Leave of Absence

[WasteofMyTime]

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I'm trying to figure out the most appropriate way to ask for a leave of absence that may not be granted in any case. And if it's not granted, how to quit fellowship as gracefully as possible.

I'm a first year fellow in an internal medicine subspecialty and I went on maternity leave until October (had my baby in July when I would have otherwise started fellowship).

I've been back for two months and the hours are punishing. I'm working 100 hours a week on average (which so far is worse than residency was). I include home call in the 100 hours per week because we get called at all times of the day and night and it seems strange to not count home call as part of my work hours. Because of my maternity leave, I have more call during my first year than everyone else (they are making me make up the home call in the 9 month period despite agreeing to let me extend my training by 3 months). We have no actual sick leave other than begging already busy co-fellows to cover us. I wasn't aware that I would have to make up all this call, or how busy call would be, or that we have a nonexistent sick leave policy until I got back from maternity leave - no one ever explained this to me and it's not written down anywhere.

I know my fellowship is going to try to blame the baby (who admittedly doesn't sleep) as the reason for my LOA but honestly this schedule sucks for everyone. I just happen to be the most vulnerable person at this time because I have a newborn and others don't. Maybe things will be better when she is older but for right now I cannot work under these conditions.

Anyway, I've made my peace with being a hospitalist if need be (hey, I always did like internal medicine) but I'm wondering how I should ask for a leave of absence. If they want to fire me, I actually don't mind that, I would just prefer that the end not be acrimonious if at all possible.

 

[IM2GI]

What fellowship? how many fellows in the program? Is it front loaded first year with lots of research/elective the second/third year?

 

[NotAProgDirector]

From a legal standpoint, you have the right to take FMLA for 12 weeks. It's possible that your leave you already took "counted" as your FMLA leave, but it's also possible that it was considered under a medical disability -- you'd know because a med disability would be paid, where FMLA is usually unpaid (except in NY, which is new). It's possible that the leave you took was a mixture. It's also possible that it wasn't a true LOA at all -- if you didn't actually start until after the baby, then you were essentially unemployed for 3 months. If you do qualify for FMLA, they legally must give it to you and must rehire you at the end.

From a personal / practical standpoint, it sounds like you need to decide what you want to do. Even if you qualify for the full 12 weeks of FMLA, will anything be different in 12 weeks? Or, perhaps put differently -- figure out how much more time off you want/need, then ask for it. If they say no, then you quit. If this is one of the competitive fellowships, then you're probably not going to get another spot (but it's not impossible)

EDIT: My statement above is not exactly correct. Paid leave (like a medical disability LOA) also counts as FMLA time. So if the OP (or anyone in the future reading this) takes a 6 week paid maternity leave, that will usually count towards the 12 weeks.

 

[Smurfette]

From a legal standpoint, you have the right to take FMLA for 12 weeks. It's possible that your leave you already took "counted" as your FMLA leave, but it's also possible that it was considered under a medical disability -- you'd know because a med disability would be paid, where FMLA is usually unpaid (except in NY, which is new). It's possible that the leave you took was a mixture. It's also possible that it wasn't a true LOA at all -- if you didn't actually start until after the baby, then you were essentially unemployed for 3 months. If you do qualify for FMLA, they legally must give it to you and must rehire you at the end.

From a personal / practical standpoint, it sounds like you need to decide what you want to do. Even if you qualify for the full 12 weeks of FMLA, will anything be different in 12 weeks? Or, perhaps put differently -- figure out how much more time off you want/need, then ask for it. If they say no, then you quit. If this is one of the competitive fellowships, then you're probably not going to get another spot (but it's not impossible)

Under federal law, I thought you have to be with an employer for a year before you are eligible for FMLA.

 

[Crayola227]

Under federal law, I thought you have to be with an employer for a year before you are eligible for FMLA.

Exactly this.

I know that some institutions have their leave policies based on FMLA criteria and may apply it to leave taken by employees in their first year, but that's a matter of individual institutional policy and not law in that case.

