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Parenthood and residency: the great balancing act

Planning can help make the most of programs' policies, but hard decisions remain

From the June 1997 ACP Observer, copyright © 1997 by the American College of Physicians.

By Christine Wiebe

Some people say the toughest job around is being a parent. Doctors might say being a resident runs a close second. Try filling both roles at the same time and, understandably, the experience can be overwhelming.

Grace Kimani, ACP Associate, for example, knows all too well the strains of juggling parenthood and residency. Dr. Kimani, a second-year resident at Georgia Baptist Medical Center in Atlanta, is the mother of a five-year-old daughter and a two-year-old son. She is also married to a physician.

illustration: Diane Teske Harris

When she gets a call to pick up her sick daughter from school, she pages her husband, a pulmonologist, to decide which of them should go. "It almost comes down to, 'Are you coding someone right now?' " she said.

Dr. Kimani represents a growing cadre of residents who are raising children during medical training. Although the current number of housestaff who double as parents is difficult to determine, a 1994 survey by the Association of American Medical Colleges (AAMC) found that 11% of female graduating medical school seniors and 16% of males had dependents other than spouses. A 1991 AAMC survey found that more than 20% of female residents gave birth during residency.

These trends are forcing training programs to address the needs of housestaff with children, according to medical education leaders. AAMC data indicate that while only about half of teaching hospitals had written policies for maternity and/or parental leave in 1989, by 1994 more than three-quarters had such policies.

Changes in how training programs treat the parents among them also stem from the federal Family Medical Leave Act, which requires employers of 50 or more workers to grant up to 12 weeks of unpaid leave each year to new fathers and mothers who have worked at least one year.

Finding 'quality time'

Despite these trends, experts say medicine could do better. Housestaff, who still struggle to combine residency and parenthood, say that in addition to a supportive spouse and top-notch day care, a flexible training program can make the difference between a good and bad parenting experience.

Cassidy Tsay, ACP Associate, for example, gave birth to a daughter in the middle of her internship at the University of California, Irvine. While she said that much of her pregnancy was a "blur" because she worked so much, Dr. Tsay said her program was very accommodating. To begin with, she got a total six weeks of paid time off, which included a month of vacation time. And when she returned to work, she was assigned to the emergency room for a month and had no overnight call. In addition, Dr. Tsay was able to take her baby to the day care center on the VA campus where she worked, which allowed her to visit during the day and take the baby home to her husband during her dinner break.

Dr. Tsay still had to work 10-hour days throughout the rest of her training—she is now a third-year internal medicine resident-and says she sometimes feels guilty about leaving her daughter, Katelyn, 2, in day care that long. "I feel like I'm not at home as much as I should be or need to be," Dr. Tsay admitted. And while she has had to sacrifice certain parts of her life-time alone with her husband or time to keep up with housework is rare—she tries hard to keep her work and home life separate to achieve "quality time" once she is home. "Once that lab coat is off, that's it," she said.

To keep her home life work-free, Dr. Tsay explained that her time at work must also be "quality time." She has quickly learned that women who seek special treatment because they are pregnant or have children at home can generate animosity among their peers. "But if you work hard while you're here, it's not a problem," Dr. Tsay said.

Of course, striking the right balance between work and home is not always easy. "Sometimes you get lost," Dr. Tsay said. At those times, her husband reminds her to keep things in perspective. "I wouldn't trade what I'm doing," she said. "A happy mom at work is a happy mom at home."

Overall, however, Dr. Tsay's foray into parenthood has been successful, so much so that she is not too concerned about the work and home complications of having another child. In fact, she was expecting her second child last month. "Life is too short to be scheduled," she said. Residents who wait for a perfect time to have children, she noted, "will find too many reasons not to do it."

Planning ahead

Residents who have had children during residency say you should inform your program as soon as you know a baby is on the way. That way schedule changes can be worked out well in advance, said Steve Kaufman, MD, a second-year resident at the University Hospital of Cleveland.

When his wife had their baby, Sam, in September, Dr. Kaufman took two weeks of paternity leave and two weeks of vacation. He had arranged to take an elective during the month the baby was due, in case his wife delivered early. He scheduled another elective, an ambulatory care rotation, and an emergency room rotation for when he returned to work. As a result, he had no overnight responsibilities for two and a half months after the baby arrived.

"It's fairly easy to arrange time off in our program, given enough notice," Dr. Kaufman explained. By the time he went back to work, he said, the baby's routine was established and he and his wife were able to make day care arrangements for when his wife returned to work part time.

The toughest part of his new life as a father are the nights he comes home exhausted from being on call and sees that his wife is exhausted, too. "You both hope the other will offer to take care of the baby," he admitted. Still, he said, life has not been too difficult thus far. "Stressful will be when I get called at three in the morning because Sam's got a fever."

To do it right, planning for a baby should really begin when medical students evaluate residency programs. At Dr. Kaufman's program, for instance, the floor team's night admissions are limited, and residents usually get a few hours of sleep even when they're on call. In addition, a few residents are always assigned to "jeopardy" duty, which means they can be called to cover for residents who have a family or other personal emergency. Experts note that larger programs are generally more flexible because they have more people available to cover for each other.

