Is residency worth it?

[whoareyou123]

I'd appreciate any advice, but would highly prefer to hear from doctors who have already finished residency and have families.
I am about to start my 4th year of medical school. I have a 2 yr old and a husband who currently makes +1M a year. I am struggling with the decision of if residency is worth it. I have decided on family medicine as it seems to be the most flexible of the specialties and family friendly. I am an older non traditional student which is why I decided to have a child during medical school, however I clearly had a desire to become a physician given I am in medical school. However, residency is a **** show that has no give or flex for anyone with families. When I had my daughter, I always knew that I would need a nanny given both my husband and I would be working (my husband works longer hours than residency ones). But I'm now at a point where I don't want some random woman to take care of my child (daycare around me are from 9-4pm, and thus would need childcare realistically full time in the mornings and evenings until I get home). I also want to be there for my children and husband. I've spoken and listened to many physicians during my 3rd year and all of them are doing this as a job/just for the money. Obviously helping people is nice, but let's be real, physicians are just people who want to make enough to live life and provide for their families. It's a plus that they can feel that they are helping and adding to society. I look at that and think about if residency/becoming a doctor is worth putting my family through 3 years of residency - no weekends, nanny raising my child (my income as a FM doctor post tax income would not even cover the nanny salary), not able to spend time with my husband...all for something that I don't really "need". Of course, I want it badly and if I was single I'd 100% do it. But now it comes at a cost. My question is if you didn't need the money, would you do residency and become a doctor?
For context, my family also ready has a beautiful house in a good school district and can buy anything we want. We also do not have crazy luxurious tastes. Isn't life about spending it with your loves ones and family? I have a choice to do just that and not have to worry about making money. But I also want a career in medicine. I know that I wouldn't become one of those jaded burned out physicians because 1) I'd prob work part time so I could spend time with kids 2) I've had careers in other industries where it's way worse than healthcare. Working part time is nice, but really has no benefit but to give me something to do while the kids are in school. But to pay $250K med school tuition, nanny salary (70-100k), residency salary to not see my family for 3 years but become a doctor. I'm torn because I'm so close. Obviously I haven't matched yet to residency, but I assume with family medicine I'd get a spot (if I don't match, it would make this an easy decision). Anyways just wanted to get some older wiser thoughts from those who have already gone through this with kids, whether you regretted not being able to spend time with kids or you felt it was completely worth it etc. Thank you!

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[wysdoc]

You cannot practice medicine without a residency, so my advice would be to push through and finish.
Hiring a "random illegal woman" to care for your child? You can use a combination of weekday daycare and weekend regular hourly sitters.
You can do either a pediatrics residency or FM residency in 3 years.

 

[cabinbuilder]

Okay. I started medical school with a 2 yr old and a 5 yr old. I wasn't the first in class, I wasn't the last. I felt I saw my kids plenty and really saw them more than when I worked full time before I went to medical school. I didn't have to worry about not seeing family because I didn't have one to see. I moved 3000 miles from Alaska to PA to go to medical school then from PA to TX for residency. I created my own family. Family practice residency isn't that hard to do, you just have to put in the time and learn what to do. It's all repetition. My advice to you is that you should finish school and residency while your child is small. They won't remember and you will have your training done and behind you. The reason I say this is.......

I hate to be the bad guy here but no marriage is ever set in stone or forever. You may think it is but life changes on a dime. That husband with a $1M salary could be gone in a month, a year, 5 years for any of a 100 reasons. You need to have a personal plan for that. Infidelity, cancer, car accident? My first husband left me for another woman. I left my 2nd husband when he started having mental health issues and told me he never loved me and only stayed because he loved my kids more than me. Currently on husband #3 - wasn't looking again. Have a great career and make my own money. Don't get caught 6 years from now with no career, no husband, a kid to feed and no money to your name because you didn't plan and thought you would always live happily ever after. Hope that helps.

 

[cj_cregg]

I don't have kids, but if I won the lottery tomorrow and had the financial opportunity to not work for the rest of my life, I would probably continue to do FM part time. On my own terms with a small, select patient panel and spending as much time I want with patients (maybe a DPC type deal?). But I still find the job really fulfilling and enjoyable, and frankly other than charity work type stuff I think I'd be bored senseless if I didn't work (although again, no kids to occupy my time).

