Tuesday, December 23, 2014

Guest post: Having Babies during Residency: A View from the Bridge

This post is in response to our MiM Mail: Residency limit for leave and having children posted in November.

The problem of maternity leave for residents goes well beyond the good will, or lack of it, of training directors and local programs. Different specialty boards establish minimum standards for residents to be board eligible, and these usually involve specified upper and lower limits of time spent in particular areas. Stipends come from multiple sources and are tied to the work that the resident does, which makes it difficult to set aside money from one year to pay for time doing make up work in another. When a resident goes on leave, other residents have to pick up her responsibilities, and they will not receive compensation for doing so. At the same time, they may not violate duty hour limits.

Program directors, of which I was once one, have to figure out how to create maternity policies that do not violate minimum requirements, do not unduly burden other residents in the program, do not violate other regulations and still acknowledge the legitimate needs of the resident who requests leave. When I became a program director, my youngest child was 4, and the issues of maternity leave were still very fresh in my mind. My first thought was to ask the department to hire a PA or master’s level nurse who could float to cover the clinical responsibilities of residents who took leave. That went nowhere, though I still think it would have been feasible and fair. I then tried to get the program directors organization to survey its membership to see what different programs were doing. The push back was immediate and negative. Programs with generous leave policies were reluctant to publish them, for fear that residents would select them to take advantage of them, multiplying the headaches of trying to make accommodations. Many programs had no policies at all.

I am sad to see that so little has changed in the last eighteen years—soon, my daughters will be the ones who have to deal with maternity leave. Change is unlikely unless more women become program directors and choose to work on modifying the policies of various specialty boards. The family practice board position (see MiM Nov 10, 2014) is one that others could adopt. It suggests that programs might create some creditable elective time that could be spent reading or doing some other scholarship from home. Women should be allowed/encouraged to schedule the more taxing rotations early in pregnancy (and I would suggest also front loading as much call as one can). It is still up to the program how much leave to allow and whether it will be paid or unpaid. The AAFP also leaves unanswered how to deal with what may be competing demands of the law in a particular state and the requirements of a specialty board.

In the end, women physicians cannot expect to be treated more fairly and generously than other women. Having a child during training will never be easy, but we should be mindful that we are generally privileged. We may have to delay some phase of education, or prolong it by working part time, or even chose a specialty or a position we would otherwise not have done, because of having a child. Compared to the pregnant UPS driver who gets fired, or the Walmart worker who has to stand on her feet all day, or the mother who can’t work at all because she can’t afford childcare, we are lucky indeed.



  1. Thank you juliaink - your post has provided a valuable insight into the difficulties faced in providing equitable mat leave. Anything that fosters conversation on this topic will hopefully serve to move it forward.

    I wanted to make some general comments inspired by, and not aimed at, your post. I'm not sure that women physicians are expecting to be treated more fairly or generously than other women, and although mindfulness is important, sometimes "we are lucky indeed" can serve as a conversation stopper, sending a message to pregnant women that we have no right to "complain" as we have it "so lucky". A little like the wealthy woman who is not "allowed" to be unhappy, as "what's wrong with her, she has everything" or "consider yourself a woman who happens to be pregnant rather than a pregnant woman". Comments such as these create guilt - "other women have it worse off so why am I struggling"

    Women physicians have just as much 'right' to feel dissonance over the difficulties they face when pregnant or mothering, as does the UPS driver or the Walmart worker. We can not expect to be treated more generously than any other working woman, I agree, but neither do we have to "suck it up" because we are "privileged". For it is hard, for all women, everywhere.

  2. Also - I'd like to point out that, for better or worse, change tends to come when people with more power demand it. This is a wonderful point made by Alexis De Tocqueville in Democracy in America and that has played out in American history ever since his writing in the 19th Century. It is perhaps contrary to our ideals about how a democracy works, but sadly, it is reality.

    Change will come when men (more power) and professional/business women (more power) demand it. That's, frankly, the best shot that the female UPS drivers and Walmart workers have. So rather than say if they have it worse we should shut up, what we need to do is organize because it is unjust, and guess what, if we stand up for ourselves, we help them too. If we could change our country's (and our profession's) maternity leave policies, we will help ourselves and help women with less power.

    So though I totally appreciate where Julian K is coming from and applaud her own direct work on behalf of her colleagues, I will go so far as to respectfully disagree with that last paragraph.

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  4. My program let me bank my 4 wks of PD vacation and use it for maternity leave. Then they let me do a 4 WK elective on breastfeeding, and I did reading and wrote a paper on what I had learned, obviously the greatest learning was in the personal experience. The last 4 wks I took as FMLA unpaid and never regretted it.

  5. If you look at maternity leave worldwide, all women in the US have the right to complain. I agree that complaints from the top are important to induce change. Some countries give a year of paid maternity leave- REALLY! We all deserve much better.

  6. Amber - what is your specialty? I'm thinking something like peds or family medicine. But if it's something else I will feel very encouraged. And great either way - just would be nice if it were general surgery or something ;)

  7. Thank you, Juliaink for this post! Very nice to hear how it is perceived from "the other side". I completely agree with you that we need more female program directors. This is the foundation of Sheryl Sandberg's "Lean In" book and campaign to encourage more women to take leadership roles. It is the only way to make our unique needs heard.

    Personally, I tried to discuss fellowships with my current (older male) residency director, who knows I have a toddler at home. His suggestion included attending a program 70 miles from my current home and coming home on weekends to see my family. Surely a mother would realize this was not a good option!

    As for your comment that we, as female physicians, have life pretty good, I would agree. However, I would disagree that it means change isn't necessary. I would argue that we should lead the change, given our unique knowledge of the health and well-being needs of new mothers and infants and our professional careers. Only then can we help women in far less fortunate situations to feel empowered to enact similar change. Otherwise we are simply not practicing what we preach.

    Great post!


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