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Invited Commentary
December 1, 2021

Parental Leave—Are We Implementing Perspectives Rather Than Policies?

Author Affiliations
  • 1Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 2Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Surg. 2022;157(2):111. doi:10.1001/jamasurg.2021.6258

In this issue of JAMA Surgery, Castillo-Angeles and colleagues1 report on the perspective and experience of surgical program directors (PDs) on paternity leave. We agree with the article’s major conclusions, which highlight a stigma surrounding child-rearing, with the potential to negatively impact children. We also agree that fathers and nonbirthing partners in surgical residency programs are unlikely to take their full leave opportunities. We postulate that there are additional facets than stigma though, 2 of which are demonstrated in the article: misunderstanding of leave policies and potential misadvising about leave policies.

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1 Comment for this article
Surgery training programs can do more to allow for Parental Leave
Steven Zeitzew, M.D. | West Los Angeles VA Healthcare Center
For prospective surgery residents who wish to start a family the options for taking paid maternity time or paternity time are limited, and often are associated with penalty or hardship.

If we increase the number of surgical residency training positions, we could increase the availability of taking parental leave without compromise to training or to patient care, and without imposing upon the remaining trainees.

If a resident takes parental leave in the current system there is not usually someone to assume their duties; it means more work for the remaining residents. The additional workload for already overworked surgical
residents is not negligible. If a resident takes time away from training and does not complete the required rotations, they will not be board eligible. A leave policy change alone is not sufficient to allow parental leave. Often resident surgeons cannot afford unpaid or underpaid leave. It is the responsibility of programs, not peers in training, to have an adequate labor force to equitably allow for their leave policies.

A program that currently educates a class of 6 surgical residents each academic year could increase that number to 8 and add a provision to allow each resident to take 3 months of paid leave during each year (if they choose) and have the same clinical workforce at any given time. Of course, each 3 months of paid leave during residency would then require 3 months of training to remain board eligible. One would not need not confine this option of paid leave to only parental leave, one could increase the range of research options, increase international service options (such as the program that has sent UCLA orthopaedic resident surgeons to Ethiopia), and allow each resident freedom to use this time as they choose to their personal advantage. Any resident who has only used this option only twice or three times during their training could have the option of completing a full additional year, including time as temporary junior faculty once board eligible, since they would then have completed surgical residency training requirements.

Resident surgeons are cost effective. One of our prior VA Chiefs of Staff told me years ago that at the VA it would cost him about $300,000 annually then in staff salaries to replace the work of one resident. The potential extra staffing from additional residents would help us address the current medical staffing shortages. Even though one would need to pay junior faculty more than a resident it would be quite cost effective. Our senior residents have usually been excellent teachers. The experience and independence they would gain as junior faculty would prove valuable to them.

There are enough potential residents. Every year there are medical school graduates who do not match into programs who would relish this opportunity.

One reason there are more male than female surgical residents, male surgical residents are more likely to be married, and more likely to have children, is that current leave policies make it difficult to be a woman interested in starting a family while completing surgical training. If those policies become more family friendly we will increase the desirability of surgical training to physicians planning marriage and family and attract more applicants.