“Babysitters” such as nannies and au pairs provide the most flexibility of all paid childcare options, although for the highest cost. That flexibility can be essential for physicians who may not always be able to leave work at a certain time. However, finding the perfect match can be difficult. There are agencies that will screen candidates for you for a finder’s fee which is sometimes exorbitant. Alternatively, ask other friends, especially physician friends, if they know of someone locally who is looking for new work. Sometimes, physician families will share a nanny as one family gets older and needs less help and another with younger children or a new baby needs more. A shared arrangement helps defray costs but potentially interferes with flexibility.

Consider that, if you choose to hire a nanny or an au pair, then you will have an extra person in your house during the day with your infant and maybe around the clock as well. Some nannies live in but others do not; au pairs typically live with their host families. Au pairs are a less expensive option than nannies but come with additional responsibilities for host families such as room and board.

MomMD is a career website that provides professional and personal support for women physicians, residents, medical and premedical students. For an excellent overview on the topic of hiring a nanny from both a doctor-mother’s and a nanny’s perspective, visit http://www.mommd.com /parenting.shtml. Key components of the hiring negotiations include schedule, salary, time off, discipline, and communication.

Here are some other things you will need to consider if you decide to hire either a nanny or an au pair, most of whom are women: Can she drive? If so, does she have her own transportation or will you need, and can you afford to, to provide a car for her? If you ask her to drive your child somewhere, will it be routinely or only in the case of an emergency? Do you or will you feel obligated to pay for her benefits such as health insurance? Would you, as a doctor, be uncomfortable having an employee who does not have health insurance? What if your child is sick – can you still go to work? What about if your childcare provider herself becomes sick? Have you considered disability insurance in case she gets injured on the job? Some home owner’s policies provide coverage for that situation.