 

[Gastrapathy]

First year of fellowship was the toughest year of GME for me by a considerable margin. I did internship before the first iteration of the work hour rules and fellowship after. Didn't matter. F1 was way worse. Add in being a mother of an infant and we can all see how hard this is. Despite all that, I'm not sure you have realistic view of your program. There were 2 first year fellows in my program. We were q2 for most of the year (week on, week off with home call).

Home call may "count" in your 100 hours to you but not to your program or the ACGME. You also don't have more call. You have the same amount of call in a shorter period of time. You also didn't show up to start fellowship on time so the other fellows had more frequent call for the first few months (during which time they probably had IM boards, etc). I doubt there is a lot of sympathy for your call schedule. You weren't aware you'd have to make up the call but really shouldn't be surprised by that. Do you think someone else should have borne that burden?

All that is to say, I doubt that they will bend very far at this point. They may not offer you a LOA. I'd be worried that I was holding a spot for someone who was going to come back for a few weeks and quit again. But...do you want to be a subspecialist? My job is way better than GIM or hospitalist. Its more family friendly with standard 3 day a week schedules for several of my partners, better paid and way more fun (sorry guys but it is and the better pay makes it easier to work part time because you can make the same amount as a hospitalist in 1/2 to 2/3 the time). If the answer is yes, then you need to keep going.

 

[IM2GI]

First year of fellowship was the toughest year of GME for me by a considerable margin. I did internship before the first iteration of the work hour rules and fellowship after. Didn't matter. F1 was way worse. Add in being a mother of an infant and we can all see how hard this is. Despite all that, I'm not sure you have realistic view of your program. There were 2 first year fellows in my program. We were q2 for most of the year (week on, week off with home call).

Home call may "count" in your 100 hours to you but not to your program or the ACGME. You also don't have more call. You have the same amount of call in a shorter period of time. You also didn't show up to start fellowship on time so the other fellows had more frequent call for the first few months (during which time they probably had IM boards, etc). I doubt there is a lot of sympathy for your call schedule. You weren't aware you'd have to make up the call but really shouldn't be surprised by that. Do you think someone else should have borne that burden?

All that is to say, I doubt that they will bend very far at this point. They may not offer you a LOA. I'd be worried that I was holding a spot for someone who was going to come back for a few weeks and quit again. But...do you want to be a subspecialist? My job is way better than GIM or hospitalist. Its more family friendly with standard 3 day a week schedules for several of my partners, better paid and way more fun (sorry guys but it is and the better pay makes it easier to work part time because you can make the same amount as a hospitalist in 1/2 to 2/3 the time). If the answer is yes, then you need to keep going.

Yea I mean the key to this whole thing is what specialty the person is. If cards/GI/onc/CCM its probably worth thinking about figuring it out. If endo/rheum/ID/nephro probably can bail and have a similar lifestyle.

Your fellowship sounds awful btw 🙂

 

[shopsteward]

How much support are you getting at home, and can you rearrange it to make managing the baby easier? Purely in terms of finance, investing in more help now could pay dividends if it allows you to have a career as a specialist. In particular, at 6 months your baby should be capable of sleeping well, and getting some expert (paid?) help in with this now is the first thing you need to do. Regardless of whether or not you continue with the fellowship, having a baby that sleeps will make the rest of your life seem a lot better.

Turning to work issues, how sure are you that a job as a newly minted hospitalist will actually be less hours and less call than the fellowship you are currently doing? Particularly if you are geographically restricted for family reasons, your choice of hospitalist job may not be a big improvement in terms of hours worked.

I will say that I am having a little trouble with understanding how an intelligent and educated person can apparently have put so little effort into finding out how their employment terms and conditions worked before taking the three month's leave. If you had put only a little effort into asking about it you might have decided to delay the fellowship for a year.

 

[WasteofMyTime]

What fellowship? how many fellows in the program? Is it front loaded first year with lots of research/elective the second/third year?

1. Not totally comfortable answering. Less competitive than cards/gi, more competitive than rheum/nephro/ID if that’s what you’re asking.
2. 9 fellows
3. Yes frontloaded

From a legal standpoint, you have the right to take FMLA for 12 weeks....

