Child Care Supplementation: Aid for Residents and Advantages for Residency Programs

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Work force data demonstrate that 72.1% of all pediatric residents graduating in 2007 were women.¹ Until the 1980s, men dominated the specialty of pediatrics. However, by the 1990s graduating residents in pediatrics were 54.4% women. On the basis of this simple analysis, it is clear that accommodations for childcare, job sharing, and plans for promotion in part-time tracks are essential, not only for fulfillment of men's and women's desire for taking care of their children and families.², ³ This is particularly important, usually in the early years of training and practice, when child bearing and preschool care are necessary.

At the 2006 Pediatric Academic Societies meeting, a women's forum was put together to discuss how to support pediatricians who are facing these challenges. The keynote speaker, Robert Levering, from the Wall Street Journal's column describing the “100 Best Places to work in America,” spoke about a very interesting request from employees. The employees of the Wegman's Food Markets wanted “more daycare support.” The company immediately built a multimillion dollar facility with appropriate staff. However, after being open for 3 months, only 30% of the facility was filled. After 6 months, there was no increase in the percentage occupancy. After 9 months, the same result. At that time, the CEO acknowledged that he must not have understood what they wanted. The employees then explained that they did not want to move their children from their current daycare but wanted more financial support to keep them in their current facilities.

At the same time, a group of leaders at the Medical University of South Carolina were trying to develop a childcare facility. An inability to find space and money to construct a facility for daycare led us to explore an option that included a weekly stipend for the average daycare cost in the Charleston area. In Charleston, there is very little land to build on, and construction costs are high. However, a plan was developed to support daycare costs during the first 6 months of a baby's life. The University has little, if any, liability. Families find the daycare facility that they want, or they use the extra support to increase their budget for childcare, providing for an in-home caregiver. The only responsibility of the Department of Pediatrics was to fund the program. This made it possible for children to move through the nadir of their immunity and then go to daycare when their immune system was nearing full functionality.

The program serves both men and women (46 residents). The rules are similar for men and women (Figure) but are based on the normal leave times that are provided for women for maternity leave and men for paternity leave. When not opting for all of their maternity leave (6 weeks or less) women were awarded 26 weeks of the daycare stipend. For men, if they took 3 weeks or less paternity leave, they were awarded 26 weeks of the stipend. In both cases, we awarded a minimum stipend of 20 weeks (accounting for the time the parent has off during the first 6 weeks). Acceptance of the stipend is purely voluntary.

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  Form to request payment for daycare during the first 20 or 26 weeks.

One of the major concerns was the possibility of more births; however, the number of births during the past year has remained steady (5 births). All of our residents who were eligible for the program opted to use the program. The policy is detailed on the form we use for requesting leave (Figure).

The policy is simple and broad, including maternity, paternity, or adoption leave. Because Med/Peds residents are working 50% of the time in the Pediatric Department, we will provide 50% of the leave amount to provide for daycare payments or to supplement their daycare expenditure. The payment tiers are based on the GME expectations. It is our hope that other departments will follow the example of the Department of Pediatrics.

As noted, this is a small start. The cost in Charleston for this program is $3900 for the maximum benefit. The University has been consulted, and no additional legal impediments have been detected. We all know the importance of the mother-child and father-child bond during the early formative months. As pediatricians we should lead the way so that work and family can stand side by side. It is time that we embrace the need for business as it should be, rather than as it has been.

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References 

1. The American Board of Pediatrics. Workforce Data. Books may be requested from 111 Silver Cedar Court Chapel Hill, NC 27514. www.abp.org. Phone 919-929-9255.
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2. Weiss A, Gordon EJ, O'Connor ME. Parental leave. Arch Pediatric Adolesc Med. 1998;152:629–633
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3. Verlander G. Female physicians: balancing career and family. Acad Psychiatr. 2004;28:331–336
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