Lauren Vogel | CMAJ | January 18, 2019
Parental leave policies for trainee doctors are unequal across Canada and the United States.
The toughest years of medical training sometimes overlap with the period that trainees start families. But parental leave policies for resident doctors vary and may be less generous than for other physicians at the same institutions.
A recent study of 15 top graduate medical education institutions in the United States found that only eight had policies on paid parental leave for residents, although all provided paid leave for faculty physicians. According to lead author Dr. Kirti Magudia, “at the training institutions without policies, trainees are really at the mercy of their program directors and departments for individual decisions in terms of parental leave.”
Even at schools with parental leave policies, residents received an average of 6.6 weeks of paid time off compared to the 8.6 weeks faculty physicians received. Fathers and adoptive parents received the least paid leave: an average of 3.6 weeks.
Information about these policies was difficult to obtain, according to Magudia. “It’s my belief that this information should be freely and publicly available so that medical students who are deciding where they want to go into training have this information and can take it into account.”
Training requirements can also pose barriers to taking time off. One recent study found that less than half of American specialty boards mentioned residents in parental leave policies, and most limited leave for any reason to a median of six weeks. That’s half the 12 weeks of parental leave protected by law, and a fraction of the six to nine months recommended by the president of the American Academy of Pediatrics.
Canadian trainees who become new parents can take up to 78 weeks off, but the financial support they receive varies across the country. Residents who pay into federal employment insurance may receive up to $562 a week for 15 weeks of maternity leave plus 35 weeks of parental leave. Most trainees who give birth receive an additional top-up under their provincial agreements to replace 60%–95% of their salaries minus employment insurance for 15–21 weeks. Fathers and adoptive parents may receive as little as five days’ pay in addition to employment insurance. Trainees in Newfoundland and Labrador don’t receive a top-up.
There are also hidden costs to consider, according to Dr. Christopher Lemieux, president of the Fédération des médecins résidents du Québec. “The biggest gap right now is being able to take the leave without being judged,” he said. “So residents decide not to have a baby, or they take the shortest leave possible to make sure it doesn’t impact how their program thinks of them.” The social stigma against taking time off is particularly intense in “more technical residencies like surgery,” he said.
The inflexibility of medical training is part of the problem, Lemieux said. Depending on the length of their leaves, residents will generally need to make up missed time and extend their training to complete program requirements. Residents must also factor the timing of licensing certification exams, which only happen once or twice a year. In Quebec, where residents cannot moonlight while waiting for the next exam cycle, “sometimes you’ll finish your residency and you’ll have months you can’t work.”
According to Dr. Elise Azzi, president of the Professional Association of Residents of Ontario, residency programs may become more flexible as they move toward competency-based medical education. Both the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada permit universities to waive some makeup time for “exceptional” residents on a case-by-case basis. However, “if a resident is leaving for six months or a year, the likelihood is their residency is going to be extended,” she said.
Some residents may also feel pressure to return quickly because there’s an expectation that they will return at full competence. “Even though they might be away from work for up to a year, the expectation may be on their first day back that they will function at the same level as when they went on leave,” said Azzi.
Photo credit: GeorgeRudy/iStock
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