations while pregnant realistic? Any advice about the timing of clinical rotations? I hesitate to talk to my school’s administration, when did you approach them? Is starting residency with a 2 yr and 6 mo doable? Is it really possible to do a “part-time” residency? How difficult is it to take the full 12 wks of FMLA for maternity leave during residency? Am I crazy for thinking that this sounds like a reasonable plan? Have you been through something similar and barely survived, or were you able to thrive? Any advice would be greatly appreciated!



  1. You *might* be able to have 2 kids during medical school and only extend by 1 year if you have unlimited financial resources for childcare and/or ample family help. Being pregnant during 3rd year is very very hard though not impossible if the pregnancy is low risk. Your hours won't be regular during your electives and you need to shine to get letters for residency so you'll need more than regular daycare hours for childcare (either grandma or a part time nanny/au pair in addition to full time day care).

    The next point I want to make might be unpopular but given that your partner is a resident in a surgical sub specialty and you're older than the average medical student, having 4-5 kids is probably not realistic without some serious career sacrifices on your part (possibly not even then). Unless you have a lot of family money and/or are s still fertile into your late 30s or early 40s the cost of having that many little kids during residency is very high (full time nanny+part time day care) and you may not have the $$ or flexibility to make it work during training. Part time residencies exist but are hard to find since you need someone to "share" with and you usually get paid 50% salary. You can take 12 weeks off in some residencies but it usually means resentment from colleagues and making up time at the end (ie finishing late).

  2. I think it depends on your career goals in terms of specialty and competitiveness. I'm a pediatrician and I really wanted to go to one of the best residency programs in the country. In my fourth year, I did two sub-I's, working at LEAST 80 hours/work in both, an audition rotation that required travel, and my med school required an ICU rotation, that also was at least 80 hours/work. I honestly worked much harder as a medical student than I did even during my intern year. I had my daughter when both my husband and I were in residency, when a 7-7 daycare and the ability to coordinate call schedules was enough childcare. We couldn't have done that during medical school.

    You also outline a very tight schedule. Babies don't necessarily do that. Meanwhile, starting residency July 1st and interviewing in the fall before that is really not mutable.

    Were I you, I would identify someone in your school administration that you think would be a good sympathetic ear, NOW and talk to them about what they can make work for you and how they advise you distribute your rotations.

  3. Thank you for your advice!


  4. If you are even halfway serious about 4-5 kids and all this, another thought is to get pregnant now … be totally on top of your studies, use board review resources as you go … so that you can have a baby next spring and still take Step 1 on time. I have a classmate who has done just that. … It's not realistic on you, your body or your relationship to have babies that close together. One at a time! And once you have a child you will understand so much better what you really want going forward. … Expanding 3rd year is generally frowned upon, but I have a friend who did in order to have baby #2 … there was no planning … that's just how it happened. In general babies and medical school, babies and residency are possible. I am a little worried about the number of babies and small amount of time you are considering … But all that may change. Just leave room for your plans to change and communicate well (including with your school, as was suggested). Talk to mom medical students and residents and get a better idea of how they did it. Good luck.

  5. I don't have as much experience as the previous posters, but I'm a pregnant 3rd year med student so can give you that perspective! I also don't plan on graduating late, which will help with some of your scheduling issues, but if you have 2 babies you are bound to run into some of the same things. I'm in my 30s and was paranoid I would have trouble conceiving so didn't want to wait to start a family. Turns out it wasn't an issue - but you really never know. My husband is an attorney - I consider that basically working like a resident. I'm due in September, so beginning of 4th year.

    In terms of clerkships being preggo...again everyone is different. I really liked getting some of the more demanding clerkships, like surgery, out of the way before I was pregnant. I had some lighter rotations during the 1st trimester, which helped because I was super tired and it was much less obvious if I had to run to the restroom quickly to puke. 2nd trimester - no problems at all. But the whole time you are having to leave a lot for doctor's appointments, which is pretty frowned upon.

    Some concerns I have that I will just have to take as they come:
    -Due to my schedule I can't rotate through my desired specialty until I'm 7 months pregnant, 2 months before residency applications are due. What if I don't like it? Hoping I can still work hard and continue to have a low risk pregnancy so I will be a desirable candidate.
    -Can only do 1 away - depending on your specialty this could be terrible for your application.
    -Taking Step 2 CK 2 1/2 weeks before my due date. Pretty sure this is crazy but my school has a hard deadline of Nov 30 and can't imagine taking it with a newborn. Also what if baby comes early? No idea....
    -Interviews! If you breastfeed this is a challenge. My mom is going to try to travel with me and the baby to help out at the closer interviews.

    In terms of talking to your school - I told mine at 13 weeks and didn't ask for advice from them beforehand. I don't think its any of their business and they have generally been unsupportive in terms of adjusting my schedule. My best resources for info have been med students at my school who have gone through this before.

    Best of luck to you!

  6. I don't have a ton of experience either but am also a pregnant 3rd year med student so have looked into these issues a fair amount. I agree with scheduling the hardest rotations first (surgery, OB), I did these and then got pregnant, luckily the exact month my husband and I were hoping for. I did the easier rotations in the first trimester (family, psych) which worked out since I felt SO NAUSEATED and SO EXHAUSTED and literally can't imagine doing a surgery rotation in that state. I'm due in 3 wks, at the beginning of 4th year for my school, and I will be able to take several months off over the summer and still graduate on time. Doing harder rotations (Medicine) has not been a problem at all in the 3rd trimester. My school has been very accommodating about scheduling my Sub-I's for 4th year the exact month I need them when I get back from maternity leave.

