Resident Leave in Plastic Surgery Training

In 2009, the minimum requirement for dedicated plastic surgical training increased from 2 to 3 years. Increasingly, programs are converting to an integrated model, where plastic surgery training starts in internship and typically lasts for 6 years. The average age of matriculating medical students is 24 years (women) and 25 years (men).¹ Thus, estimating 4 years of medical school and 6 years of residency, the average program will train residents from the ages of 28 to 29 through 34 (integrated 6 years) to 36 (independent 5 + 3 years), excluding additional research time. During this extended period of the lives of residents, it is only natural that life events continue to occur. These include marriage, parenthood, becoming sick or disabled, or experiencing personal hardships. At times, these events necessitate residents taking leave of absence from training.² Thus, the issue of resident leave in plastic surgery training must be considered in more depth.

The ages of 28 to 36 years represent a prime period in residents’ lives in which they may become parents. Therefore, it is important to have an open discussion on the attitudes, environment, and support for parental leave. Female residents, in particular, often delay childbearing,³ thus increasing the risk of infertility and pregnancy complications. As women in plastic surgery residencies have increased from 12.5% (1989) to 37% (2015),⁴ this affects a significant number of our plastic surgical residents.

Since the early 1990s, there have been 13 publications on the topic of “leave in plastic surgery residency”, including 2 prospective cohorts (1995 and 2015),^2,5 1 editorial, and 10 letters to the editor. Forty-six percent of women had their first child during residency,⁵ and 73% of programs had experience with either a resident or spouse of a resident pregnancy over a 5-year period.² Seventy-five percent of female residents worked up to the day of delivery,⁵ 88% took less than 6 days off after delivery in 1995,⁵ and only 22 women of 131 residents took more than 3 weeks in 2015; 11 of whom made up the time.²

Specific logistics of parental leave are left to individual plastic surgery residency programs, provided that they abide by the rules of governing bodies within graduate medical education, such as the Accreditation Council for Graduate Medical Education, which includes following appropriate federal laws, such as the Family and Medical Leave Act. The American Board of Plastic Surgery (ABPS) requires “at least 48 weeks of full-time training experience per year” for board eligibility. The 48 weeks may be averaged over the training years, allowing for some flexibility, but limits “extra” time for leaves of absence.

In the current era of competency-based training coupled with increased training length, is the 48-week/year requirement still appropriate? The American Council of Academic Plastic Surgeons has created a resident leave task force to address these issues in depth and to develop recommendations that will be presented to the ABPS to be considered for a universal resident leave policy.