Guidelines needed for short term leaves from residency programs

Leave of absence during residency presents significant challenges to program directors and colleagues. Unpredictable events resulting in lost time from the program do occur. The most frequently encountered reason for absence is parental leave. Women now make up more than 50% of paediatric residents, and a significant number become pregnant during their training. Male residents are now more likely to participate in parenting, and other unavoidable short term disability leaves can occur. Scheduling in residency programs does not take these inevitable events into account, creating considerable disruption in an already stressful situation.

Ensuring that residents’ absences do not compromise patient care is the most important issue. Often remaining residents in the department adjust their schedules and work additional hours to provide coverage for clinical work and on-call time. The difficult task of reassigning work usually becomes the responsibility of the chief resident, with variable support provided by the program director. Limited resources mean hiring nonresidents, such as staff physicians and nurse practitioners, to cover for leave happens infrequently.

Without carefully set guidelines, the remaining residents may be overwhelmed by vigorous educational and additional service demands. Combined with sleep deprivation and a lack of attention to personal care, this pressure can lead to feelings of being used and overburdened. Fatigued residents are prone to make mistakes, compromise education and work goals, and blame the system for failure. Not only may residents feel resentful of those taking leave, but there may be loss of compassion for patients.

In addition to coverage for clinical work, it is the program’s responsibility to ensure that educational requirements are fulfilled by the resident requiring leave. Additional costs to the system may be incurred. Funding for medical education is increasingly constrained, and stipends and benefits may not be provided during leave of absence and make-up time. This adds to the stress suffered by often financially burdened residents.

NATIONAL SURVEY

Paediatric programs across Canada vary considerably in the amount of leave granted. Some examples of the amount of leave granted are presented in Table 1.

TABLE 1:

Examples of the amount of leave available to residents in Canadian residency programs

University of Calgary	Maternity leave is 20 weeks Other leaves of absence are 12 weeks, at the discretion of program director Remaining residents cover call nights as necessary
University of Alberta	Parental (maternity/adoption) is 18 weeks without pay and requires extension of training as determined by program director Paternal leave is one week without pay Remaining residents cover call nights as necessary
McGill University	Department is currently developing a policy for short term leave Maternity leave of 20 weeks at 95% pay plus additional 10 weeks if necessary at 65% pay Marriage leave of seven days with pay, seven additional days without pay Remaining residents cover call nights with maximum 10 calls per month
University of Toronto	Guidelines are set by Professional Association of Interns and Residents of Ontario (PAIRO) and the Teaching Hospitals Committee Maternity leave is 17 weeks, with four weeks advance notice, for first time parent (maternity or adoption) 18 weeks following the birth of the child Back-up system is available for acute shortage in call (eg, due to illness) Clinical associates are hired to fill prolonged gaps in call schedule so that extended leave is not covered by the remaining residents
Dalhousie University	No set policy for short term leave ‘Unaccredited’ time including leave secondary to illness or parental leave with no penalty for a maximum of 14 weeks Remaining residents cover call nights as necessary
Université Laval	19 of 20 paediatric residents are women Maternity leave and compensation policy set under an agreement between the Association des médecins résidents du Québec and the provincial government

CONCLUSIONS

Where defined policies for short term leaves can reduce stress and enhance equity for residents who need leave and for their colleagues, there is also a need to accomplish the following:

• define and differentiate educational goals from service roles;

• ensure strict adherence to educational guidelines to minimize excessive service demands, thus decreasing the burden on the remaining residents; and

• increase participation by residents in the policy making process affecting their educational and service functions in programs and on a national level.

Recommendations on parental leave for residents and paediatric training programs by the American Academy of Pediatrics were published in a policy statement in 1995. In an effort to address these issues in Canada, the Residents Section of the Canadian Paediatric Society (CPS) is gathering information from across the nation on program policies. We are excited about the prospect of the draft of the first national guidelines for paediatric residents on short term leave of absence, which will be prepared at the upcoming Residents Section Workshop during the 1997 CPS Annual Meeting in Halifax, Nova Scotia.