Abstract
This study investigates how new parent leave policies are perceived by dermatology program directors and residents.
New parent leave (NPL) has been defined as leave from work for all parents after welcoming a child regardless of how they became parents (including giving birth to a child, adoption, surrogacy, or fostering). New parent leave is essential for the well-being of the infant and family. Of note, the United States and Papua New Guinea are the only 2 nations in the world that do not have statutory paid leave.1
A study reported that 64.1% of dermatology residents are women, most of childbearing age.2 A recent survey found that female dermatologists were most likely to have a child during residency (51%) compared with during other stages of their training and career.3 Residents have a finite time to learn their medical specialty and are subject to rules of the American Board of Dermatology (ABD)4 and varying institution-specific policies for absences during their training. The goal of our work was to investigate how NPL is currently handled in dermatology residency programs and how the policies are perceived by program directors (PDs) and residents.
Methods
The resident and PD surveys about NPL were sent via the Association of Professors of Dermatology email listserv, which includes the PD and chairs of 91 discrete residency programs, who then forwarded the resident survey link to members of their residency program; responses were collected from October 16, 2017, to March 13, 2018. The resident response rate could not be calculated owing to this distribution method. Survey answers were deidentified and analyzed using Excel (Microsoft Corp). This study was granted exempt status by the University of California, San Francisco Institutional Review Board. Participation was optional, and participants had to provide informed consent before accessing the survey.
Results
Of the 91 programs surveyed, 54 PDs (59.3%) and 139 residents responded. The PDs reported that their residency programs consisted of 261 women (65.3%) and 245 men (34.7%). During the past 5 years, programs had a mean of 4.4 pregnant residents and 2.1 nonpregnant residents take NPL. Only 1 PD reported having a resident who had to delay taking the board examination. The NPL policies varied in their inclusion of pregnant residents (49 [100%]), nonpregnant partners (39 [79.6%]), adoptions (22 [44.9%]), and fostering or surrogacy (11 [22.4%]).
For the resident survey, of the 139 responders, 98 (70.5%) were women, 40 (28.8%) were men, and 1 (0.7%) was a person of nonbinary gender. The mean (SD) age of residents at the beginning of residency was 27.8 (2.3) years (range, 24-39 years). Of the responding residents, 37 (29.8%) became parents during residency.
As indicated in Table 1, the 12 residents who were pregnant and gave birth to a child took a mean (SD) leave of 6.8 (2.6) weeks (range, 4-14 weeks). One resident was active duty military and took 14 weeks, which was the longest reported in the study; the military guarantees 12 weeks paid leave. The 6 male residents who became new parents had a mean (SD) leave of 2.0 (2.6) weeks (range, 0-8 weeks). Resident and PD perceptions of NPL are presented in Table 2.
Table 1. Experiences and Opinions of New Parent Leave by Residents Who Became Parents During Residency.
| Survey Question | Findinga |
|---|---|
| New parent leave length, mean (SD) [range], wk | |
| Male residents (n = 6) | 2.0 (2.6) [0-8] |
| Female residents (n = 12) | 6.8 (2.6) [4-14] |
| Within your residency responsibilities, were you exposed to potentially harmful substances or situations during your pregnancy? | |
| Yes | 14 (41.2) |
| No | 20 (58.8) |
| Did you have to make up any or all of your new parent leave time? | |
| Yes | 9 (26.5) |
| No | 25 (73.5) |
| How satisfied were you with your new parent leave? (pregnant resident responses) | |
| Satisfied | 12 (40.0) |
| Neither satisfied nor dissatisfied | 1 (3.3) |
| Dissatisfied | 17 (56.7) |
| Did you have to delay your board examination? | |
| Yes | 0 |
| No | 33 (100) |
| Did you breastfeed your child? | |
| Yes | 26 (100) |
| No | 0 |
| How long did you breastfeed your child? | |
| 1-3 mo | 4 (16.0) |
| 4-6 mo | 8 (32.0) |
| >6 mo | 13 (52.0) |
| What was your reasoning for stopping breastfeeding? (check all that apply) | |
| Too difficult with residency obligations | 15 (62.5) |
| Choice | 8 (33.3) |
| Low milk supply | 4 (16.7) |
| Are residents provided with a convenient, designated place to pump? | |
| Yes | |
| Program directors | 33 (71.7) |
| Parent residents | 10 (38.5) |
| No | |
| Program directors | 13 (28.3) |
| Parent residents | 16 (61.5) |
Data are presented as number (percentage) of survey respondents unless otherwise indicated.
