Are pregnancy and residency compatible?

Viewpoint #1.  Training programs might say: we are headed for a major league collision in the training of women physicians.  Soon 50% of all trainees will be women, and in some specialties, such as OB/GYN, they will be 80-90% of the residents in any particular program. Training years coincide with prime child bearing years. Imagine if even only half the residents in a program were pregnant at once.  What would happen to the strictly scheduled training trajectory?  What would the hospitals sponsoring the programs do without the cheap, around-the-clock physician workforce to staff the wards and clinics?  Chaos and undone work would ensue.

Viewpoint #2.  Women physicians might say:  As difficult as choosing a field of practice, deciding when to have a baby is at least, if not more, difficult.  If we put it off, we might have to rely on technology, first to conceive and then to safely deliver.  Or maybe seek help in adoption. What is going to happen to my career if I choose to have a child during residency?  What will the other residents do when I am gone?  Will they (and the program directors, hospital and other faculty) be angry?  Will I finish on time?  Stress and uncertainty prevail.

When I asked at a roundtable discussion we ran last week, “What one thing would you change to make your life easier as a woman physician?” I was stunned to hear, “Not be afraid to have a baby during my training.  I am afraid I will not be allowed to finish or I will be shunned by the people in my program.”

Wow, I thought.  How can this be?  Many women are having babies during residency (I certainly did 30 years ago without much ado).  Maybe she is an isolated phenomenon.  And then the 8 or so other women in the room echoed very similar sentiments.  And so the research project for the next year was born.   What are the parental leave policies in our specialty’s training programs?  What are the barriers the women face who want to take time off to have a baby?  How do the women feel, how do they act, and most of all, how are they treated?

The challenges for the residents themselves and the challenges for residency training programs are quite different.

Residency training needs to be a concentrated time of learning.  The resources needed are enormous.  The scheduling is complex.  There is a rhythm that needs to be respected for optimal outcomes–that is to train excellent physicians.

Women residents need the time to have the baby (sometimes a few days to several months–everyone is different).  Most want the time to enjoy nurturing their newborn without interruption during the first months of life–some up to 6 months.  You cannot work as a resident 80 hours a week and give primary care to an infant, and do both well.  If your institution defines a resident as a student, it is not obligated to give you any time off.  So often that resident saves up vacation or takes a leave and has to worry about scheduling.  Will the baby come on time?  Will it be healthy?  Not an easy decision, not an easy problem to solve.

Both sides have legitimate concerns.  That’s where creative problem solving should come into play.  For the accrediting residency training body (ACGME), residency training programs and institutions here are a few suggestions:

  1. Have a well spelled out policy that is fair to the residents and works for your program.
  2. Consider the use of locum tenens to fill gaps when residents are out for family leave of any type.
  3. Augment the team with nurse practitioners and physician assistants which could be shared inter-departmentally in the same institution.
  4. Look for women or men who want to have additional training and have a gap in their employment plans.
  5. Allow residents to “make up time/training” in other programs where they are experiencing a resident on family leave.  This would take ACGME cooperation in revising the guidelines for training.
  6. Create a climate free of fear of becoming pregnant.  A climate of fear is harmful to a culture of quality, and certainly should not be part of the already large emotional burden a resident faces.

For women physicians:

  1. Look for programs that have well defined family leave policies.  Most policies can be found on line.  But even though it is “illegal” to discriminate, do not ask what these policies are during your interview, particularly if you are looking at highly competitive programs.  You should ask to see the resident handbook when applying.
  2. After the match, definitely get the institutional and departmental policies if you are thinking about having a child during the 3-7 years of training.
  3. Look for programs that have successfully experienced child-bearing residents.  One where the residents and faculty have availed themselves of such policies.  One surgical residency in the Midwest has a 2-3 year research/additional degree block.  Many of their women surgeons had their pregnancy coincide with this time.
  4. Talk to faculty about their attitudes towards leave for pregnancy and other family matters.  (When I was  applying for residency, the chair told me, “All of our female residents have children during their residency.”  I was taken aback since I was not married and didn’t even have a boyfriend, which I told him.  I had my first child when I was a chief.  I heard another chair announce from the podium to a room filled with young men and women residents that he himself puts his family first and, when appropriate, helps his residents to do the same.)
  5. Talk to other women and find out how they have done it.  Compromises often have to be made; you just need to know what yours might look like.  Hearing how accommodations were made for others helps you to creatively solve problems and overcome challenges that inevitably arise.

When we presented the project to more than the 200 women physicians in attendance at the general assembly, many were delighted to hear our research direction for the coming year.  One woman lamented that she had missed the deadlines for fellowship applications and interviews while she was off having her baby and didn’t know what to do.  Should she give up on her sub-specialty choice?  Post your thoughts in the comments.

Linda Brodsky is a pediatric surgeon who blogs at The Brodsky Blog.  She is founder of Women MD Resources.

