A juggling act

By Allison Evans, Assistant Managing Editor, January 1, 2023

The juggle is real. For physician parents, the challenges of parenthood are magnified with long hours, unpredictable schedules, and mounting pressures to do more at work and at home. When you add in childcare, family activities, administrative work tasks, and trying to find a moment to yourself, an equilibrium between professional and home life may feel divorced from reality. The tug-of-war between physician and parent roles can be maddening, although dermatologist parents agree that parenthood has made them better physicians. While it’s tempting to harness superhuman powers in both facets of life, it’s untenable — and often unsatisfying.

Dermatologist parents share their struggles, insights, and experiences with raising a family while building a career — attempting to find fulfillment and balance in both spaces of their lives.

Hard beginnings

Self-proclaimed “derm-mom-tologist” Asmaa Chaudhry, MD, FAAD (IG: @derm_mom_tologist), a dermatologist in private practice in Northern Virginia, had her first child 10 years ago as a chief resident (she’s now a mom to three). “People tell you that there’s no good time to have a child, and that’s true. You have to make time for it.”

Having a child while you’re in residency can be particularly difficult, Dr. Chaudhry said, because you don’t have any control over where you end up because of the match system. “Where I was a resident, I had no family or friends — and my husband was not even there because he had a job and was settled in another place. When I became a mother, I had very limited resources and support; there was really zero support from the residency program.”

“People tell you that there’s no good time to have a child, and that’s true. You have to make time for it.”

With no official family leave policy at the time, she was told that if she were to take more than the three weeks of allotted time off, she would have had to make up that time the following year, which could have delayed taking the board exam, or starting fellowships or private practice jobs. “Because we only had two residents per year, it was clear from the culture that nobody was happy or willing to take over any of the work,” Dr. Chaudhry said.

Not being able to be present during the earliest phases of her child’s life was nothing short of traumatic, she explained. “After depleting all your time for a few weeks of leave after the baby is born, it was expected that you would not take any additional sick or vacation days. This meant that you could not attend your child’s milestone wellness visits. At the time, my husband was basically single parenting.”

A financial hit

After years of training and accruing mountainous levels of debt, starting to practice is a welcome opportunity to earn money. “This was also the time I needed to have children,” Dr. Chaudhry said. For the next six to seven years, she worked three- and four-day weeks so that she could grow and care for her family.

While the specialty allowed her to have these abbreviated work weeks, it also delayed the financial reward, she said. “I’m so grateful that I was able to work three days per week, but no wonder it took me so long to pay back all of my loans.”

There is often a financial penalty to spending more time with family. “I try to have quality time with my son as much as I can. However, this is only a moment in my day — mostly at night,” said Fabiana Suero Ramos, a dermatologist in Lima, Peru. “I find myself in the dilemma of getting paid, providing a future for my boy and becoming a better physician, or to just live my life as a mother. It is very difficult!”

“In private practice in Nigeria, being a dermatologist means you also consult as a physician. The work hours are unpredictable and to have quality time with the children sometimes means less pay,” said Aderonke Omowumi Edun, MBBS, FWACP, an in-house consulting physician and dermatologist in Lagos, Nigeria.

Parenting and practice

“The trauma of my earliest years as a mother evolved into something beautiful. It made me value systems and efficiency and organization that much more,” Dr. Chaudhry said. Everybody at her practice is cross trained in two to three different positions to minimize interruptions when people are out. “It’s very efficient from note templates and the EMR down to the check-in and check-out processes. I’ve maximized all the systems that can make me efficient, which has really helped me save time so I can spend more of it with my family.”

“The practice is really a labor of love. When I first opened the practice, my entire family —including my three young kids — were in the rooms helping me set up before the first day. On the weekends, when I have work to do in the office, we all go in as a family.”

Many of Dr. Chaudhry’s employees have children, and so the practice is family friendly. “When there is a teacher institute day and kids are out of school, we have a special room at the office for children of employees that’s outfitted with a TV, workbooks, art supplies — anything they need to pass the time. Sometimes a staff member simply needs help coming into the office or flexible schedules. This flexibility and support have made our employees more dedicated.”

“I have four kids, so I must love kids — and I love seeing kids as patients,” said Pennsylvania dermatologist Danielle DeHoratius, MD, FAAD. “I try and stay a little bit later in my workday so that I can see my kid patients once they get out of school so they miss as little academic time as possible. I know how hard it is to be a working parent and try to get a child a doctor’s appointment at a convenient time.”

Since COVID, Dr. DeHoratius has also reserved telemedicine appointments for late in the afternoon one day a week so she can accommodate the students with acne. “Seeing the struggles of getting health care as a parent has made me more flexible.”

Insanely organized

With work schedules and family schedules, being a parent and dermatologist often means living in a constant state of juggling. Sometimes a ball or three is dropped, resulting in temporary bouts of insanity. (Raise your hand if you’ve ever forgotten to pick up your kid at camp.)

School activities and schedules aren’t necessarily planned far in advance whereas patient schedules are often booked out, Dr. DeHoratius said. “My Google schedule is my best friend,” she said. “I only operate 24 to 48 hours ahead of schedule. Each child is color coded on the schedule so that I know who has to go where.”

At the beginning of the year, Dr. DeHoratius studies her kids’ school schedules to note the most important dates. “I also touch base with the teachers in the beginning of the year to find out if there are any special activities that I should be aware of and maybe block that day off of work.”

“You have to be insanely organized to survive,” echoed Maryland dermatologist Rebecca Kazin, MD, FAAD, mother to three daughters. “There is a lot of sharing of calendars, but even with that technology, there’s definitely times where someone has forgotten to take someone somewhere or pick someone up.”