I agree above that it's worth planning for contingencies and I think having the option for a good career in medicine will be advantageous to you if plans change in the future, especially if you're already almost through medical school. There are plenty of relatively cush/low time commitment family medicine residencies out there with the bare minimum of inpatient and OB rotations. As you mentioned, FM is pretty family friendly - my residency had lots of residents with kids, and they all took turns babysitting, getting kids to soccer practice, having playdates, etc. I think if you can find a residency that will support a good work life balance, it's worth doing.

 

[smq123]

What were your childcare arrangements during your rotations? Or did you never need to go in early, stay late/overnight, or work weekends during your third year?

What do you plan on doing (if you don’t do residency) when your children are old enough to be in school?

 

[Sardonix]

Why did you go to medical school in the first place? Other than doing research or very limited private industry roles, you cannot have a medical career without residency.

Yes, residency sucks. But you have already admitted that money is not the issue here--which frees you of like 75% of the stress most residents and physicians face outside of the clinical work. As already stated by others above, you can have children and still go through residency--I have several co-residents who did so and they don't have the privilege you do.

It sounds like you worked with burnt-out, money stressed preceptors. If money wasn't an issue for me, I would still work but I'd do so free of any stress related to compensation and admin pressure.

 

[dozitgetchahi]

I'd appreciate any advice, but would highly prefer to hear from doctors who have already finished residency and have families.
I am about to start my 4th year of medical school. I have a 2 yr old and a husband who currently makes +1M a year. I am struggling with the decision of if residency is worth it. I have decided on family medicine as it seems to be the most flexible of the specialties and family friendly. I am an older non traditional student which is why I decided to have a child during medical school, however I clearly had a desire to become a physician given I am in medical school. However, residency is a **** show that has no give or flex for anyone with families. When I had my daughter, I always knew that I would need a nanny given both my husband and I would be working (my husband works longer hours than residency ones). But I'm now at a point where I don't want some random woman to take care of my child (daycare around me are from 9-4pm, and thus would need childcare realistically full time in the mornings and evenings until I get home). I also want to be there for my children and husband. I've spoken and listened to many physicians during my 3rd year and all of them are doing this as a job/just for the money. Obviously helping people is nice, but let's be real, physicians are just people who want to make enough to live life and provide for their families. It's a plus that they can feel that they are helping and adding to society. I look at that and think about if residency/becoming a doctor is worth putting my family through 3 years of residency - no weekends, nanny raising my child (my income as a FM doctor post tax income would not even cover the nanny salary), not able to spend time with my husband...all for something that I don't really "need". Of course, I want it badly and if I was single I'd 100% do it. But now it comes at a cost. My question is if you didn't need the money, would you do residency and become a doctor?
For context, my family also ready has a beautiful house in a good school district and can buy anything we want. We also do not have crazy luxurious tastes. Isn't life about spending it with your loves ones and family? I have a choice to do just that and not have to worry about making money. But I also want a career in medicine. I know that I wouldn't become one of those jaded burned out physicians because 1) I'd prob work part time so I could spend time with kids 2) I've had careers in other industries where it's way worse than healthcare. Working part time is nice, but really has no benefit but to give me something to do while the kids are in school. But to pay $250K med school tuition, nanny salary (70-100k), residency salary to not see my family for 3 years but become a doctor. I'm torn because I'm so close. Obviously I haven't matched yet to residency, but I assume with family medicine I'd get a spot (if I don't match, it would make this an easy decision). Anyways just wanted to get some older wiser thoughts from those who have already gone through this with kids, whether you regretted not being able to spend time with kids or you felt it was completely worth it etc. Thank you!

Is residency rough, especially with kids? Yes, but it ends.

A medical degree without GME training is basically worthless. As others have pointed out, your job options would be limited to only a very narrow range of non clinical roles. These are not easy to find (even drug companies, insurance companies, etc usually want doctors who have done residencies and are board certified).

Also, there are specialties whose residencies are arguably even more chill than FM. Occ med, preventative med, and others. Some feel that pathology is an easy residency (job opportunities aren’t necessarily great). Maybe PM&R.

If you don’t want to do residency, why even finish the 4th year of medical school? If you want to get out and not do any GME training, might as well cut and run now and save yourself the debt.

 

[whoareyou123]

Okay. I started medical school with a 2 yr old and a 5 yr old. I wasn't the first in class, I wasn't the last. I felt I saw my kids plenty and really saw them more than when I worked full time before I went to medical school. I didn't have to worry about not seeing family because I didn't have one to see. I moved 3000 miles from Alaska to PA to go to medical school then from PA to TX for residency. I created my own family. Family practice residency isn't that hard to do, you just have to put in the time and learn what to do. It's all repetition. My advice to you is that you should finish school and residency while your child is small. They won't remember and you will have your training done and behind you. The reason I say this is.......

