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Child Care For A Busy Physician Family

September 22, 2019

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Childcare for a physician/ musician household

My son turns two in November. In honor of his birthday, and our family’s changing childcare strategy, I wanted to share what this past year has looked like for us. Below is an outline of a strategy that works for us, along with some helpful tools you may want to try! 

A little background

Since my husband is a musician and I’m a physician, we have a schedule that vacillates between demanding and erratic. My husband teaches music lessons from home, and gigs daily/ nightly, depending on the season. Sometimes, he travels for up to a week. So our childcare plan has been tailored to prioritize flexibility and convenience, while we juggle our careers with learning the parenting ropes. 

The part-time stay-at-home dad

Since my husband is a freelancer, with greater flexibility and fewer work hours than me, he takes primary parenting responsibility most days. He takes the lead on scheduling and execution of the child care plan. This empowers him to schedule according to his needs, including coverage for music lessons, administrative time, gigs, or getting to the gym. He schedules Wes’ well-child visits and gets him vaccinated. (Luckily, I can run across the street from work to join them 90% of the time.) 

A typical day, when the primary parent is a musician, involves waking up by 9 or 10 am. They enjoy a hearty breakfast of eggs, sausage, and English muffins, before heading out for a toddler-friendly adventure. We are members of the local Children’s Discovery Center, an expansive kid’s museum, as well as the Palm Springs Art Museum. Bob and Wes roam there, looking at paintings and sculptures. Sometimes, they head to the park, the indoor play area at the mall, or the local aquatic center. Outings like these allow Wes to socialize with other people, learn things, and get the stimulation he needs. The remaining time is spent running around at home, or experimenting on the piano.  

A part-time nanny helps us with childcare

Since Bob still chooses to work, we have a part-time nanny I found on She is a semi-retired former daycare owner, with grown children of her own. Working with her lends us incredible flexibility: she’s willing to work four hours or twelve, depending on our needs. In addition to caring for our boy, she helps us keep the house tidy, runs the washing machine, and folds our laundry. It’s a huge help. We pay her hourly, excluding bonuses. 

Her typical schedule is noon to six, Tuesday through Thursday, with some work on the weekend sprinkled in. When I’m on call, and Bob is occupied, we put an asterisk on the end time; this means the end time is flexible. This strategy has relieved so much potential tension in the system since I often don’t know when my work will be done. On those days, Marsha knows I could be home before 5 or after 9, depending on the emergencies that arise.  

Nanny payroll

Nanny payroll is key to paying a household employee above board. If you pay someone like a caregiver more than $2100 per year, or more than $1000 per quarter, payroll tax is required by law. We use SurePayroll, a service that allows us to input the number of hours Marsha has worked each week. Then, payroll taxes are calculated and deducted for you. A flat weekly or monthly pay rate is also an option. This site is a user-friendly, and comes with great customer support. I’ve even had longitudinal support from one of the representatives via email. She’s become my go-to person with questions. 

Nanny payroll is then executed via a Zelle transfer. Sure Payroll provides the check amount after deductions, and we initiate an electronic transfer for that amount. 

Pay for childcare with pre-tax money!

If you are spending more than $5000 on childcare each year, you must check out a dependent care flexible spending account (FSA). This type of FSA allows you to pay up to $5000 in childcare expenses with pre-tax money (which is amazing, because pre-tax money is worth one-third to one-fifth more, depending on your tax bracket!) Since I have a professional S-corporation, I administer my own payroll, using Sure Payroll. On the site, I can set monthly or lump sum contributions to come out of my pay automatically.

If you are employed, I suggest checking with your Human Resources, benefits or payroll manager to set up FSA contributions. Ask your accountant how an FSA can benefit your specific tax situation. Over several years of daycare and childcare expenses, this benefit is sure to save you money!

Childcare, the big spend:

Household payroll service costs us $39.99 per month. Nanny wages and associated payroll taxes run $400-700 per week. 

In January, Wes will start at a local Montessori school, which costs $150 per wk. We will pay this fee whether school is in session or not, so the total cost will be about $7800 per year. We will use FSA funds to cover $5000 of this expense.  

I’m excited about the increased socialization our boy will experience when he enters pre-school; he adores being with other kids. When we read Brown Bear, Brown Bear, and reach the page with children, he lights up like a lightbulb! 

The childcare gap for a physician parent

We will still need gap coverage when Bob is gigging and I’m working late. We can have Marsha pick Wes up and give him dinner while I finish my day. Maybe she’ll be willing to be on call for pickups, when she’s not caring for someone else’s baby. Otherwise, on days that run late, I may pick him up myself, and bring him to the hospital for my last case. One of the benefits of the school is its location, just one mile from the hospital!

We will also need to adhere to the school’s sick child policy. With new exposure to other little fomites, we will need Marsha when Wes is too sick for school, and we are both working. Thankfully, her immune system is bullet-proof as a former daycare owner!

My role in the childcare setup

Since Wes was born, I’ve taken one week off per month. This allows me to take care of life maintenance activities a doctor’s schedule doesn’t usually allow, like appointments for myself, car maintenance, and the like.

Otherwise, I take my turn as the primary parent those weeks. When I’m not working, we still call on Marsha, but give her a lighter schedule. This way, I have time to work on my own projects, like committee work, conference calls, the blog, and managing our rental property. 

When I am working, I arrive home as the relief. Marsha goes home to her fur babies, and Bob, Wes and I spend time as a family. Sometimes we go on outings to the park or the street fair downtown. Other times, I take over: feeding and grooming Wes, playing and reading with him, Facetiming with grandparents, and putting him to bed, while Bob heads to the gym or practices music. 

Childcare in a physician family is a true team effort.

I cannot imagine one person taking sole responsibility for child care, and it’s a wonderful luxury to have help. I revere full-time stay at home parents, while knowing I could never thrive as one myself. Although ours is an expensive approach, this setup has allowed for outstanding around the clock care for our toddler, as we develop our respective working-parent roles. 

Medical careers are time-intensive, but they provide a good income, which allows for the gamut of childcare options. Mine is an example of how one family makes it work. I hope you find the best balance for you!

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