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Residency and Parenting Are Incompatible

By EMILY JOHNSON 

Being a parent during residency requires one or more of the following:

●     Family and/or friends nearby who are willing and able to provide free childcare

●     A stay-at-home spouse/co-parent

●     A spouse/co-parent who is willing to let their own career to be a distant second priority beneath family responsibilities and the resident’s career

●     Significant amounts of generational wealth that allow you to outsource household and childcare obligations with money you didn’t personally earn

●     High levels of financial risk tolerance and willingness to incur extraordinary levels of debt above and beyond average medical school debt ($234k!). 

Because medical residency in the United States is incompatible with being a parent.

It is a Sunday evening, and I am writing this as I wait for my husband to get back from the hospital. He was “on call” today, which, in lay terms means his work hours were “all day.” He was out the door before I woke up, and it is now 9:30pm and Find My shows that he is still at the hospital. So that means he’s on hour 15 or 16 of his workday, and he could be leaving in a few minutes, or he could be there for another few hours (and I have no idea which).

I do know he got at least a 15-minute break today, because our toddler and I went to the hospital today to have lunch with him. Why interrupt his workday, drag a toddler across town right before nap time (thereby risking the loss of my cherished mid-day downtime because of the dreaded car nap), and pay for parking and mediocre cafeteria food on a Sunday? Because if I hadn’t, I truly don’t know when my son would have seen his dad next.

This pattern – out before the family wakes up, back after bedtime- is the rule, not the exception. An “early” day might mean he gets out before 7pm – but that doesn’t guarantee that he’ll see our toddler, who goes to bed between 7 and 7:30pm.  

As a medical spouse with a young child, of the most infuriating comments I ever hear is among the lines of “but don’t they cap work hours now?” Or even worse – the occasional insinuation that perhaps today’s residents have it “too easy” because of work hour restrictions. Because the answer is yes – work hours are technically capped at 80 hours/week – but let’s talk about that: 

First, here’s what an 80 hour/week schedule looks like, in case you haven’t worked one lately:

 MonTuesWedsThursFridaySatSun
Start6:45am6:45am6:45am6:45amOFF(but studying for upcoming board exam)6:45am6:45am
End8pm6pm5:30pm8pm8pm10pm
Total Hours13+111113+13+16 (and counting)
Total: 77 + study time (Bingo! No problems here! Under 80 hours/week)

Second, from a caregiving perspective, an 80/hour week cap is laughable, because you can still miss 100% of a toddler’s waking hours most days of the week on an 80 hour/week schedule.

Continue reading…

Rooting and Leveraging the Innovation Economy


The use of the term ‘innovation’ is getting pretty worked up lately. In fact, almost every healthcare entity whether health plan, health system, IDN or even ‘mature ACO’ (morphed from an IPA or risk bearing PHO “chassis” or “carcass” as the case may be) seem to have anointed a ‘CIO’ as in ‘chief innovation officer’ to steward the critical transformation from volume-to-value during a yet to be determined period of conflicting if not schizophrenic incentives coupled with its legacy cultural inertia.

In fact some institutions via branded ‘Centers for Innovation or Transformation‘ have made substantial investments in people and infrastructure (“bricks, sticks and platforms”) as well as the promise of the essential ‘firewall inoculation’ and separation from the ‘mother-house’ to catalyze the required re-engineering during a likely period of cannibalization of traditional revenue streams.

So the ancient Chinese curse (paraphrased below) most likely applies here:

..we live in ‘interesting times’ with both ‘danger and opportunity’ before us.

For those tasked with this challenge and fortunate enough to participate in conferences (Health 2.0Exponential MedicineHealth DatapaloozaTEDMED to name a few of the trophy organizers) at the disruptive and transformational tip of the spear, the nature of the challenge including opportunities to meet and leverage connections of like minded and focus colleagues is a distinct strategic advantage.Continue reading…

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