I hate to be the bad guy here but no marriage is ever set in stone or forever. You may think it is but life changes on a dime. That husband with a $1M salary could be gone in a month, a year, 5 years for any of a 100 reasons. You need to have a personal plan for that. Infidelity, cancer, car accident? My first husband left me for another woman. I left my 2nd husband when he started having mental health issues and told me he never loved me and only stayed because he loved my kids more than me. Currently on husband #3 - wasn't looking again. Have a great career and make my own money. Don't get caught 6 years from now with no career, no husband, a kid to feed and no money to your name because you didn't plan and thought you would always live happily ever after. Hope that helps.

Thank you for your candid response and sharing your personal experience! You are definitely not the "bad guy", I had the same thoughts. However, I also don't want to put my family through residency just as a hedge in case my marriage ends. I don't think that's a good reason. If that was the main reason, then I prob shouldn't be married to my spouse. If I continue, I'd want to do it because its somethings I enjoy/passion about (which it is) and I believe it's the right choice for me/my family's future.

 

[whoareyou123]

What were your childcare arrangements during your rotations? Or did you never need to go in early, stay late/overnight, or work weekends during your third year?

What do you plan on doing (if you don’t do residency) when your children are old enough to be in school?

I was fortunate that my parents were able to help during medical school. But for residency, I'd have to find a nanny to cover hours around residency. I struggle as it almost doesn't make financial sense to continue, in fact it feels net negative. My post tax income as a resident and even as a FM attending (even FT, and I'd prob opt for PT if I could) wouldn't cover nanny salary. I've looked and interview nannies in my area, and they're asking for 35-40/hr plus benefits (gas, health stipend, days off etc), that's $120k for 12hrs 5 days/wk. I also have my $400k medical school loans. I could break even after maybe 7-8 years of FT working making $200k...but even working FT, I would have to still pay for a nanny, so I dont' think I'd even break even then. I think the financial practicality also concerns me. I don't love the idea of pursuing a career with a net negative financial outcome

 

[whoareyou123]

Is residency rough, especially with kids? Yes, but it ends.

A medical degree without GME training is basically worthless. As others have pointed out, your job options would be limited to only a very narrow range of non clinical roles. These are not easy to find (even drug companies, insurance companies, etc usually want doctors who have done residencies and are board certified).

Also, there are specialties whose residencies are arguably even more chill than FM. Occ med, preventative med, and others. Some feel that pathology is an easy residency (job opportunities aren’t necessarily great). Maybe PM&R.

If you don’t want to do residency, why even finish the 4th year of medical school? If you want to get out and not do any GME training, might as well cut and run now and save yourself the debt.

I have definitely thought of not even finishing to be honest. If I don't go on to residency, the medical degree is useless, I agree. My thoughts (please let me know if you think I'm completely wrong) are that if I look for a job, finishing medical school would look better than me "dropping out". At the same time, any job I could get after finishing med school and not going to residency, I could prob get with just my bachelors (I went to a top school, but did major in biology which again is a bit useless). I go back and forth between this. As of now, I've decided to finish more for closure to be honest and the hope that'll it'll be additive if I look for a job down the road.

 

[whoareyou123]

Why did you go to medical school in the first place? Other than doing research or very limited private industry roles, you cannot have a medical career without residency.

Yes, residency sucks. But you have already admitted that money is not the issue here--which frees you of like 75% of the stress most residents and physicians face outside of the clinical work. As already stated by others above, you can have children and still go through residency--I have several co-residents who did so and they don't have the privilege you do.

It sounds like you worked with burnt-out, money stressed preceptors. If money wasn't an issue for me, I would still work but I'd do so free of any stress related to compensation and admin pressure.

I understand where you are coming from. Prior to medical school, my husband was not making as much as he currently is, so the income as a FM doctor would have meaningfully helped us financially. We have gotten to a base case state where we can live comfortably without my income, and I could relieve pressure at home (helping with childcare which would cost $120k during residency and even as a FT attending). Also factoring in that we'd like to have another child at some point.

Financially it also doesn't quite work out to finish residency. I explained a bit in another response, but I had my parents help with childcare during medical school (so gratefully saved there). But $400k med student loans + $120k/yr nanny is not nothing even with my husbands income, and my $200-250k income as an attending would mean $100k post tax that would barely cover the nanny salary. It would take around 10 years to break even for the investment to become a FM doctor. It's almost like I'd be working for free for 10 years...I appreciate it's such a first world problem too, so thank you for entertaining my question!

