Life Happens During Training

Life happens during residency. We learn, grow, and change – this happens on a professional and personal level. We become better diagnosticians, troubleshooters, critical thinkers, and proceduralists. Many of us meet our life partners, get married, and think about starting a family.

Whereas men are often praised for becoming fathers and growing their families, women are looked at differently. Stigma surrounding mothers in medicine still exists. It is especially apparent if you’re in training. Will she still work as hard? Are her priorities going to shift? Is she going to stay committed?

For women, our prime reproductive years fall during the years of medical school and residency. If you take the traditional path towards becoming a physician, you obtain a four-year undergraduate degree, complete four years of medical school, work as a resident for three to seven years, and possibly end with a fellowship, lasting anywhere from one to three years. On average, that lands you in your early to mid-thirties. Compared to the general public, studies have shown higher rates of infertility, miscarriage, and elective abortions among female physicians. This has been attributed to stress, more demanding work hours, and advanced maternal age.^1–3

Last year, I had a child. I worked eighty-hour weeks up until my due date, took my three weeks of vacation for “maternity leave,” and gave up breastfeeding early because of the perceived lack of support. I felt alone, depressed, and relatively unsupported by my team.

Fast forward a few months and things improved. Time does tend to heal wounds. I’m happier now more than ever. And I think I’m a better physician – more productive, efficient, and compassionate towards patients. As I reflect on my own experience of having a child during my fourth year of a surgical residency, I think it is time to start advocating for change.

The Accreditation Council for Graduate Medical Education (ACMGE) currently has no recommended minimal standards for duration of parental leave for trainees. This leaves individual institutions and training programs to set their own leave policies.

As one of the leading advocates for maternal-child health, the American Academy of Pediatrics (AAP) states, “regardless of gender, residents should be guaranteed a minimum of six to eight weeks of parental leave.”⁴ The American College of Obstetricians and Gynecologists (ACOG) has a similar policy, recommending, “Medical schools, residency and fellowship training programs, medical specialty boards, the ACGME, and medical practices should incorporate paid parental leave policies as part of the physician’s’ standard benefit package.” They go on to advocate for a “minimum of six weeks leave” and encourage training programs to develop mechanisms enabling residents to still be board eligible if they take greater than six weeks of parental leave.⁵

A recent comparative study of family leave policies showed the majority of residency training programs, both medical and surgical, allow for a maximum of four to six weeks.⁴

So why have we not adopted the recommendations of AAP and ACOG? Maybe it’s because we don’t think about it. Maybe it’s because “that’s how it’s always been.” Maybe it’s because hospitals rely on the resident workforce and are apprehensive to allow for extended time away. Maybe it’s because programs are worried about residents not meeting their case minimums. Maybe it’s because peers may perceive a deficit in time-away equity between trainees. Or maybe it’s because medical boards set arbitrary thresholds for the amount of time trainees can be gone and are reticent to adopt competency-based education.

Medical training is at a crossroads. Lifestyle issues now affect recruitment and retention. The rising number of females going into medicine and the increased number of women beginning families during training demands departmental leaders and program directors to address the challenges faced by childbearing trainees.

Doctors are meant to care for people. Healthcare is meant to promote the wellbeing of individuals – our patients and each other. Somehow, we’ve forgotten to care for each other. There’s benefit in allowing a mother’s body to heal, affording her the bonding time with her newborn, and providing her the opportunity to establish a breastfeeding regimen before returning to work.

In a nationwide survey of childbearing general surgery residents, three risk factors were associated with professional dissatisfaction: (1) altering fellowship plans owing to difficulty balancing childbearing, (2) lack of formal maternity leave policies, and (3) perception of stigma associated with pregnancy. In the same study, 39% of respondents strongly considered leaving surgical residency and 30% would discourage female medical students from a surgical career because of lack of support and inadequate duration of parental leave allowed during training.⁶

Unless women and their allies demand and drive necessary changes, they will never happen. Solutions begin with acknowledging failures and identifying opportunities for improvement. And failure is the perfect word to describe what we’ve done so far for childbearing residents and new parents. We, as a medical profession, have contributed to the collective failure in supporting childbearing during residency. We haven’t yet dedicated the emotional intelligence towards solving this “problem” and generating creative solutions to encourage our trainees to have children during training. Let us start the discussion – is there a better model?

Interventions at the program, hospital, state, and national levels should identify obstacles to maternity leave policies, design approaches to implementation of flexible training tracks, and examine methods to reduce maternal discrimination.

When a trainee approaches you with an announcement she’s pregnant, ask not “what have we done in the past,” but rather, “what should we be doing?” Stop waiting for top-down mandates and instead, challenge the archaic system by implementing your own policy change. Be the catalyst within your department and advocate for the mothers around you.

Gone are the days when we as physicians need to sacrifice our own needs for our patients. Healthier, more fulfilled physicians make better doctors. And we owe it to our patients to be the best we can be, both at work and at home. Often, this means procreating with our partners. And this procreation should be supported, dare I say even celebrated, during training.