By Alaina Trivax, WCI Columnist
If you have kids, you know: sick season is something else. From August through December 2022, my two boys had to stay home sick from daycare for more than 25 days. Some days, they were both home; other days, it was just one of them. We’ve had colds, RSV, asthma exacerbations, ear infections, RSV again (lucky us!), and ear infections again, and again, and again. There was an eight-day stretch in November during which they had 10 doctor visits and an ER trip.
My husband, Brandon, and I both work full time; he’s an early career PM&R attending and I teach middle school. Our boys are 1 and 2.5 years old.
My job allows 10 “personal days” per year for personal or family illnesses, appointments, etc. Ha! These sick kids had eaten through those 10 days by early November. (In fact, my husband and I had to cancel our plans to attend WCICON23 because I was completely out of days to take off.) Of course, my kids haven’t gotten the memo about this, and they are continuing to get sick. I’ve written before about how we maximize my income by participating in all of the benefit programs offered by my employer. Even knowing how much my job contributes to our financial security (and to my own sense of personal satisfaction), it’s clear that raising two small kids would be much easier if I stayed home.
Although I’m out of sick days, it’s not clear what exactly that means. I asked my principal, and he wasn’t sure either. I expect that they’ll start reducing my pay if I take additional days, a loss of around $250 for each day off. After accounting for all of our benefits and pre-tax savings contributions, my take-home pay is very little. That’s where it could get tricky—I might be docked the pay AND lose out on a contribution to my retirement or Health Savings Account. On top of these financial considerations, my school is struggling with a significant sub shortage; when one teacher is absent, our coworkers are often pulled to cover. I know it’s not my fault, but I feel bad about the extra work I’m creating for my colleagues.
Brandon has had to take some sick days this year, too. He doesn’t have a set number of sick days like I do, though it’s still a major pain to have to arrange coverage or reschedule patients. The cost of him missing work is a lot harder to calculate. Depending on his schedule, we figure it comes out to an insurance collection loss of about $2,000 per day.
What can we do?
It’s just so hard. I’ve at least found some comfort in commiserating with other parents. Childcare challenges seem to be a universal struggle. My boys have been sick a lot this year, and their classmates and our friends’ kids are constantly fighting illness as well. Even our friends whose kids do not attend daycare are struggling to find reliable childcare—nannies are hard to come by in our area.
We love our daycare. The curriculum has been incredible for our kids. Our older son came home counting to 20 the other day, and we taught him exactly zero of those numbers. Still, it’s a constant gamble and negotiation. A school-night fever sends us spiraling through potential childcare options:
“OK, how about you do rounds at your sub-acute at 6am? Then, come home and switch with me so I can teach my 8:30 class. I’ll come back home for lunch at 11:30. Oh, and maybe grandma can tag me out so I can go back to school to finish out the afternoon.”
Is this patchwork of childcare coverage just how everyone is getting by? It’s stressful. It’s exhausting. It’s hard on us and, frankly, on our employers and colleagues. And it seems like such a waste of money. We spend between 10%-15% of our monthly income on daycare. What are we getting for that price? Some education and socialization along with a whole host of germs. Is there a better way? We’ve considered a few approaches to our childcare needs.
More information here:
What’s the Value of Our Time, Anyway?
#1 A Stay-At-Home Parent
The kids are getting sick because they are going to daycare. They go to daycare because we are going to work. So, the first question: Should one of us just stay home?
Logistically, it would have to be me. Even without having to pay for childcare, we could not meet our expenses and fulfill our financial goals on my income alone.
Should I stay home? We’ve talked about it a few times and keep returning to the fact that we get a lot out of my job and income. After considering the cost of our healthcare and the contributions to my 403(b), HSA, and FSA, my job nets us nearly $30,000 per year beyond my salary. If we chose to send our kids to my school when they are a bit older, we’ll enjoy a significant tuition discount at one of the premier independent schools in the area. And I like my job. I really enjoy teaching middle schoolers. I love my own kids, of course, and after spending summer vacation and winter break with them, I know that I’m not cut out to be a stay-at-home parent. Between the lost income and the impact on my personal happiness, it’s clear that having me stay home is not the answer. I’m grateful to feel this certain about it, at least.