 

[dozitgetchahi]

I understand where you are coming from. Prior to medical school, my husband was not making as much as he currently is, so the income as a FM doctor would have meaningfully helped us financially. We have gotten to a base case state where we can live comfortably without my income, and I could relieve pressure at home (helping with childcare which would cost $120k during residency and even as a FT attending). Also factoring in that we'd like to have another child at some point.

Financially it also doesn't quite work out to finish residency. I explained a bit in another response, but I had my parents help with childcare during medical school (so gratefully saved there). But $400k med student loans + $120k/yr nanny is not nothing even with my husbands income, and my $200-250k income as an attending would mean $100k post tax that would barely cover the nanny salary. It would take around 10 years to break even for the investment to become a FM doctor. It's almost like I'd be working for free for 10 years...I appreciate it's such a first world problem too, so thank you for entertaining my question!

I’m not sure where you live, but I have never heard of nannys costing $120k/year. I know doctors with nannys who don’t pay them anywhere near that much. Usually they are paid way way less than that - $20-30/hr is a common rate even in NYC. $65k or so is on the high end, from what I’ve heard.

 

[whoareyou123]

I’m not sure where you live, but I have never heard of nannys costing $120k/year. I know doctors with nannys who don’t pay them anywhere near that much. Usually they are paid way way less than that - $20-30/hr is a common rate even in NYC. $65k or so is on the high end, from what I’ve heard.

I say this with respect, but does this come from personal experience? I live in the NYC area and all the nannies I've interviewed are 30/hr minimum plus benefits. I've spoken to dozens and the tops ones with 10+ yrs experience I spoke to were actually $40-45/hr (which I agree is ridiculous, they'd make more than I would as a doctor). And even those with a couple years of experience want $30/hr. I could find some in the $20-30/hr range probably via care.com, but I would not want someone of that level/experience (I mean no offense for any doctors who have paid that, I'm sure there are some good ones...). But nannies are just humans doing a job for money, and I'm part of a couple of "nannies for physician" groups and there are countless issues. So I would not be willing to bet my children's care to the lowest per hour nanny I could find.

 

[SXMMD]

Would echo what has been said above

1) if you are passionate about patient care/being a physician, the opportunity cost of doing residency significantly outweighs not doing residency. You may never get another chance to do this if you walk away now- not an absolute, but a very likely possibility. You don't "disappear" from your family during training, you'll still see them, but not in the same capacity as a SAHM or someone working a stable 9-5, though you'll DEFINITELY have months mirroring the stable 9-5. You can always work as much or little as you want after that for the remainder of your (hopefully long and happy) life. 3 years vs 30...

2) if your husband is making 1M+, why is paying for the nanny a difficulty? Without judging your individual circumstances/local opportunities, as others have said $120k year for a nanny is wildly out of the norm, but it would appear your husband could still manage that on an income as large as you mentioned especially if you're contributing to it with part of your residency salary. Obviously you know your own finances best but this concern didn't add up to me.

3) Most FM working FT are making much more than 200k. Medscape: Medscape Access. Location dependent obviously but many of us are easily banking 300k plus on a 9-5 working 4-5 days per week FT. Even in saturated markets savvy docs are making more than 200k.

4) If you don't practice as an attending, how will you pay off loans? If husband/family support is there for this, then even if you practice in a lower paying market, you're still financially solvent. Do you have background in another industry with comparable income potential? You did mention being from a nontrad background/previous career. If family isn't paying those loans and your background doesn't give you a comparable income, a career in medicine still appears more favorable.

5) While we don't want to assume the worst, what cabinbuilder notes about independence is important and it's not medicine specific. I don't think you have to convince yourself to go to residency "for survival just in case" but if you already have a passion for this work, that's just ANOTHER good reason to move forward.

I think a question you have to answer for yourself first and foremost is whether or not you have a passion for this work. If you do, the rest of your concerns are, frankly, solveable. But if you're not sure if you even want to care for patients, then you're measuring 3 years of some sacrifice for any number of life long benefits as an attending- and we need not overstate the rigor of residency, it's not the 1970's work 36 hour straight shifts anymore. Only you can really do the math if that sacrifice is worth the benefits for your short term/long term wants and needs.