From a personal / practical standpoint, it sounds like you need to decide what you want to do...Or, perhaps put differently -- figure out how much more time off you want/need, then ask for it. If they say no, then you quit.

1. I was entitled to and took full 12 weeks of FMLA.
2. If I take an additional leave and continue to accrue additional call to be completed in an increasingly shorter period of time, it will only be harder every time I come back. I’m not sure how much time I “need” or how I would even begin to figure that out. I need to not work 100 hours per week right now, period - the fellowship is going through some growing pains and these work hours might be better in the future with more NPs and fellows. But no guarantees.

All this to say, I need to leave and NOW; I might try to come back IF they are willing to have me. I wasn’t confused about not being able to do my subspecialty if I take this leave. Maybe I would rather be a subspecialist but some things just aren’t worth it, though.

Under federal law, I thought you have to be with an employer for a year before you are eligible for FMLA.

1. I have and did take FMLA

I doubt there is a lot of sympathy for your call schedule. You weren't aware you'd have to make up the call but really shouldn't be surprised by that. Do you think someone else should have borne that burden?

All that is to say, I doubt that they will bend very far at this point. They may not offer you a LOA. I'd be worried that I was holding a spot for someone who was going to come back for a few weeks and quit again. But...do you want to be a subspecialist?

1. Not to be rude - but I don’t give a tiny rat’s behind who was supposed to make up my call days or, for that matter, who is sympathetic to my cause. Sympathy is pretty useless right now lol. Hire an NP or PA if need be to make up the call — OR make it clear that as a program, you don’t have the resources to support FMLA so I can decide to go elsewhere or become a hospitalist. Either is fine with me. I was supposedly allowed to extend my training by 3 months, I don’t see why call is different. I’m sorry that my 8 other cofellow s had to take additional call during my absence but as far as I’m concerned they’re getting a sh11t deal, too, and instead of saying “oh gosh, the program doesn’t have enough resources to support maternity leave” the dialogue is “what the h311 is wrong with [me]?”. Don’t offer FMLA that you can’t follow through on.
2. I don’t expect them to offer me a LOA, which is exactly why I posted about how to approach this.
3. I clearly did want to be a subspecialist but everything comes at a cost. And I never minded hospitalist work...

Your fellowship sounds awful btw 🙂

1. The people/PD/attendings are incredibly nice but seem completely unable to help the work hours situation.

How much support are you getting at home, and can you rearrange it to make managing the baby easier?...

Turning to work issues, how sure are you that a job as a newly minted hospitalist will actually be less hours and less call than the fellowship you are currently doing?...

I will say that I am having a little trouble with understanding how an intelligent and educated person can apparently have put so little effort into finding out how their employment terms and conditions worked before taking the three month's leave. If you had put only a little effort into asking about it you might have decided to delay the fellowship for a year.

1. I have plenty of support at home. Literally every meal is made for me by family, my husband changes every diaper, all I do is the breastfeeding.
2. Very sure that I will have better hours. I’ve interviewed for hospitalist jobs before in this area.
3. I’m sorry for your difficulty understanding. I already took a chief year for this purpose — I’m not sure how familiar you are with the reproductive system, but you can’t always choose when your baby comes, particularly when you’ve been trying for over a year. I feel like I’m not dealing with people who are particularly educated about FMLA or leave — had I chosen a different program I would not have qualified for FMLA (look up the guidelines and come back to me if you have questions).

I think there may be some confusion as to the nature of maternity leave. I wasn’t sitting on my tush doing nothing and not taking call - I actually got very sick during childbirth and it took a long time to recover. I guarantee you I took and passed my ABIM boards on less sleep than others had.

All of this to say - my question is how to ask for a leave of absence. Not whether I should have known better, or should I be able to handle my current workload, or do I understand I can’t be a subspecialist, or did I think about hiring a nanny.

Just “how would you approach the mechanics of asking for a leave of absence.”

 

[deleted480308]

If you think home call counts as hours and that it’s unteneble, you don’t want a LOA...just quit

 

[Ironspy]

It is illegal for you to accrue work obligations during FMLA leave. This includes call. It hard for your coresidents but that's what the law says.