#2 A Nanny
This is the logistical gold standard—someone who is tasked with caring just for our children, who does it at our house, and who can minimize their exposure to all of these germs. Of course, the gold standard comes with a high price tag.
Nannies in our area make around $20-$25 per hour. We would need an absolute minimum of nine hours of care per day. Having talked with other families, it seems that a nanny would run us somewhere between $55,000-$65,000 per year.
It’s not fair to evaluate the cost only against my salary, but knowing that I would be the parent to stay home if we went with Option #1, we did compare. Paying a nanny would cost more than my entire salary and benefits package. Plus, we’d lose two hours of childcare per day compared to our current daycare schedule. Right now, I use the extended daycare hours to get in a child-free workout or to run some errands on my own after school. We could probably have a nanny take on meal prep or do some housework to lighten our load a bit, but honestly, it’s more the doing-things-with-two-toddlers-in-tow aspect that’s challenging. The convenience of having a nanny come to our home and minimize our need for sick care is beyond appealing, but logistically and financially, it just doesn’t make sense for us.
More information here:
A Candid Conversation with My Physician Spouse About Burnout, Guilt, and Resentment
#3 The Status Quo: Daycare
Our daycare bill for an infant and toddler runs around $2,400 per month. This pays for 11 hours per day—7am to 6pm. We are on a school-year schedule, meaning we only pay for 10 months of care. The schedule runs from mid-August through mid-June with an additional 30 days off for various school holidays and teacher workdays. I teach in a different district but generally have the same vacation days as the boys.
Though the sticker price seems high, it’s shockingly cheap when broken down hourly:
$24,000 for 4,048 hours of childcare = less than $6 per hour per kid.
I had to run the numbers several times just to be sure I didn’t mess up the math. Even after accounting for a potential loss in our income due to taking sick days, there’s no way we can beat this price. Honestly, even if we add in an additional consideration for the stress of having to piece together sick care, the daycare option still comes out ahead.
So, here we are.
We’re happy with the boys’ daycare teachers and the skills they are learning. I love my job and don’t want to stay home. And daycare is easily the most affordable option—even after accounting for all the sickness. These lifestyle and financial factors have led us to stick it out with daycare, at least for now.
More information here:
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A Bonus Option: My Dream—Daycare Plus Sick Care
Like me, most of the sick days that my colleagues take are due to their own kids needing care. This is a fairly prestigious private school; families pay a lot of money to send their kids to our school, and they have high expectations for the education that their children will receive.
And it’s just as disruptive and even more costly when my husband has to take a sick day to care for our kids. Patients have taken time off work for their appointments, and they are frustrated when the doctor cancels.
I would be perfectly comfortable with a trained professional taking care of my sick kids in our home. I imagine this would be someone who is trained in reducing disease transmission and in caring for sick children. I know of a few other employers in our region who offer something similar. This sounds delightful to me (or, as delightful as arranging childcare for a feverish, pukey toddler could be). Depending on a family's income, this option could cost somewhere between $10-$30 an hour.
Is this the norm for parents of small children? It’s impossibly hard, and none of the options are that great. Our older son will be eligible to attend preschool at my school in 2023-24. Faculty receive a significant tuition discount, and this will reduce our childcare expenses by quite a bit. Of course, a new school also means all new germs coming to join our party.
How have you handled taking care of sick children in a two-income family? Are there any other better options available? Does it get easier as they get older? Comment below!
We are two highly compensated professionals. We followed the live in nanny route when our children were little. Our nanny was salaried and was more like a parent with undefined work hours. If the baby was napping, the nanny would nap as well. It was expensive but well worth it. We were even able to have a spontaneous date night, just the two of us, once in a while.
