Maternity and medical leave during residency: Time to standardize?☆

I was full of dread the day I went to the pediatrician for my newborn son’s three-week checkup. The following week I was to return to my clinical duties as a dermatology resident, just 4 weeks post partum. The pediatrician learned of this and strongly urged me to take more time off. She insisted that 6 weeks is the minimum time needed to establish breast-feeding, strengthen my mother-baby bond, and regain my strength. The time is important not only for me, she, and later my OB-GYN lectured, but also for my new baby. The dread came because I knew that I could not follow my doctor’s advice. A maternity leave longer than 4 weeks was not possible for me. Restrictions from the American Board of Dermatology made the physician recommended maternity leave almost impossible to achieve. Longer than 6 weeks leave during any academic year or over 14 weeks leave over 3 years is grounds for “strongly recommended” make up time after residency. Sick days counted against the 6 weeks, and so I was left with 4. The institutions that certify doctors to advise patients on health at the same time prevent those doctors from pursuing best health practices for themselves. Throughout the country, residency programs have different policies about the leave theyoffer to newparents. Indermatology alone, programs range from offering 3 months off, to only offering unused predetermined vacation days each academic year. Up and through the 1970s, residency programs had no guidelines at all on medical and parental leave. In the 1980s and 1990s the American College of Physicians and the American Medical Association took the position that residency programs should establish written policies on parental leave. At that time those policies started to appear. The Accreditation Council for Graduate Medical Education requires that graduate medical educational institutions give trainees printed statements of such policies. Yet often times those policies are both vague and restrictive. This results in inconsistencies amongprograms and, frequently, very strict policies. The policies inmedical training programs rangewidely. A recent article inAm J Surgery highlights the lack of program-specificmaternity/parenting policies in general surgery residency programs and emphasizes the need for creating such policies (Merchant et al., 2013). A 2001 survey of OBGYN program directors showed that 93% of OB-GYN programs will require make-up time if their residents exceed 20 weeks of leave over 4 years (Davis et al., 2001). The board of Pediatrics, on the other hand, published a statement in 2013 declaring 6–8 weeks should be the minimum time a resident who becomes a new parent should take off, in addition to their allotted yearly vacation time (Parental Leave for Residents and Pediatric Training Programs 2013). As a dermatology resident, the American Board of Dermatology issued the guidelines on what my medical leave would look like. In theory, the guidelines set forth allow for flexibility but the flexibility translates into a lack of consistency among residency programs, with many residents