Wishing you luck whatever you decide

 

[dozitgetchahi]

I say this with respect, but does this come from personal experience? I live in the NYC area and all the nannies I've interviewed are 30/hr minimum plus benefits. I've spoken to dozens and the tops ones with 10+ yrs experience I spoke to were actually $40-45/hr (which I agree is ridiculous, they'd make more than I would as a doctor). And even those with a couple years of experience want $30/hr. I could find some in the $20-30/hr range probably via care.com, but I would not want someone of that level/experience (I mean no offense for any doctors who have paid that, I'm sure there are some good ones...). But nannies are just humans doing a job for money, and I'm part of a couple of "nannies for physician" groups and there are countless issues. So I would not be willing to bet my children's care to the lowest per hour nanny I could find.

$30/hr for a nanny does not come out to $120k/year. Nor does $45/hr.

 

[smq123]

$30/hr for a nanny does not come out to $120k/year. Nor does $45/hr.

Well....let's be fair to the OP. I don't think she's exaggerating.

I work with an NP who had a baby 2 years ago. When she came back to work, her mom was willing to babysit the baby for 6 months, so she started looking for a nanny at the end of her maternity leave. She found a few nannies who came highly recommended, but all quoted her $40+/hour. One wanted $45 an hour PLUS paid vacation and holidays. My friend was astounded and frustrated that a nanny is making more than NP with significantly less education/skills. For context, we're in the Miami area - another area of the country with a very high cost of living, probably comparable to NY.

In a physician mom group on Facebook, nannies are a frequent topic of conversation. Most people in areas with a lower cost of living usually pay $25-30/hour for their nannies (this goes up to $35 if you have more than 1 small child). People in areas with a higher cost of living are paying around $35 for one child.

The OP is assuming that she will need a nanny for 12 hours a day, 5 days a week - not unreasonable for a resident (that's 6 AM to 6PM, M-F). That's 60 hours a week. So if you assume $40 x 60 hours x 50 weeks a year, that = $120,000. I don't think that the OP's math is that far off. It sounds like an outrageous number, mainly because that's more than some highly skilled and experienced NPs/PAs make, which is a little crazy to think about.

 

[smq123]

I was fortunate that my parents were able to help during medical school. But for residency, I'd have to find a nanny to cover hours around residency. I struggle as it almost doesn't make financial sense to continue, in fact it feels net negative. My post tax income as a resident and even as a FM attending (even FT, and I'd prob opt for PT if I could) wouldn't cover nanny salary. I've looked and interview nannies in my area, and they're asking for 35-40/hr plus benefits (gas, health stipend, days off etc), that's $120k for 12hrs 5 days/wk. I also have my $400k medical school loans. I could break even after maybe 7-8 years of FT working making $200k...but even working FT, I would have to still pay for a nanny, so I dont' think I'd even break even then. I think the financial practicality also concerns me. I don't love the idea of pursuing a career with a net negative financial outcome

So, I think that you're basing your thinking/decision making process on two periods of time that are very intense, but also short and that don't last forever.

For context - I had my kids 7 years after residency. One is 5, one is 3. I went part time when my oldest was born, working .6FTE (= 60%, or 3 days a week). My husband is also a physician; as a subspecialist he makes much more. We could probably live fairly comfortably on his income alone - so, not terribly dissimilar from your situation.

1 - Yes, residency is intense. It is also only 3 years, and it is not "balls to the wall" all the time. Some months will be easier than others. Some years will be easier than others, too. You might miss some things, but certainly not their entire childhoods. You, and your family, and your relationships, will survive.

2 - Yes, raising small children is also intense. They have. SO. VERY. MANY. NEEDS. And they need you for literally everything! They can't perform most activities of daily living without help - they can't take care of their own personal hygiene or dress themselves, or feed themselves, or prepare any food, or or or.

But they don't stay little forever. Even if you have another child, that child won't stay little forever, either. They won't need you as intensely. In just a few short years, your kid will be off to kindergarten, and will develop their own friends and have their own "places to be" each day. And, if you're not working, that will leave you with a vacuum that will be hard to fill. What will you do with your days when they're off at school all day? It will be fun for a few months, to have some free time, but eventually you'll need something to do to fill your days.