We went with live in stay at home grandma. Then after a couple years of that, she got super sick to the point where we were having to stay home and take care of her often times, plus still staying home for kids…
Being military doesn’t help either, since it’s a whole new pool of germs every 3 years.
Live in grandma-care sounds like a dream! Or at least, that it was at first… I’m sorry that it ended up adding to your care burden. That’s so tough.
Our daycare closed at 7 am this morning due to a power outage–we were already in the car and on our way. We were lucky that grandma was still in town from Mother’s Day weekend and could hang out with the boys for the day.
Anecdotally and in our experience, this has gotten significantly better as the kids have gotten older. I do think there might be some truth to the idea that kids have to be exposed to a certain number of germs and if it doesn’t happen in daycare it’ll happen when they get to elementary school.
I hear that from so many people. Fingers crossed! Our oldest is heading to preschool in my district next year and I’m a little terrified of the combination of germs from two DIFFERENT school/daycare campuses. Hoping he has enough immunity at this point to fend off at least some of the sicknesses.
Been there.
My wife worked at a Montessori School for twenty years with no benefits, because she wanted to. She was able to take all four kids there from breast feeding through Kindergarten and got discounted tuition.
They came home sick a lot. The only difference really is it had no benefits and she had unlimited sick leave as the boss was a friend.
I read all the issues and it seems like finding a retired LPN to be “on call” to come and care for the little ones might work.
You could pay a “retainer”?
Advertise in the newspaper: Looking for a retired or semi-retired LPN or similar to care for our children (one or both, ages ..,) when they are home sick. We would pay a $500 a month “retainer” if no services were needed that month, and would pay $200 a day ($20 per hour), if either child had to stay home. That’s $11,000 a year if they are sick 25 days a year.
We did this when we had only one child and both my wife and I worked. We interviewed about six, picked one, and back then (1991), we paid $10 an hour for in home care.
Just a thought. Best of luck.
How about an au pair? You can not beat the flexibility. The price is right around what you pay for day care and you get 45 hours per week up to 10 hours per day. They only need 1.5 days off per week and only 2 weeks of vacation. They also do all child related activities including laundry and keeping the kids room and play room together.
Potential downside is they live with you and they need their own private room.
We had a nanny for 7 years and just started with an au pair for our three kids 4 months ago and would never go back.
I’ll second this option. We had a au pair before my wife decided to stay home and it worked out fabulously for us.
Wow! That is a lot of child care (and house help!) for the cost. If we were in a bigger home, I’d definitely have to look into an au pair.
I’ve heard of hospitals desperate for nurses which have daycare on site AND sick kid daycare coverage to decrease nurse absences and recruit staff. I was lucky? Don’t recall our now 30 year old causing us to miss much work. For a year or so of her first 3 our neighbor in our small German dorf then my mom when spouse deployed kept her. The other 2 were in topnotch Army daycare. As clinic commander all 3 years I know she came to the office with me some days I worked weekends but don’t recall missing much work for her. Amnesia?
Now retired and having chosen to move closer to her and new grandkid I and rarely Grandpa are on call babysitting as well as the other grandma when she is in town. Starting with me covering his care as the new parents transitioned from parental leave to part-time and work from home until their daycare slot opened. However he solved my higher risk immunocompromise concerns/ his care by sharing the daycare COVID with both parents immediately followed by RSV for which they shared coverage once they were well enough to work again. He was back at daycare and I was able to see him again when he promptly shared a 3rd virus with us all which I brought home to Grandpa and Great-grandma. White collar non face to face clients along with work from home for both parents enabled both parents to still do some paid work through that long month and making Grandma covered sick care easy if they are in the house available when needed.
Important thing to recall is this too shall pass. I recommend “Getting to 50/50” which in summary says hellish early childhood hassles are short, career life is long, and if you opt out now you may have 20-30 years in 5-10 when you will wish you still had a career. As a teacher it’s possible you might resume that career then but the loss of the work benefits during your absence plus the risk that this pretty awesome specific job will not be open then outweighs that, and for your husband (and me/ my spouse both doctors) 5-10 years fully off would be a career ender.
