Showing posts with label maternity leave. Show all posts
Showing posts with label maternity leave. Show all posts

Thursday, September 17, 2015

MiM Mail: Maternity leave policies during medical school

Hi Mothers in Medicine,

I am a medical student, a mother, and I am working with a team at my university to further develop its policies on maternity leave and flexibility for mothers in the medical program. Currently women have to withdraw from the year and repeat it the following year, or are allowed only a few weeks off after the baby is born. Surely this can be improved! Part of my role in this initiative is to research the policies that other medical institutions have in regards to this issue. If you went to a medical school that had a great policy in regards to taking time off, being flexible etc would you mind leaving the university information and possibly a contact in a comment on this post?

Many thanks,

*Anyone is also free to send your contact information to be forwarded if you don't feel comfortable leaving it in a comment.

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.


Thursday, May 8, 2014

Question: Maternity leave

Lately every night I'm on call I seem to be the magnet for pregnant patients - trauma, acute abdomens, appys, choleys - you name it.  During my last call as we talked about my pregnancy magnet, it lead to a discussion about having babies during residency.  We happened to be a diverse group of providers with a diverse and international training background. The take away from the discussion was basically that in the US we don't value new moms, dads or babies.  Those who had trained elsewhere (in surgery) seemed to feel that it was just natural to expect residents to take 4 months, 6 months, or 1 year off (mom or dad).  Meanwhile we all told stories of post c-section residents NSAIDing their way through full operative days 4 weeks after giving birth.  We talked about how broken your body can feel so soon after giving birth, both mentally and physically.  We talked about those itty bitty 6-week old babies in daycare.

So, for those of you who have trained elsewhere in the world:
What is the attitude towards new moms and dads in other countries with more flexible and lengthy maternity leave policies? 
Are residents looked down upon for taking leave (like they often are in the US)?  
Does a culture of more family centric leave create a more equitable distribution of gender roles in the home and the workplace? 

I'm just wondering...

Monday, May 20, 2013

MiM Mail: Pregnant and joining a new practice


I've stumbled across this page from time to time and have found it very supportive and informative.

I am a soon-to-be graduating neonatology fellow in the south.  I have one son who is almost a year and a half.  I am married to a very supportive, non-medicine type husband.

A few months ago, I accepted my first position as an attending in a private practice, community hospital setting to start a month after I graduate from fellowship.  I just recently found out that I am 7 weeks pregnant with our second child.  While my first emotions were excitement and joy, very shortly after came apprehension and guilt about joining a new practice while pregnant.  I am know I am not the first, and will certainly not be the last, to be in this position but I would like to hear from other moms in medicine about their experiences with this.  When should I tell my new practice that I am pregnant?  As soon as possible or just show up to work 20 weeks pregnant and tell them then?  How and when should I broach the subject of the length of maternity leave?  I would really appreciate any advise or insight from other moms in medicine.


Thursday, May 16, 2013

Guest post: Maternity leave, or lack thereof

I am a psychiatry intern currently about to have my first baby towards the beginning of my second year.  I feel so blessed to have this baby, who we recently found out is a girl.  I am not the emotional pregnant lady everyone speaks of--just so so happy about our family's future.  It took me a long time to decide to do psychiatry, and when I wasn't sure if I would have kids in residency, I thought of ob-gyn.  Now, seeing how accepting and supportive my program has been of my pregnancy, I am happy with my decision.

But, there are a few things they can't change, and they have made that clear to me.  For example, if I want to fast-track into child psychiatry, which I do wish to do as the fourth year curriculum at my program isn't ideal, I absolutely cannot take more than 35 days off during my second year.  This includes all vacation and sick time.  After some deliberation with the program director, we have come to decide that I will be taking my four weeks of vacation, plus 10 days sick time, to make a total of 6 weeks maternity leave.  This leaves me with 5 days of baby sick time or emergencies for the entire remainder of my second year.

While I am okay with this scenario, and actually it's more than I expected to have in residency, I grow more and more bitter towards the field of medicine.  Family and friends are always so shocked when they hear about the above "maternity leave."  My friends in finance always fire back with, "What! So-and-so at my job got pregnant and had 4 months paid maternity leave, without using vacation."  Gosh, wouldn't that be so nice.  When MIL heard about the maternity leave, she couldn't believe it.  Her response was, "But that's not fair!"  Who's to decide what's fair?

I am beginning to think more and more about simply extending the residency and doing a fourth year as much as I don't want to.  It's an easy call free year and I may like to have the time to spend with my little daughter.  However, with looming debt over our heads, I would really like to be able to make an attending salary sooner.

Some that read this post may think, "Wow you are lucky, that is a great amount of time!"  But I don't feel lucky to have to pass my baby on at 6 weeks.  I don't feel lucky that I'll be taking a lot of call while my baby is an infant.  Or that after much hard work, I still have to squeeze pennies to buy baby stuff.

Does anybody else agree that medicine just sucks for motherhood?