    As far as part-time residency: it is possible, but unfortunately not for intern year. Basically everywhere that offers part-time residency has it start your second year, and you still have a very grueling first year of likely avg 80 hour work weeks. My husband (also in medicine) and I are planning to get an au pair and ALSO do daycare for at least that year. Second issue- part time for most residency programs means one month on (super busy!) and one month off, alternating, not half-days or every other day or anything more convenient-sounding. To have a more consistently reasonable schedule it seems like one needs to just do a residency that comes with a friendlier full-time schedule- path, derm, pm&r etc.

    Good luck! I truly believe that family comes first and any family plans you might have are feasible- you just have to decide how flexible you are willing to be with timing, specialty, career goals etc.

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  8. I had my twins at the end of my third year, and I could not have hoped for my school to have been more supportive. I found out that I was pregnant in October and went to talk to the deans right away. They switched my 3rd year schedule around and pushed my graduation year back a year from 2015 to 2016, but told me that I didn't have to take the whole year off, I could do my 4th year rotations at any point that I wanted, essentially spreading my fourth year over two years instead of one. I was lucky to have a smooth pregnancy and go all the way to term. I finished my 3rd year at the end of May, took step 2 CK, and had my twins a week later. I then took the first 7 months completely off before doing my first 4th year elective, and since then have been going on and off. I could have taken a whole year off before jumping into 4th year with the class below me, or I could have powered through 4th year and had a whole year free before residency, or anything I'm between - they left it completely up to me. At this point, I have about 20 weeks of 4th year to complete on my own schedule before next May. I am sorry for all those mothers in medical school whose schools have been less than supportive. I hope it works out for you. I really don't see why taking two semesters off at different times should be a problem. Good luck!

  9. It's going to be HARD, no matter when you have kids. My husband and I had our son when we were both residents (I'm now an anesthesia attending, he's doing an interventional radiology fellowship) and our close friends who had babies during residency were anesthesia/radiology and anesthesia/surgery. It requires a lot of help and coordination. Our daycare is 6a-6p, but we also have two sets of retired grandparents within a 1 hour drive who help us if we are on call, working weekends, or working overnight. My aunt and our neighbors help us if we need last minute always need a back-up plan as childcare is not an excuse to miss work at our institution. We looked into a nanny initially, but with the hours we needed and overtime pay, it would have been more than one of our resident salaries. Our friends also do daycare and have grandparent help--they fly in to stay for a month during hard rotations or live close by. No matter how many hours you work or how demanding your specialty is, you will need a lot of help if both of you are in medicine....and it will be expensive if you don't have "free" family help.
    In anesthesiology residency, it is possible to go part-time or take time off (FMLA) for portions of your residency if your program is willing. However, you have to make every single day up by extending your residency! Other residencies have more lenient requirements for taking FMLA...several of my pediatrics friends who had babies were able to take an easy elective rotation that was mainly home study after maternity leave, thereby extending their time "off." And my neurosurgery friend took extra call during her pregnancy so that she could have 4 weeks off without extending her residency.
    Oh, and it doesn't get easier after training...despite being "less demanding specialties" (anesthesia/radiology), we still both work 60-70 hours per week...but now as an attending I have the financial means to hire a part-time nanny if I want.
    Not to be a downer, but keep in mind the stress that both residency and children can place on a marriage. In keeping with statistics, 50% of our friends who were married in med school or residency are divorced now at after residency...including those with and without children. It's hard to plan for everything so far in advance, as unexpected things like divorce or a sick child can happen. Just take it one pregnancy at a time.

  10. I had two children while both me and my husband were second and third years. I delived both boys over the Christmas holiday break just by chance! I had flexible babysitters and extra help when studying for step exams. I graduated but have not returned to residency. My husband continues and now works in the community in primary care. We now have 5 kids under 9. I wish I could have done something more like nursing so that I could have worked odd shifts to help support us during residency. Now that I don't work, we have both our med school loans to repay. Kinda sucks. But I would never trade work for being a full time mom. I wish you the best! Having having kids during school kinda helped put life in perspective. It does put starin in the marriage. We made it through but not without stress. I believe though, that children are the most precious gift God can give us.

  11. Hi, just to chime in, I had my son when I was half-way through residency. My husband was and still is a surgery resident...I finished several months ago. Having kids while in residency is doable; we *survived* but I definitely did not *thrive*. I posted a few times on this blog pretty much crying my brains out wanting to quit residency. It is so hard to go through residency with a child!!! I agree, they are amazing miraculous gifts and I would never change the joy my son gives me and I'm so thankful every day he chose me for his mommy.....but STILL! It's so hard!! Sometimes I think I should repeat residency because I was a zombie through my entire 2nd year when I was breastfeeding him and taking q3-q4 calls year round. I don't really have a ton of advice; I do hope it all works out the best for you.

    1. I meant "half way through INTERN year" I went basically my entire residency with my son.


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