By Dr. Lillian Erdahl
When I got married at the beginning of my lab years, two years into seven years of General Surgery Residency, I was not sure that I wanted to be a mother. I had been single-mindedly pursuing my career for so many years continuously overcoming the emotional pain of my own mother’s illness and transformation from someone who cared for me into someone who needed care and protection. My surgery resident husband wanted children but was not in a hurry. I hadn’t really thought it possible for us to have a child during residency until I attended a panel at the American College of Surgeons Clinical Congress in 2009.
The timing was ideal – being able to breathe and look around me during my non-clinical two years had allowed me to consider what gave meaning to my life. I no longer felt I could wait five or six more years to have a baby, nor did it seem like a good idea based on what I heard about infertility and the pressure to meet productivity targets as an employed surgeon.
What was not ideal was the availability of childcare for two parents working 80 hours a week. Family was not an option for the primary daily care of a child. My mother became profoundly disabled when I was sixteen and was living in a nursing home by the time my son was born. My father and step-mother were both working full-time 1000 miles away and traveling to help my step-brothers’ family whenever they could. My in-laws were both working full-time and lived close enough to provide help on weekends or in a pinch.
Other women residents, attendings, and friends with children had used a variety of options. Many did not have a spouse who was also a surgery resident. I finally settled on daycare plus a part-time nanny to cover the hours before and after daycare was open. We found one on Care.com who worked well for those first several months. She was experienced enough to give our son nebulizer treatments when he was sick with RSV and taught my mother-in-law how to do so. We paid her an hourly wage for 20 hours/week. Did I mention that was in addition to full-time daycare on the salary of two residents with a large medical school debt burden?
When I was still pregnant, we made the decision that my husband would pursue Fellowship 90 minutes away – living there, while I completed my last two years of residency. There did not seem to be a lot of great options for a two-career academic surgeon couple. One of us could work as a general surgeon while the other completed advanced training, but this simply felt like prolonging what is already an intense training process. So, we decided to hire an au pair to live with us and provide the additional childcare beyond the nine hours/day of daycare needed to make our lives possible. The hours that we needed help were early mornings and evenings with occasional weekends. The split shift was difficult for someone who was coming to and from our house.
When people in the U.S. talk about an au pair, they usually mean someone who comes from another country on a J-1 visa to provide childcare for 1-2 years while pursuing six hours of post-secondary academic credit. Au pairs are thus regulated by the federal government. Most families hire an au pair with the assistance of a private agency who assists with finding the au pair, processing the paperwork, and providing support to the au pair throughout their time with the host family.
How do you hire someone to care for your precious children? It is never completely without fear and yet your ability to continue working depends on it. I was so grateful for the mentorship of Drs Amy Reed, Rena Kass, and Ann Rogers as I embarked on this journey. I learned to write the job description very specifically. Explain what you are looking for and how you expect your child to be cared for while you are away. If you want help with pets, laundry, food prep, or something else make sure that is negotiated in the beginning. Think about the skills you need which will vary depending on the ages of your children and your family life. For instance, I was looking for an au pair who could drive my child to and from daycare since I had to be at work before the place opened.
The pandemic has added to the burdens of physician parents while taking away many of the resources we relied on to make our lives work. When it all started in March, I no longer felt comfortable having more people in my home than absolutely necessary. So I put the house cleaners on hold and eventually decided to let them go. I also stopped taking the dog to daycare so that we wouldn’t have to interact with people in the lobby during drop off and pick up. Groomer – no, after school activities -no, school – no. Instead of needing help before and after school, I now needed full-time childcare at home during the day. I was fortunate because I already have a full-time employee. We were able to shift schedules to accommodate this new circumstance but not without significant challenges and the need to spread some of my work into the evening hours.
The U.S. government reaction to the pandemic has been a challenge for those who rely on au pairs. However, there is an exception to the J-1 VISA restrictions for au pairs hired to provide care for children whose parents provide medical care to individuals with COVID19 or perform medical research related to COVID19. Even with exceptions, international travel may be challenging during the pandemic.
What are the other options? You could hire domestically to fill the gaps. It is important to set expectations from the beginning. Interviews now include a COVID attitude questionnaire and discussions of pandemic prevention expectations. Will you ask your new sitter to wear a mask in your house? What do they do in their off work time and how do you talk about it? My advice is to be clear and consistent in your expectations. You cannot control what someone does in their personal time but you do need to trust that they are considering the needs and safety of your family.
The most important lesson that I have learned through my journey through various forms of childcare as a surgeon is to have contingency plans in place. During the pandemic this is more important than ever. We do not know when someone will be ill or quarantined or have an accident. Flexibility must exist on the part of our employers, as well. There may be an option for backup care when your child’s school goes online for a period of time, but what is the option if your child is quarantined? How does your child feel about staying at home? Are they afraid of getting sick or worried about an ill teacher? Do they need their parents for support during that time? Hospitals must take into consideration the need to allow parents to care for their children.
Lillian Erdahl, MD FACS is an Associate Professor of Surgery at the University of Iowa. She serves as Associate Program Director in General Surgery as well as the head of the Iowa City VA Medical Center Breast Clinic. Her research interests include breast cancer prevention, faculty development, and simulation in teaching clinical examination. She is the Communications Director for the University of Iowa Department of Surgery which includes overseeing the department’s social media accounts. Her work for Gender Equity includes serving as the Association of Women Surgeons Communications Committee Co-Chair. Outside of the hospital, she enjoys yoga, cross-country skiing, cooking, and gardening.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.