Monday, September 8, 2008

This looks like more fun than it is

I remember in the last few weeks of my pregnancy, it took every ounce of my strength to drag myself to work every morning, between being sleep deprived and having pain in every joint that was capable of feeling pain. I hung in there because my maternity leave was finite and I wanted to spend every moment of it with my baby. So that meant coming in to work until the bitter end.

But it turned out I wasn't the most miserable person around. In fact, it never even occurred to me that there might be people out there who were actually jealous of me and my thirty-pound belly.

I discovered the truth one evening, while I was sitting in the office I shared with my swingin' single male co-resident. We were complaining about our workload and suddenly he blurted out:

"I wish I were pregnant."

I had never been so shocked. Immediately, a range of angry replies ran through my head: What part of pregnancy would you like? Would you like to carry 30 extra pounds around with you everywhere you go? Would you like to have to wake up 10 times a night to pee? Or would you just like to go through a painful labor possible ending in a major abdominal surgery? What part of being pregnant appeals to you the most??

I didn't say any of that though. My reply was, "You don't really mean that."

He quickly said, "You're right, I don't."

Of course, what he really meant was that he wanted to have a six week maternity leave. Except what he really meant was that he wanted six weeks in Bermuda.

To many people who have never cared for a newborn before, maternity leave seems like just that: a vacation. And those who cover for you when you're gone get resentful that they have to work harder so that you get a six week vacation, while all they get is a measly 3-4 weeks.

Comments like the above fed into the extreme guilt I had surrounding my maternity leave. When I came back to work, I was afraid to even talk to anyone for months because I assumed all the other residents hated me for getting a "paid vacation".

And even though it's been over a year since I returned from leave, I still haven't completely left those feelings behind.

Friday, September 5, 2008

Childbearing in Surgical Residency

My intent was not to make such a serious posting, but I did not succeed.

After 8 years of surgical residency and fellowship, I am happy to report that our lives are returning to some sort of “relative normalcy.” Stress the word “relative” as most would not describe it anything close to “normal.” Life as a junior staff surgeon involves frequent call, occasional emergencies, and the ability to pick up slack for my senior partners. But my life now carries with it innumerably greater amounts of flexibility than life as a resident or fellow.

I now have a small teaching group of 2 female medical students in their first year of medical school. They “shadow” me in clinic or the operating room once a week. Although both are interested in what I do as a surgeon, inevitably they are most curious about my decisions and experiences with childbearing and family life. I tell them about training. I tell them that it is hard but that family life and motherhood are great and well worth it.

It was harder than what I tell them, especially as most of my training was before 80-hours and “80-hours” is often still theoretical in surgical training. All medical training is difficult, but surgical training is perhaps the hardest. Finding the balance between family life and work duties is hard for all surgeons, particularly for women surgeons in training.

The “ethos” of surgery remains principally masculine and rigid. Surgeons are supposed to be particularly strong, not to complain, and to go along with the “status quo”. While this may sound backward and negative, paradoxically in many circumstances I find the first two of these qualities admirable, and I still believe surgery to be one of the most exciting and rewarding career paths that anyone could choose.

As most parents will testify, childbearing is one of the less challenging aspects of parenting. But decisions around childbearing and the time with your newborn are important shaping experiences.

The concept or image of a pregnant surgeon, whether or not in training, is still a foreign one to quite a number of surgeons, some of whom feel free to share their opinions. The decision and process of pregnancy for women residents (I suspect in a number of medical fields) produces anxiety and (both subtle and overt) comments. I have seen female residents leave surgical residency either for another medical specialty or leave medicine entirely as a result of issues surrounding childbearing. Two of my female resident colleagues “decided” to return to work only a few weeks after giving birth because one had been placed on bedrest before giving birth and the other was told two weeks was all the residency program could bear. Female residents that take full time for maternity leave often “owe” additional months (as it might be in other training programs) but also often suffer palpable resentment from fellow residents.

This is, in part, because typically the decision for a female surgical resident to have a child directly impacts the entire training system. And surgery, worse than most other medical sub-specialties, has not found solutions to address these issues. Most surgical training programs suffer from more limited people-power. When one person is not performing optimally or is absent for any reason, the entire team feels it. The call schedule might change from every 3rd night to every 2nd (of course, illegal under current regulations). This issue is perhaps the worst in some of the sub-specialties where the entire training program is composed of a handful of individuals. Interestingly, several of my female friends who have entered small private practices after training also experience similar pressures as childbearing would impact their partners' lives significantly.

Issues of maternity leave, parental leave, and time for other parenting duties in most residency training programs have not been traditionally prioritized. Not surprisingly, fields like surgery which have been slowest to find solutions and to transform their ethos feel much-needed pressure to start making changes -- as women now make up over half of graduating medical school students nationwide.

Personally, I “timed it” well, having my daughter during my years in research during residency. My 4-year-old daughter is beautiful, well-adjusted, and a great kid. And my husband and I have found a satisfactory parenting balance that works. I am extremely lucky, but I would like for my experience to be less of the exception.

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?