 

[IM2GI]

All of this to say - my question is how to ask for a leave of absence. Not whether I should have known better, or should I be able to handle my current workload, or do I understand I can’t be a subspecialist, or did I think about hiring a nanny.

Just “how would you approach the mechanics of asking for a leave of absence.”

So you're Allergy, heme/onc or pulm cc. Given your work load probably not allergy. The practice of either one of those specialties is very different than being a hospitalist. You will be working every other weekend and lots of holidays. That gets old fast for those with families. People are trying to show you that lots of us have had families during fellowship and it sucks but the long-term gain is worth the short term pain in selected specialties.

Our question to you is: Why do you want a leave of absence if it just sounds like you want to quit anyway? Sounds like you have a saint of a husband and a supportive family which is not enough help for you.

 

[shopsteward]

I notice that you omitted the part about trying to solve your baby's sleeping issue. It is probably one of the issues at the root of your current state: sleep deprivation is a form of torture and will be reduce your ability to cope with working, and your posts here sound as though you are at the end of your tether. Your first action should be to get help in getting your sleep needs met.

As you chose your program because it would give you FEMA that suggests to me that you researched, and took advantage of, the benefits the program provided without researching and accepting the disadvantages, such as hours and the lack of sick leave (although I'm not sure how a sick leave policy would have helped you anyway in your current situation, unless you are claiming the consequences of sleep deprivation as an illness). Given human gestation, you had a six months minimum before your baby was born in July to find out about your program's hours and leave policies. There will possibly also be minimum hours you need to complete in order to get your professional qualification, separate from your employer's requirements, which you should also have been aware of.

As to asking for special leave (or part time, or any other accommodation on working hours) -

1. Is there anyone in the hierarchy who is designated as your employment adviser/help person? A residency adviser? Someone in HR who is designated as helping staff? I'm guessing you have no trades union: these are the circumstances in which they are very useful to have. If there are any welfare people whose job is to help staff who are in difficulty you could try them for support, although they may have limited ability to help with formal procedural issues.

2. Absent anyone in the management hierarchy whose job is to be on your side, you need to read your contract of employment, or appointment letter etc. Read the terms and conditions of your employment in the staff handbook and the other employment policies relating to your place of work. HR will have these. If there is anything there it will set out both the nature of any change which can be considered and the procedure for requesting it, probably through HR. Remember though that HR are not on your side, they are on the side of your employer.

3. If there are no provisions in your employment terms and conditions about procedures for reducing hours/leave of absence then you are not entering a negotiation with management through the formal structures, you are putting in a personal request. You need to find the person in the hierarchy who is most likely to be able to influence the decision and most likely to want to influence it on your behalf. You then need to put to them your request: a clearly defined request that will seem reasonable to them, with reasons why they should grant it: these reasons should include benefits to you and to your employer.

Best of luck.

 

[NotAProgDirector]

Under federal law, I thought you have to be with an employer for a year before you are eligible for FMLA.

I know that some institutions have their leave policies based on FMLA criteria and may apply it to leave taken by employees in their first year, but that's a matter of individual institutional policy and not law in that case.

Yep. My bad. My institution give everyone FMLA protections on day 1, I forget this isn't universal. In any case, sounds like the OP's program does the same.

It is illegal for you to accrue work obligations during FMLA leave. This includes call. It hard for your coresidents but that's what the law says.

This is true, but the program may point out that overnight call isn't just "work", but is part of training. Hence, they can require that she make it up.

That said, the better way to do this (IMHO) is to give the OP the same amount of call, and spread it over the full 12 months (including the 3 month extension into next year). But that does cause some imbalance in the schedule -- for the first three months of the year, the fellows would end up with some extra calls to cover her absence, then in the next 9 months it would be even, and in the last 3 months (which would be next year) the call schedule would be a bit lighter, as they would have an extra 1st year fellow. But it all depends upon how you define "fair".

I need to not work 100 hours per week right now, period - the fellowship is going through some growing pains and these work hours might be better in the future with more NPs and fellows. But no guarantees.

