Emergency medicine requires flexibility as we work irregular shifts, nights, weekends, and holidays. Unlike the general populace, we face the unique challenge of seeking childcare options that can adapt to unpredictable and often nontraditional work hours, requiring creative solutions or adjustments to the typical childcare options. Here are some to consider.

Daycare Centers

“[My daycare] does drop-in day care. You buy five days at a time and then let them know the week before you want to use one. Only weekdays though.”

—Dr. Kaps

Day cares and programs are great options if you have partners who work more “regular” hours. Many day cares have drop-off as early as 7 a.m. and pickup as late as 6 to 9 p.m. As your child gets older, they may start attending educational programs with shorter hours, but these facilities often offer extended or flexible care options. Day care can be a more affordable option than nannies and babysitters and has the added benefit of early socialization.

Nannies and Babysitters

“I posted on every social media platform, and almost everyone we talked to said they weren’t interested in our erratic schedule. We found one woman who quit after just one summer, and the search had to start all over again.”

—Dr. Grossman

Hiring an in-home caregiver (e.g., nannies, nanny shares) can be especially challenging, as caregivers often expect regular daytime hours. Be up front in searching for caregivers who are willing to adjust their schedules to meet your needs. When negotiating pay structures with in-home caregivers, you may need to increase compensation for added flexibility. A mutually agreed-upon contract that is finalized before the start date will help set expectations and get everyone on the same page.

Potential options:

• Hourly Rate with Shift Differentials: Offer an hourly rate, with higher pay during evenings, nights, weekends, and holidays.
• Guaranteed Minimum Hours: Provide guaranteed payment for a minimum number of hours per week or month, regardless of the actual hours worked.
• Standby Pay: Offer standby pay for times when the caregiver is required to be available but not actively caring for the child, such as when you’re on call.
• Overtime Pay: Clearly outline overtime policies and rates for hours worked beyond a certain threshold in a day or week to fairly compensate caregivers for extended shifts or last-minute schedule changes.

Night Nanny/Night Nurse/Night Doula

“I had a rough pregnancy and worked until the day I went into labor. I also experienced postpartum complications. Having a ‘baby nurse’ or ‘night nurse’ was crucial for me during that first month because it allowed me to get the extra sleep I needed to recover and be there for my baby. It also was helpful, as a first-time parent, to learn from an experienced professional how to take care of a newborn. It definitely reduced my anxiety significantly.”

—Dr. Haimowitz

Especially for nocturnists or any emergency physician on nights, hiring a night nurse, night doula, or night nanny can be a crucial and anxiety-relieving support system. These caregivers, who have varying levels of training (from RNs to CNAs to nannies), specialize in newborn overnight care and can help guide parents in establishing healthy sleep patterns. Even before returning to work, having additional assistance at night can be helpful for any parent needing to regain some much-needed sleep.

Au Pair

“Au pairs can be awesome, but the program has flaws. For the most part, you’re bringing in a teenager to your house who has never been outside their native country, which can come with all the teenage problems. We were fortunate to have two great au pairs, but a third left after five months. It is not the panacea for childcare.”

—Dr. Propersi

Au pairs are typically college-age adults from other countries who live in your home. Au pairs have certain working-hour guidelines they must abide by.

Screen potential candidates carefully to ensure they understand and are comfortable with the demands of your irregular shift schedule. Establish clear communication and expectations from the outset, including a written agreement outlining the au pair’s duties, schedule, compensation, and any special arrangements related to your shift schedule. Maintain open and ongoing communication with your au pair to address any concerns or adjustments needed as your schedule changes over time.

Family and Friends

Enlisting the help of family members or trusted friends can be a valuable childcare option, especially for sporadic or last-minute shifts. Build your babysitter network early, and don’t be afraid to take advantage of your network of medically trained colleagues.

Emergency Backup Care Services

Some companies and hospitals offer emergency backup care services for employees, providing temporary childcare in case of unexpected schedule changes or emergencies. Check to see if your employer provides this benefit or if there are local agencies offering similar services.

Flexible Childcare Apps

Several childcare apps connect parents with vetted caregivers who offer flexible scheduling options. Apps like UrbanSitter or Care.com allow you to search for qualified caregivers who are available during irregular hours. These can be especially helpful when you need last-minute childcare for an unexpected shift.

Community Resources

Investigate community resources such as childcare cooperatives, community centers, or religious organizations that may offer flexible childcare options or support networks for parents with nontraditional work schedules.

Shift Adjustments at Work

When considering childcare options such as daycare or nannies, it’s essential to align your work schedule to facilitate seamless coordination. Here are some strategies for adjusting your shifts at work to accommodate childcare arrangements:

Request more rigid shifts. If you are opting for daycare or hiring a nanny, consider requesting more rigidity in your shift schedule to make it easier to schedule childcare. This could involve requesting the same schedule every week or asking for consistent days off each week.

Explore nocturnist roles. If you have nighttime help available, transitioning to a nocturnist role can automatically add a degree of regularity to your schedule and may even decrease your number of required hours. Night shifts often follow a more predictable pattern, making it easier to coordinate childcare during the day.

Bolus your shifts. If you have out-of-town family or friends coming to help with childcare, bolusing your shifts each month can be useful. Concentrate your shifts into specific blocks of time, allowing you to maximize the support from your family while minimizing the number of days they need to assist each month.

Reduce hours during early months. During the early months of parenthood, consider reducing your clinical hours as you adjust to parenthood. Have this conversation with leadership early to ensure adequate coverage should you choose to reduce your hours or take extended leave.

Explore remote work opportunities. If you’re able to supplement your income with telemedicine or remote work opportunities, consider a more remote work schedule on a temporary basis.

Finding suitable childcare as an emergency physician with irregular shift schedules requires creativity, flexibility, and careful planning. Remember to prioritize clear communication, reliability, and consistency when selecting childcare arrangements, and don’t hesitate to reach out for support from colleagues, friends, and community resources. With careful consideration and proactive planning, managing childcare alongside a career in emergency medicine is achievable.

Dr. Grossman is an associate program director for the emergency medicine residency at The Mount Sinai Hospital in New York City.

Dr. Haimowitz is a clinical instructor for the emergency medicine ultrasound department at New York Presbyterian Queens.

Dr. Soo is the associate medical director at Illinois Emergency Medicine Specialists in Chicago, Ill.