I know it doesn't feel that way now, but that day will come sooner than you think. It feels like my oldest was just born last week, but she's 5. She is potty trained. We had an unexpected free day in the middle of the week, so we decided, on a whim, to go to a museum. Whereas a few years ago, every outing required planning like we were embarking on D-day (and a FULLY EQUIPPED DIAPER BAG), this time all I had on me was a cellphone and keys. She can use the bathroom on her own. Bathroom accidents are a rarity these days, because she can tell in advance when she needs to pee/poop, and verbalize it in a way that is easy to understand. She can eat adult food (not just formula and yogurt melts). She can put on her own shoes.

Another thing that I need to emphasize, because many people claim to realize this (but they really don't) - once you stop this physician education train, it is almost impossible to start it up again. If you don't graduate, and you don't do residency, that's it. There is no re-starting the train. Back when I was an intern, most programs would filter out your application if you were more than 5 years out from graduation - but this was back when residency spots outnumbered US MD grads. That is no longer the case. The competition is fiercer and there are fewer spots to go around. So you have to be very very very sure that you want to get off the train.

I don't think you should quit now. I think you should finish residency, and at least become board certified (not just eligible). The number of doors that are open to you if you are BC so outnumber the doors open to you if you just have an MD degree that it's not even a question, in my mind.

 

[smq123]

I say this with respect, but does this come from personal experience? I live in the NYC area and all the nannies I've interviewed are 30/hr minimum plus benefits. I've spoken to dozens and the tops ones with 10+ yrs experience I spoke to were actually $40-45/hr (which I agree is ridiculous, they'd make more than I would as a doctor). And even those with a couple years of experience want $30/hr. I could find some in the $20-30/hr range probably via care.com, but I would not want someone of that level/experience (I mean no offense for any doctors who have paid that, I'm sure there are some good ones...). But nannies are just humans doing a job for money, and I'm part of a couple of "nannies for physician" groups and there are countless issues. So I would not be willing to bet my children's care to the lowest per hour nanny I could find.

Yes, nannies are expensive. But they're not the only option.

Many hospitals/residency programs offer in-house daycares, which have more residency-friendly hours. The hospital where I work now has one, as did the hospital where I went to med school.

Another option would be an au pair. If you have the space for another person, it could be a great option for your family - many people have wonderful experiences learning about another culture from a native, while showing this person around the US. If you live in NYC, you will be in high demand; it's not like you're trying to get people to come to BFE, Nebraska. Au pairs are generally much cheaper than a nanny.

 

[MidwestRadOnc]

Do radiation oncology.

It’s an easy residency in terms of hours and the specialty is over saturated so we would all love someone to take a spot that doesn’t plan on practicing full time. You’ll make the same part time rad onc locums as you would full time FM (caveat you may not work much or at all if you can’t move but that’s obviously not an issue for you.)

All you need is a pulse to match these days because of the above issues

 

[sloh]

Just to play devil's advocate to the majority of the responses above, OP's child is 2 years old and if she continues into residency, do you think there is reason for concern she will miss out on the years up to age 5-6 to really establish that mother-child bond?

 

[SXMMD]

Just to play devil's advocate to the majority of the responses above, OP's child is 2 years old and if she continues into residency, do you think there is reason for concern she will miss out on the years up to age 5-6 to really establish that mother-child bond?

No I honestly don't think so. I think we are overstating the intensity of residency, ignoring rotations when one does have a more normal schedule, families/relationships don't just whither and die because mom is working (medicine or other industries). Child is 2, a relationship is already there. Residency doesn't last forever.

On the other hand will one miss some meaningful milestones? Probably. Are those milestones important enough to simply forgo residency? I don't think so, but I think OP is the one who has to weigh that and decide. Lots of good experiences shared above.

 

[Ironspy]

Yes, nannies are expensive. But they're not the only option.

Many hospitals/residency programs offer in-house daycares, which have more residency-friendly hours. The hospital where I work now has one, as did the hospital where I went to med school.

Another option would be an au pair. If you have the space for another person, it could be a great option for your family - many people have wonderful experiences learning about another culture from a native, while showing this person around the US. If you live in NYC, you will be in high demand; it's not like you're trying to get people to come to BFE, Nebraska. Au pairs are generally much cheaper than a nanny.

When I was in nyc an appt with 3 bedrooms (we were in a 2 bedroom with multiple kids) was an additional 3-5k/month which makes the au pair option less affordable

 

[smq123]

When I was in nyc an appt with 3 bedrooms (we were in a 2 bedroom with multiple kids) was an additional 3-5k/month which makes the au pair option less affordable

Yes. But OP has posted that her family has a nice house already; generally houses have more space than apartments.

