It is no secret that family planning is hard. If family planning is compared to an electrocardiogram, then family planning during cardiology fellowship is as hard as an intracardiac electrogram (EGM). However, we cannot allow life to stop during fellowship, and much like an EGM, we should spend the time and effort necessary to understand and navigate the hurdles of family planning during fellowship.

As an international medical graduate (IMG) and new father of a beautiful six-month-old girl, I have first-hand experience with the challenges, opportunities and realities of family planning during fellowship, particularly from an IMG perspective. Before bringing our daughter to life, my wife, who is also an IMG, and I extensively discussed the challenges we thought we would encounter. There was, however, a slew of unexpected – and oftentimes lovely – surprises and challenges along the way.

If you are planning to start a family anytime soon, and especially if you are an IMG, here are a few things to keep in mind:

Plan Ahead

Timing a baby's arrival is close to impossible. However, it is useful to have a rough estimate of the baby's delivery date. Try to plan your vacation and elective time around this estimate.

Know Your Institution's Leave Policy

The ACGME requires institutions to provide at least six weeks of fully paid paternal leave. Some institutions mandate the parental leave to be taken immediately after birth, while others allow it to be taken any time during the first year since birth. Also, some institutions deduct leave from vacation days, while others do not. It is important to know your institution's policies and plan accordingly.

Plan Paternal Leave With Your Spouse

This is especially important for IMG fellows who may not have a good support system. For example, my wife took her maternity leave first, and I took my paternity leave after hers ended. This allowed us to maximize time the baby spent at home, as well as reduce daycare expenses. Discuss priorities with your spouse and plan your leave in a way that works best for your schedules and in accordance with your institution's policies.

It Takes a Village

As an IMG couple, we felt the effects of not having familial support readily available around us. Thankfully, we were surrounded by a large group of friends, and my program was beyond supportive. We appreciated all support, whether it was food in the days after delivery, help with taking care of the baby, help with the baby registry or emotional support. It is important to realize what kind of support you have around you and to make use of it.

Plan Visas For Family in Advance

The world is a crazy place, and things may unexpectedly happen. If you are expecting a baby or even if you are planning for one, urge your families to get their U.S. visa status in order so they can plan their visits and support you as much as possible.

Expect the Unexpected

Sometimes things go according to plan, and sometimes your house burns to the ground while you're on vacation with your two-month-old (true story). Do not be dismayed by the challenges thrown at you; adjust quickly, regroup and move on.

Plan Your Study Time:

Life does not stop with fellowship, and fellowship does not stop with life. Your study and research time may be affected soon after birth, but you will soon readjust. You may become a night owl or find yourself studying during down-time at work.

Having a baby during fellowship is challenging, but I promise you it is worth it. I just finished a week of twelve-hour shifts during which I barely saw my daughter, which was heartbreaking for me. I cannot begin to tell you how much I missed her, but also how much I enjoyed my time catching up with her this weekend.

Enjoy every minute of it. It will be a difficult journey but also the most rewarding accomplishment.

For more information on resident leave policies, visit the AGCME website.