We know it’s worth it; keep reminding yourself it is only for a few years of your next decades of work and life.
My husband and I were in private practice together when our now 32 yo and 29 yo were in elementary school. We used aftercare at their school once they were full time in school. I used to bring them in to recuperate in the “sick sofa” in my office and that worked out fine. Also even though we had unlimited sick days it was a big financial hit when one of us missed work so we played injured ie I took a only a handful of sick days during the 30 years we were in practice .Remember, “the days are long but the years are short”- I miss those years and can’t wait until grandchildren appear on the scene since both of us are now retired
Great post!
Imagine the life of a single parent.
You are very fortunate as you have a spouse and resources.
It will get easier.
I think about that a lot. My mom raised my brother and me on her own for most of our childhoods. We were lucky to have a lot of extended family who helped out, and I’m so grateful to have that same support (plus my husband!) for my own kiddos.
You could look into an au pair. Probably only slightly more than the day care price.
In the trenches with you! Dual physician couple with three littles (7, 4, 2) and nothing stresses me out more than a middle of the night fever.
This year our hospital started providing subsidized back up care as part of the benefits package. They contract with a company called Bright Horizons, which sends a sitter to our house; it cost us $6/hr out-of-pocket for up to 3 kids. Rumor was the hospital started this to stay competitive with other area hospitals– if this is in fact the trend, might be worth asking your employer or union rep if they can offer something similar.
We’ve also used back-up care offered by a local nanny agency- you paid an annual fee (I recall it was around $100) and they would send a sitter for the day PRN
We currently have a nanny but have tried just about every childcare arrangement in the past seven years- daycare, grandparents, stay-at-home mom, pack-n-play in the corner of my office…. Pros and cons to all, and all (except the last) are workable with a good back up plan
That backup care arrangement is amazing! And seemingly a good offering on the hospital’s part–they need you to come to work, and you need childcare in order to do so. Is it sick care, too? I found a few childcare companies that provide similar services in my area, but they mostly offered just backup care for days your normal daycare is closed–not sick care.
It is the rare family with small children who cannot relate to this issue. I am a physician and my husband is an orchestral musician, three kids 7, 5, and 7 months. Even though he can handle the sick days it was hard on him so when we had a third child in the fall we decided to hire a full-time nanny even though my husband is also on sabbatical this year. She is our favorite luxury item! Personally, I would do that and just accept that it’s more expensive. Like you, my husband enjoys his job and doesn’t want to quit even if it’s a money-loosing proposition. Not all decisions need to be based on the financial utility of the choice. I personally think the stress-relief is worth it. Another option to consider is trying to find an older person who would be happy to work half-days – pick kids up from daycare at nap time, kids nap at home while they help you with household chores, then care for kids post nap – but also pick up full days if needed. I would pay this person a premium to be available on short notice. Consider spending some of your money to buy back time. I’ve found that to be highly rewarding.
My wife and I had both our kids during medical school and residents. 2 kids and 2 residents with no family is brutal. But: 3 hospital systems in our area pooled money to run a sick kid day care staffed by an NP. $5 per day (2006-8) subsidized so staff would not call out. It got cost cut our last year of training but was amazing.
Luckily there was start up that sourced 1-off nannies that were pre-vetted via an app (eg Uber but for nanny) and filled the niche. That was great too until that shut down. Without those supports we would never have made it.
It is a horror show.
You drop your kids off at 7am and pick them up at 6pm? Don’t the young ones go to sleep at 7pm ish? Is it even legal in your state to leave the kids there for that long? I think the limit is 10 hours in my state. Aren’t you a teacher, with flexibility being a strong point of the job? Soapbox alert: You need to spend more time with your children!
Also, on further reflection, I can’t believe you ditch your kids for 11 hours a day for THIRTY GRAND net a year! Unbelievable! You should be ashamed of yourself.
I suppose the same could be said about me for many years. Hopefully I’m making up for it by being around a lot now while they’re teenagers. This is pretty darn common for doctors, isn’t it? Or does it not count as ditching them if they’re with the other parent?