Is everyone working this hard? Needless to say, the limit is 80 hours per week (averaged over 4 weeks). Note that home call "counts" but only for the time you're on the phone or actually working. Unfortunately if you get woken up every hour for 5 minutes over an 8 hour night, although your sleep may have been horrible, you only get to log 40 minutes.

Hire an NP or PA if need be to make up the call — OR make it clear that as a program, you don’t have the resources to support FMLA so I can decide to go elsewhere or become a hospitalist.

Although I agree with you that your situation seems untenable, hiring anyone for 3 months to cover something like this is basically impossible. Most NP/PA's don't have the skill set to do it and need a bunch of training, and if they do there are few who are willing to do it for a short period of time. Ultimately the solution ends up being the one they've picked (redistribute the call so it remains "fair"), or having your co-fellows cover the call you missed, or moonlight it (for which there usually isn't any money in the budget), or make faculty cover. Not having resources to support FMLA = not legal (although as pointed out, since you're in your 1st year of employment, they are not legally required to give you any FMLA at all).

So, back to advice:

If you're going to ask for an LOA, you have to have a timeframe in mind. If a resident came to me and said: "I need an open ended LOA until I feel ready to return to work", I'd have quite a bit of trouble agreeing to it. I need to make plans, and the options are totally different if you're going to take an LOA for 2 weeks vs 6 months. So although you might not know exactly how long you want, you at least need to have some approximation.

From a practical standpoint, they might give you an additional 3 months, probably no more than that. If you want more than that, they are better off letting you go and finding someone else. They might not agree to anything at all. You should probably talk to them about call, and explain that you want to spread your call throughout the 12 months of F1 year.

Which raises the question of whether the problem is that you're still not at 100% from having your baby and 3 more months will help fix this, or whether you can't stand working 80 hours a week for 12 months while you have a young baby at home. If the latter, an LOA isn't going to really solve your problem.

Another way to address this would be to try to be put out on a medical LOA. If you could convince a physician that you have postpartum depression (or another medical illness) that prevents you from working, then they would have to put you on leave. You'd have to show a marked impairment to make this an option.

Working with my female residents returning from a pregnancy LOA, their experiences have been varied. Some jump back into work with a vengeance as if nothing happened. Some have great difficulty coming back to work -- separation anxiety, or extreme emotional distress from not being with their baby, and a feeling of abandoning them. In my program, all women in the latter group end up resolving their issues over 2-3 months, but describe this period in their lives as very unpleasant.

TL;DR version: Ask yourself whether the problem is the extra call, or the workload in general. If the former, perhaps you can ask for it to be changed. If the latter, will another LOA really fix anything. If they really like you, you could ask to quit and restart next year, and they can try to find someone to take your current spot. But as mentioned above, I have had women in my program have difficulty re-integrating postpartum and seriously consider quitting, then 6 months later report that in retrospect they feel those thoughts were somewhat irrational and perhaps bourne of hormonal swings of pregnancy (their words, not mine).

 

[AdmiralChz]

Wow, this is an interesting post with a pretty angry OP. Full disclaimer: I'm a new parent myself, I took two weeks of vacation leave during my fellowship as the male and my wife took (is still taking) unpaid 12 weeks (like 2 weeks was vacation so paid) as she didn't work at her job for a year. We are thankful they let her do it at all!

The ACGME is very clear here - your home call responsibilities do not count towards duty hours. Did you not know it would be like this going in? Anyways, There is a lot to address here:

1. Not to be rude - but I don’t give a tiny rat’s behind who was supposed to make up my call days or, for that matter, who is sympathetic to my cause. Sympathy is pretty useless right now lol.

Pretty callous and short-sighted comment here. You were out for 12 weeks (almost 3 full months), and your co-fellows had to work more to cover you. I know you have a new baby at home, but everyone else has situations at home too and it isn't fair to be that selfish.

OR make it clear that as a program, you don’t have the resources to support FMLA so I can decide to go elsewhere or become a hospitalist. Either is fine with me. I was supposedly allowed to extend my training by 3 months, I don’t see why call is different.

