The price of parenting: Childcare and physician mothers

Childcare imposes substantial financial penalties on physician mothers due to a multitude of factors, including lack of a national paid parental leave policy, reduced work hours, and high costs of childcare.1-3 A national study highlighted that among physicians with children, the discrepancy in income between men and women amounted to over US$3 million dollars in a 40-year career, primarily due to the fact that female physicians with children worked 18% fewer hours than their age-matched male counterparts with children1 because they spent more hours on domestic responsibilities.2 The impact on earning potential for physician mothers starts immediately upon their child's birth; approximately 50% of female physicians sustained income losses due to unpaid maternity leave.4 Although data exist around the financial implications of childbearing, there is little data on what kinds of childcare physician mothers utilize or the financial costs of childcare. We conducted a survey from July to September 2024 asking female physicians when they had children, what types of childcare they used, how much of their salary went toward childcare, and whether their work schedule changed once they had children. The survey was distributed through social media channels in physician groups nationwide, with 288 responses. Data were collected through the secure Research Electronic Data Capture (REDCap) and summarized through descriptive statistics. Our institution's institutional review board approved this study (Protocol number: 2024P000252), and participants provided consent prior to initiating the survey for publication of anonymous quotes. Most female physicians (54.7%) began having children after completing training. Nannies and daycare were the most common childcare options utilized. Childcare represented up to 20% of the majority of physicians' salaries (Figure 1) and was cited as “a major financial burden.” The prohibitive cost of childcare affected people's decisions about family size, with one physician stating, “We decided to stop trying for more as … kids are very expensive.” Nearly half of women (48.2%) shifted their work schedule due to the lack of reliable childcare and noted that juggling work schedules with childcare was “a daily challenge.” The most common modifications in individual schedules entailed changing the start and end of clinics to accommodate school or daycare hours. Other women worked more nights and weekends or worked longer hours to decrease overall days worked. Some physicians went part time, especially when childcare costs represented a significant chunk of their salaries. Female physicians changed the scope of their practice to have more flexibility. One gynecologist stopped performing major surgeries while another pivoted to only gynecology to decrease call volume. They switched to locum jobs or stopped being hospitalists to avoid the long hours. Many found greater flexibility in private practice jobs and left academic medicine. Physicians also shifted to leadership or administrative roles or research, which allowed them to work from home. Two themes emerged: childcare represents a financial burden for women physicians, and lack of reliable childcare prompted female physicians to change work schedules or the scope of clinical practice. Solutions for affordable childcare require initiatives at both the institutional level as well as at the national level. Institutions can create reduced cost, onsite daycare centers at hospitals, or subsidize daycare centers that are affiliated with hospitals. Employers can pay for backup childcare services and consider flexibility in working hours. The American Academy of Pediatrics recommends 12 weeks of paid parental leave, which enhances retention of women in the workforce and benefits parents and babies,5 and other national societies should follow suit. Our national societies should lobby for affordable childcare subsidized by the national government. This approach is essential to correcting the lack of policy initiatives that prevents the establishment of a national paid parental leave act, as well as ensuring affordable, reliable childcare. HF assisted in design, planning, data analysis, and manuscript writing. JP-B assisted in design, planning, data analysis, and manuscript editing. The authors have no conflicts of interest to declare. Authors will share data upon request; please email the corresponding author.