Wednesday, September 28, 2011

Dear American Board of Surgery (a rant that may get me in trouble...)

NOTE: The communications manager for the American Board of Surgery responded to the post below with an assurance that the leave policy for medical or maternity has not changed. The quotation below was sent to program directors yesterday which lead to the misinterpretation. I decided not to delete the entire post however because I think it still brings up relevant points about leave during residency. I apologize for any problems caused by the post but I am happy that the issue has been cleared up.

Today, after having a nice conversation with a fellow mom/surgery resident about trying to achieve life balance and how much we are committed to being surgeons, I went back to my desk to find this in my inbox:

48 Weeks of Full-Time Experience Required. We require all residents to complete 48 weeks of full-time experience in each clinical year. No more than four weeks of time off is allowed per year, regardless of the reason.

Now this is an amendment to the previous rules that allowed 46 weeks in some years for different reasons - illness, maternity leave, etc. However, apparently the almost exclusively male American Board of Surgery has decided that in 2011, the most progressive move for them is to make surgical residency even harder for women if they are crazy enough to want to have a family! Seriously! I own my choice to be a surgeon. I love it, I can’t imagine myself doing anything else. But I am also 31 years old, and I own my choice to have kids. I will do both, it is hard but it can be done. Women surgeons are a valuable and necessary asset to the practice of surgery and as a result of biology, many of us who would like to have children have to do it during training. I do not apologize for my desire to both be a surgeon and a mom. I will take my call and operate and do whatever. Is it too much to ask that I be given a remotely appropriate amount of maternity leave while forfeiting my vacation and any travel to meetings. Many residents already take less than 6 weeks of maternity leave just because they may have to fly to interviews and only have 5 or 4 weeks remaining. This new rule will leave women with 2 or 3 weeks of maternity leave. We would never ask a patient to perform the tasks we do 2-3 weeks post op. LEAD BY EXAMPLE!

be better, be innovative, be smart, be equitable, be accountable. This is ridiculous. Stop being unrealistic about reality. I will make a great surgeon. So will/do lots of women with kids and people who have to interview for jobs and present at meetings and would also like a week of vacation or who may just once need to stay home with a sick kid so as not to destroy the career of their spouse in order to meet your rules. Grow up ABS. Figure out ways to train surgeons more efficiently. We work 90 hours a week (yes, I said 90, 100, 80, 60 pick your number), we care about our patients, we care about being good surgeons - figure out a way to make that happen with humanity and 2 less weeks.


  1. Wow, this is insane. I remember how I felt 6 weeks post partum and I couldn't fathom going back to my OFFICE job where I would sit all day at that time, let alone going back to an OR and standing for hours to operate.

  2. That is absolutely insane. And I thought our colleges were misogynists....

  3. And are they recommending that women who miss more than 4 weeks extend their residency to make up the missed time? What about fellowships, which start on July 1?

  4. Here's what I found online, looks like there is an option for maternity leave (6 weeks):
    Leave During a Standard Five-Year ResidencyFor documented medical problems or maternity leave, the ABS will accept 46 weeks of training in one of the first three years of residency and 46 weeks of training in one of the last two years, for a total of 142 weeks in the first three years and 94 weeks in the last two years. Unused vacation or leave time cannot be applied to reduce the amount of full-time experience required per year without written permission from the ABS. Such requests may only be made by the program director.

  5. Thanks for the agreement!

    Anon: The rules online were last updated in July according to the website. These new rules per my program director were released today, eliminating the 46 week rule. I plan to investigate more. If the new rule stands, then it brings up huge issues with starting fellowships!

  6. That is ridiculous and I am disheartened to hear about it. I'm currently developing a learning module for PGY1's on pregnancy in residency. In Canada, the maternity leave provisions are unanimous for all programs, and it is not unusual for residents to take 6 months (with EI and top up from our benefits making up to 93% of our salary).

  7. I don't understand why the American rules are so archaic. As Jess said, in Canada it's not uncommon for residents to take 6 months (some even take a full year) for maternity leave. And I don't think we're graduating worse physicians than the US is.

  8. Unfortunately, the pattern of behavior in the medical world for the past 100 years has been to exclude women, minorities, and anyone other than rich, white males. It's really sad to see that the AMA, residency programs, and others have all acted to try and squeeze others out of their world and maintain the little microcosm that they've been monopolizing for the past century.

    Unfortunately, the people that have paid the most for it, are the ones that can most ill afford it. Patients.

    Shit like this really makes me angry.

