Is an MD/PhD plus a residency starting at 31 y/o compatible with having a family?

Glutenlover1948

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I am currently applying this cycle and I'm gradually learning more about what's in store for me down the road. The more I learn about how awful residency programs are in terms of weekly hours of commitment (80-100+ hrs a week at some programs), the more I'm realizing that being in a residency through my mid-30's may not be compatible with having a family.

Before even considering things like a spouse's potential career aspirations, I don't know if I could go years without being involved in my own family. Do y'all have any experience or advice to impart in that regard?

MD alone, I finish residency by 30. PhD alone, I'm an independent PI with an established lab by 30. But it feels like MD PhDs are just starting the most grueling part of their career by 30.
 

tp53

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I am currently applying this cycle and I'm gradually learning more about what's in store for me down the road. The more I learn about how awful residency programs are in terms of weekly hours of commitment (80-100+ hrs a week at some programs), the more I'm realizing that being in a residency through my mid-30's may not be compatible with having a family.

Before even considering things like a spouse's potential career aspirations, I don't know if I could go years without being involved in my own family. Do y'all have any experience or advice to impart in that regard?

MD alone, I finish residency by 30. PhD alone, I'm an independent PI with an established lab by 30. But it feels like MD PhDs are just starting the most grueling part of their career by 30.

To be fair, it is highly unusual for a PhD scientist to have an independent and established lab at 30. More than likely, you will still be in the postdoc phase at that point. I believe that the average age to first R01 is actually closer to ~40, which holds true for nearly every path (PhD, MD/PhD, or MD).
 
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MD/PhD finishing late 20s/early 30s, + kid(s) during residency, + faculty/lab startup package mid 30s (~33-37 years old from a few recent people I know) is very possible. I would avoid fields that have excessive hours and no real chance for protected research time. You will work hard and some of it will be luck. You may often think (once in residency research phase with kids), wow I was able to do such more during my PhD without kids-- sure, but it's temporary and worth it. You may need child care or other help at some point. To even think about this, you need a field with protected research time in residency. This is a good thing compared to 100% clinical time since you can structure that time more or less how you like, whereas your colleagues are still doing clinic and can't control their hours. Radiation oncology and Radiology have the Holman research pathway, medicine has the ABIM and other research track residencies, surgery has some that also extend training, some other fields do as well. There is no real shortcut to establishing your own lab- so some people still need additional research/postdoc/instructor type positions. On the residency trail try to identify potential mentors.

Also consider your type of research. Molecular biology takes an enormous amount of effort daily to do experiments, but you can do experiments quick (many per week). Mouse experiments may take months/years. Computational biology is a lot easier to fit in a normal work/life balance. Try to identify mentors who understand the early career grant game and will provide you with a technician to do things while you are in lab and also when you have to be in clinic. YMMV.
 
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The difficulty of (non-surgical) residency is overrated. Residency is fine if you are an efficient person and choose your program wisely. Do not go to a program just because they are prestigious but work their residents like dogs because they do not know how to teach efficiently. Work should not stop you from having kids. *Make sure you can afford a good nanny and/or day care.*
 

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The correct answers to this question are grossly divergent depending on the sex of the OP.

Non-gestating parent? You're fine.

Gestating parent? It's going to be a rough ride.

("You may need child care or other help at some point?" This poster is male, or childless, or both.)

I don't see a reason to be rude. I'm very proud of my family. Are you trying disincentivize early career physician scientists posting on this forum? In the above statement, 'may' is swaying toward "highly recommend / you will likely need." I am writing this to someone who hasn't been a parent yet and probably hasn't thought this through much- so hey, here's a statement of something you should think about! A younger crowd reads this forum.

