Choosing Childcare as a Physician and Parent

Access to quality childcare is a challenge for all working parents, but especially so for physicians who work long hours with unpredictable schedules. A 2014 Work/Life Profiles of Today’s U.S. Physician by the AMA reports that 20% of physicians between the ages of 40-61 work more than 61 hours per week. Finding childcare that accommodates that kind of schedule is nothing short of daunting. There are pros and cons to every arrangement.

Childcare Center

Typical Cost for an Infant: $833-$1,083/month1

Pros:

- Regular, reliable care that is less likely to be disrupted due to caregiver illness or vacation

- State regulations and multiple providers in the same room offers some level of assurance that children will be adequately supervised.

- Payment is easy and often directly debited from a bank account.

- On-site daycare at large hospitals is an amazing benefit that allows for streamlined drop-off/pick-up and even daytime visits.

Cons:

- May lack the warm, home-like environment of other arrangements.

- Hours are limited and may be too short for a physician’s schedule.

- Strict sick policies may mean that a very reliable back-up plan is required.

- Requirements such as bringing filled and labeled bottles on a daily basis can add a real burden to the family routine.

Family Based Childcare in the Provider’s Home

Typical Cost for an Infant: $820/month(1)

Pros:

- Home-like environment fostering a close relationship between child/parent and caregiver.

- May offer greater flexibility to accommodate hours or other needs, such as washing bottles or providing diapers as part of the fee.

- Sometimes offer “vacation” periods where the family doesn’t have to pay if the child won’t be utilizing care.

Cons:

- May close with little warning that puts parents in a position where they have to take whatever childcare they can find.

- Regulatory oversight varies dramatically by state.

- When the provider gets sick, parents need an emergency backup plan in place or must use their own sick or vacation leave.

- One caregiver may have 6-8 children depending on state ratio regulations.

Nanny in the Family Home

Typical Cost for One Child: $2,600/month(2)

Pros:

- Generally, offers significant flexibility in hours, although parents are well-served by providing a regular paycheck for nannies that they want to stick around.

- Usually willing to take care of sick children including older kids that need to stay home from school.

- May provide additional services like driving children to school/activities or housekeeping.

- The relationship between a nanny and the family can be particularly strong. Eliminates the seemingly constant churn of caregivers in a daycare center.

- Nanny sharing with another family can reduce the expense and provide for additional social opportunities.

Cons:

- The cost of having a household employee is hefty. According to the Bureau of Labor Statistics, the average hourly nanny wage is $11-$14/hour with high cost of living areas being significantly more.

- The administration of a nanny employee is not for everyone. Parents need to withhold and submit Social Security and Medicare taxes from wages, calculate and pay applicable state unemployment and/or disability taxes, secure worker’s compensation insurance, and maintain adequate records. All of the above requirements include the process of establishing and sustaining online accounts for each of the appropriate agencies. Nannies cannot be treated as independent contractors and must be treated as household employees if they are paid more than $2,200 in a calendar year.

- Screening and hiring a nanny is a long process coupled with nannies sometimes leaving with little warning.

- Matching personalities and caregiving styles can be a challenge. There are also drawbacks to having care in the family’s home. For example, out of home care allows a parent with a vacation day to enjoy time alone.

- Nanny share arrangements introduce a third party and sometimes, three is a crowd.

Au Pair

Typical Cost: $1600/month plus room and board(3)

Pros:

- Significant flexibility for hours within labor regulations.

- Many are from international locations which can provide a valuable perspective for the family. It can be similar to the experience of hosting a foreign exchange student.

- In-home care reduces the strain of packing bags on a daily basis, the often incredibly stressful process of getting kids out the door in the morning, and needing to rush after work to meet pick-up time.

Cons:

- The onboarding time for an au pair is long. It’s not the answer for a parent in a hurry to find care.

- Hours are limited on both a daily and weekly basis so it’s not necessarily the answer for physicians who work long shifts.

- Au pairs require other resources such as a furnished bedroom, assistance with legal processes, and transportation.

- The au pair industry is not without a dark side. While the relationship between parents, children and caregiver can be deep and meaningful, parents should research the history of au pair agencies and determine if it fits their values. A Denver-based lawsuit was settled in 2019 awarding $65.5 million to as many as 100,000 au pairs due to au pair companies colluding to keep wages low, ignoring wage and labor laws, and limiting the fundamental right of an au pair to leave dangerous or hostile working conditions.

Family Members

Typical Cost: Nothing

Pros:

- Children can benefit from the loving and trusting bond that often develops with a grandparent or other family member.

- It can almost go without saying that the cost of this option is a winner.

- The flexibility of this arrangement is second to none.

Cons:

- Boundaries and decision making between family members can be difficult to navigate.

- Differences in caregiving strategies may create challenging conflict.

- The caregiving family member may eventually begin to feel taken advantage of or unappreciated. Parents should remember to respect the mutual relationship of the arrangement.

- Illness or disabling injury may create a sudden need for alternate childcare options.

Five Tips for Securing Childcare

1) The first call to make after a positive pregnancy test is to request a spot at a local childcare center. Seriously, do it in the first trimester. Wait lists for infant care are incredibly long and experienced parents know it’s best to have a spot and then be able to decline it later. It bears repeating: even if you think that you would never need to place your child in a daycare center, it’s better to have a spot and not need it than to find yourself with no options.

2) Trust your gut. Never leave your child with a caregiver that doesn’t feel right. Move on to another option instead.

3) Follow the law. Don’t pay your childcare provider under the table and don’t ignore household employee laws. If you wouldn’t trust an unlicensed physician, electrician, or tax advisor, why choose an unlicensed (full-time) childcare provider?

4) Learn about Flexible Spending Accounts for Dependent Care and enroll as part of open season or with a qualifying life event.

5) Be cautious before accepting a family member’s offer to provide child care. Think it through and discuss expectations beforehand. It’s much easier to say “I’d really like our child to have the benefit of being with other kids” than to later get out of a family caregiving situation that has turned ugly.

Do you have valuable insight to add for new parents or parents looking to change their childcare arrangement? Comment below!

Cost Estimates:

1 Child Care Aware at www.childcareaware.org

2 Bureau of Labor Statistics at www.onetonline.com

3 RVPF Research of multiple Au Pair websites