 

[Sardonix]

Financially it also doesn't quite work out to finish residency. I explained a bit in another response, but I had my parents help with childcare during medical school (so gratefully saved there). But $400k med student loans + $120k/yr nanny is not nothing even with my husbands income, and my $200-250k income as an attending would mean $100k post tax that would barely cover the nanny salary. It would take around 10 years to break even for the investment to become a FM doctor. It's almost like I'd be working for free for 10 years...I appreciate it's such a first world problem too, so thank you for entertaining my question!

I'm sorry, but... what? Was this a typo where you meant you would make $100,000 post taxes, loans, other costs?

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Using the above rough estimator I don't see how you would be coming out with only $100,000 after taxes. Even for NYC, tax rate of 60% sounds incredibly high.

Overall, I understand even your SO's income of $1,000,000 isn't as much in NYC as it sounds and again you know your financials better than we do. But I disagree with your math and your conclusion that residency would a financial net negative decision. If you don't want to do residency then don't do it--it's your life, you do you. But I'm hard pressed to see how you can use your finances to justify it and it would appear most everyone here posting thus far agrees.

 

[dozitgetchahi]

I'm sorry, but... what? Was this a typo where you meant you would make $100,000 post taxes, loans, other costs?

Free Paycheck Calculator: Hourly & Salary Take Home After Taxes

SmartAsset's hourly and salary paycheck calculator shows your income after federal, state and local taxes. Enter your info to see your take home pay.

smartasset.com

Using the above rough estimator I don't see how you would be coming out with only $100,000 after taxes. Even for NYC, tax rate of 60% sounds incredibly high.

Overall, I understand even your SO's income of $1,000,000 isn't as much in NYC as it sounds and again you know your financials better than we do. But I disagree with your math and your conclusion that residency would a financial net negative decision. If you don't want to do residency then don't do it--it's your life, you do you. But I'm hard pressed to see how you can use your finances to justify it and it would appear most everyone here posting thus far agrees.

I agree with you.

There are lots of doctors out there - even doctors in less intense, “lower earning” specialties - who somehow get adequate child care for their kids. Hell, some even have nannies. Somehow I don’t think that every physician who pays for child care is running a “net negative” financial situation.

I agree that it seems like OP is trying to rationalize not doing residency - which is fine, given that she is in a good financial position where she can afford to make a decision like that. But why go this far just not to finish training? Why not stop *now* (if she wants to stop), rather than finishing medical school? Residency or not, the loans still have to be repaid.

 

[DoctorMD1]

I say this with respect, but does this come from personal experience? I live in the NYC area and all the nannies I've interviewed are 30/hr minimum plus benefits. I've spoken to dozens and the tops ones with 10+ yrs experience I spoke to were actually $40-45/hr (which I agree is ridiculous, they'd make more than I would as a doctor). And even those with a couple years of experience want $30/hr. I could find some in the $20-30/hr range probably via care.com, but I would not want someone of that level/experience (I mean no offense for any doctors who have paid that, I'm sure there are some good ones...). But nannies are just humans doing a job for money, and I'm part of a couple of "nannies for physician" groups and there are countless issues. So I would not be willing to bet my children's care to the lowest per hour nanny I could find.

childhood is so short. If I were you, I would finish med school and postpone residency until your kid is a little bit older. In the meantime, you can just focus on being a mother. Medicine is just a job. Fortunately, you don't have to worry about money.

 

[Sardonix]

childhood is so short. If I were you, I would finish med school and postpone residency until your kid is a little bit older. In the meantime, you can just focus on being a mother. Medicine is just a job. Fortunately, you don't have to worry about money.

From what I have seen personally x1-2 in real life and the 100s of examples on here and reddit, this is a bad idea.

 

[Keona]

I have 3 kids. Had one at the beginning of medical school, one at the end of medical school and one after my first year of being an attending. I work 4 days a week. I have a great relationship with my kids and husband. We typically planned our childcare around his days since he is in business and his hours were more consistent. We had a variety of different childcare things throughout but he actually had a daycare in one of his offices and that worked fantastically. Family medicine after intern year was mostly outpatient with weekends off. It is a lot of clinic. Find a residency program that fits you as well. I still had er and in patient months but for the most part 2nd and 3rd year I was able to do either the drop off or pick up for the kids. We also sometimes had in home sitters. They watched the kids at their house but picked them up and dropped them off from our house. Now I’ve got kids from high school down to preschool. We have a part time nanny and thankfully live in a low cost of living area. She comes on Monday and Tuesdays. The younger two kids have childcare at their school until around 5:30 or 6. I can drop them off and pick them up each day. My husband does sometimes; the nanny does sometimes. Family medicine is very flexible in terms of career options. While your child is young they need so much of your time and mine still take a lot of my time but it’s easier now. I honestly love my life and my kids are so proud when they get to tell their friends at school that their mommy is a doctor. They also know I still work hard and that school was hard work along with residency. One of my kid’s happiest discoveries when they saw my clinic for after residency was that there are no call rooms and that there wouldn’t be any more nights without me home.