I watch my kids (plural) full-time on the weekends while my wife works 2 x 12's. During the week they are in day care 6-7 hours/day. I often drop them off (2-3x/week) and occasionally pick them up (not on the same day). I do dinner majority of days and put them to bed every single day. We'd be able to get by without the daycare but it would be more stressful (a lot more stressful). We got by without it for several months during Covid. Again, some residencies will need more arrangements, and YMMV. I have co-resident physician scientist women with infants/toddler age children in similar situations with less childcare than I have, who are very successful. As a downside, there are times when I am very tired especially when trying to do work after kids are in bed. It's very difficult balancing everything- research, clinic, family. As mentioned in first post, "wow I was able to do such more during my PhD without kids."

There are regions/programs that may make the above arrangements close to impossible. I chose a program that allows me (and other research track residents in my program with kids, including women) the chance to be successful. It's incumbent on the applicant to talk to mentors, residents, go on a lot of interviews etc. and try to identify such places.

What's your story tr?
 
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Sorry not trying to be rude. I just think the cavalierly optimistic responses here may be misleading if the OP is female.



www.nytimes.com/2016/06/26/business/tenure-extension-policies-that-put-women-at-a-disadvantage.amp.html

 
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As a male PD, I have counseled a few dozens female physician scientists... It is harder because we have biological differences. I can't be pregnant. However, women physician scientists can have it all, but that is not the case if your partner is not fully supportive of your career. My daughter made the decision to pursue our career (she is a current MSTP student), but only after being at NIH and seeing how it could be done. Time management is crucial. I understand what @tr has posted from Nature and NYT. The Doris Duke foundation has a program specifically tailored for female physician-scientists. We need institutional buy-in into those types of programs.
 
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I don't know if small-scale grant programs that provide career support to a select group of high-achieving women would go as far as some broader cultural progress on the equitable distribution of household labor.
1593443338691.png

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This is an interesting suggestion: providing a 'household labor benefit' as part of a university benefit package. That seems, to me, more likely to be successful than a grants program.


Check out what happened to female-first-authored paper acceptances after everyone became their own full-time daycare.

Proportion of research papers accepted where the first author is female, by month of submission over past five years

1593441788928.png

 
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sluox

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I am currently applying this cycle and I'm gradually learning more about what's in store for me down the road. The more I learn about how awful residency programs are in terms of weekly hours of commitment (80-100+ hrs a week at some programs), the more I'm realizing that being in a residency through my mid-30's may not be compatible with having a family.

Before even considering things like a spouse's potential career aspirations, I don't know if I could go years without being involved in my own family. Do y'all have any experience or advice to impart in that regard?

MD alone, I finish residency by 30. PhD alone, I'm an independent PI with an established lab by 30. But it feels like MD PhDs are just starting the most grueling part of their career by 30.

I think we got slightly diverged from the question.

If the question is can I have a child in during residency, the answer is, typically, yes. Once you have a child or even during pregnancy, things tend to start to reconfigure in a way that make it likely to sustain a career in a particular way.

Having said that, I have observed anecdotally that there are a significant size of childless female PIs, either MD/PhD or PhD. Childless male PIs are somewhat more rare. My suspicion in that this a selection bias. As you said, women are not able to tolerate "go years without being involved [in a way that is sufficiently significant] in my own family." In particular, if in your imagination residency is less problematic than after residency, you'd be mistaken. Junior PIs often work many more hours, especially nights and weekends, than a senior resident. Choosing this career path by definition is being psychologically okay with the idea that you will NOT be reading your children to bed every night, and you will NOT be spending every weekend playing with children, etc. etc. knowing that statistically, the outcome of the children are equivalent (and in a number of studies, working mothers often have BETTER outcomes, likely due to selection bias).

Logistically, the critical piece of this is your mate choice. It's best if you go down two tried and true pathways of successful women who are mothers and in demanding careers: 1. marry someone even more powerful and wealthy than you'll ever be, or at least will contribute significantly to wealth building and would agree to your commitment to a career that potentially pays less and requires more work. Many examples of this model. This resolves the issue of childcare through extensive hiring of help. 2. having a father who is willing to be the primary childcare provider, and relocate if necessary--this is much more common in lower cost of living areas, as the salary of one physician-scientist even during training is often sufficient for a household.