1) Your program obviously supports FMLA, as they gave you the maximum time off allowed and didn't suggest you just delay start of your fellowship. So that's not a great statement.
2) You mentioned your program is front-loaded with calls (sounds like Heme-Onc), so the time at the end won't be as heavy. They paid you vacation and split your calls amongst your co-fellows, of course you'd have more to make up latter that's how a call system works. I don't get the sense that you view your co-fellows as part of a central team, instead it's like you are on your own. That's how medicine and the working world is - you cover for your partners when they are sick and vice-versa!

I’m sorry that my 8 other cofellow s had to take additional call during my absence but as far as I’m concerned they’re getting a sh11t deal, too, and instead of saying “oh gosh, the program doesn’t have enough resources to support maternity leave”

You clearly aren't that sorry about them having to work more, as you aren't willing to pay it back.

Just “how would you approach the mechanics of asking for a leave of absence.”

There really isn't much for mechanics, as your program is unlikely to grant it. Think of it from their point of view - they'd again have to split your call amongst the other co-fellows (which is more now that you are in make-up mode, which is temporary). How long would you need? This is unlikely to get better for you very quickly.

It sounds like you already know the answer here - quitting fellowship is probably the best and most fair option going forward for yourself, your family and your co-fellows. And you don't have to be a hospitalist, you can do what Internal Medicine was designed for - being an internist.

Please try to think of your co-fellows and what you are asking of them going forward, I know it is tempting to be selfish on minimal sleep with a crying baby at home... but you aren't exactly being objective. I'd try to talk with your program director and express your concerns if you want to stay on. But banging your fist demanding NP/PAs be added so you don't have to work as much won't get you very far.

 

[IM2GI]

.

Yea Im not sure why the OP is so angry and hostile. Likely a mix of not sleeping, new parenthood, and maybe some postpartum issues. There is an irrational hatred and one-sided view of the situation from only her perspective. To think that a program is going to hire a midlevel to cover you while you are out is insanity. There is no respect for her co-fellows, some of whom Im sure have children of their own.

The bottom line OP is that if you want to be an oncologist/whatever there is a short term sacrifice to be made. Whether that is your husband staying up with the kid while you sleep in another room, hiring someone to do it, having grandparents help with night time issues, etc. People have figured this out for decades with worse duty hour situations. At least a third of medicine subspecialty fellows I know have had or already had small children during fellowship. There is never a perfect time to have kids during medical training.

When you realize 2-3 years from now that you hate being an internist/hospitalist because you really wanted to be an oncologist you are going to regret the short term play here. Even if you have to take on more debt to pay someone it might be the right play long term.

I wish you and your family good luck. I don't think a leave of absence does anything for you in this situation.

 

[WasteofMyTime]

If you think home call counts as hours and that it’s unteneble, you don’t want a LOA...just quit

Home call does count as hours in my book. Yeah I'm a little concerned about promising to come back if things aren't looking too hot if I do come back.

It is illegal for you to accrue work obligations during FMLA leave. This includes call. It hard for your coresidents but that's what the law says.

Yeah, I do feel terrible for them but I did think I had some legal protections. I looked at my contract and it DOES say they can make me make up whatever "educational obligations" they want to within that year, but not work hours. Getting called in the middle of the night for med refills is really playing fast and loose with the definition of "education."

Our question to you is: Why do you want a leave of absence if it just sounds like you want to quit anyway? Sounds like you have a saint of a husband and a supportive family which is not enough help for you.

I still enjoy the subspecialty. I do have a "saint of a husband" by today's standards. Since he does none of the feeding, he makes up for it with all of the diapering. Sometimes we also call it parenting! 🙂

As to asking for special leave (or part time, or any other accommodation on working hours) -

1. Is there anyone in the hierarchy who is designated as your employment adviser/help person? A residency adviser? Someone in HR who is designated as helping staff? I'm guessing you have no trades union: these are the circumstances in which they are very useful to have. If there are any welfare people whose job is to help staff who are in difficulty you could try them for support, although they may have limited ability to help with formal procedural issues.

