The absent parent

I can guess of some of your wife's reasons for not wanting the photos online. I've posted several baby pictures of my grandchildren, but the older and more recognizable they get, the more I feel queasy about it.

You will never regret spending more time with your daughter. Here's how you can do it, if you want:

If you have an individual practice, you could rely on attrition while taking no new patients for a while. If you have partners or are salaried, you could negotiate this situation. A reasonable workload should support a comfortable lifestyle for three people. The U.S. Bureau of Labor Statistics estimates that internists earned an average $167,270 in 2007. The average household income in Chicago is $58,100, less than half of what you presumably earn.

Not a physician, and never as well off as you, but one whose work devoured much of his sons' youth.

Hang in there Pal. What about baking her a cake (even if it's uh, not perfect) with icing of her favorite color so she'll remember you were at her party but you also made her a special cake. It's all about the little things. Happy birthday to your little girl!

let me count the ways I fucking hate male gaze.

A child's birthday is a fixed date and only once a year. There's no reason in the world you can't schedule your availability.

It's the other 364 days that really hurt - especially if you can't be home in time to read the bedtime story. Been there, done that. But my daughter, now 33, still remembers that even if I was very tired, if I was home she got her bedtime read.

I have a family member who's an internist (well, his residency was in internal medicine, but his job is as a "hospitalist". I'm not sure if there's a distinction to that). He works 3 days a week and makes 80K a year. That's less than half what the average internist makes, but he gets to spend time with his family, pursue other interests, and still live a perfectly comfortable lifestyle.
I doubt that you would regret it if you pursued a similar lifestyle.

Both my parents worked two jobs and my sibs and I grew up cooking dinner, cleaning the house, helping with the grocery shopping, and making beds. Nobody is any worse for the wear. We all love my parents (who still work) and never doubted for a second that they loved us.

Now my husband and I find ourselves in the same situation: gazing at a little face, smelling a little head awash yourself in guilt and love. I work my kids into everything I can. If they can play next to me while I do charts I take 'em. If I only have a few patients on my schedule my kids color at the front desk. They help me with dinner, with the laundry, shopping, and cleaning. We can make a game out of anything. I have caregivers my children love who love them back. And my parents are only a phone call away.

Good luck.

Wow. I really feel your angst. You have committed to a career which is very demanding and not subject to "9-5" hours. I have a civilian job and serve as a military reserve officer (yes the specter of deployment looms large at times). My work is challenging, but I am determined to provide a good life for my spouse and two kids.

I also am determined to make sure to be there for their childhood. The time invested through their 11th year is critical for making sure they are morally centered and well equipped for the challenges of middle school.

My spouse is a medical practitioner and works part time to satisfy her professional career and meet the needs of the children. Work-life balance is the tough nut of the modern age. How to remain relevant and impactful with your children and not be relegated to a secondary source (with mass media, peers and the like usurping the parent role).

The challenge has been compounded with our transient society. Children do not live amongst extended families who provide moral continuity and consistency. Working less, making choices about what's important and surrounding yourself with suport is the only way to make this work.

If you come across the silver bullet, let me know...

small towns will take all the GPs they can get...

otherwise, make yourself a promise like Sam Vimes, to always do one thing every day with your child (his was to be home at 6pm, no matter what, to read a book to his son)

My wife and I actually had a conversation about this topic in which you were brought up! I had been saying how I didn't ever want to go into upper management or run my own company since it was such a huge investment in time away from my family. That's something that a regular job could never make me give up, time with my family. I suggested that it would be a much more difficult situation if my job actually mattered. Here's where you came in. I mentioned reading about your concerns with work-family balance. Being a doctor, taking care of people actually matters, in the larger scheme of things. There has to be terrible pain in deciding which option should get top priority in a given situation: providing an invaluable service to the populace or providing a presence to your children. I don't think there is an easy answer. I admire you for both your dedication to humanity and your dedication to your family. Some children may grow up with a (relatively) absent parent and be absolutely fine with it. Others may end up with resentment. It probably depends a lot on the parent's own attitudes. If your wife is constantly at home with the kids grumbling about you having to go in to the damn office again, I would suspect that there would be more resentment. But if everyone is supportive, and your child understands that what you're doing is important but that it would never replace your love for them, you're probably ok.

