Making the case for parental leave during residency

As the numbers of women entering medicine grow, we must do a better job of ensuring new parents have time to bond with their babies.
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Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.

When I was an orthopedic surgery resident and pregnant with twins 27 years ago, there wasn’t a formal maternity leave policy for residents in my program. Women in the program had never given birth during residency, and everyone worked intense shifts that often stretched 36 hours. 

But when I told my chairman I was pregnant, he said, “OK, we’ll figure it out.” Fortunately, I was able to take six weeks off when my daughters were born, and I did not have to extend my training because of that leave. To this day, I cherish the time that I had to bond with my children and get them off to a healthy start in life. I was fortunate and grateful to have a department leader who supported me.

Yet even today, not all residents have that opportunity, and whether they do should not be left to luck. Across the graduate medical education spectrum, we must develop leave policies that support the family needs of our residents. The reasons are simple: Healthy parents with healthy babies, career satisfaction, and a work-life balance create a ripple effect that strengthens them, their families, patient care, and, ultimately, our nation.

The need comes amid a rapidly changing landscape in which, for the first time in history, women outnumber men entering medical school in the United States. What’s more, the residency years are a common time for a female physician to have her first child. Expecting women to delay pregnancy until after medical school and residency — which can take more than eight years — isn’t reasonable or moral, given the increased risk of infertility and pregnancy complications among older women.

Healthy parents with healthy babies, career satisfaction, and a work-life balance create a ripple effect that strengthens them, their families, patient care, and, ultimately, our nation.

Yet the challenges these women face can be dismaying. For example, a 2018 national survey of general surgeons who had one or more pregnancies during residency found that 39% seriously considered leaving their program and 30% said they would discourage female medical students from a surgical career because of the difficulties of balancing pregnancy and motherhood with training.

If we make childbearing and child rearing so challenging that our residents abandon the profession, what are we losing in human capital and the investment we have made in them?

This is particularly problematic in the face of a predicted shortfall of up to 120,000 physicians by 2030. Now more than ever, creating policies and cultures that will attract and retain talent in medicine is critical.

The Family and Medical Leave Act of 1993 entitles employees to up to 12 weeks of unpaid leave, a handful of states require employers to offer family leave with partial pay, and some teaching hospitals provide paid leave to care for a child.  Yet many residents feel they can’t take off more than four weeks per year for any reason, including parental leave.

The hesitation to take a longer leave stems from requirements that residents work a certain number of days to qualify for exams or graduation. To take more leave may risk extending their training, which can impact board eligibility, their status in their program, or their ability to start a subsequent training program on time. Residents therefore may pack in extra shifts while pregnant or with an infant at home to make up for missed time. Some residents even return to work just a couple weeks after giving birth.  

As executive vice president and chief operating officer of a major hospital system, I had to ask, “What does this say to the next generation of physicians about our commitment to them and to a fundamental value system?”

At NewYork-Presbyterian, we implemented a new paid parental leave policy last year. In addition to medically necessary time off for a woman giving birth, our employees, including residents, can take six weeks of paid parental leave for the primary care-giving parent and two weeks for the secondary parent. This is available to all parents, women and men, whether for birth, adoption, or surrogacy. We engaged our graduate medical education leadership throughout the policy-creation process so that the benefit wouldn’t come at the expense of quality of training. We want our residents to have the peace of mind and resources to start and nurture their families. After all, they are not only caregivers at our hospital but at home, too.

Expecting women to delay pregnancy until after medical school and residency — which can take more than eight years — isn’t reasonable or moral, given the increased risk of infertility and pregnancy complications among older women.

But as a community, academic medicine needs to do more to support resident parents. All stakeholders — from training hospitals to medical specialty boards and the Accreditation Council for Graduate Medical Education — need to work together to explore solutions so residents feel they can actually use leave policies.

Potential solutions include building more flexibility into training requirements to accommodate parental leave and allowing a pregnant woman or new parent to delay the start date of her or his residency. In addition, we may need to provide physician extenders, like nurse practitioners and physician assistants, to cover shifts for a parent on leave, rather than relying on other already overstretched residents.

Fundamentally, it comes down to our core values. At NewYork-Presbyterian, we have focused on building a culture of respect, inclusion, and belonging that values the contributions of every employee. A culture of respect means caring and investing in their well-being so that today’s residents become the next generation of physician leaders. We owe it to them, to our patients, and to our nation.

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Laura Forese, MD, MPH, is executive vice president and chief operating officer at NewYork-Presbyterian. A pediatric orthopedic surgeon, she has been a faculty member at Columbia University Vagelos College of Physicians and Surgeons since 1993.