If you are committed to a demanding career and want children, it's vitally important to have these discussions early in engaging a romantic relationship. If your husband is capable and onboard, it's perfectly doable. In terms of outcomes of children, in general examples of successful women working demanding careers and never particularly paused for childrearing seem to have pretty good children, based on my observation of incidental cases of females in senior management. If you don't choose your mate carefully, divorce is very common. You cannot afford to have delusions about romantic relationships. People's long term goals rarely change.

In fact, beyond the junior faculty/young children stage, while unmarried/childless might get faster at the starting phase, I don't recommend deliberately choose to go down this path purely for career advancement, because based on my observation it's distinctly not a good thing in later phases. Very few in senior management are unmarried/childless, and to a certain degree, I think it's institutional mistrust of this demographic. To another extent it's selection bias: unmarried/childless are less interested in the type of work/relationship building that will result in institutional advancement.
 
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sluox

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I don't know if small-scale grant programs that provide career support to a select group of high-achieving women would go as far as some broader cultural progress on the equitable distribution of household labor.

This is not the question here. There are two questions that are largely unrelated IMO. One is institutionally how do you design the system to encourage one or another outcome *statistically*. Another is given the system as it is, how do I optimize my choices to achieve a particular outcome FOR MYSELF. Institutionally there are larger and conflicting considerations that preferentially choose women who will have children who, say, also married a high-income professional who will have the means to survive with their own childcare, than someone who married a poor musician who refuses to be a stay at home dad. In fact, in the latter scenarios institutionally there's a preference if said women move to LCOL. Unless you think LCOL schools have no worthwhile research. One of the stated goals at NIH is to equitably distribute funded PIs geographically. Given the limited number of spots and the diversity mission is primarily driven by demographics rather than total household income, the former scenario is clearly preferred on an institutional level. On a personal level, sometimes these choices cannot be made easily: it's difficult (though certainly not rare) to dump your charming high school sweetheart who is not destined for wealth that you married at 22 just because you decided that you want to go down a certain career path.
 
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I think we got slightly diverged from the
Choosing this career path by definition is being psychologically okay with the idea that you will NOT be reading your children to bed every night, and you will NOT be spending every weekend playing with children, etc. etc.


I really don't think it's the bedtime stories that are the time suck. An infant or toddler adds the equivalent of a second more-than-full-time job in raw household labor (laundry, dishes, food prep, housecleaning) plus childcare (feeding, bathing, exercising, soothing, entertaining).

Statistically, most of this labor is done by women, and this is still true when women are FT employed (see graphs above comparing women and men scientists). You can hire out some of it (housecleaning being most amenable to this, see Fig 2 above), but you can't hire out nearly most of it.

I don't think the difficulty with women's career advancement in science/academia has much to do with overt discrimination at work. It's because women who have young children are adding the equivalent of a second full time job to their plates, *killing* their productivity in the crucial postdoc/early faculty years, whereas men are (*usually*, before you #notallmen me) adding the equivalent of a relatively demanding hobby.

When the review committee sits down to look at the grant applications and sees that Dr Y Chromosome published eight papers last year while Dr X Chromosome published two and has a little note that she had a baby on her biosketch, who do you think is going to be funded?

Parenthetically I think the physician-scientist path compounds this issue because there is already a productivity lacuna in residency due to the clinical care. Reviewers aren't handing out adjustment points for this stuff; and to be fair, it all adds up to a huge period of time. Our productivity might start out even with PhDs at the end of med school, but inevitably falls behind during residency. You can make that up by working like a dog in fellowship/postdoc, but if you make the dumb move of having a kid at that time, that's no longer an option. So you end up with like a 7+ year period of very low productivity compared to a straight PhD who is male or childless. There's no way a grant reviewer is going to overlook that big of a productivity difference.
 
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sluox

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I really don't think it's the bedtime stories that are the time suck. An infant or toddler adds the equivalent of a second more-than-full-time job in raw household labor (laundry, dishes, food prep, housecleaning) plus childcare (feeding, bathing, exercising, soothing, entertaining).

