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Published: September 29, 2020

Show and Tell / September 2020

Navigating the Parent-Physician Journey in a Pandemic 
By Tipu Khan, MD, FAAFP, FASAM
We discuss work-life balance all the time, but the conversation often ends as a cursory discussion about finding that sweet spot. For years, I have been trying to find balance in my life and it has been hard. Other than those in shift work schedules or working less than full time, I have not seen the balance modeled as I would envision it. As a busy family doc, 45-50 hours a week is a conservative minimum; add inpatient, obstetrics, and emergency work along with CME time and we are up to 50+ hours. Parenting for physicians is thus relegated to second tier in many situations. Second tier is not the parent I want to be.   

As schools reopen in the era of COVID-19, physician parents need to find creative ways to doctor and parent. In our practice, my partners were willing to allocate two-half days of administrative time to be taken from home. We called this admin time, Parent Teaching Time (PTT). The understanding is that those of us with young children will complete our admin duties on our own time, e.g. nights/weekends, to stay up to date with our responsibilities. 

This unique PTT opportunity allows me to be home and lead my children’s educational curriculum, giving my partner, who is also working, a break. With all the negative and disheartening news around COVID-19 in our country, I have found this PTT to be a silver lining. As a busy academic full spectrum family physician, I cannot imagine another situation where I would be given dedicated time like this with my young children during business hours unless I dropped to part-time or moved to shift work. I look forward to re-imagining my work-life balance moving forward post pandemic with a focus on being available more for my young kids.   

One thing I have noticed is that it’s hard to manage the quick and often role switch … doctor dealing with a pandemic to parent dealing with a pandemic. I’m careful not to bring home my emotions or stories of the day unless they are positive. My kids are scared and tired of everything already, the last thing they need is ongoing stories from dad’s work of suffering or pain. I’m learning how to best help my kids psychologically cope with social isolation with ideas such as future plans, a dedicated routine, and giving them more input in daily chores such as what we’re having for dinner. 

Different households have differing access to physical activity but remember a core part of school is social and physical interactions. Many family physicians, including our own Lauren Simon, MD, MPH are urging schools to develop online physical activity classes that can be done with little to no equipment and from home. Consider using your role, as a parent-physician, to advocate within your own school district for organized and equitable physical activities. For more on this topic, check out this blog.     

The resource below, Helping Kids Cope While Sheltering in Place, from the American Academy of Child and Adolescent Psychiatry provides great advice on helping your kids cope with sheltering and school from home. I particularly like #7, “Encourage kids to choose something new to learn about. It could be a game, a craft, or a challenging book.” Over the past few months our house has ditched the training wheels for the bike, learned to skate, read through five of the Harry Potter books, and started distance running. Not bad for a 1, 4, and 7-year-old. Take a moment to read through the 14 tips they discuss – maybe you will find something useful in your journey as a parent-physician in the pandemic.  

We asked colleagues to share their tips for physician-parenting and heard these comments. Please share your suggestions on CAFP’s SPARK or at the 2020 virtual Clinical Forum: 

“Once my immunocompromised mother- in- law went home (early August) after staying with our baby for 10 months, we put baby in daycare three days- per- week and sent our sons to “after school camp” from 11-5 giving my husband time to think straight after Zoom school. Camp is with the same 12 children every day; they wear masks and have all their own supplies and a designated seat and table. Lots of hand washing,,  and temp checks and shoe cleaning on entry. They also spend a large part of the time outside. I think hiring out help is important for sanity and how to do it depends on how much risk you are willing to take. We also have opened our bubble to my parents (ages 69 and 75) because they said they would rather die than be away from their grandchildren for any longer. When we are with them my husband and I wear a mask and so do my parents and we eat in different rooms, but the kids do not. My parents are much happier and so are the kids. So now we basically have four pods (my work people, our sons camp group, our daughter’s daycare group, and my parents). I do almost all the shopping for our family and my parents and we do not really see anyone else.”
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“While our normal daily routine has been upended, it is helpful to start a new routine that includes things you enjoy, like making a place in your daily schedule for music or skateboarding. We also use the “three deep” communication technique: Asking my child a question that requires more than a yes or no answer. Asking a follow-up question that goes deeper into their experience or observation. Repeating three times. My wife and I identified families who share our level of health precautions during the pandemic, so we feel comfortable safely socializing. It has been fantastic for our kids and us too. My younger son is just one-and-one-half and was enjoying nursery school when the pandemic hit. It was disconcerting to see him run into the bathroom one evening, grab a few sheets of toilet paper to hold over his nose and mouth, and shout “mask, mask.” But what is more concerning is the reluctance he has in meeting new people. We have found that modeling our relaxed mood and having friendly conversations with the “stranger” quickly de-escalates the situation. Like so many of us, my family has discovered a few pleasant surprises. We were always on the go, every weekend loading up on lots of activities. Now we are enjoying a slower, more relaxed pace. That is something we’re going to carry forward.”
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“Unfortunately, I feel so many docs in this situation, self-included, have been kind of thrown to the wolves! I think it falls on the non-medical partner if one is fortunate to have one. It was horrible in the first months of the first surges because those who had to do full time childcare really couldn’t help as much with additional volunteer shifts. The only thing that has kind of worked is to try to schedule a split day — my partner has consistent morning meetings, so I’ve tried to schedule afternoon clinics/meetings. and then both of us work at night after bedtime. And just lower expectations all around.”
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“We are super privileged to afford having an au pair to help (two-physician household). Quite frankly, I feel fortunate to be able to leave the house for work several days a week compared to my friends who work and teach full-time from home (my kids are eight, seven, and three)… Nevertheless, we sometimes feel at the end of our wits, and being cooped up indoors for a month of heavy smoke definitely broke the last straw for a while there. School from home does not work well for many kids with special needs. One of my children has ADD and it is a struggle. We are basically coming to terms that he is probably going to learn very little academically in this year, unless schools open up for kids with special needs and for families who need it at the very least. My first grader on the other hand is doing fine. Self-motivated kids enjoy this model, she’s halfway through her math book and eagerly completes her journal for the next day in the evening (yes, she wants to be a family physician :D)… While I am tired, I feel fortunate to be able to afford hiring help, which many in our communities are not. In addition to an au pair who lives with us, we have the privilege that our three-year-old can start in person preschool four mornings a week next week. That will allow whoever is working with the older two to focus better on them. Accepting the slightly increased risk of bringing COVID into our family by allowing him to go to in person preschool is well worth it for us (plus their COVID protocols are incredible, they are really all doing their best)” 

Other resources on parenting in a pandemic:
AACAP 
WHO 
Harvard Medical School 
Boston Children’s Hospital

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