Table 2. Perceptions of New Parent Leave Policies by Program Directors and Residents.
| Survey Question | No. (%) of Respondents | No. (%) of Respondents | ||
|---|---|---|---|---|
| Agree | Neither Agree nor Disagree | Disagree | ||
| Does your program currently have a written new parent leave policy? (answer: yes) | ||||
| Program directors | 45 (83.3) | NA | NA | NA |
| Residents | 56 (40.3) | NA | NA | NA |
| At what point do you require residents who have taken parental leave to make up missed time? (check all that apply) (program director responses) | ||||
| Missed >14 wk of residency | 25 (42.4) | NA | NA | NA |
| Missed >6 wk in the academic year | 12 (20.3) | NA | NA | NA |
| Did not require making up time if the resident was in good standing | 10 (16.9) | NA | NA | NA |
| Were not meeting milestones | 7 (11.9) | NA | NA | NA |
| Which elements contribute to residents delaying starting a family? (check all that apply) (resident responses) | ||||
| Lack of time off | 16 (22.5) | NA | NA | NA |
| Imposition on fellow residents | 15 (21.1) | NA | NA | NA |
| Fear of hurting your career or education | 13 (18.3) | NA | NA | NA |
| Our program’s new parent leave is sufficiently accommodating to residents | ||||
| Program directors | NA | 34 (73.9) | 5 (10.9) | 15 (32.6) |
| All residents | NA | 56 (40.6) | 50 (36.2) | 32 (23.2) |
| Parent residents | NA | 20 (54.1) | 7 (18.9) | 10 (27.0) |
| Pregnant residents experience resentment from faculty and/or coresidents during or after pregnancy | ||||
| Program directors | NA | 12 (26.1) | 13 (28.2) | 29 (63.0) |
| All residents | NA | 21 (18.4) | 29 (25.4) | 64 (56.1) |
| Parent residents | NA | 6 (18.2) | 3 (9.1) | 24 (72.7) |
| The pregnancy or new parent leave negatively affected my residency class's morale and/or education | ||||
| All residents | NA | 10 (8.8) | 26 (23.0) | 77 (68.1) |
| Parent residents | NA | 1 (2.9) | 7 (20.0) | 15 (77.1) |
| My desire to be a parent factored into my choice of dermatology as a career (all residents) | NA | 95 (68.3) | 19 (13.7) | 25 (18.0) |
| My residency program's structure pressures residents to delay starting a family (all residents) | NA | 21 (15.1) | 45 (32.4) | 73 (52.5) |
Abbreviation: NA, not applicable.
Discussion
We observed significant variation among dermatology residency programs for how NPL was handled. Many PDs commented that a lack of clarity on the rules from the ABD results in variable lengths of leave, usually erring on very short leaves. The number of male and female residents who reported their length of leave was low (n = 18), possibly because of survey question fatigue or concern about negative consequences for themselves, the program, or future parents.
We were struck by the baseline lack of awareness by residents of NPL policies despite most programs having policies in place. We also noticed a discrepancy between PDs and residents when it came to opinions of sufficiency of NPL and pumping facilities. A limitation of our study was an inability to determine which programs were being represented by the deidentified PD and resident surveys. Our findings suggest that residency programs and the ABD should examine and clarify NPL policies for residents to ensure that they support new parents and safeguard their physical and mental health as well as career development.
References
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