I agree basically with ALL of what you say. However, I'm asking a different question. You are saying, okay this system is messed up, we should change reviewer criteria such that we shouldn't demand as much productivity from women who had children. This causes problems: 1. many childless people aren't very productive EITHER--your productivity isn't linearly coupled with having children. 2. women who decide to not have children end up having greater regrets later on than if they had children but didn't get good grant reviews on a temporary basis. 3. people who end up taking advantage of this are people who may or may not need it: people who are wealthy enough from either parents or spouse that they CAN indeed hire multiple full-time job equivalent of household labor. And those spouses tend to cluster around the coasts, so it worsens the mal-distribution problems in a very aggressive way. So broad policy changes end up having very complicated collateral effects. And in any case, these are very long term changes that'll be slow anyway.

I'm asking, given the system as is, what's the *mechanism* to achieve holistic success as a female physician-scientist ("having it all"). The answer, IMO, shockingly, is mainly picking the right spouse and having the right and clear agreement with your spouse from day 1, and just accept the fact that you need a nanny+cleaner+babysitter+possibly cook. And if you can't afford to hire out because your husband makes no money then you just have to accept the fact that you need to move to a cheaper area and/or have him stay at home. These are the realities of making it work. These arrangements critically depend on the spouse's buy-in. and the process runs contrary to everything the mainstream is teaching and feels at first glance incredibly disempowering (i.e. the faulty premise that women can be successful *independent* of men). But I think it's the truth. People get significant criticism for this un-PC advice (see the Princeton mom article, which caused so much controversy that it was removed from The Daily Princetonian). Secondarily, it's picking the right job: e.g. scrutinize scenarios where jobs are not immediately performance-driven, and slowly transition, etc. This again runs contrary to conventional wisdom if you asked your postdoc supervisor for advice in picking a job. Nevertheless, these are closed door suggestions that if you'd often get when you go directly to female senior management.
 
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I agree basically with ALL of what you say. However, I'm asking a different question. You are saying, okay this system is messed up, we should change reviewer criteria such that we shouldn't demand as much productivity from women who had children.

No no, I'm actually not suggesting that. I think it is untenable and unrealistic. I am actually suggesting more that the search for solutions should focus on the housework gap, not on funding mechanisms that are specific to women. I really liked the idea of a 'housework supplement' as part of a faculty startup package, which might obviate the regressive need for women to gold-dig successful husbands who can afford to hire a housecleaner so their wives can spend more time in the lab.

I also think, broadly, more cultural recognition of the housework gap as a major contributor to pipeline problems for women would be useful. I think we can very usefully look to same-sex couples for better models of the division of household labor. They have a lot of things figured out that the caveman heteros would do well to emulate.

I'm asking, given the system as is, what's the *mechanism* to achieve holistic success as a female physician-scientist ("having it all"). The answer, IMO, shockingly, is mainly picking the right spouse and having the right and clear agreement with your spouse from day 1, and just accept the fact that you need a nanny+cleaner+babysitter+possibly cook.

I think there's broad agreement across camps that picking the right spouse is crucial. However I'm not so clear that your assertion that the right spouse is one with money is correct. Actually what usually happens when women marry a higher-earning spouse is that his career takes precedence, meaning because she makes less money she will be the one to backpedal, downshift, and move to an area that supports his career progression but not hers. The money to hire a housecleaner is meaningless in this scenario.

The stay-at-home dad is the best bet, hands down; Princeton mom be damned. But where are those guys? Thirty thousand women scientists can't all marry the same four people.
 
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sluox

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I really liked the idea of a 'housework supplement' as part of a faculty startup package,

Parental supplements are very problematic. They tend to worsen existing "inequalities" for reasons even beyond ease of "abuse". I.e. as I said, female PIs who are married with children who are temporarily "disadvantaged" at junior level actually carry an advantage at the senior level.