2. Absent anyone in the management hierarchy whose job is to be on your side, you need to read your contract of employment, or appointment letter etc. Read the terms and conditions of your employment in the staff handbook and the other employment policies relating to your place of work. HR will have these. If there is anything there it will set out both the nature of any change which can be considered and the procedure for requesting it, probably through HR. Remember though that HR are not on your side, they are on the side of your employer.

3. If there are no provisions in your employment terms and conditions about procedures for reducing hours/leave of absence then you are not entering a negotiation with management through the formal structures, you are putting in a personal request. You need to find the person in the hierarchy who is most likely to be able to influence the decision and most likely to want to influence it on your behalf. You then need to put to them your request: a clearly defined request that will seem reasonable to them, with reasons why they should grant it: these reasons should include benefits to you and to your employer.

Best of luck.

Not sure why FEMA is involved in this(??) I did research the program to the best of my ability but since the only two other women in my program who had children either quit or shortened their training, I didn't have a lot to go on. My contract states there is sick leave but is vague about the details (it only says "must be approved by the program director"). I am working on sleep with my baby but I get the feeling this is the wrong forum for advice in that matter.

1. No other mentor
2. My contract specifies that a leave of absence exists but not who qualifies, for what reasons, or how to get it.
3. I think this is probably considered a personal request, and yes a quick google search got me that far. I'm not sure if there are any benefits to the employer. I'm not totally sure if there are benefits to me if I'm just going to rack up more call days I have to make up even further beyond what I'm already making up. I need a LOA that doesn't make me accrue more call days that I have to make up in an increasingly shorter period of time. I guess the benefit to my employer is that they won't have to give already tired other cofellows even MORE additional call as compared to me leaving outright??

But it all depends upon how you define "fair".



Is everyone working this hard?


Although I agree with you that your situation seems untenable, hiring anyone for 3 months to cover something like this is basically impossible. Most NP/PA's don't have the skill set to do it and need a bunch of training, and if they do there are few who are willing to do it for a short period of time.

So, back to advice:

If you're going to ask for an LOA, you have to have a timeframe in mind. If a resident came to me and said: "I need an open ended LOA until I feel ready to return to work", I'd have quite a bit of trouble agreeing to it. I need to make plans, and the options are totally different if you're going to take an LOA for 2 weeks vs 6 months. So although you might not know exactly how long you want, you at least need to have some approximation.

From a practical standpoint, they might give you an additional 3 months, probably no more than that. If you want more than that, they are better off letting you go and finding someone else. They might not agree to anything at all. You should probably talk to them about call, and explain that you want to spread your call throughout the 12 months of F1 year.

Which raises the question of whether the problem is that you're still not at 100% from having your baby and 3 more months will help fix this, or whether you can't stand working 80 hours a week for 12 months while you have a young baby at home. If the latter, an LOA isn't going to really solve your problem.

Another way to address this would be to try to be put out on a medical LOA. If you could convince a physician that you have postpartum depression (or another medical illness) that prevents you from working, then they would have to put you on leave. You'd have to show a marked impairment to make this an option.

Working with my female residents returning from a pregnancy LOA, their experiences have been varied. Some jump back into work with a vengeance as if nothing happened. Some have great difficulty coming back to work -- separation anxiety, or extreme emotional distress from not being with their baby, and a feeling of abandoning them. In my program, all women in the latter group end up resolving their issues over 2-3 months, but describe this period in their lives as very unpleasant.

TL;DR version: Ask yourself whether the problem is the extra call, or the workload in general. If the former, perhaps you can ask for it to be changed. If the latter, will another LOA really fix anything. If they really like you, you could ask to quit and restart next year, and they can try to find someone to take your current spot. But as mentioned above, I have had women in my program have difficulty re-integrating postpartum and seriously consider quitting, then 6 months later report that in retrospect they feel those thoughts were somewhat irrational and perhaps bourne of hormonal swings of pregnancy (their words, not mine).

