More women than men entered medical school in the United States for the first time in 2017. Will this generation also set new trends in parenting during their training? One study suggests that 40% of female residents plan to have a child while in residency.1

Can our graduate medical education system withstand even a modest increase in the number of resident parents? Can your hospital?

The Problem

In the United States, the average age of residency trainees is 28 years old and the average age at which a woman has a child is 26 years old. Our medical education system pressures many residents to make a choice between their residency training and starting a family during usual childbearing/childrearing years. There are significant policy challenges that must be addressed to support new resident parents.

First, specialty boards mandate a minimum number of training weeks per year during residency. For example, the American Board of Emergency Medicine (ABEM) requires 46 weeks of full-time training per year inclusive of vacation and any necessary leave time. Residents who complete less than 46 weeks must extend their training beyond the traditional end of the academic year. Extension of training often complicates the start date of a new faculty job or fellowship position, while risking a delay in eligibility for the next ABEM Qualifying Exam.

Second, hospitals rely heavily on residents to staff their clinical services. It can be very difficult to accommodate residents on parental leave without significant notice and flexibility in clinical scheduling. In smaller residency programs, even a single resident physician on parental leave can force overtime for peers in training and a social burden for the new parent.

An Example of a Return to Work Policy for Residents

Academic Emergency Medicine (AEM) published a special ‘Gender Issue’ in January 2019 that included the report of a pilot study of a Return to Work Policy for New Residents Parents in Emergency Medicine at Stanford University. This resident-centered policy addresses three main themes:

  1. Return‐to‐work clinical scheduling
  2. Identification of resources to support new resident parents
  3. A checklist of key steps to guide expectant parents

AEM Special Issue Editor, Dr. Esther Choo of Oregon Health Sciences University, describes the effort as “the kind of on-the-ground, practical policy that we need to start making our good intentions about supporting parent-physicians a reality.”

The policy applies to both male and female residents anytime a child is added to their family, through birth, adoption, surrogacy, or foster parenting. A similar policy has been in place for faculty members in the Stanford Department of Emergency Medicine since 2016.

The Return-to-work Clinical Scheduling Guidelines are the most innovative portion of the resident policy. Highlights include:

  • No jeopardy (sick call):
    • Antepartum (expectant birth mothers): 4 weeks before due date
    • Postpartum: 6 weeks for all parents from their return‐to‐work date
  • No overnight shifts (unless requested by the resident):
    • Antepartum (expectant birth mothers): 4 weeks before due date
    • Postpartum: 6 weeks for all parents from their return‐to‐work date
  • No more than 3 scheduled shifts in a row (unless requested by the resident):
    • Antepartum (expectant birth mothers): 4 weeks
    • Postpartum: 6 weeks for all parents from their return‐to‐work date

Big Picture

“We created this policy and wrote this paper not only for our own residents, but so that other programs might adopt it,” said Dr. June Gordon, lead author of the study and former Stanford Emergency Medicine Chief Resident. She added, “Hopefully programs can use our policy as a starting point and craft something that works for them locally. Being supportive of resident parents should be the norm; the policy is not meant to be something that sets Stanford apart.”

References

  1. Blair J, Mayer A, Caubet S, Norby S, O’Connor M, Hayes S. Pregnancy and Parental Leave During Graduate Medical Education. Acad Med. 2016;91(7):972-978. https://www.ncbi.nlm.nih.gov/pubmed/26606722.
Michael Gisondi, MD

Michael Gisondi, MD

Associate Professor and Vice Chair of Education
Department of Emergency Medicine
Stanford University
Editor, ALiEM EM Match Advice series
Michael Gisondi, MD

@mikegisondi

Vice Chair of Education, Department of Emergency Medicine, Stanford University