Rija Siddiqui, MD is a pediatrician, public voices fellow through The OpEd Project, and mother to 17-month old Noah.
Almost 40 years ago in April 1983, the Journal of the American Medical Association published a column by sisters Anne E. Ricks and Sarah Ricks calling for hospitals to provide daycare for employees’ children. They described how hospitals are hurt when employees lack child care: Workers run late or are forced to take days off, their productivity falls, and turnover rates are high.
Now, in the middle of a pandemic in which that care is more urgent than ever, Covid-19 has brought a half-century-old problem back into the spotlight. And not much has changed.
As a hospital-based pediatrician, taking care of patients is a privilege, and every day I can do that is an honor. But treating other people’s children when I don’t feel I have adequate care for my own has crippled me with guilt and feelings of inadequacy.
I became a mother during my third year of pediatric residency. Before my son was born, I was working long shifts and 80-hour weeks. Walking through the eerily quiet hospital floors during night shifts, my scrub pants progressively getting tighter and lower on my waist, I could feel his kicks and turns and knew that I was taking care of him at all times of the day. But after maternity leave ended, this was no longer the case.
When I returned to work, my son was 10 weeks old. Ever since, he’s gone to a daycare center with traditional hours that only works for my family because my husband isn’t also in health care. Even now, my daycare has remained open to serve essential workers like me. We have made these traditional arrangements work, but they have never worked well. And we are the lucky ones.
All around me, colleagues and peers for whom daycare plans were always precarious have found themselves in crisis as coronavirus spread. They’re scrambling to find new care at a time when they should be focused on scrambling to care for surges of patients. Those who once filled in the child-care gaps — grandparents, extended family, or nannies — are no longer options.
Recently, medical students have been volunteering baby-sitting services for hospital workers to help fill the gaps caused by Covid-19. My state and others have also offered daycare arrangements or allowed private daycares to remain open for essential workers. But these temporary measures do not address the larger issue of a lack of support for those who care for patients.
For hospitals, one answer seems obvious: Hospital centers, many with thousands of employees, should provide their own on-site care. The physician admitting patients, the nurse placing IVs, the techs monitoring vital signs, and the sanitation personnel disinfecting rooms are all essential personnel. They all must have access to good care even when the pandemic has abated.
Of course, it is not just health-care workers who need better options. Other, more expansive policies from universal child care to government support for independent daycares with flexible hours should be available for all kinds of workers who need affordable, flexible, high-quality care. Many are also essential workers whose wages do not support the kinds of flexible care that’s needed for irregular hours. But for hospitals, there is a business and health-care case that they should prioritize this kind of accommodation for their own employees.
The current crisis shows the precarity of our daycare arrangements: How can health-care employees provide the best care for their patients when they’re struggling to take care of their children?
The lack of child-care support adds to physician burnout, which studies have shown results in emotional detachment, decreased productivity, and decreased professional effort. But now more than ever, society needs health-care workers to be emotionally attached, productive, and professional.
Employer-based daycare centers are not a novel idea, and most hospitals do advertise child-care options for its employees that are in close physical proximity. The problem is child-care options aren’t set up to accommodate traditional work hours — not the hours of doctors, nurses, respiratory therapists, laboratory technicians, sanitation services, or other health-care personnel.
Many parents know the feeling all too well: A meeting ends well after you need to leave to pick up your child, and the panic and hurriedness ensues as you rush to daycare before closing time.
But in health care, doctors and nurses cannot just cut a patient’s visit short or send an email once returning home. Caring for people in times of illness and vulnerability do not correlate with daycare pick-up times.
What’s more, the need to care for patients does not stop when your child is unable to attend daycare due to the center’s “sick kid” policies. Back-up child-care options offer assistance by inviting strangers into parents’ homes to take care of their children during times of need — sometimes at an unaffordable cost. Care.com reports based on a survey of its users that in 2019 that the average weekly U.S. child-care cost for one infant is $211 for a daycare center. Cost for a nanny, or child care within the home, is $596 per week.
In the last 40 years, some hospitals have adopted daycare structures that do make more sense. Unsurprisingly, in Forbes’ “America’s Best Employers for Women 2019,” five of the top seven health-care systems on have on-site child care.
Yet in my own research as I have sought out models that work, I have found only a handful of hospital-based centers across the country that provide hours that truly work for healthcare workers. Tampa General Hospital and St. Louis Children's Hospital are among the few centers offering extended care until 8 p.m., when the majority of health-care workers finish their day shift.
A better daycare system would also protect those who do the honorable work of taking care of children at a time when child-care businesses — most run by women — struggle to survive during coronavirus. In some places, the providers with the most flexible hours are small in-home providers, and they may face the most precarious futures after this is over. Employer-based daycares would provide a more stable and reliable option, and employ some of these workers in communities in need.
I recently corresponded with Sarah and Anne, authors of that Journal of the American Medical Association article. Reflecting on battles fought and lost to get an employer-based daycare at a hospital where she worked as an ophthalmologist in New Jersey, Anne observed that with rising costs and limited accessibility, the daycare challenge appears even worse now than it was at the time she wrote the article. “It's disheartening that workplace equity issues from the 1980s — affordable, accessible childcare — remain workplace equity issues 40 years later,” wrote her sister Sarah, who is now a law professor at Rutgers University, in an email.
It is time for onsite child care for health-care workers to be a common and universal option. Those who care for others must have viable and convenient choices for others to care for their children.