 

[FrustratedFamDoc]

Was FM your first choice of speciality, a backup or a scramble/soap spot? I could be way off base but it almost sounds like FM was your backup and you’re now also moving where you did not want to go and you’re now looking for an out. It does feel like there are some key facts missing from your story.

Is your husband’s job portable?

The career itself, I wouldn’t know what to do otherwise. I LOVE what I do, and you’ll find that with the vast majority of docs. The going trend is that physicians hate their JOBS. There is a big distinction there. Autonomy is decreasing, but FM is more insulated from this than other, especially surgical specialities.

I could go really long as I have a tendency to do, and may still later when time permits, but if your primary intention was money, then here’s what I would, since you’re right there about to finish:

1. Finish
2. Pay off ALL med school debt with the great income your guy makes in the first 2 years.
3. Do at least the first year of residency. You can then reapply if you feel you want to try something else. If not, then you can quit and then at least be employable in some capacity if need be.

This way if tragedy happens and 2 become 1 (many ways this can occur), you then have a way to make ends meet and have no student loan debt.

As it is right now, you’re setting yourself up to unemployable, potentially single mom, completely financial dependent on one person with a $400,000 anvil above your head 24/7. In no way am I saying you don’t have an awesome marriage that will go the distance, but you’re making a gigantic gamble that it will.

 

[whoareyou123]

childhood is so short. If I were you, I would finish med school and postpone residency until your kid is a little bit older. In the meantime, you can just focus on being a mother. Medicine is just a job. Fortunately, you don't have to worry about money.

I'd 100% do this if it was possible. From my understanding, there's no way to postpone it or defer it for that long. I'd ideally wait until my kids are in middle/high school and do residency then but that's in ~12 years...unfortunately that doesn't seem like a realistic option.

 

[whoareyou123]

Well....let's be fair to the OP. I don't think she's exaggerating.

I work with an NP who had a baby 2 years ago. When she came back to work, her mom was willing to babysit the baby for 6 months, so she started looking for a nanny at the end of her maternity leave. She found a few nannies who came highly recommended, but all quoted her $40+/hour. One wanted $45 an hour PLUS paid vacation and holidays. My friend was astounded and frustrated that a nanny is making more than NP with significantly less education/skills. For context, we're in the Miami area - another area of the country with a very high cost of living, probably comparable to NY.

In a physician mom group on Facebook, nannies are a frequent topic of conversation. Most people in areas with a lower cost of living usually pay $25-30/hour for their nannies (this goes up to $35 if you have more than 1 small child). People in areas with a higher cost of living are paying around $35 for one child.

The OP is assuming that she will need a nanny for 12 hours a day, 5 days a week - not unreasonable for a resident (that's 6 AM to 6PM, M-F). That's 60 hours a week. So if you assume $40 x 60 hours x 50 weeks a year, that = $120,000. I don't think that the OP's math is that far off. It sounds like an outrageous number, mainly because that's more than some highly skilled and experienced NPs/PAs make, which is a little crazy to think about.

Thank you, yes this is was the math I was using

 

[FrustratedFamDoc]

I she has already matched, she would be in breach of contract should she postpone residency at this point. She will never be able to match in the future.

 

[DO2015CA]

I also can’t overstate the benefit of having a nice daycare/preschool where there is a curriculum. We pay about 1,500 per child per month in a midwestern city in a professional daycare school. There is a curriculum, they learn life skills, their food palate has expanded, etc. My kids would’ve drastically missed out if we put them in a nanny situation. My kids are VERY well prepared to start their formal education because of their daycare center. That would very likely not be the case if we utilized a nanny unless the nanny was a teacher/talented at utilizing curriculum and us willing to pay for mommy’s day out activities to work on socialization.

 

[smq123]

I she has already matched, she would be in breach of contract should she postpone residency at this point. She will never be able to match in the future.

She’s an MS3.

 

[FrustratedFamDoc]

Got it!

I missed that part entirely.