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Prescriptions for parenting: How two-doctor couples balance the family game

When both parents are physicians, the demands of juggling work and family require flexibility and often a little bit of creativity.

By Beth Wilson, amednews correspondent. Feb. 11, 2002.

After Christina Nicolaidis, MD, MPH, had a miscarriage, she made a career change. As an internist and an assistant professor at the Oregon Health and Sciences University in Portland, Dr. Nicolaidis spent most of her time seeing patients every 15 to 30 minutes. She was working about 60 hours a week, unable to complete her research to her liking.

"I wasn't happy, and I realized had I carried that pregnancy, it would have been difficult to come back to work after my leave," she said. "I thought, 'Why am I spending all this time at work when I'm not happy and it's taking me away from my family?' "

So she made a decision. She told her boss, "I'll take a pay cut," hoping to lighten her clinical load, do more research and get pregnant again.

Dr. Nicolaidis, who was successful in her plea and in obtaining research grants, isn't the only doctor re-evaluating her schedule to make room for children. Physicians, like the rest of the work force, strive to achieve the precarious balance between work and family. In two-physician families, it's not always the women who are altering their schedules. After having children, some doctor couples return to work full time, hire nannies or rely on relatives. In some instances, husbands are seeking paternity leaves or taking time off from their careers.

Role reversal

When Charlie Polsky, MD, and Isabel N. Polsky, MD, had their first son, William, they were finishing their internal medicine residencies at the University of Chicago Hospitals and Health System. Each took the first month off; Isabel continued her maternity leave two more months and Charlie, who also had saved some vacation time, took off the next six weeks.

Later, they both considered fellowships. Isabel accepted one in New York, and Charlie raised their son at home. "I wasn't feeling a sense of loss," said Charlie about his decision not to pursue a fellowship. "I was excited to stay at home."

"I didn't feel like it was role reversal, because my father [an artist] was home a lot," he said. "People would say it was great that I made such a sacrifice, but I never saw it as a sacrifice. I was actually doing what I wanted to do."

During Isabel's fellowship, she became pregnant again, and soon Charlie was taking care of two sons, William, now 3, and Edward, 21 months.

"People were surprised Charlie was at home," Isabel said. They assumed she must have greater earning potential, she said. "They didn't ask me what he did [for a living]. People didn't know he was a doctor.

"People who knew he was a doctor didn't get it," she said. "Some may think it's wasteful."

Others wished they had a caregiver they could trust as much watching their children.

Charlie, meanwhile, found his new job was at times more tiring than his residency. "I was frequently the one up at night, and when the kids don't sleep well, the fatigue factor is greater," he said. "It's unremitting. There is no weekend."

Even when on vacation, "I was doing the same thing, only it was a change of venue," he said. "The term vacation with children is a oxymoron."

Isabel knows it's not an easy job. "At the end of the day he looked weary," she said.

Their sons, however, responded to his care. "The kids are crazy about him," she said. "Rather than wanting mommy when the chips were down, they ran to him."

Now the tables are turned. Following her fellowship, the couple returned to Chicago where Charlie works at an investment management firm and Isabel stays at home with their sons.

"We've discussed having more kids, and if she wants to go back to work," Charlie said. "It's not impossible, but every year away [from medicine], it becomes incrementally more difficult."

Ken Mukamal, MD, and Gale Fiarman, MD, of Lexington, Mass., also have tried a variety of methods of juggling work and family responsibilities. When they focused on their careers, they believed their children suffered. When they focused on their children, their work suffered, and when they tried to devote their energy to both, their marriage suffered, Dr. Mukamal said.

During this period of trial and error, Dr. Fiarman took a less challenging position that offered more flexible hours, and Dr. Mukamal negotiated paternity leaves.

"It's a very difficult task," Dr. Mukamal said of striking a desirable balance. "The bottom line is every person has to work through this themselves."

Presently, Dr. Mukamal, an internist, arrives at work between 9 and 9:30 a.m. so he can take his children to school and tries to be home by 6 p.m. on Mondays and Fridays.

"I'm not always successful," he said. "Scheduling realistically is important, and sometimes I have a hard time not trying to squeeze something in."

They share a family dinner Friday nights and spend alternate Mondays enjoying a "date night." Other days of the week, Dr. Mukamal may work until 8:30 p.m.

With 3-month-old Isaac at home with his brothers, William, 2, and Alexander, 5, "we're not sleeping well right now," he said, "but six months ago, we had a reasonably good balance."

"At times I feel like my job encroaches on my family life," he said. "My wife is better at putting up barriers."