Not that I know what I'm talking about. I work 8-5 M-F. I put my kids to bed every night. But I'm sure they'll find something to resent me for when they grow up. Especially as they become teenagers ;-)

I tend to agree with the picture of kids thing. I don't use my kids' names or post pictures on my blog, only on Facebook since the people I'm connected to there are actually are my friends.

Small update: canceled office hours this morning to go to school birthday for kiddo...got paged (important page) during party and had to step out, but still, was there.

It's always a tightrope...

I agree with your wife re posting pictures of your daughter. It's very dangerous.

Good luck with navigating priorities!

Our kids have been in full-time daycare since infancy. We really try to focus on quality, rather than quantity when it comes to our time together.

I completely agree with CyberLizard above that the particulars of *what* you are doing during your work hours are significant here. Both my husband's job and my own involve improving human health. Our kids understand enough about what we do to value our efforts to this end, and moreover they can see that *we* value it. A parent who expresses the inspiring and rewarding aspects of his or her work can make an extremely positive impression on a child. When we talk about what the kids want to be when they grow up, I always tell them that I hope they'll find a profession that makes them very happy. Through me, they have an example of what this might look like in practice--yes, there are piles of laundry and soap-scummy sinks involved. There are rushed drop-offs and juggernauts of multi-tasking (and excessive hyphens). But in the midst of all that they find a personally fulfilled individual--one who has had to work through balancing her home and work realms, and who is a better parent for doing so.

Luv your posts on fatherhood. See my recent comment here. I do not often post here, as much of what is said is beyond my expertise. But I read you religiously.

We work hard. We work fairly long hours. We have to plan.

Being an internist in private practice means no spontaneous trips. We plan vacations nearly a year in advance. Thanks to EMRs, we get to work even while home.

However, unlike so many, we get to set our own hours. We can plan ahead for the important things. We arrange coverage. We have cell phones. We don't have to rush in to deliver a baby or perform emergency surgery. At least we don't in large towns and in large institutions.

The "small town doc" may not have the support system that we have in the larger institutions. He/she may be the only doc around. The grass may not always be greener in Mayberry.

Could you do anything to reduce your workload in non-critical areas? Anything from sending clothes to the cleaners rather than washing them yourself to hiring a PA or NP to help at work? In other words, trade money for time?

"When she turned over she grabbed my arm and held it like a teddy bear. But I'm sure she doesn't remember." She KNEW you were there, even asleep.

And maybe you could make a father/daughter tradition next year of a "good dinner" together. What is "good" will change as she gets older, but for a start, some place with tablecloths and real menus and no TVs.

I took my nephew to dinner at a fancy-schmancy place with my boss - I was babysitting and the boss wanted to have dinner and was OK with the kid coming. He was four and was totally awed by the experience. The restaurant came up with something simple for him to eat. He sat there and chatted about the weather and school and my boss's farm and in all was a delightful dinner guest. He even shook the boss's hand goodbye.

I'm glad to see that this important to you. I think there is a double standard when it comes to parenting and a lot of people think a father's involvement with his children is less important than the mother's. But I can tell you from experience that it is as important for fathers to strive for a good work-family balance as it for mothers. My father used to travel and work late very often, and it was harder on me than he ever realized. However, it's really difficult for most people to reduce their work hours. The best thing you can do is make the most of the time you spend with your daughter. Doing little things with her will make a big impact.

I can see why your wife would not want the daughter's pix online, as there are entirely too many nuts and pervs out there.
You may not be able to show up for everything in your daughter's life, but it speaks well of you that you're that worried about it. Some fathers would not be.

"While I was watching her play in the park the other day, I wondered---should I move to a small apartment, get rid of a car, get rid of the cable, the phone? Move to a small town? Should I simplify my life so that I can work less?"

Yes, you should. "Quality time" is a myth.