Tuesday, May 27, 2008

Maternity leave for medical mothers

The association of directors of residency training in psychiatry has just started surveying program directors about their ATTITUDES toward maternity leave for residents. Years ago, when I was a member, I tried to survey them to find out what the range of actual policies might be, but no one wanted to disclose this for fear, I guess, that women would choose programs with better policies. Still, this punt is a form of progress, and the day may come when young women may have that kind of information, and not be penalized for making use of it.

Since I have changed to medical student education as my professional focus, I have become even more concerned about this issue. My first year in the job, an excellent student failed her clerkship exam about a month after delivering her first child. This led me to research the issue of "motherbrain"--cognitive problems women report after delivery. (I recall my pregnancy friend describing it as "someone took my brain out, administered a few swift kicks, and replaced it rotated 45 degrees.") Although the problem is one women commonly report, the research on it, like earlier research on perinatal depression, has been dismissive. Because the studies all exclude women with depression, severe insomnia, or medical complications, they have not found "objective" evidence of impairment on a limited number of tests.

Research or not, cognitive impairment (poor concentration and short term memory) may be a significant problem for women after delivery, lasting an unknown period of time. While I don't want to discourage anyone from working and demonstrating that mothers can be competent professionals, inadequate maternity leave and too early return to work is not a trivial problems. Students may fail their exams, and the rates of human error, already too high in medicine, may be affected as well. If I thought the information would be used in a non discriminatory fashion, I would be advocating for more attention to research in perinatal cognition. As it is, I try to warn students and residents not to underestimate the impact of childbirth, and to take adequate leave, even if it requires financial sacrifice or prolongs training.

Has anyone else been concerned about this?

9 comments:

  1. I think this is a very real concern - maternity leave for trainees (and all physicians) should be maximized. I wrote a rant about this when I informed my supervisors of my then upcoming need for maternity leave and was met with, "What is it? 6 weeks?"

    Friends outside of the medical realm were incredulous: you would think doctors of all people would understand it's importance.

    I've also wondered how much of the cognitive impairment is due to the effects of sleep deprivation alone.

    Don't get me started about how the US does not guarantee extended paid maternity leave like most of the rest of the civilized world. Our preoccupation with "productivity" seems short-sighted.

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  2. I guess my sister is lucky. She's currently on leave, and has been since her water broke 7 weeks early in November. I'm guessing it hurt more than just the call schedule to lose a 2nd yr resident 6-7 weeks early, but the apparently managed.

    Even though they were trying their best to get her to take some shifts starting in March, she's holding out until the end of June to pick back up. Sure she's "behind" 7 months, but she'll make up the time, they've been able to suck up the loss of money, and her little man will be so much better off having spent so much time with his mama.

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  3. I have been thinking about this too. I wonder if our professional societies could take the lead on this? Even in Cardiology we are approaching a critical mass of women in positions of influence. Perhaps a joint effort with AMA, ACP and ACGME? Having a standard policy could protect young women.

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  4. It's not just the US, it's medicine. I am 13 weeks pregnant, and graduated from medical school this week. One of our convocation addresses included: "Long maternity leaves are not meant for doctors, if you want to work part-time, do it when your kids are teenagers -- no toddler ever fell into the wrong crowd or started smoking pot. It's important to 'give back' and to pull your weight"

    My response to that, and all other suggestions that "too many women in medicine" is the reason for a physician shortage is BITE ME.

    I am taking my 52 weeks of mat leave (the standard in Canada) and I'll finish my program a year later. That year matters little to my program, but a lot to my family. They can kiss my ass. (Pardon my french)

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  5. One of the most difficult things I find with having children and being in medicine, specifically during training, is lack of adequate childcare availability. It is important to have the access to take extended leave with your newborn, but once you return to work- who will watch the child? I live in the DC area- where wait lists are over one year long for daycare. I got called when my child was 15 months that we got into daycare, and I put him on the list when I was 3 months pregnant!! It is impossible to require physician parents to work 80 hour weeks, but not provide the support needed for childcare. My entire salary goes to a nanny right now, and she can't support the fellowship hours I will be working come July- she works 50 hours per week now! I love my job, and can tolerate the long hours, but having to rush home at 5-6pm because I can't afford to pay my nanny longer hours or because daycare closes doesn't provide the support needed to fulfill job obligations. As we all know, our days don't end predictably at 5pm, resident and fellow salaries are minimal, but those who choose full time training suffer the disparaging thought that it will be our kid sitting at the curb waiting for us to pick them up when everyone else has gone home. Hospitals should provide that support to their physicians.

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  6. Call it what you want, but adoptive mothers have it too. So you may need to look for something other than hormones.

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  7. Funny to read this. I am just being told by my residency director I *might* have to do "make-up time" at the end of my residency to compensate for six weeks of maternity leave and some disability due to preterm labor (my total absence being about three months). As it turns out, there's no specific guideline in my program. Turns out, my specialty board ALSO does not have a written guideline. So it seems that the decision whether I will finish on time or not will be up to whatever my program director and the residency person at the specialty board hash out. Two 60+ year old farts whose careers (admittedly, in one case) were made possible by their SAHM wives.

    Don't get me wrong, I love my program, and I adore my residency director, who is a fun, witty, very, very nice gentleman, and who is genuinely concerned about my baby's and my health. But I do have a creeping feeling that IF I can make a deal with him to graduate on time, it will involve me *offering* to give up my vacation time, research time, and going back to work at 37+0 weeks. I think this is a disadvantage that I have to bear only because I am a woman having children. Is this discrimination?

    I think that as a resident, I am in a very vulnerable position to negotiate my own case. I was shocked by the amount of arbitrary decision making apparently involved. I thought there were no written guidelines because my residency program, and my specialty, was so tiny. Now I hear that this is, in fact, the rule, not the exception. I think as mothers (and mothers to be) in medicine, we definitely WOULD profit from some more organized form of taking influence on this matter, and getting written guidelines established for each specialty board. Even if the rules are not generous, at least they will be rules that you can rely on as a mom to be. You face many uncertainties regarding the future path of your career when you decide to throw caution in the wind and have a baby. This should not be one of them.

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  8. How about I was negotiating my maternity the year official maternity leave was introduced in the univerosty.And was told that despite me being in a research year, having already taken the board exam needed for my specialty, I cannot use up 2 month maximum leave, "because my collegues would feel it is unfair for them" to have to carry a pager call for me extra few times per months. 80% of collegues women without children. We should also be kind to each other to make it work for those who are vulnerable (pregnant at the time).

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  9. Confused in anesthesia/hopeful mom 2BJuly 18, 2010 at 9:31 PM

    How about my program doesn't have maternity leave.....sure they will support you and let you take as much time as you need but according to our specialty boards (I haven't actually looked into this yet) they say we are required to work so many hours and complete so many cases that any time you take off is tacked onto the end of residency for you to pay back unless you choose to give up 4 your weeks of vacation and use that as your maternity leave then you won't have to pay back anytime..

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