Closing the Gap Between Parental Leave Policy and Practice

Parental leave, while essential for residents who choose to start or expand their families during training, can create challenges for residency programs. The Accreditation Council for Graduate Medical Education (ACGME) and the ABFM have established requirements and policies regarding compensation for and duration of parental leave for programs and residents.^1,2 These are supported by evidence demonstrating that, because shorter leave times equate to higher rates of burnout and postpartum depression among trainees, parental leave should be at least 6 weeks in duration.³ The challenges faced by programs are operational and cannot be addressed by these policies alone. These challenges include determining how the work of residents on leave will be covered and ensuring a smooth transition back into training. A program-level leave policy that does not address both questions effectively transfers the burden onto trainees.

Because patient care duties remain constant, there is a risk of hidden cost to covering peers when a resident takes parental leave. Existing literature shows significant variability across programs as to whether parental leave policies address the need to make up missed call shifts, compensation for co-residents who cover shifts, and overall transparency of parental leave policies.^4-6 Concern about burdening co-residents has led some trainees to delay childbearing.³ Although this additional burden is often perceived rather than directly measured, program directors can address these perceptions through thoughtful program design.⁷ Programs can negotiate non-resident coverage for selected patient care responsibilities when feasible. If possible, parental leave can also be incorporated into the annual schedule as an anticipated event, rather than an unexpected disruption. Another option is to explicitly compensate covering residents so that additional coverage does not become a source of resentment or stigma. This can be accomplished by reducing call responsibilities later in the year.

A Canadian study reported that family medicine residents found their programs to be supportive before and during their leave but markedly less so upon their return to work.⁸ Residents who took parental leave reported a perceived decline in clinical competence compared with their peers, contributing to performance anxiety. Among lactating residents, one-half stopped earlier than planned because of barriers to pumping, including a lack of private lactation spaces, refrigeration for milk storage, and protected time.⁸ Many residents also face difficulty securing childcare that accommodates their unpredictable work hours.

Program directors can create structured re-entry plans to address these concerns. Careful consideration should be given to the rotations scheduled immediately after a resident returns to work. Office-based or shift-work rotations with more predictable hours may ease the transition. Offering a graduated return or part-time options, as permitted by ABFM and ACGME requirements, might further facilitate the transition back to training. Allowing residents to participate in didactics, even virtually, before their clinical return offers a way to mitigate perceived declines in clinical confidence. Providing schedules well in advance can help residents secure adequate childcare. Programs should ensure that resources, such as lactation rooms, refrigeration, and protected pumping time are in place before residents return to work. Assigning a dedicated re-entry point coordinator within the program may further ensure residents’ individual needs are addressed.

It is vital that programs foster a supportive culture in which residents feel comfortable taking parental leave. This culture should support both child-bearing and non-childbearing parents. Two structural approaches that can strengthen that culture are: extending training only when resident competency or compliance with ABFM and ACGME policies necessitates it and educating the whole program about the importance of parental leave.

The evidence supporting the necessity and appropriate duration of parental leave is well established. What distinguishes programs is their ability to engineer coverage models that minimize the burden on co-residents while creating re-entry plans that support returning parents. Program directors can foster a culture in which residents do not feel compelled to leave training or delay starting or expanding their families.