The author makes it sound like she and her husband are out of the house for at least 7am-6pm every single day, and the kids are at the daycare during the same period, on a continuing basis.
The author is a teacher, and has claimed in other articles she’s written for this site that her schedule is flexible, she gets off mid afternoon, etc. Seems like there is time for her to be able to pick up the kids a little earlier a few days a week. I have a feeling the parents here are stretching the usable/extended daycare hours to do some solo relaxation time. It just strikes me the wrong way that the author is trading her children’s youth for 30k a year net. That’s an FTE equivalent of $14-15/hr. I assume the doctor here makes ~300k a year. What if the author did part time teaching to preserve her resume and mother’s day out a couple times a week so she could hit the gym and go to Costco?
The 11 hours a day definitely puts her above the limit of some state regulations on daycare time limits. My state only allows 10 hours of regularly scheduled out of home care. The author is regularly exceeding that, and also asking for even MORE childcare time!
It seems you are being mean just for the sake of being mean, Peter, so I’m not going to address too many of your points. I’m certainly not going to quantify how many hours my kids spend at childcare and how I use that time. But, as Amanda inferred, my kids are not at daycare from 7a–6p each day. Those are the hours of service available to us; our boys’ schedule varies depending on our own work schedules and personal appointments. They get plenty of time with us and are well-loved and cared for. And, I’m confident that my state-licensed, school-based daycare is not running an illegal program!
It’s interesting that you’ve framed this as *my* problem–that *I* am throwing away my children’s youth. My husband works a half day once a week and gets out even earlier than I do. Sometimes he’ll need to use the time to catch up on notes or prepare a lecture for his residents; other days he’ll have some time to relax by going to the driving range or squeezing in an extra workout. On a typical work day, he works a good 11+ hours so these few hours of “free” time are pretty precious. Is he also at fault here?
What a ridiculous comment. This women spends every weekend, school holiday, and summer with her children. It is also likely that the children are not there the full time every day, but as pointed out in the article the extended hours can be used to run errands like grocery shopping or even, gasp, do something for herself like exercise a couple of times per week. I’d also like to point out that teaching is NOT a flexible job (I’m not a teacher). They often can’t just take an hour or two out of their day to do something personal, if they need to take a day off it is usually a full day, etc. Sadly as pointed out many physician parents do need to utilize many hours per week of childcare. But what is the solution to that? Don’t be a parent and a physician at the same time? Don’t be in a two-physician relationship? Mom quits her job? You should be ashamed of yourself for your ignorance and this comment.
“You should be ashamed of yourself?” Are you for real, dude? Or are you just trolling for the hell of it? Maybe read some other of her other writing before you make such an ignorant judgment.
https://www.whitecoatinvestor.com/maximizing-the-benefits-of-the-lower-paying-job/
https://www.whitecoatinvestor.com/whats-the-value-of-our-time-anyway/
https://www.whitecoatinvestor.com/a-candid-conversation-physician-burnout-guilt-resentment/
Always gotta be a troll. Go get a life.
You didn’t mention anything about an au pair. My husband (an attorney) and I both work full time and we have 4 kids. We could not have worked without our au pairs! It’s a great option and you should definitely consider it. When the kids were sick they must stayed home. When the au pair got a cold she couldn’t ‘call in sick’ because she lived with us! And they became part of our family and are people my teenage kids still keep in touch with.
It’s so interesting to see some of these responses.
The shaming from Peter for needing childcare beyond normal hours is so interesting on a physician site. As a resident, I definitely needed childcare from 7am to 6pm. That *almost* covered my work hours. Apparently that makes me a bad parent.
