Marie-Claude Grégoire | Victoria, BC | July 24, 2019
For medical trainees, taking time off to address personal issues puts added strain on their already-busy colleagues.
This summer, a new crop of medical school graduates started their specialty training, joining more than 10,000 resident doctors in Canada. They will soon discover the challenge of juggling life events, especially those requiring leave from work, while completing medical training.
The rigours of medical residency is no secret, and it’s not unique to Canada. In the United Kingdom, for example, some medical trainees in the National Health Service (NHS) have documented their “brutal” work conditions and the “petty tortures” they endure, including being denied leave to deal with important or traumatic personal issues. One NHS trainee, Dr. Joanna Poole, compiled a dossier of more than 400 testimonies of struggling junior doctors denied leave to attend funerals, to visit sick relatives, to get married, or for many other important events. Such treatment may explain, in part, why so many doctors are quitting the NHS.
The situation may not be as dire in Canada, but medical residents are still hesitant to request time away from work, even if their contracts allow it. “It’s tough for a resident to make the decision to take a leave,” said Sandi Carew, CEO of Maritime Resident Doctors, noting that doing so puts tremendous strain on the other residents in their programs. In smaller residency programs, this can be particularly difficult to manage, often requiring other staff to step in and take on extra work.
Last year, the threat of an unexpected en bloc departure of medical residents from Saudi Arabia was a wakeup call for program directors in Canada about how little slack there is to compensate for fluctuation in the resident workforce. “It pointed to the vulnerabilities in the system,” said Dr. Glen Bandiera, associate dean of postgraduate medical education at the University of Toronto.
In recent years, however, attitudes in medicine about taking personal leave have improved. There has been a growing focus in the profession on reducing burnout and improving physician health, both physical and mental. To reduce fatigue among medical residents, this shift has come with reductions in duty hours. Still, tensions remain between younger doctors seeking better work–life balance and some of their more senior colleagues.
“There will be a generational difference. The medical students, the residents, now are being told from the very beginning to ask for help, to take the time off that they need, to attend to their personal needs, which of course they should be told,” said Dr. Julie Maggi, director of the Postgraduate Wellness Office at the University of Toronto. “But they probably, if I had to guess, are up against a system of people from our generation where it’s not what we did.”
Medical students have more flexibility than residents when it comes to taking leave, since they can cover missed teaching material in various ways, including catching up online. Medical schools will also sometimes accommodate schedule changes, although 3-year programs have less flexibility than 4-year programs. Still, many medical students, like medical residents, are reluctant to take leave for personal reasons.
As a medical student, “you have no idea what is happening with your life,” said Stephanie Smith, president of the Canadian Federation of Medical Students. “Students are very hesitant to ask for time off … they don’t want to look like they are weak.” It is also hard to plan ahead for important personal events because medical students don’t know their schedules until the last minute, added Smith.
It’s not that staff at medical schools aren’t supportive of students facing personal issues, noted Smith. For the most part, she said, a medical program “will do everything they can to help you.” But a supportive environment doesn’t mean students will seek leave, even if they should.
“People are hesitant to ask for time off, especially when you are on a core rotation,” said Smith. “We worry about the image that we have; perception is everything … and that is going to impact how people make decisions.”
Photo credit: iStock/xavierarnau
Connect with CMAJ