The stay-at-home dad is the best bet, hands down; Princeton mom be damned. But where are those guys? Thirty thousand women scientists can't all marry the same four people.

Those exist. But women who prefer these types of men are not prevalent in competitive careers for very obvious reasons: women prefer to have the *option* to backpedal even when they have the means not to. Who doesn't? Most men don't even have a choice if they want to backpedal, because their spouse tends to make significantly less money to begin with, and after having children, it's much more socially acceptable for her to quit her job instead. Marrying rich gives you a lot more options than marrying poor regardless of gender. The risk of involuntarily taking the backpedal is low vs. the very real downside of having to relocate to a LCOL--or really what it implies for your future (less prestige, lower institutional resources, etc).

Destigmatize "gold-digging" IMO is important. Also, there's a huge problem of do as I say not as I do. Very few senior female PIs are married to stay at home dads. Very, very, few. It may be a chicken or egg problem, but stay at home dads self-select in a way that don't encourage career growth.
 
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Parental supplements are very problematic. They tend to worsen existing "inequalities" for reasons even beyond ease of "abuse". I.e. as I said, female PIs who are married with children who are temporarily "disadvantaged" at junior level actually carry an advantage at the senior level.

I agree that the child penalty mostly goes away after the kids are out of the early needy stage. The problem is that after the multi-year productivity hit in the crucial transition-to-independence phase, most women won't make it that far.


Those exist. But women who prefer these types of men are not prevalent in competitive careers for very obvious reasons: women prefer to have the *option* to backpedal even when they have the means not to. Who doesn't?

I don't know if this is a calculated decision among young people for whom family formation is still a theoretical future event. I think it's more that they just don't meet those types of men, and maybe are not attracted to them if they do. Successful driven people are attracted to other successful driven people, and if you are spending all your time in med school and grad school, other successful driven people are mostly what you're meeting. Hypergamy is a thing, but power couples are more common now. However, when women think they're half of a power couple, men in those same relationships think their own careers are the priority.


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Two-thirds of Millennial men expect their partners to take primary responsibility for raising children. Fewer than half of Millennial women expect that they will take primary responsibility.

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Marrying rich gives you a lot more options than marrying poor regardless of gender. The risk of involuntarily taking the backpedal is low vs. the very real downside of having to relocate to a LCOL--or really what it implies for your future (less prestige, lower institutional resources, etc).

I think the risk of taking a backpedal is close to 100% if your husband makes more money than you do and you have a child together. Somebody has to do it, and if he makes more money, he is just not going to be the one.

Also relocating to a LCOL area is not at all a bad career move for most scientists, as long as the move is specifically for your job and not your spouse's.

Universities in LCOL areas seem to offer way more support for their junior faculty. I know several women who left their fancy coastal institutions where you were basically sink or swim from day one as far as protected research time (because if you couldn't fund your own time there was somebody just as eager and accomplished in line right behind you), for plum jobs in middle-of-the-country states where they got solid departmental funding and/or multi-year startup packages. It looks like a fantastic deal to me. But your husband has to be on board to take the backpedal.
 
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MD alone, I finish residency by 30. PhD alone, I'm an independent PI with an established lab by 30. But it feels like MD PhDs are just starting the most grueling part of their career by 30.

I don't understand your question.

Are you concerned because you'd be starting residency at age 31? This is standard age for MD/PhD.

IMO, there is no good time to start a family as an MD/PhD. All the times suck. This life is too long, too hard, and too uncertain. The average age at first R01 is ~45 years old (as of 2016, though that keeps going up).

It's not much better for PhDs at 42 years old.

You'll find something that works for you if you have children. Most of the time I find myself working around 60 hours a week. You'll need help, but those kinds of hours are not that abnormal for career professionals like us.

Also relocating to a LCOL area is not at all a bad career move for most scientists, as long as the move is specifically for your job and not your spouse's.

