Medical Specialty Board Parental, Caregiver, and Medical Leave Policy Updates After 2021 American Board of Medical Specialties Mandate

Abstract

This study assesses how member boards of the American Board of Medical Specialties (ABMS) have adhered to a 2021 ABMS policy change allowing residents a minimum of 6 weeks of parental, caregiver, and medical leave.

Parental, caregiver, and medical leave is essential for the well-being of medical trainees and their families. However, leave may be limited by ambiguous or restrictive policies or underused because trainees may fear the consequences of taking leave, including required “make-up” time resulting in delayed graduation.^1,2,3 Effective July 1, 2021, the American Board of Medical Specialties (ABMS) mandated member boards to allow residents in programs with durations of 2 years or longer “a minimum of 6 weeks…parental, caregiver and medical leave at least once during training without exhausting all other allowed time away from training and without extending training.”⁴ We assessed if and how boards adhered to this mandate, board policy variability, and changes compared with prior policies.

Methods

This study was deemed not human subjects research by the Mass General Brigham institutional review board. We reviewed publicly accessible websites for leave policies related to residency training requirements and eligibility for Initial Certification for ABMS boards on October 21, 2021. Boards were contacted by email to verify that the listed policy was current. A board’s policy was deemed adherent to the ABMS mandate if a minimum of 6 weeks of leave in addition to vacation was possible with the policy as worded. Variables analyzed included requirements related to time and need for training extension, relationship of parental, caregiver, and medical leave to other nonclinical time or time off, and changes since 2018.² Maximum allowable leave across all boards for which data were available, normalized by training duration, was compared between 2018 and 2021 and between surgical and nonsurgical specialties using the 2-tailed Mann-Whitney test. Analysis was performed with GraphPad Prism version 9. A P < .05 was deemed statistically significant.

Results

All 23 boards (100%) with 2-year or longer training pathways had policies that adhered to the ABMS mandate, although policies were variable. One board policy (4%) relied on the discretion of the program director or institutional policy without time limit guidance for its 2-year or longer pathway, and 3 policies (13%) did not specifically address parental, caregiver, and medical leave (Table). Ten boards (43%) set maximum limits on leave per year (median, 8 weeks; range, 6-24 weeks), while 21 (91%) defined limits over the entire training duration. One board stipulated only minimum time requirements for leave. In 2018, 4 boards (17%) did not have a formal leave policy; in 2021, 23 boards (100%) had a formal leave policy. Fifteen boards (65%) increased the maximum allowable leave compared with 2018. The mean total annualized leave allowed by boards was 7.5 weeks (range, 3-24 weeks [n = 21]) in 2021 compared with 5.2 weeks (range, 4-8 weeks [n = 18]) in 2018 (P = .02). The mean leave durations of surgical specialties (7.3 weeks; range, 3-17 weeks) and nonsurgical specialties (7.7 weeks; range, 4-24 weeks) were not significantly different (P = .75).

Table. Summary of ABMS Member Board Parental, Caregiver, and Medical Leave Policies.

