HealthFebruary 25, 2020

Should you start a family in residency? Thoughts from a medical resident mom

By: Marilyn Chau, MD
The best time to start a family is a question many medical professionals struggle with. Here’s some advice from one medical resident mom.

I went into labor on a Tuesday. By Wednesday morning, I was holding my beautiful daughter in my arms, feeling both completely overwhelmed and excited about the new life in front of me. Less than two weeks later, I put on my heels and gingerly walked across a stage to accept my medical doctorate degree, ready to start my new career as a medical resident mom.

Within the following month, I had moved across the country and started one of the most physically and mentally challenging years of my life: my medical internship. Those first several months are mostly a blur of activity in my mind. However, I was keenly aware, despite my general lack of sleep, of the fact that I had just taken on two new roles in my life with the title of “MD.” I was now a medical doctor and a mother-doctor, and both titles felt completely overwhelming at times.

The question of when to start a family is one that many medical students and residents grapple with. The “ideal” fertility timing often doesn’t correlate with financial or career convenience, and someone who might not be done with their medical training until their late twenties faces a different decision from someone who has already logged years in the workforce. Of course, the need to balance a career and a personal life is one that affects those with and without children, but the decision to have children makes maintaining that balance even more difficult.

Financial factors

The financial consequences of starting a family in residency are some of the first factors you should consider. Other than the tradition of allowing for a significantly reduced schedule load during the fourth year of medical school, the medical field does not have any time “built in” for beginning a family.

According to a recent paper in Academic Medicine, the lack of a standard federal rule on parental leave means that there is wide variability in what residency programs offer new parents. Smaller programs may have still less flexibility, note the authors of an article in Plastic and Reconstructive Surgery. Even if you do have access to some accommodations, the practical implications of actually choosing to exercise your rights to request time off after the birth of a child are significant. Such time off is typically unpaid, leaving you with reduced income at a time when you likely need that paycheck the most. Yet if you choose to forgo a traditional maternity leave and opt for a faster return to work, most childcare centers won’t allow a child younger than six weeks old to be admitted.

Loan repayment is another top factor when weighing the financial considerations of starting a family. Physicians who financed their education with private loans may find themselves with less flexible repayment options than those who have solely government loans. While most government income-based repayment plans take your number of dependents into consideration—having dependents typically causes your expected monthly payments to decrease—private loans may not be under the obligation to do so. Paying for child care with a decreased monthly educational loan repayment plan is obviously much less stressful than being obligated to a fixed payment system.

Your partner’s career should of course also factor into consideration—that’s true for everyone, not just medical residents. Two medical residents starting a family together are likely in a different financial situation from a one-resident family. If your significant other’s job offers paid leave through the Family and Medical Leave Act, then the financial stresses of having a child will be less significant. With my own family, my husband’s company was able to offer about two weeks of paid leave of absence, which was enough to carry us through a potentially financially stressful period.

Post-residency consequences

The financial and career implications of the decision to start a family don’t end in residency. For any resident interested in pursuing a fellowship, the timeline for starting usually doesn’t leave any room for making up any time owed to a residency program if you’ve chosen to take a parental leave.

Graduate medical education departments typically dictate that residents must work a certain number of weeks per year in order for their residency training to be considered complete. Any extra time off taken during residency is often added on at the end, which could easily leave a resident with obligations to a primary residency program that extend past the start date of most fellowship opportunities. Even for physicians who choose to pursue an attending position immediately, their start dates for finally receiving a full physician’s salary would still likely be delayed in comparison with their colleagues. Academic Medicine notes that the desire to avoid extending training is the most common factor residents weigh when they’re considering the length of their maternity leave.

While there’s no right answer to this dilemma, your career goals and the goals of your partner need to be considered. For some of my colleagues, having a child in residency actually helped to balance out differences between their residency timeline and that of their partners. For those with shorter residency timelines, such as pediatrics or family medicine, waiting until after residency to start a family may be more realistic than for those with longer residency obligations, such as surgery. Similarly, anyone who is interested in a two-year fellowship program is facing different considerations from a resident applying for a one-year option.

Personal considerations

While financial and career implications are clearly important factors to weigh, they’re still just that: individual factors within a very complex personal decision. There’s no ideal timeline for having children within the medical field. Every season has challenges unique to it, whether with a resident’s salary and schedule or an attending’s responsibilities.

I believe that the high level of empathy I have developed for patients and families (particularly my pediatric cases) comes from my new viewpoint as a mother, and I have little doubt that being a mother has made me a better doctor. Just the experience of being a recently hospitalized patient during a complicated postpartum period has provided me with insight into a patient’s perspective, which has also undoubtedly made me a better physician as well.

Looking back, one of the most common remarks I’d get from colleagues who learned I was a medical resident mom was, “Leaving her must be so hard!” While accurate, that comment only really summed up half of the picture. Leaving a child in the care of a daycare employee (no matter how kind they may be) was hard, but coming home to hold that same child after an exhausting day of life-or-death medical decisions was one of the most soothing therapies possible.

For me, doing residency as a mom was hard—running through days sleep-deprived was my norm. But doing residency without motherhood may have been even harder. My desire to be a doctor had always coexisted with my desire to have a family, and seeing that both dreams were possible gave me greater personal fulfillment than taking on either role by itself could have.

Marilyn Chau, MD