Challenges in Childcare

My first Child was 8 months old when I started residency. I finished my first shift at 2 am with lactating breasts about to erupt through my scrub top. It felt like I had a biologic imperative to remain with my Child. Leaving her was only possible because I knew she was in good hands when I was gone. During residency I had a solid Childcare combination of a full-time nanny, a partner with regular hours, and family who lived locally.

Since then, finding safe, reliable, and nurturing Childcare for my three Children has been a priority and a huge Challenge. Like many women, I sometimes worked fewer hours and took lower paying jobs to spend more time caring for my Children. Five years ago, I became an only parent, and I had to become even more creative with Childcare arrangements. I have utilized part-time and full-time preschools, nanny services, babysitting apps, word of mouth, family, neighbors, friends of friends of friends, and government agencies to find Childcare. Sometimes it has worked well, and at other times, it has not.

As a female emergency physician, I want to start talking about the Challenges of finding Childcare while working long shifts at odd times before and after the COVID-19 pandemic. By being vulnerable, I want to encourage other women who are navigating motherhood and emergency medicine. I want to advocate for more Childcare support for female physicians so that we can pursue our careers to the fullest and at the same time embrace motherhood. Finally, I want to acknowledge that there are many other women, lots of them earning low wages, who face the same struggles of finding Childcare while working non-traditional hours.

In the US, parents shoulder the burden of finding and financing Childcare due to a lack of broad social support such as paid leave and universal access to early childhood education and care.⁸ Women perform more Childcare duties than men and are more likely to take time off from work to care for family members.² Trends for female physicians mirror this data. A study of recent residency graduates revealed that women were more likely to work part time than men, and Childcare most influenced the decision to reduce their hours.¹ As a result, a lot of us are just trying to make it all work in whatever ways we can find.

“All I need is a warm body and a background check,” I have often said. It is not that I have low standards for the people I hire to care for my Children. Instead, it’s out of desperation that at times I have needed ANYONE to do the job. Perhaps my deepest dive into this territory was with a babysitting agency.

I paid a one-time fee to utilize the service, and then I could schedule my care needs ahead of time on an online calendar. The service would provide me with the sitter’s information. I would then contact the sitter and work out the details. Although I had requested to have a team of regular caregivers, the agency was unable to provide this consistency in the face of my odd hours.

As a result, my pre-work evening routine included not only packing my bag and my lunch but also cold calling a random sitter and walking them through the intricacies of school pick-ups, meal preparation, and pet care. To make matters worse, I usually did not meet them in person until I arrived home from work, and my kids had no idea how to recognize the person picking them up from school because they had also not met the sitter.

We had some wonderful sitters, and overall, despite the complexity of the arrangement, my kids were fine. On good days, I imagine it gave them a degree of resiliency and self-reliance they will appreciate later in life. On bad days, I can’t fathom how chaotic it must have been to have all those random people picking them up from school. We look back and laugh about some of that time with the humor that comes only from perspective.

There was the time that the sitter ran screaming into the carport when she encountered one of our small cats peering through the glass storm door. Somehow, she had missed the full disclosure we had made on our family description that we had two cats, a dog, and a rabbit. Then there was the time that the sitter refused to believe that the kids really did have ice cream for dessert EVERY night. My kids also cringe when they remember the way one sitter interpreted the instructions, “Dinner is macaroni and cheese and green beans” to mean the green beans needed to be mixed into the pasta.

Those times did not compare to the time a sitter forgot to pick-up my youngest at preschool. Unfortunately, even time and space do not make this story funny. My son was attending a half-day preschool with very strict pick-up rules, and all the parents were punctual. One day, I was tied up at work and realized 45 minutes after the scheduled pick-up time that the sitter had not arrived. I could imagine my son sitting in the school office with an adult gazing at him with a cool, judgmental stare as they repetitively dialed my number. Ultimately the sitter picked him up, I moved him to an all-day preschool with before and after care, and the agency did not schedule that sitter with us again.

All that took place before the COVID-19 pandemic. With the arrival of the pandemic, my kids spent the last few months of the 2020 school year online, and my two youngest completed the next school year completely virtually as well. While there were some perks to the arrangement- no car pick-up lines, no packing lunches, and no in person school meetings- I found myself struggling with the continuous need for childcare in the face of a new administrative role that filled even my non-clinical days with work.

I was not alone. Female academic physicians surveyed during the COVID-19 pandemic reported spending almost 4 more hours caring for their Children and about 2 more hours providing education than prior to the pandemic.⁶ About half of the women shouldered the majority of both Childcare and schooling, a third of the respondents reported they shared Childcare equally with their partner, and about 20% shared schooling duties with their partners.⁶ Even before the pandemic, a study of partnered academic physicians with children found that 37.5 % of female respondents and only 7% of male respondents adjusted their work schedules when their Children became ill or their typical Childcare arrangements were unavailable.⁵

The impact of the pandemic for US women collectively was immense. In a study of over 3000 women, 10% indicated they had quit a job during the pandemic, and, among mothers, about half attributed their choice to school or daycare closure.⁹ This study also reported that 46% of women took unpaid leave due to school or daycare closure.⁹ With the pandemic still in full force as I write, I can imagine these trends will continue.