Universities in LCOL areas seem to offer way more support for their junior faculty. I know several women who left their fancy coastal institutions where you were basically sink or swim from day one as far as protected research time (because if you couldn't fund your own time there was somebody just as eager and accomplished in line right behind you), for plum jobs in middle-of-the-country states where they got solid departmental funding and/or multi-year startup packages. It looks like a fantastic deal to me. But your husband has to be on board to take the backpedal.

YMMV. This has not been my experience.
 

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I think the risk of taking a backpedal is close to 100% if your husband makes more money than you do and you have a child together. Somebody has to do it, and if he makes more money, he is just not going to be the one.

Disagree. If he makes more money, AND you care enough about your work, then you can afford to hire out everything even if you don't get paid a lot. This is the most common model of female PIs at "coastal elite" schools I've seen so far. Nobody takes the backpedal, and the only downside is you don't get to see your kid as much as you might want, and the women basically make peace with it.

The "bigger" problem of your SAHD proposal here is successful women aren't attracted to men who are more interested in staying at home or even take a very relaxed job that makes no money which then might eliminate the option of pursuing the above, should they decide to do so. In particular, men who have the personality to do this but have the training/skills often get PUSHED by the women to not do this, but instead, work in a job they don't like to make more money. This is a major marital conflict point. Many personal examples. This is also I would say the main reason most married MEN with children drop out of academic science at the postdoc stage. In examples when this works in "coastal elite schools", where the husband's a teacher/musician, someone's family's wealthy and paid for the downpayment (and then some) for a house. This is not even rare...so if this is the road you want to go down, perhaps it's time to psychologically prepare yourself to have that conversation with your parents...

It looks like a fantastic deal to me. But your husband has to be on board to take the backpedal.

Agree. However, this still doesn't solve the problem. 1. Few successful husbands will take the backpedal. After all, being a PI isn't THAT desirable of a job by conventional standards. The desirability of the job is not commensurate with the competitiveness of the job. So if you can do the whole hire out thing, you end up doing that. 2. A lot of the time it's the woman who doesn't want to move to LCOL even when the SAHD is totally up for it, for other personal reasons (family, lifestyle, politics, etc.) SAHD types can be pliable about these demands, but successful career women often aren't. I've seen this causing huge conflicts especially when the female PI wants to push the SAHD type to "work harder" so they can stay at "coastal elite".
 
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Disagree. If he makes more money, AND you care enough about your work, then you can afford to hire out everything even if you don't get paid a lot. This is the most common model of female PIs at "coastal elite" schools I've seen so far. Nobody takes the backpedal, and the only downside is you don't get to see your kid as much as you might want, and the women basically make peace with it.

It's just a myth that you can hire out 'everything.' Housecleaning, sure. Laundry, maybe, though organizing pickup/dropoff/put away is demanding enough that it doesn't save much. Food shopping/cooking/dishes? You'd have to be really rich, this is a huge number of hours per week. Breastfeeding? This is an incalculable time suck and I don't see too many wet nurses on the market. You can hire someone to give the kid a bottle while you're away but you're still stuck pumping a whole bunch of that time AND you have to wash all the bottles later so it's like triple the work in the end. Picking up your husband's socks and dirty cups, endlessly? I mean, are you going to pay someone to live in your house and follow him around??

Nanny you can have 40 h/week, not much more. As Neuronix notes, successful scientists more typically work 60. And if you have significant clinical demands and are trying to get science done using your nights/weekends, you can forget about that once you reproduce because every single second of your time is now accounted for. With an under-3, either you are directly caring for the kid or you are paying someone else to do it, every hour of every day.

The "bigger" problem of your SAHD proposal here is successful women aren't attracted to men who are more interested in staying at home or even take a very relaxed job that makes no money which then might eliminate the option of pursuing the above, should they decide to do so. In particular, men who have the personality to do this but have the training/skills often get PUSHED by the women to not do this, but instead, work in a job they don't like to make more money. This is a major marital conflict point. Many personal examples.

I'm sure we all have lots of fun gossipy anecdotes about people but I'm not sure that's helpful to young scientists trying to make individual decisions about their lives. That said, the OP doesn't seem to have returned to this thread so perhaps it's all just moot ranting.
 