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  • Meggan Zsemlye

    As a residency program director in a female dominated specialty I can fully appreciate the challenges posed by having a baby in residency. My program is very family friendly and in fact in recent years we’ve had a quarter of our residents give birth in one year (2010-11, must have been something in the water!). Frequently our residents will have more than one child during residency. I agree that family should come first and we do all we can to support our residents who choose to have children during residency. One factor has been a real problem for us – money, of course. Our department cannot afford to hire a locums nor have they been successful in hiring enough nurse practitioners that are needed even for regular patient care much less to help cover during absences. In addition, due to the rules from our national specialty board, residents who are absent for more than a short period must make up time at the end of residency. Their pay at this point is not covered by Medicare etc and so must be footed by the department. We take care of the indigent (as do many training hospitals) and are barely breaking even. For now, residents and faculty take up extra duties for residents on maternity leave but it is tough and many of the residents feel guilty and take maternity leave of only one month (not enough in my opinion). I hope we can get some change at the national level to support these doctors in training who will be taking care of all of us in the future!

    • LBENT

      Meggan, you have hit the nail on the head. We are underfunded to train our doctors! The present system is antiquated and does not reflect the growing needs, changing demographics and what really needs to be a major overhaul in training.
      I understand the guilty part. I remember when I told my 3 fellow soon-to-be chief residents that I was having a baby. The first response was, “are you going to take all of your call?” Since I was admin chief and married to an MD, they let me make the call schedule and I had at least as much call as everyone else. Everyone was happy and gave me great baby gifts, etc.
      Time to take this nationally.

  • Docbart

    Shouldn’t male residents get to take paternity leave, as well?

    • LBENT

      Yes and no. The male’s body has not been torn apart, literally, however there is room for support and enjoyment. So I think that there can be accommodations, but pregnancy is really a woman’s job. Men play supporting roles.

      • Docbart

        Ah, so men are really just DNA donors in your view. They don’t need to bond with their babies and they have no nurturing skills, right? Or perhaps the system won’t sustain actually treating men and women as equals except when that favors women.

        • LBENT

          No, I didn’t say that. I said they don’t need the same time to recuperate. Paternity leave is a good idea, but if you are a resident in training, taking off the same time as the women physicians is neither necessary nor practical in my opinion. Some time off and an adjusted schedule for a few weeks or a month might be a good alternative.
          Men and women are not equals but they deserve equity. that means different things in different situations.

          • Docbart

            Equity is good. How do male residents get to take months off, get everyone else to pick up their load and still finish the program on time, with less training and still get full credit?

          • LBENT

            Why would they want months off? Everyone wants the most training possible. Women who take off time have to make it up and often don’t finish “on time” whatever that means. I think we have beat the horse dead for now. :-) Thanks for the interesting discussion.

          • Docbart

            The articles about this have women concerned about finishing on time, so clearly some expect to be able to do so, even having taken time off. Men might want time off for paternity leave or other reasons, as I noted.
            Some would like to square the circle and be equal when it suits them- as in pay and status, but privileged when they prefer to put in less work.
            Thanks for your insights.

  • Jill

    Pregnancy during residency must have been easy for you Dr. Brodsky if you had a baby without much ado. It’s unfortunate that not all women are as lucky. Some pregnant women have dizziness, numbness, fatigue, headaches, swelling, pain, fainting, and morning sickness for 9 months. If a woman feels like she could vomit or faint is she really focused on doing surgery? What if a surgeon thinks she is okay but gets sick in the OR before walking away from the patient’s body? Infections in the hospital are a growing problem and the patient can die from it. I wish physicians and other providers would work to “create a climate free of fear” for the patient. Patients have families dependent on them and friends and co-workers waiting for them to get well. Residents already work limited hours and Dr. Ezekiel Emanuel would like to reduce the length of time spent in medical school and residency training.

    • LBENT

      Jill, I had three children while working as a surgeon. Did I have morning sickness? Yes. Did I have back pain? Yes, I had other symptoms. I was trained to focus 100% on the patient and I did what had to be done. When you are in surgery or taking care of sick people, it has been my experience that your own aches and pains go away. I am not “superwoman”. I have spoken to many women surgeons who have had similar experiences.
      Before the days of limited work hours, we were trained to work hard and well with little sleep and little attention to our own needs. I was still operating when I went into labor with my third. I finished the operation, did one more short case, to finish my list, and gave birth 9 or 10 hours later. That patient remembers me and brings his family to me 20 years later. I did have a post partem hemorrhage which was not fun. I only had to cancel my office hours the next day (my last planned day). The kid wasn’t due until the following day, but came early. Go figure. We cannot control everything. Women physicians who are pregnant are more than able to care for their patients.
      As for reducing the time training, this trend has to be reversed and as I said to Meggan, we need to invest more money in training our physicians, not less. Thank your ofr the comment.

  • http://www.facebook.com/laura.mitchell.3781 Laura Mitchell

    Having a baby during nursing school was tough, but having a baby during residency is way tougher. As an L&D nurse in two teaching hospitals, I saw a few pregnant residents and my cap is off to them. I think Dr. Brodsky is spot on with her suggestions and recommendations.

    • LBENT

      Thank you for your kind words. It’s hard for everyone, but that shouldn’t stop us! We can change things and make it work for everyone. After all, kids are our future and I think having kids is helpful in patient care, especially if, like me, you take care of kids. Not absolutely necessary, but it did change my point of view.