A Brief Overview
I am an emergency medicine resident, and I am also a parent of two young children. I had my daughter during medical school and my son during the intern year of my residency. My older sister had a child during internal medicine residency, and one of my younger sisters is currently navigating maternity leave during the intern year of her OBGYN residency. Through conversations with my sisters and peers, I have realized the crucial need for better support on a national level for pregnant and post-partum medical students and residents during their medical training.
Colleagues and I recently conducted the first national anonymous survey among EM residents regarding pregnancy, breastfeeding, and child care. We sent an anonymous survey to all EM residents, regardless of parental status, in ACGME-approved residency programs in the United States that utilized skip-logic, which means residents only answered questions pertinent to their personal experiences. While future research will be published analyzing the results, the free-text responses illuminate to me that my sisters and I are not alone in our experiences navigating residency.
The American Academy of Pediatrics (AAP) recommends 12 weeks paid family leave.1 After the Accreditation Council for Graduate Medical Education (ACGME) updated its policy in 2022, all ACGME-accredited programs must offer residents and fellows 6 weeks of paid parental leave, which is half the time the AAP recommends.2 As one survey responder wrote, “I had postpartum depression which made coming back to work incredibly challenging, and there [were] no built in protections for it.” Furthermore, many of the male respondents had less than 2 weeks of leave. Male residents should be able to support their spouses and bond with their new child during this critical time. ACGME needs to further update its policy to include more time for paid parental leave to reflect the AAP recommendation.
Many programs have residents use their vacation and elective time for this leave. As many respondents wrote, “I had to use all of my sick and vacation days in order to get paid. Insurance lapsed after 6 weeks of leave. [I] have to make up 5 weeks after residency graduation” and “Only after union negotiations were we able to have any paid leave. I took mine unpaid and extended with vacation and elective time” and “too short… [I had] no vacation when I came back, [and] worked many more night shifts when I got back from leave.” I too had to utilize all my vacation and sick days for my maternity leave.
Not having a break for the entire academic year leads to increased burnout and decreased work satisfaction. Parental leave is far from a vacation, and having to use these days is detrimental for resident well-being when they then do not have other breaks from their rigorous schedule. Parental leave should not require using vacation and sick days to prevent graduating late, which is not a possibility for those who want to do a fellowship. Furthermore, many residents are still required to participate in emails or events during their maternity leave. As two respondents wrote, “[I] still got emailed responsibilities during maternity leave” and “I still had to [keep] up with emails and administration related stuff, and when I wouldn’t answer, this was used against me. I was not being ‘professional’.”
I was required to take the annual in-house training exam (ITE) three weeks postpartum during my maternity leave, while surviving on just a couple of hours of intermittent sleep in between nursing sessions. ACGME current guidelines have a “minimum of one week of paid time off reserved for use outside of the first six weeks of the first approved” leave.2 While this is a step in the right direction, ACGME needs to update this guideline so it is within the same academic year as the parental leave. Furthermore, programs must understand that individuals on parental leave will not be answering their emails or participating in residency events.
A large part of the issue is that many programs have their own internal guidelines, so parental leave can be institution dependent. Indeed, many programs have created a supportive environment for residents: “My program was incredibly supportive, and I'm not sure if that is unique to my situation, or having a female program director with kids who truly understood the situation, but I am so grateful to have had the support” and “I am grateful for the support of my program and co-residents for supporting my leave.” I am thankful to be at my residency program, which has worked tirelessly to help me during pregnancy, maternity leave, and nursing. However, having support should not be program dependent.
Through both program support and updated ACGME guidelines, I believe that residents can successfully balance their professional responsibilities with their personal lives, not only helping to improve the immediate training environment but also fostering a more sustainable and fulfilling career path for physicians.
References
- Dammann CEL, Montez K, Mathur M, Alderman SL, Bunik M. “Council on Community Pediatrics, Council on Early Childhood, Section on Breastfeeding, Section on Neonatal Perinatal Medicine; Paid Family and Medical Leave: Policy Statement.” Pediatrics November 2024; 154 (5): e2024068958.
- “ACGME-Approved Focused Revision: September 26, 2021; Effective July 1, 2022.” ACGME Institutional Requirements, 2022. Accessed 2024.