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:
- Have a well spelled out policy that is fair to the residents and works for your program.
- Consider the use of locum tenens to fill gaps when residents are out for family leave of any type.
- Augment the team with nurse practitioners and physician assistants which could be shared inter-departmentally in the same institution.
- Look for women or men who want to have additional training and have a gap in their employment plans.
- 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.
- 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:
- 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.
- 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.
- 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.
- 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.)
- 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.