Specialty Board Leave Policies for Resident Physicians Requesting Parental Leave

Abstract

This study compares family and childbearing leave policies for resident physicians among American Board of Medical Specialty (ABMS) member organizations that set training duration requirements for US residency programs.

A study of family and childbearing leave policies for academic faculty members at 12 top US medical schools found the mean duration of paid childbearing leave was 8.6 weeks in 2016-2017.¹ For physicians in residency training, determinations of parental leave duration are complicated by training requirements set forth by specialty boards. Board policies aimed at ensuring adequate preparation for independent practice often include time-based residency training requirements. Residents taking more than the allowed leave may have to extend training to be eligible for board certification. In practice, decisions on parental leave for resident physicians are typically made with residency program directors, which are influenced by specialty board organization leave policies. We identified and compared leave policies for resident physicians among American Board of Medical Specialty (ABMS) member organizations (boards).

Methods

Websites of the 24 ABMS boards were accessed in July 2018 to identify leave policies related to residency training requirements and board eligibility. The following variables were collected: (1) whether the policy specifically included terms referring to parental leave (maternity, paternity, parental, childbearing), (2) maximum amount of leave time allowed for any reason, and (3) whether exemption from extending training duration was permitted if leave taken was longer than the maximum leave allowed. The median annual allowed leave time was calculated. Qualitative analysis was performed on clarifying language within leave policies to determine whether extension of training was required to remain eligible for board certification if leave taken was longer than the maximum allowed amount stated in the policy. Analyses used an iterative thematic approach, focusing on training program autonomy vs specialty board control.² Clarifying language was collected to exemplify variability across policies.

Results

Twenty-two of the 24 boards had leave policies but only 11 specifically mentioned parental leave as a potential reason for resident physicians taking leave (Table). No boards had a separate policy for parental leave. Twenty boards had time-based training requirements for board eligibility, allowing a median of 6 weeks of leave (range, 4-12 weeks) for any reason during any 1 year. There was considerable variation in the clarifying language regarding leave policies and maintaining board eligibility. Eight boards had explicit and clear clarifying language that allowed program directors to seek exemption of resident physicians from time-based training requirements without extending training duration.

Table. Summary of American Board of Medical Specialties (ABMS) Member Boards Parental Leave Policies for Resident Physicians.