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The way I see it, children are a more than full-time job. It's not demanding work, but it is repetitive and it requires your attention. So sure, a stay at home spouse can certainly take care of children, though I know that's not in vogue. You can have children and a stay at home spouse basically at any time and on a resident's or even MD/PhD student's salary if you're frugal and in a reasonably low cost of living location.

If both spouses are professionals working 60 hours a week, you need either very supportive family to raise your kids or two nannies. Two nannies are expensive, so for that at least one of you needs to be an attending. If you do use family, you also need to live near your family, which typically means family needs to come to you because picking location at any stage of life for a physician-scientist is very challenging to impossible.

If one spouse works a more normal or part-time physician job at more like 30-40 hours a week you can do it with one nanny or day care. That depends on the hours and situation. You can probably do that at resident stage or maybe even student stage--that depends on finances, COL, your standard of living, etc.

Now whether you're willing to have small children and work ~60 hours a week is up to you. I don't see how you can really push yourself to a physician-scientist career at less than 60 hours a week, but I'm sure that it's happened. There is some amount of self selection in this in your residency, how hard you push yourself and your research career, etc.

In the end, there are lots of ways people make it work. I get annoyed by these discussions of what "women want" and what "men want", etc. There's a huge variety of people out there. At the end of the day you pick a mate, agree on your mutual goals, and move forward. Or you get divorced--there's plenty of that too. Good luck.
 

sluox

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You'd have to be really rich, this is a huge number of hours per week. Breastfeeding? This is an incalculable time suck and I don't see too many wet nurses on the market.

I agree. The trick is the details, namely what you mean by "really rich". I think one needs to be "really rich" to be willing to blow somewhere between 30-50k+ a year for 5 years minimum on household labor for 2 young children at a medium to high cost of living areas, which would include, very minimally 1. full-time nanny/full-time-extended daycare. 2. cook who comes 1-3 times a week. 3. minimally weekly cleaner. 4. part-time non-public preschooling for the older child. 5. regular cleaning and sporadic other chores. If you want a more luxurious experience you'd typically want an au pair AND a nanny, etc. Ideally it'd even come in a "package". Like if I pay a company 50k, they outsource everything for 60 hours a week.

As of right now, this is very doable if your husband makes 300k+ and you make 60k, a not uncommon scenario in this demographic. Other common scenarios involve you making 150k and your husband making 200k, you making 60k your husband making 150k and your parents chip in 150k, etc. None of these scenarios meet my definition of "really rich", though perhaps they would if you think from the perspectives of the bottom 50%, where the total savings ~ $300. This will NOT work, however, if you make 100k and your husband makes 60k, esp. at HCOL. This math, in my mind, precludes institutional support, as the amount required to make this happen is actually quite substantial taken at a group level.

The basic estimated cost of being a dual-income couple with a female physician-scientists during childbearing age is somewhere between 250k and 500k in an HCOL, and maybe 100-200k in LCOL. While this sounds like a huge number, the total income of a female physician-scientist through a career is something like 3-5 million, and that's not considering the compound interest in savings. At the moment there's no clear pathway to finance childcare-related costs, but this is probably a growth area, as more women in childbearing years without family means go into high-income high work demand scenarios. As is large banks have physician personal loans at 100k. For a female physician with a track record of residency training completion, the default rate on a personal loan of 250k paid on installments for childcare is probably minimal, but this type of financial product doesn't exist as of right now.
 
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Neuronix

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I'm curious how they manage to get an R01 part-time and have patients or even do anything clinical. I struggle myself to achieve this at 60+ hours/week.

PS: 1 R01 equivalent at a time... Funding rates at NCI are often less than 10%... If you can stay R01 funded for long periods of time, even with just one, you can be a rockstar in my specialty. In what specialties are people in even in their 40s still routinely rocking multiple R01s? Median age to first R01 for MD/PhD is up to what now, 45?
 
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