Racing back to work

By Bethany Harvey

But, what about FMLA? That is the common response I receive when friends and family ask why I am working on formalizing a maternity/paternity leave and lactation guidelines for my residency program. Inspired by the work by Dr. Sarah Shubeck and Dr. Arielle Kanters at University of Michigan and with a now 55% female residency program; frequent AWS blogger and co-resident Dr. Jane Zhao and I decided that a formal policy was overdue.

FMLA (Family and Medical Leave Act) entitles eligible employees of covered employers to take 12 weeks of unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Unfortunately, most surgical residents are unable to access even half of that time. A recent study by Rangel et al. surveyed 347 female surgeons who had had at least one pregnancy in residency to analyze factors associated with dissatisfaction. She found 6 major themes, and unsurprisingly to those who can associate with this, inadequate leave was one of the most reported factors. 86% of respondents had continue to work an unmodified schedule prior to giving birth, though nearly three-quarters of them were concerned that this negatively impacted their health or their growing child. Only 35% reported a formal maternity leave policy and the vast majority taking 6 weeks or less for maternity leave. Unsurprisingly, for those residents taking less than 6 weeks of leave, 72% described the leave duration as inadequate. Typically, residents have 4 weeks of vacation per year. Residents are also able to take up to 2 weeks of paid leave without affecting their standing with ABS between PGY1-3 and between PGY4-5; therefore, allowing residents to take a maximum of 6 weeks of leave in any given year. 

The ABS recently reformatted their published leave policies to clarify flexible training tracks, including extension of the chief year by the duration of leave taken. A study by Lumpkin et al. actually directly compared programs with stated residency leave policies to the 12-week leave in FMLA statues. They found that taking the full 12 weeks would result in a 1-year delay in board certification in 3 surgical subspecialties. Interestingly, while programs can utilize the ABS flexible leave policy, no programs were found to explicitly mention this policy. This is likely due to many programs being unsure of how to properly apply for this exception. In addition, ACGME does not require programs to offer these alternative pathways to new parents.

Of these studies focused on maternity leave, none have yet to look at the broader category of maternity/paternity leave in the medical field. Initiating a clear policy across the board may help alleviate some of the tension that both female and male residents report surrounding their decision to take leave. Becoming a resident-parent is challenging and life changing regardless of gender. While male residents will never face all the same challenges as their female counterparts; picking rotations based on if they will be too pregnant to cover q3 trauma call or worry that their sleep deprived 4-week postpartum brain will alter their ability to clearly and succinctly relay their plan to the on-call attending, taking steps to make equitable leave policies available to all regardless of gender will ultimately benefit both groups. By implementing a new standardized policy in our program, we can begin to gather data which will hopefully support this assertion and add to the growing body of work in this field. 

Bethany Wood Harvey, MD MHS is a 3rd year general surgery resident at the University at Buffalo. She received her MD from Tufts Medical School and her MHS from the Johns Hopkins Bloomberg School of Public Health. She lives with her husband, 2.5 kids and 2 dogs in Buffalo NY and plans on pursuing a Hospice and Palliative Care fellowship between PGY3-4 and a Surgical Oncology fellowship after graduation. You can find her on twitter at @bdwood62

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