Member boarda	Duration of training program(s), y	Policy specifically addresses parental, caregiver, and medical leave	Leave without extension of trainingb	Prior leave policy (2018)2
American Board of Allergy and Immunology	2	No	Maximum 8 weeks of leave over 2 years; program director can request more for consideration by the board’s Ethics and Professionalism Committee	8 Weeks over 2 years
American Board of Anesthesiology	4	Yes	8 Weeks of parental, caregiver, and medical leave beyond vacation without extension of training in training years 2-4 (once during training)	12 Weeks over 2-4 years
American Board of Dermatology	3	Yes	Maximum of 8 weeks away from training per y (6 weeks of leave plus 2 weeks of vacation) or 16 weeks away from training over 3 years; additional leave can be considered on a case-by-case basis	6 Weeks per year or 14 weeks over 3 years
American Board of Emergency Medicine	3 or 4	Yes	6 Weeks of nonclinical time per training year with additional 2 weeks for parental, caregiver, and medical leave per year	6 Weeks per year
American Board of Family Medicine	3	Yes	Up to 20 weeks of total leave throughout residency (up to 12 weeks in 1 year) without extension of training; 8 weeks can be for parental, caregiver, and medical leave	4 Weeks per year
American Board of Internal Medicine	3	Yes	Up to 5 weeks of leave per year are cumulatively permitted for vacation and parental, caregiver, and medical leave	4 Weeks per year
American Board of Medical Genetics and Genomics	1, 2, or 4	Yes	Average of 4 weeks of leave per year for any indication; 6 weeks of parental, caregiver, and medical leave allowed once during training with additional 2 weeks of leave	4 Weeks per year
American Board of Neurological Surgery	7	Yes	Length of parental, caregiver, and medical leave and whether extension of training is required to be determined by program director in conjunction with institutional policies and applicable law; no explicit maximum and leave time should come from 30 months of elective time	No maximum given
American Board of Nuclear Medicine	1-3	Yes	For programs ≥2 years, parental, caregiver, and medical leave is not to exceed what is permitted by institutional policy and/or ACGME; for programs <2 years, 6 weeks of leave per year	6 Weeks per year
American Board of Obstetrics and Gynecology	4	Yes	12 Weeks annual maximum for any vacation and leave including parental, caregiver, and medical leave; no more than 24 weeks of leave over 4 years	8 Weeks per year; 20 weeks total during training
American Board of Ophthalmology	4	Yes	Parental, caregiver, and medical leave granted at the discretion of the department chair and/or residency program director; must have at least 6 months of clinical training per PGY level	No maximum given
American Board of Orthopedic Surgery	5	No	Average of 6 weeks per year for individual leave and vacation	6 Weeks per year
American Board of Otolaryngology	1, 2, or 5	Yes	No more than 6 weeks away in any PGY year, except up to 8 weeks (6 weeks of leave plus 2 weeks of vacation) in a single year for parental, caregiver, and medical leave (once during training) for trainees in 5-year program	6 Weeks per year
American Board of Pathology	3 or 4	Yes	Up to 6 weeks for parental, caregiver, and medical leave in addition to vacation time (once during training)	4 Weeks per year
American Board of Pediatrics	3	Yes	4 Weeks annually for vacation, illness, or family leave with an additional 8 weeks permitted once during training for parental, caregiver, or medical leave (6 weeks for nonstandard/combined pathways)	4 Weeks per year
American Board of Physical Medicine and Rehabilitation	4	Yes	Up to 6 weeks of leave per year; 4 additional weeks (once during training) allowed for parental, caregiver, and medical leave	6 Weeks per year
American Board of Plastic Surgery	3 or 6	Yes	Average of 4 weeks of nonclinical time per year; additional 12 weeks permitted for parental, caregiver, and medical leave derived from time for elective rotations (once during training)	4 Weeks per year
American Board of Preventive Medicine	1 or 2	Yes	4 Weeks of leave per year; an additional 2 weeks is allowed per year if in accordance with the training institution’s policies on parental, caregiver, and medical leave; additional time to be considered case by case	8 Weeks per year
American Board of Psychiatry and Neurology	4	Yes	Minimum 4 weeks of leave, including vacation as well as parental, caregiver, and medical leave, per year, averaged over training period; minimum of 6 weeks for parental, caregiver, and medical leave must be allowed at least once during training	Minimum of 4 weeks per year, averaged over the training period
American Board of Radiology	4 or 5	Yes	Average of 8 weeks of “time off” per year for any reason including vacation as well as parental, caregiver, and medical leave	Not based on time
American Board of Surgery	5	Yes	Extra 4 weeks of leave in first 3 years and last 2 years for parental, caregiver, and medical leave (once each time period) without extension of training in addition to 4 weeks of vacation or other leave per year (also option to complete training in 6 years for additional flexibility for leave)	4 Weeks per year
American Board of Thoracic Surgery	2-6	Yes	6 Weeks (once during training) for parental, caregiver, and medical leave allowed in addition to vacation on general surgery/congenital subspecialty pathways; 6 weeks of leave (twice during training) in addition to vacation can be taken on the integrated pathway	No formal policy
American Board of Urology	5	No	46 Weeks of clinical training required per year, which can be averaged over the first 3 years and over the last 2 years	6 Weeks per year

Abbreviations: ABMS, American Board of Medical Specialties; ACGME, Accreditation Council for Graduate Medical Education; PGY, postgraduate year.

^a Only member boards with training durations of 2 years or longer are presented. The American Board of Colon and Rectal Surgery has only a 1-year training pathway. Confirmation of trainee clinical competence is required for successful graduate medical education training completion and hence Initial Certification. Surgical specialties included the American Board of Neurological Surgery, American Board of Obstetrics and Gynecology, American Board of Orthopedic Surgery, American Board of Otolaryngology, American Board of Plastic Surgery, American Board of Surgery, American Board of Thoracic Surgery, and American Board of Urology.

^b Adherence to the ABMS mandate was determined by assuming a minimum allowable vacation defined as at least 2 weeks during training⁴ (at least 1 week per year for a 2-year program) if not explicitly defined. A board’s policy was deemed adherent if a minimum of 6 weeks of leave in addition to vacation was possible with the policy as worded. The maximum annual leave was analyzed when explicitly stated in the leave policy. The maximum allowable leave was calculated by tabulating all leave (parental, caregiver, and medical leave or otherwise) over the entire training pathway of 2 years or longer offered by each board, if defined, and divided by the number of years required by each pathway. The maximum value was taken when multiple pathways were available.

Discussion

As of October 2021, all board leave policies were adherent to the ABMS parental, caregiver, and medical leave mandate and most had expanded the duration of allowable leave since 2018. Leave policies remained variable among boards, possibly reflecting differences in specialty and program training requirements. This underscores the need for clear guidance from each board issued in conjunction with national governing bodies.^2,3

Some boards defined parental, caregiver, and medical leave and other leave (or overall nonclinical time) in aggregate. The ABMS provided guidance for “at least 2 weeks of vacation time”⁴ during training. For some boards, fulfillment of parental, caregiver, and medical leave requirements required use of other nonclinical time, including vacation, which can negatively affect professional and personal well-being.⁵ Starting in July 2022, the Accreditation Council for Graduate Medical Education will mandate a minimum 6 weeks of parental, caregiver, and medical leave for residents and fellows in accredited programs. In addition, programs will also need to provide a minimum of 1 week of paid leave outside of the first 6 weeks of parental, caregiver, and medical leave taken.⁶ Further distinction between parental, caregiver, and medical leave and vacation by national governing bodies may facilitate strengthening of leave policies by programs and institutions.^1,3

The study was limited to publicly available board policies, which include varied levels of detail and may be subject to interpretation.

The ABMS’s leave mandate and resultant board policy updates are important steps forward but also demonstrate the need for continued attention, evaluation, and innovation. Future studies should assess the effect of current policies on actual parental, caregiver, and medical leave taken, trainee well-being, milestones attainment, and timing of graduation and Initial Certification.

Section Editors: Jody W. Zylke, MD, Deputy Editor; Kristin Walter, MD, Associate Editor.