ABMS Specialty	Policy Specifically Addresses Parental Leave	Maximum Leave Allowed for Any Reason	Exemption From Extension of Training Is Allowed	Excerpts of Clarifying Language
American Board of Allergy & Immunology (ABAI)	No	8 Weeks (over 24-month period)	Yes	“If program directors believe that an absence of more than two months is justified, they should send a letter of explanation to the ABAI for review and approval …”
American Board of Anesthesiology	No	12 Weeks (during clinical anesthesia years 1- 3)	No	“Duration of absence during the clinical base year may conform to the policy of the institution and department in which that portion of the training is served.”
American Board of Colon and Rectal Surgerya	NA	NA	NA	No formal leave policy available on website.
American Board of Dermatology	Yes	6 Weeks (per training year); 14 weeks over 3-year period	Yes	“An absence exceeding six weeks in any one academic year, or a total of 14 weeks in three years, may necessitate additional training to successfully ‘make up’ for that lost time … If the time is not made up, any resident approved to sit for the certifying examination despite such an absence must have completed each year of training in an above average or excellent manner as recorded on the annual residency evaluation forms.”
American Board of Emergency Medicine	No	6 Weeks (per training year)	No	“If a residency program already has a policy in effect for leave time that is less than six weeks, the program may operate according to its own policy.” “[absences] that exceed 6 weeks … require extension of residency”
American Board of Family Medicine	No	4 Weeks (per training year)	No	“Absence from residency education, in excess of one month within the academic year must be made up before the resident advances to the next training level, and the time must be added to the projected date of completion”
American Board of Internal Medicine (ABIM)	Yes	4 Weeks (per training year)	Yesb	“If the trainee's program director and clinical competency committee attest to ABIM that the trainee has achieved required competence with a deficit of less than one month, extended training may not be required.”
American Board of Medical Genetics and Genomics	Yes	4 Weeks (per training year)	No	“Of the required training period, programs may grant up to one month/year for vacation, pregnancy, parental or family leave, or illness. Training must be extended to make up any absences exceeding one month per year of training.”
American Board of Neurological Surgery	Yes	No maximum given	Yes	“… any reduction from the standard 84 months of training must come from the resident's 30 months of elective time” “… the Program Director should follow the Human Resources policies of his/her institution and applicable law when determining whether to approve such leave requests, in whole or in part, and whether any time away from training needs to be made up at the back end of the resident's training”
American Board of Nuclear Medicine (ABNM)	No	6 Weeks (per training year)	Unclear	“If leave exceeds these limits … the program director must have a plan approved by the ABNM to compensate for the lost educational time.”
American Board of Obstetrics and Gynecology	Yes	8 Weeks (per training year); 20 weeks total during training	No	“Leaves of absence and vacation may be granted to residents at the discretion of the Program Director … However, the total of such … leaves for any reason—including … maternity or paternity leave … may not exceed 8 weeks in any of the four years of residency training. If any of these maximum weeks of leave per year are exceeded, the residency must be extended for the duration of time the individual was absent in excess of 8 weeks …”
American Board of Ophthalmology (ABO)	No	No maximum given	Unclear	“Duration of training is a specific requirement for board eligibility. If you have taken time off or extended leave … you will need to make up the missed time in consultation with your Residency Program Chair or Director. The ABO does not accept less than one PGY-1 internship year, followed by 36 months of ACGME-accredited residency training in ophthalmology.”
American Board of Orthopedic Surgery	No	6 Weeks (per training year)	No	“Program directors may retain a resident for as long as needed beyond the minimum required time to ensure the necessary degree of competence in orthopedic surgery.”
American Board of Otolaryngology (ABOto)	No	6 Weeks (per training year)	Yes	“If a circumstance occurs in which a resident’s absence exceeds the allotted time outlined by the ABOto, the program director must submit a plan to the ABOto for approval on how the necessary training will be achieved, which may require an extension of the residency.” “Leaves of absence and vacation may be granted to residents at the discretion of the program director in accordance with local rules.”
American Board of Pathology	Yes	Average of 4 weeks (per training year)	No	“Each institution sponsoring a pathology training program should develop their own sick, vacation, parental, and other leave policies for the resident. Regardless of institutional policies … any training less than 48 weeks must be made up.”
American Board of Pediatrics (ABP)	Yes	4 Weeks (per training year); not >3 months of entire training	Yes	“If the program director believes that the candidate is well qualified and has met all the training requirements, the program director may submit a petition to the ABP requesting an exemption to the policy.”
American Board of Plastic Surgery	Yes	4 Weeks (per training year)	Unclear	“Should absence exceed four weeks per annum for any reason, the circumstances and the proposed correction (ie, make-up time) of this irregular training arrangement must be approved by the program director.” “The 48-weeks can be averaged over the training years in the program.”
American Board of Physical Medicine and Rehabilitation	Yes	6 Weeks (per academic year)	Unclear	“A resident must not be absent from residency or fellowship training for more than six weeks (30 working days) annually. Regardless of institutional policies regarding absences, any leave time beyond six weeks will need to be made up by arrangement with the program director.”
American Board of Preventive Medicine	No	8 Weeks (per training year)	No	“The training must include at least ten months of direct patient care.”
American Board of Psychiatry & Neurology (ABPN)	Yes	No maximum given	NA	“The ABPN recommends that all programs allow a minimum of four weeks of leave time (including vacation, sick time, maternity/paternity leave, etc) during training per year. These four weeks should be averaged over the four-year training period.”
American Board of Radiology (ABR)	No	Leave policy is not based on time	NA	“Leaves of absence and vacation may be granted to residents at the discretion of the program director ... Depending on the length of absence ... the required period of graduate medical education may be extended accordingly. Residency program directors and their institutional GME offices determine the need for extension of residency training. Therefore, it is not up to the ABR to determine graduation dates for individual residents.”
American Board of Surgery (ABS)c	Yes	4 Weeks per year (averaged over first 3 years and last 2 years)	Yes	“The ABS will also consider other arrangements beyond what is noted above on a case-by-case basis. These will also require advance approval. All requests for approval must be made by the program director (not the resident).”
American Board of Thoracic Surgery	NA	NA	NA	“The American Board of Thoracic Surgery does not have a formal medical or maternity leave policy.”
American Board of Urology (ABU)	No	6 Weeks (per training year)	Yes	“Should circumstances occur which keep a resident from working the required forty-six weeks in one year, the program director must submit a plan to the ABU for approval on how the training time will be made up, and an extension of the residency may be required.”

Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; GME, graduate medical education; NA, not available; PGY-1, postgraduate year 1.

^aA prerequisite is ABS certification.

^bAs long as training deficit is less than 1 month.

^cPolicy is for certification in general surgery. Policies for certification in other ABS subspecialties were excluded.

Discussion

Specialty boards allowed resident physicians requesting parental leave a median of 6 weeks without extension of training duration, less than the leave allowed faculty¹ and similar to the 6 to 8 weeks of paid parental leave recommended by the American Academy of Pediatrics.³ However, most board policies lacked specific reference to parental leave and were ambiguous about whether training would need to be extended, which may create barriers to resident physicians taking parental leave.

Inadequate parental leave during residency has been associated with delayed childbearing, use of assisted reproduction technology, and difficulty maintaining breastfeeding.^4,5 Lack of support for adequate parental leave during residency training may contribute to persistent sex disparities in certain specialties, dissatisfaction with work-life balance, and increased risk of physician burnout.⁶ Conversely, residency program directors face unique challenges in making determinations of parental leave duration for resident physicians. They must weigh potentially conflicting factors such as adhering to board and institutional policies, maintaining adequate clinical service coverage, considering precedent within the program, and ensuring that resident physicians are well trained.

Balancing the needs of resident physicians, training programs, and specialty boards may require novel approaches such as use of competency-based rather than time-based training milestones to determine eligibility for board certification. Study limitations include possible lack of identification of all relevant policies and subjective evaluation of policies.

Section Editor: Jody W. Zylke, MD, Deputy Editor.