Dr. Fiarman, whose specializes in gastroenterology, worked four days a week after their first son and wanted to work three days a week after the birth of their second son.

"The leadership changed, and they were less responsive [to Gale's plan]," Dr. Mukamal said. "So she took a job that was less challenging by a substantial degree.

"It's a sacrifice, but by the time she did it, she knew that was what she wanted," he said of his wife, who now works three days a week. "She'll always have a chance to go back. You can always see other patients or give another talk later, but our children won't be this age again."

Fortunately, he said, "There are still enough jobs out there that you can find the ones that you want."

Margaret Dunn, MD, who worked as a staff surgeon at a veteran's hospital in Dayton, Ohio, did not sense that luxury. "There weren't any women practicing surgery in town," she said. "In surgery, there is a lot of pressure to conform -- to travel, to go to that meeting. It's harder to create flexibility.

"I had a sense of responsibility for how I conducted myself," she added. In turn, Dr. Dunn said she worked harder when she was pregnant with her eldest son, Chris, now 17, than she did with her daughter Marie, now 14.

"I was probably the only pregnant woman who worked on six-hour cases and did not go to the bathroom," she said, laughing. "With my daughter it was more like, 'Find me a place to sit down!' "

During her first pregnancy, "I felt more internal pressure to conform to a kind of ideal behavior," Dr. Dunn said.

Meanwhile, her husband worked full time as a pediatrician, and the couple hired a pediatric nurse's aide who looked after their children for 16 years.

"I worked a lot harder and traveled more when the kids were little," she said, "and if you're not going on about your guilt or your angst, they don't know any different."

Now, as an associate dean for faculty and clinical affairs at Wright State University in Dayton, Ohio, Dr. Dunn has more time to spend with her children and considers the possibility of a career change when they're both in college. "I've seen other people taking jobs and moving teenagers when they're in high school, and it's not pretty, but five years from now that could be a crossroads for me," she said. "I could go anywhere."

In her mother's footsteps

Elinor Christiansen, MD, a retired family physician living in Colorado, worked both part and full time while she raised her three children. Dr. Christiansen said she's surprised to see so many couples struggling to balance work and family responsibilities. Part of the problem, she said, may be parents' reluctance to give young children more adult responsibilities.

When Dr. Christiansen was a young girl, she did her own laundry, packed her school lunch and cooked family meals while her own mother worked as a physician. Her children also assumed similar responsibilities, and when her youngest was 12 years old, Dr. Christiansen increased her workload to full time. "It enabled me to have a full life, no regrets, no guilt," she said. "I had the courage to know that I was in the driver's seat.

"Many people today are slaves to their children's schedules," she added.

Dr. Christiansen hopes more women will follow her lead. "Our young women today are hungry for role models to see how it's done."

Dr. Nicolaidis, meanwhile, is happy with her current situation. She enjoys a flexible full-time schedule while her mother cares for her 4-month-old son, Andonis, during the day.

About 30% of her time is spent with patients, and the remaining hours are spent doing research, which allows more flexibility. "I love my job now," she said. "By the end of my maternity leave, I was looking forward to coming back to work."

ADDITIONAL INFORMATION:

Paternity leave: A guide

One could say Ken Mukamal, MD, is a pioneer of sorts, at least in the area of paternity leave.

After the births of his three sons, Dr. Mukamal successfully negotiated three paid leaves, ranging from three to six weeks in length.

"Some junior physicians have said, 'How did you do that?' " Dr. Mukamal said.

That's because few policies or precedents exist regarding paternity leave, he said. "When I talked about men taking time off, people looked at me with blank stares."

But the 35-year-old Boston internist does offer these suggestions:

Ask about leave and be prepared to negotiate. "If you don't ask for it, you certainly won't get it," he said. "But by the same token, you won't always get a 'yes.' " Usually a compromise is reached.

Be persistent. "When I went to the head of our practice, he sort of blew me off," remembers Dr. Mukamal. "Then I went to him again. They didn't say I couldn't take it, but they did look at me like I had two heads." Eventually, Dr. Mukamal, who considered taking unpaid time, received a six-week paid leave, agreeing to come in one or two days a week to answer phone calls, keep up with paperwork and see a few patients. After his third son was born, Dr. Mukamal wanted clearer boundaries and took a shorter three-week work-free leave.

Know your rights and the maternity leave policy. Under the Family and Medical Leave Act, you're entitled to up to 12 weeks of unpaid leave after the birth of a newborn child. Also, use maternity leave as a negotiating tool, he said.

Negotiate upfront and with conviction. "Ask for it upfront when you're looking for a new position," he said. Or, at least ask about their paternity leave policy, which shows that it's important to you, he added.