Women physicians are disheartened when they discover the financial implications of having children. Most of us will not get paid leave. Many of us are the breadwinning partner. And most of us will not become stay at home moms so we will need to pay for high-quality childcare or have a stay at home spouse.

Certain things should be in place prior to becoming pregnant. So even if you’re single, I recommend you obtain some term life insurance and disability insurance now. You’ll never be as young and healthy as you are right now.

But pregnancy doesn’t always go according to plan. You’ll need to accept the fact that you will likely make less during pregnancy, during your leave, and even after you return to work. This is due to how practices usually pay you and adjust your pay for time not seeing patients.

Brace for impact.

Before your first pregnancy

1. Know your contract. Find out what happens to your pay when you take leave. Some employers will adjust target RVUs or collections, and some don’t. This means that it’s possible you’ll have to make up a sizeable deficit when you return to work.

2. Research state-sponsored paid maternity leave. If you live in California, Rhode Island, and New Jersey, or New York, you may be eligible for state-sponsored paid maternity leave. It won’t replace your physician salary, but it is definitely helpful.

3. Review the Family Medical Leave Act (FMLA). This federal law provides guaranteed job protection for 12 weeks (not paid leave) to take care of your newborn. The 12 weeks can be taken at any time within 12 months of your baby’s birth. To be eligible, you need to work for an employer with at least 50 employees and have worked there for at least one year.

4. Look into life and disability insurance. Get term life insurance and disability insurance in order before your first attempted pregnancy. Otherwise, you may get a pregnancy exclusion or worse, develop gestational diabetes, which will result in a significant increase in premiums. Your partner should also get these insurances in order as well.

5. Explore your health insurance. Find out what your total OOP costs will be. This can range from 0 to several thousand.

6. Stockpile your vacation time. Start hoarding vacation days to use towards paid leave if applicable.

You’re pregnant!

Congratulations! Don’t panic. The good news is you have about nine months to plan:

1. Create a will. You’ll need a basic will in place to name the guardian of your child. This often becomes a non-urgent to-do item after the baby is born. Left undone, it can have dire consequences.

2. Strategize with your retirement plans. Depending on your expected due date, you’ll want to frontload your accounts so they are maxed out before you deliver. Frontload these accounts at least two months prior to your expected delivery date in case of a preterm delivery. Beware that frontloading may affect employer matching.

3. Plan your maternity leave. Figure out how many weeks you want to take off. This is a highly personal decision. If you can use your vacation days towards paid leave, hoard them! Finally, tell your boss or administrator so everyone at work can start planning for your leave and coverage gaps.

4. Think about childcare options. It comes down to daycare vs. nanny vs. stay at home partner. Daycare and nanny costs vary significantly based on location. In some cities, there can be a significant waiting list for young infants. I recommend you pay a nanny “on the books.” Not only is it illegal not to do so, but you open yourself up to a ton of liability if you don’t.

5. Double check your medical insurance options. Think about whose medical insurance the newborn will go under: yours or your partner’s. It may just end up being the one where the pediatrician is in-network and convenient for you. You may be responsible for paying your benefits during leave.

6. Figure out what your baby actually needs. Start drawing up three lists: need, really want, want. The need list is much shorter than you think.

Whether you end up having a baby shower or not, I would still create a registry. Close friends and family will want to buy you a gift. You might as well receive items that you want.

Don’t forget that you’ll need some stuff too — maternity and nursing clothing, postpartum and nursing supplies. Breast pumps are required to be covered by your insurance.

7. Save up! Start saving for supplies and your leave. You’ll need to save for monthly expenses, not total income replacement. I hope you are living below, if not well below, your means.

8. Plan a babymoon. I highly recommend you and your partner take a babymoon. The second trimester is a great time to do this. The nausea and unrelenting fatigue of the first trimester are over, and you are not yet inhibited by your growing belly.

It is easy to turn all of your focus on your baby, but do not forget the primary relationship: the one with your partner. Plan and budget for weekly date nights. Investing in your marriage is a financial investment.

9. Outsource. While you’re probably a type A, can do-it-all mom-to-be, the reality is that it gets harder to do this as your pregnancy progresses. Don’t feel guilty to start outsourcing things like cleaning and laundry so you can get much-needed rest. You may also need to hire help with the baby if you don’t have a good support network or family nearby.

10. Find local mom groups. Not only are they a source for used and free baby items, but they are a source of support during this exciting and sometimes anxiety-provoking time.

Final thoughts

It can be overwhelming to be a pregnant physician. You will figure out how to make it work. Thousands of physician moms already have.

Bonnie Koo is a dermatologist and can be reached at Miss Bonnie MD.

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