It takes a village … really!

Dr. Kazin considers family support a critical factor in her ability to manage her family and career. “I’m from Baltimore and my husband grew up in Baltimore, so both of our parents are less than a mile from our house. I could write a book on childcare. We’ve done nannies, au pairs, daycare. I’ve done everything. But at the end of the day, it’s always our parents who save us and are the most helpful. If we didn’t have both sets of grandparents nearby, there’s no way I could continue working at my pace.”

While Dr. Kazin recognizes that not everyone is lucky enough to live near family or have that level of support, she encourages physician parents to find their support system. “Whether it’s relatives or just a circle of friends or other moms, you have to be vulnerable and ask for help when you need it.”

Quantity vs. quality

An International Journal of Women’s Dermatology survey asked women whether they feel like they missed out on their child(ren)’s milestones and 40% answered yes (doi:10.1016/j.ijwd.2017.04.001). “If you work outside the home, you’re definitely going to miss milestones. That’s just a fact of life,” said Dr. DeHoratius.

“The flexibility of dermatology versus some other specialties affords us the opportunity to be a little bit more flexible with schedules,” she added. “My children see how much I love my job and how rewarding it is, which offsets missing milestones a little bit.”

“While telemedicine has been given new life since the pandemic, being a dermatologist means that you have to physically see patients in the office,” noted Dr. Kazin. “There are times when I’m able to reschedule patients and be there for important family events and activities. But there are also times when I can’t come, and I have to tell my kids that I can’t come.”

“It’s all about the quality of time you spend with them, not the quantity. When I’m at home, I really try to focus on my family and engage with them as much as possible,” she added. “At the end of the day, there’s always a sacrifice. I want to work on a good marriage, and I want to have a good relationship with my kids. I am successful in my career, but that’s not my primary purpose.”

Value of time

“As a physician who absolutely loves the physician-patient interaction, the pull for my time is inescapable,” said Travis Blalock, MD, FAAD, a dermatologist in Atlanta, and father to three children. “I love my family and my career, but the one asset you have that you cannot easily divide is time, and I frequently struggle with that.”

When Dr. Blalock moved to Emory University, his mentor and friend Thomas Stasko, MD, FAAD, gave him some advice. “He warned me not to let my job stretch me too thin. As someone who had been in academia for many years, he knew how natural it is for organizations to ask you to do more, but advised me to resist that push,” he said.

As so often happens, Dr. Blalock got to Emory and found himself scheduled Monday through Friday. “It’s taken me eight years to dial back that initial misstep so that I can devote some professional time for me and personal time for my family.”

“I love my family and my career, but the one asset you have that you cannot easily divide is time, and I frequently struggle with that.”

As someone who prizes efficiency, Dr. Chaudhry admitted that scrolling on social media is one of her biggest time wasters. “I’ll find myself thinking ‘I can’t get rid of Instagram or Facebook. I need them for my business.’ It’s the biggest lie I catch myself in because even when I’m not on my professional pages, I’m mindlessly scrolling.”

To help combat the false sense of dependency on social media, Dr. Chaudhry and her family make a concerted effort to spend time together outside. “As a family, we decided it’s healthiest if I don’t bring work home because there’s no stopping point. We’ve taken up gardening. I’m pretty proud of my green thumb.”

“I’m striving for balance,” she added. “I can’t be working all the time. But I also need time away from the kids. I’m getting there some days and failing others.”

Guilt

“The hardest part about navigating life as a dermatologist and mom is the constant guilt of either not being enough for your children or not being enough in your career,” Dr. Chaudhry said. “If you try to be supermom and then part of your work lapses and maybe you’re not volunteering in the community or going to all the conferences, or you’re not writing a book, it’s easy to feel like, ‘I’m a bad dermatologist.’ You need emotional grace for yourself to know that you’re doing the best you can,” she said.

“Every so often I check in with the kids and ask if it would be a better experience for them if I worked less or if I stayed at home — and 100% of the time, they’ve said no. They qualify it with things like, ‘But then you wouldn’t be able to help other people,’ or ‘We’re glad that you’re a doctor.’ Whatever sort of mental gymnastics we play with ourselves, the kids seem unfazed by it. They’re pretty proud.”

“At the end of the day, you have to be a fulfilled person,” Dr. Kazin said. “I feel like being a fulfilled person makes me a better parent. You shouldn’t feel guilty for wanting to be the best version of yourself.”

Interconnected roles

“Being a parent has changed my perspective as a dermatologist,” Dr. Chaudhry said. “My empathy has increased. My patience has increased. My understanding has increased. My desire to handhold parents through difficult processes or chronic conditions of the skin has increased.”

“You realize that parent brain is very different from other parts of your analytical brain. It helps me to relate to parents when I see concern or panic or fear. A handful of my pediatric patients have severe chronic skin conditions, so I feel like I can offer a perspective that a lot of parents relate to because I can say, ‘Let me talk to you as a doctor first and then I’ll talk to you from the parent perspective.’ I feel like it really enhances doctor-patient trust.”

Dr. Blalock agrees that being a parent has made him a better physician. “When I step into a patient’s room, there is always a background narrative in my mind reminding me that the person in the exam chair has parents or has children or family that values them as much as I do my own children. Taking care of them is a huge privilege and responsibility.”

“I tend to think that if you are not thinking about finding that balance between your personal and professional life, then you are likely getting it wrong,” Dr. Blalock said. “That natural pull to find balance is a good thing — it reminds me that I am lucky to have so much to be thankful for.”

“The best part about being a dermatologist and a parent is that both accentuate a unique and sacred bond — the patient-physician relationship in the former and the parent-child relationship in the latter,” he added.

Additional DermWorld Resources