Complications

Not all transitions are as smooth as Dr. Kaufman's. When Yvette Crabtree, ACP Associate, began her third year of residency just eight weeks after having a baby, she felt distracted. "I was not ready to go back," she said. "I think there's no way anyone can be 100 percent right after having a child."

But Dr. Crabtree felt she could not take off any more time. She had been named chief resident for the following year at Baptist Hospital in Nashville and feared administrators would change their minds and give the position to someone else. In fact, administrators questioned whether she was motivated enough to assume chief resident duties after having the baby. "I thought I was getting scrutinized unfairly," Dr. Crabtree said. In the end, however, she was able to keep the position, and now that her daughter is older and her work hours as chief resident are shorter, it's easier to focus.

While Dr. Crabtree wishes that she had taken more time off before returning to work, she said that she "just didn't know how long I would want or need." Dr. Crabtree recommends that new mothers take at least three months off when possible, although she realizes that some residents cannot financially afford to delay their training that long.

Other unforeseen circumstances can complicate a new mother's return to training. Marie Jhin, MD, was caught off guard at the start of her third year of residency at New York Hospital in New York City when her daughter arrived five weeks early. The baby weighed in at 4 pounds, 7 ounces and spent the first week in the hospital.

As soon as she went into labor, Dr. Jhin took sick leave. She stayed home an additional two months with her baby, who had a string of illnesses. "That time was hard," she recalled, "but it was more stressful going back to work." She worried about what her colleagues, most of whom she said did not have children, were saying. "I think people do kind of resent having to cover for you, even if they don't say so," she said. "You get the feeling that people don't understand."

Once she returned to work, Dr. Jhin plunged into a critical care unit rotation with 36-hour shifts. She said at times she felt so overwhelmed by the combined demands of work and home "that I seriously thought about just quitting."

The choices at home were not making it any easier. Dr. Jhin found a nanny through a placement service, but wishes things were different. Her husband works 12 hours a day and can't help out much, she said. Fortunately, she lives just across the street from the hospital, so she can run home periodically to check on the baby. Still, she struggles with guilt-especially about giving up breastfeeding during her stressful critical care unit rotation-and with separation anxiety.

If she could do it all over, Dr. Jhin said she would probably have had a baby during the last year of medical school so she would be better prepared to start her residency in the following fall. She might also choose a residency program more carefully; she describes her current program as "very academic, very rigorous and very male-dominated." "They would never make you chief resident if you had a baby," she said, "because they would think the job was not your top priority."

In fact, Dr. Jhin decided more than a year ago to switch to dermatology, a specialty she views as less time-intensive and more accommodating to her family priorities. She will begin a new residency this fall.

The big picture

While even the most positive resident-parents admit that the road can be rough, some manage to glean the best from both worlds.

Dr. Kimani from Atlanta, for instance, did not plan to start a family until after her residency, but said it has worked out well. When she was in her second year of medical school and her daughter was born, Dr. Kimani took only two weeks off. When her second child arrived shortly after graduation, she took off an entire year. During that time, she found a supportive residency program in the same city as her husband's without going through the Match. By the time she started her internship, her husband was an attending physician and had more regular hours.

Still, there were problems. When Dr. Kimani's children began bonding more to her husband because she worked so much during her first year of training, for example, she learned to make the most of her time at home. Today, she takes piano lessons with her 5-year-old in their home, and Friday nights are set aside for movies and popcorn for the family.

Overall, Dr. Kimani said, parenthood has actually enhanced her medical training. "I think it's been more joyful, having had kids," she said. "It puts your whole life in perspective." And during residency, Dr. Kimani's rich home life has helped her deal with difficult patients and difficult issues. "[As a resident] you see so much death around you," Dr. Kimani said. "Then you look at your kids and think, 'I'm a lucky person.'"

Christine Wiebe, of Providence, Utah, writes frequently on issues related to medical residency.


Resources for parenting residents

  • "College and University Reference Guide to Work-Family Programs, 1996" is published by the College and University Personnel Association (CUPA) and examines work-family policies at academic centers across the country. Cost: $60. Information: CUPA, 202-429-0311; World Wide Web, www.cupa.org.
  • "Guide to the Family and Medical Leave Act: Questions and Answers," a 22-page guide updated in 1997, is available from the Women's Legal Defense Fund (WLDF) for $3.95. The WLDF also publishes "What the Pregnancy Discrimination Act Means to You," a free, two-page booklet. Information: 202-986-2600; World Wide Web, www.afj.org/wldf.html.
  • "Medicine & Parenting: A Resource for Medical Students, Residents, Program Directors and Faculty," is available from the Association of American Medical Colleges (AAMC). The AAMC also publishes "Enhancing the Environment for Women in Academic Medicine: Resources and Pathways." Information: 202-828-0400; World Wide Web, www.aamc.org.

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