The persistent suggestion of an au pair for cheap childcare is also interesting. It requires a large enough home, which I was not able to afford as a resident. It is also a well-documented system of exploiting young foreigners. Designed as a culture exchange program, it is now most often used as suggested here: underpaid labor. An overview and well documented perspective is here: https://law.lclark.edu/live/files/33141-261-muirhead
As an attending you can likely afford back up child care, but as a resident or fellow, typically when women are in their prime childbearing years, money can be very tight. We make less money than many nannies. And when a baby is very sick, it is appropriate for a parent to take care of them. A system that is overly lean cannot accommodate this, but the parent is blamed, rather than the system.
It seems there really isn’t a good solution for women physicians. Either delay childbearing and face the reality of high infertility rates, or have babies when is possible and be shamed and resented by colleagues.
You’ve correctly identified the many complex issues at play here.
I’ve worked for several companies (not medical) that offered backup care through Care.com: https://www.care.com/business/products/backup-care/ It’s a fantastic benefit, although it’s only available if the kid is only mildly sick.
Really enjoyed this article, thanks so much for sharing. I think your choice to continue working is completely valid, despite the financial and logistical obstacles you guys are facing. Too often parents don’t consider their own desires when making these decisions, and you’re fortunate to have a job that you enjoy where you ARE contributing financially to your family (and will more so in the future), helping other families/children, and likely nurturing your family in so many positive ways because you have career satisfaction.
In my house we’re fortunate to have a high enough combined income to layer our childcare and basically do Pre-School/daycare ~30 hours per week + full-time nanny. This is by far our biggest expense but while our children are young it is justifiable to us as it makes our lives so much easier. On the flipside our home is <1x our annual income, we drive old cars, don't buy expensive electronics/clothes, etc. Another financial piece to consider when weighing the pros and cons of continuing to work with young kids is the long-term impact of taking a step back from work on future earnings. I believe one study showed that women who took a break from paid work while children were young re-entered at a 30% lower pay-rate compared to peers and never made that gap up over the course of their career. So, in addition to considering childcare a shared expense between two partners (i.e. it's not all coming out of the lower earner's salary), couples should consider the long-term earning potential of both partners and consider childcare an investment in the future.
Regarding the back-up care options, I think these are nice for companies to offer but I feel like it would be really hard for me to leave my children with a stranger, even if they were "vetted" by the back-up care company. Maybe this would be easier with older children, but I don't know that I would love this option. I think this is just a really hard stage of parenting. To commiserate I left work early yesterday during my administrative time to take my daughter in to the doctor for (yet another) ear infection.
That double-layered childcare sounds so wonderful for your family and for your kids! I bet they are learning so much at preschool/in daycare, and I’m sure it’s incredibly helpful for all of you to also have individualized care from the nanny.
You raise a good point about the sick care programs. It would be tough to leave my kiddo with a stranger, especially when they’re sick. I think I could use this as a sort of bridge situation–a few hours of care until grandma could get into town–but probably not long term. It’s definitely a hard stage of parenting, that’s for sure!
Our kids are older now. 1 in elementary school and 2 teenagers but I remember those days. Unfortunately the options aren’t great for “sick” child care. For our first one my wife took like 6 months off and then daycare but working part time she had the flexibility to skip work if needed. For our second we split child care duties between daycare and a grandmother who watched out kids in her home. This allowed us flexiblity since we could leave them with her later than the usual daycare hours. It also gave us a lovely relationship with this grandmother and her family. Because it was in her home she also would watch them if they were sick (moderately sick.. if they were really sick my wife would still take off. Our daycare wouldn’t let anyone in with the sniffles).
Unfortunately there’s not a lot of great options. The child care issues improve as the kids get to being school aged. Have though about going part time now and then when they’re older going back to full time classroom teaching?
This is a very relatable challenge – thank you for bringing it to light. We also used a prn nanny service for sick child care. The change that helped us the most was one partner moving to a work from home position with some ability for asynchronous work.
Alaina,
Great article. I sincerely appreciate what your profession does. My wife is a full time doc at the hospital and I am the “flexible parent” who typically has to call out of work. All I can say is I feel your pain. Thank god for grandma who lives an hour away. That lady should be up for sainthood. Hope the moral support helps despite some of the negative commentary.