Once when my son became sick at school, I found myself without the ability to quickly find someone to pick him up. I worked my contacts and found an acquaintance of my parents to pick my Child up from school. This arrangement involved me pleading with the school to allow them to pick my son up even though I was not able to provide advanced written authorization. The impromptu babysitters reported he seemed fine, and I felt reassured. When I arrived home later, my son told me that he had been trying very hard to not throw-up because he felt so embarrassed to be sick with strangers.

While my son recovered, and the situation could have been worse, it illustrates how hard it is to suddenly shift gears when a Child gets sick, or a snow day pops up. Especially as ER doctors, we can’t leave the department on a moment’s notice or at all. Many of us also work as independent contractors and do not have access to any paid sick leave. The Challenge is not only logistical but also emotional. I felt guilty that I had not anticipated the need to find a back-up babysitter in the event my Child got sick on that day, and I felt sad that I was not with him when he needed me.

A few years ago, I again found myself in a Childcare dilemma. It was around the winter holidays, and I had to work a nightshift without much notice. I could not find anyone to babysit, and I made the choice to leave my oldest, then thirteen, in charge. I searched online to see if the situation was legal and reassured myself that I would not face prison time or an investigation by child protective services. I notified my neighbors, crossed my fingers, and my kids and I made it through that night.

Quite a while later, I listened to an episode of the podcast, the Double Shift. I felt such a sense of community when I heard an interview with the owner of a 24-hour daycare, Peace Garden, in Las Vegas. The center caters to many women who work in the hotel and restaurant industry and thus work odd hours.³ Many of the women also work at night because they are attending classes in the day.³

Centers such as Peace Garden are rare, and Childcare is costly. In 2019, less than 10% of US Childcare sites offered services overnight or on weekends.¹⁰ In my home state, the median income is $57,341, and the average annual cost of Childcare here is $8797.¹¹ With very few options for Childcare outside of the usual hours, babysitters and nannies are another solution.

However, they are costly with an average hourly rate in my city of around $16. An ER doctor working ten 12-hour shifts per month and employing a nanny would easily exceed the average Childcare cost in my state in a matter of 4 or 5 months. Thankfully, our income is much higher than the median income. However, many of our nursing colleagues and other hospital employees must face this Childcare landscape with a lower salary.

As I write this essay, I am finding the need to continually frame Childcare struggles in this broader perspective. What can be more unifying than mom guilt? The hidden thread in my anecdotes is a sense of failure for not being able to do it all. I love this quote from author Amy Westervelt, “We expect women to work like they don’t have Children, and raise Children as if they don’t work.”¹² The fact that so much of the burden of Childcare falls on the shoulders of women is perhaps that society thinks it should.

I grew-up in a very conservative Southern state. When I first started talking about wanting to go into medicine, I was questioned about my ability to balance work and family responsibilities. It was assumed that after marriage I would be the one to adjust to accommodate the Children I would certainly have and that my ambitions or Career plans would take a back seat to motherhood. Later I worked with a boss who asserted that, with small Children, “you really wouldn’t want to work full time, would you?” A 2018 qualitative study of almost 6000 female physicians detailed similar experiences of gender and maternal discrimination.⁴ I am sure we, as female emergency medicine physicians, have more to say.

It has been hard and continues to be hard to navigate work and Children. Without large systemic and societal Changes, women and families will continue to secure or provide Childcare mostly alone. My social and economic resources make it possible to have a demanding job and secure the safe, quality care my kids need. Many women, some of whom we see as patients, and some of those with whom we work, face the same Childcare Challenges with less support. What could be possible if we all speak-up, own motherhood, and advocate for others?   

References:

1. Frank E, Zhao Z, Sen S, Guille C. Gender disparities in work and parental status among early career pJAMA Netw Open. 2019;2(8):e198340.
2. Germano M. Women are working more than ever, but they still take on most household responsibilities. Forbes. Published online March 27, 2019. Learn More
3. Goldstein K. The night shift in sin city. The Double Shift website. Accessed September 30, 2021. Learn More
4. Halley MC, Rustagi AS, Torres JS, et al. Physician mothers’ experience of workplace discrimination: a qualitative BMJ. 2018;363:k4926.
5. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160(5):344-353.
6. Kasymova S, Place JMS, Billings DL, Aldape JD. Impacts of the COVID-19 pandemic on the productivity of academics who mother. Gend Work Organ. 2021;28(2).
7. Leonhardt M. Fewer than 1 in 5 Employers Offer Child-care Help, but Experts Say Coronavirus May Make it an Imperative. Make It. Published online May, 2020. Accessed July, 2021. Learn More
8. Olivetti C, Petrongolo B. The Economic Consequences of Family Policies: Lessons from a Century of Legislation in High-Income Countries. Journal of Economic Perspectives. 2017;31(1):205-230.
9. Ranji U, Frederiksen B, Salganicoff A, Longe M. Women, work, and family during COVID-19: findings from the KFF women’s health survey. Kaiser Family Foundation website. Published March, 2021. Accessed September, 2021. Learn More
10. Beras E. Millions of workers don’t do 9 to 5. So where’s the child care? Marketplace website. Published January 2019. Accessed September 2021. Learn Mor
11. Wheelwright T. The top 10 most expensive (and least expensive) states for child care. org website. Published April 2021. Accessed September 2021. Learn More
12. Ziegler SG. How to let go of working-mom guilt. Harvard Business Review website. Published September 2020. Accessed September 2021. Learn More

Anna Wright, MD CAQ-SM
Emergency Medicine Novant Health