A study of family and childbearing leave policies for academic faculty members at 12 top US medical schools found the mean duration of paid childbearing leave was 8.6 weeks in 2016-2017.1 For physicians in residency training, determinations of parental leave duration are complicated by training requirements set forth by specialty boards. Board policies aimed at ensuring adequate preparation for independent practice often include time-based residency training requirements. Residents taking more than the allowed leave may have to extend training to be eligible for board certification. In practice, decisions on parental leave for resident physicians are typically made with residency program directors, which are influenced by specialty board organization leave policies. We identified and compared leave policies for resident physicians among American Board of Medical Specialty (ABMS) member organizations (boards).
Websites of the 24 ABMS boards were accessed in July 2018 to identify leave policies related to residency training requirements and board eligibility. The following variables were collected: (1) whether the policy specifically included terms referring to parental leave (maternity, paternity, parental, childbearing), (2) maximum amount of leave time allowed for any reason, and (3) whether exemption from extending training duration was permitted if leave taken was longer than the maximum leave allowed. The median annual allowed leave time was calculated. Qualitative analysis was performed on clarifying language within leave policies to determine whether extension of training was required to remain eligible for board certification if leave taken was longer than the maximum allowed amount stated in the policy. Analyses used an iterative thematic approach, focusing on training program autonomy vs specialty board control.2 Clarifying language was collected to exemplify variability across policies.
Twenty-two of the 24 boards had leave policies but only 11 specifically mentioned parental leave as a potential reason for resident physicians taking leave (Table). No boards had a separate policy for parental leave. Twenty boards had time-based training requirements for board eligibility, allowing a median of 6 weeks of leave (range, 4-12 weeks) for any reason during any 1 year. There was considerable variation in the clarifying language regarding leave policies and maintaining board eligibility. Eight boards had explicit and clear clarifying language that allowed program directors to seek exemption of resident physicians from time-based training requirements without extending training duration.
Specialty boards allowed resident physicians requesting parental leave a median of 6 weeks without extension of training duration, less than the leave allowed faculty1 and similar to the 6 to 8 weeks of paid parental leave recommended by the American Academy of Pediatrics.3 However, most board policies lacked specific reference to parental leave and were ambiguous about whether training would need to be extended, which may create barriers to resident physicians taking parental leave.
Inadequate parental leave during residency has been associated with delayed childbearing, use of assisted reproduction technology, and difficulty maintaining breastfeeding.4,5 Lack of support for adequate parental leave during residency training may contribute to persistent sex disparities in certain specialties, dissatisfaction with work-life balance, and increased risk of physician burnout.6 Conversely, residency program directors face unique challenges in making determinations of parental leave duration for resident physicians. They must weigh potentially conflicting factors such as adhering to board and institutional policies, maintaining adequate clinical service coverage, considering precedent within the program, and ensuring that resident physicians are well trained.
Balancing the needs of resident physicians, training programs, and specialty boards may require novel approaches such as use of competency-based rather than time-based training milestones to determine eligibility for board certification. Study limitations include possible lack of identification of all relevant policies and subjective evaluation of policies.
Accepted for Publication: September 20, 2018.
Corresponding Author: McKinley Glover IV, MD, MHS, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Bulfinch 205, Boston, MA 02114 (mckinley.glover@mgh.harvard.edu).
Author Contributions: Drs Varda and Glover had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Both authors.
Acquisition, analysis, or interpretation of data: Varda.
Drafting of the manuscript: Both authors.
Critical revision of the manuscript for important intellectual content: Both authors.
Statistical analysis: Varda.
Conflict of Interest Disclosures: None reported.