  9. I had a baby during my family medicine residency in the US and had to graduate from residency 3 weeks late. I took 6 weeks off for maternity leave and 2 of those weeks were vacation weeks I had saved up, and 1 week was a CME week (and I had to actually do CME during my maternity leave to make it count). Thus the three more weeks that pushed my residency completion date back. I was told in order to qualify for board certification in FM that you cannot just take a maternity leave (or other kind of leave) without making it up later on. I know a fellow resident took three months off and had to graduate from residency 3 months late. I didn't really care to be honest - 3 weeks, not a big deal.

    I feel for you - it sucks when you have a FIVE year residency. Good luck with getting the word out and hopefully some changes can be made!

  10. Jess: I doubt any residency program would allow you to take 6 months off without making it up. Would we even want that?

    The question: what does it mean that no less than 48 weeks are allowed? Does that just mean you have to make up the extra weeks at the end? If so, that's not wholly unreasonable. If you miss more training than other people, why shouldn't you have to make it up?

    If you're simply not allowed to take more than 4 weeks off, then that's disgusting.

    Maybe we need to be addressing fellowships, to allow fellows to start after July 1 if they have to make up time from maternity leave.

  11. Fizzy: The policy on making up weeks is unclear especially since the policy was just released yesterday. However, I know that there have been past residents who have had to make up time which has implications for starting fellowship (basically you either don't do one or try to delay it a YEAR) and it also means that you can't sit for the boards for an ENTIRE YEAR. Also, given that most residents try to take extra call or take maternity leave during elective time I don't think that those two weeks really translate into significant less learning/training than those who don't take the two weeks. We work nearly every weekend and with constant call for five years - its a dense residency. I don't think two weeks will make a big difference. I think, as a country, we need a culture that values family more. This is a pervasive problem across most medical specialties and many other industries and unfortunately we seem to be often moving in the wrong direction.

  12. I. Am. Really. Astonished. I leave and practice in Italy, where COMPULSORY maternity leave is 5 months (which can be used 2 antepartum and 3 postpartum, or 1 antepartum and 4 postpartum). Our retribution is 80-85% in those months. After that you can choose to have "parental" leave for up to 6 months, with a variable retribution depending on your job (30-80%). And I thought our laws were not that good..............I am in my last year of residency and now on my first month of antenatal maternity leave. I plan to be at home, if possible, for 8 months in total. Of course this time off for residents has to be regained later, but with regular retribution!!

  13. this is concerning not only for general surgery, but also other surgical subspecialities. I could see other boards using the ASC as an example to further restrict maternity leave. Very concerning.

  14. Don't flame me too badly...

    I birthed my 10#, 4 oz baby boy in 1991 without medications after a 2 hour labor.

    3 weeks later, I went back to work as FMLA did not cover me despite that I'd been employed for over 10 months.

    Sometimes, anything is better than nothing.

  15. Hi,
    I'm Christine Shiffer, communications manager for the American Board of Surgery. There has been no change in our leave policy, which still permits time off for medical or maternity leave. Please see it here:
    The paragraph your program director cited was in cases where there is no such leave approved.
    Please feel free to contact me if you have further questions at

  16. Doc2Be: there will always be stories and examples of people who are able to proceed outside the norms. That doesn't mean everyone should be required to operate within those parameters. Especially when for many people those parameters would not even be medically advisable.

    Christine: Thank you very much for responding. I contacted my program director and his interpretation of the e-mail he received was that it was to supplant the current leave policies. I verified with him before my post. I'm sorry for incorrectly interpreting this change and I'll write a retraction if indeed the leave policies have not changed. The bolded portions I indicated in my post were also bolded in the correspondence that went out to program directors, as a result, I wouldn't be surprised if this misinterpretation is widespread. I was planning to also write a letter to the ABS along with some of my fellow residents. Thank you for listing your contact information.

    Either way, I still think that the topic of leave and residency is a valid one. Thanks to everyone who commented.

  17. Fizzy: Yes, we do have to make up the time for maternity leave, but that does not seem to be an obstacle or deterrent for most people. In my program, women are allowed to write their Royal College exams at the same time as their peers, and then work in areas that interest them for the remaining time. Most feel that this is a good experience, and they don't graduate as less skilled physicians. Residency is also a financially wise time to have a baby in Canada, because we get paid leave which you don't as a practicing physician.

  18. Cutter, I agree with the length of maternity leave being lengthened. Was not trying to say I'm supermom, altho sometimes I feel like I'm trying to be one!

    In retrospect, I have no doubt it would have been far better for my son if I had been home to recuperate for a longer period of time.

    My only point, poorly stated, was that I wish I had been given more time at home with him... and that the issue of maternity leaves being shortened or somehow diminished in importance does not fall only in the health care industry.

  19. Just proves what I always thought about surgeons is true....


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