Regarding "it all depends on how you define fair" -- truer words were never spoken and I'm not insensible to this at all. I really appreciate your practical advice; maybe a bit more time would make a difference and I guess it's up to me to decide how I frame this. I'm not incapable of seeing the other side of the coin, but the thing is the program promised me FMLA (and I stayed at the institution I trained at, so honestly, they didn't have much choice in FMLA - I had the same employer). I don't really care one way or the other if they honor FMLA in general, but if they SAY they're going to honor FMLA, then they should just do it. If you're going to honor FMLA with huge asterisks (**subject to making up overnight, weekend and home call) then just be straightforward about it BEFORE I even leave, not right when I get back.

Yes everyone else is working this hard, which is why they are trying to get funding for more fellows. The co-fellow who sits next to me talks about suicide an awful lot, in that "joking, god i hope she's joking" kind of way. My other two co-fellows from my year have thought hard about quitting and I actually wouldn't be shocked if one of them did (he has an hour commute and a baby on the way). We've already lost two women fellows who shortened their training or left in the setting of having kids, so we are short on fellows (blame the babies if you want, I mean it doesn't hugely make a difference WHY they left, just that they did leave). I am really hesitant to share more, but I actually got in a car accident 2 weeks ago where I could have been hurt or killed, and I have no doubt that it was due to sleep-deprivation. Circumstances aren't great for anyone here.

I'm very sure our home call could theoretically be covered by PAs or NPs. How hard is it to say "sure I'll refill your neurontin" and "we will have someone call you with a followup appointment in the morning"? That's really the majority of our calls. But again, the only point I was trying to make earlier is that asking a woman who is 3-9 months pregnant to figure out staffing in a fellowship she only just joined right as she gave birth is asking for a tad much. They REALLY don't pay me enough to do that, haha.

It probably would help to space out my call and potentially re-evaluate after a 2-month leave. I will try to be specific in the request. I thought about getting labeled postpartum depression but it just seems really wrong to have to label myself as handicapped when I'm basically just trapped in a corner with an unmanageable workload - I'm very sure I could get the diagnosis if I needed to, though. I figure I need to ask for the leave soon so that I can give them as much time to plan for my absence as possible (I feel like I can work out the rest of this month and then I have two weeks of vacation in January). Other than that, I'm not sure what else I can do.

Wow, this is an interesting post with a pretty angry OP.

I'm glad my post could interest you 🙂 Ah yes, the "angry woman" trope "banging your fists" "callous and shortsighted" and the "we have it worse" trope. I'm not angry in the slightest, but thank you for mansplaining my feelings to me - I asked about how to take a leave of absence, remember?

I think it's a little ridiculous to ask me to figure out staffing for my own maternity leave unless you basically don't believe in maternity leave, but that's all I was trying to say by not caring who covers me. I mean it's not my job to figure out how to staff a fellowship appropriately, because they don't pay me to do that. Given that I agreed to extend my training by 3 months, it seems only reasonable to believe that ALL aspects of the training would be extended, not just picking and choosing some of it. Not mad at all, promise ;-)

I'm not sure I had much constructive to respond to this post. I'm glad you feel like you are able to leave your wife with the baby after 2 weeks. It sounds like she is probably having a tough time of it. No -- let me correct myself -- I am very SURE she is having a tough time of it. My sympathies to her. Regrettably, taking the shortest possible paternity leave doesn't make you a hero in my eyes, hopefully it does in hers.

 

[WasteofMyTime]

Yea Im not sure why the OP is so angry and hostile. Likely a mix of not sleeping, new parenthood, and maybe some postpartum issues. There is an irrational hatred and one-sided view of the situation from only her perspective.

Thank you for explaining my feelings to me 🙂 LOL. Sigh.

 

[WasteofMyTime]

To the mods: Please don't shut down this thread because there is some obvious disagreement in whether or not I "deserve" a LOA or "should have known better" or am "angry"; I still would appreciate advice from anyone who has actually taken a LOA in terms of the mechanics of what they did, how long they took, and what it was like when they got back.

 

[Gastrapathy]

If your program really has a track record of multiple people quitting over a few years, that is very abnormal. You won't be violating the match to quit. If you're an AMG, you'll have a decent chance to go back later somewhere else since it's not one of the most competitive fellowships.

also, your husband could do one late night bottle of pumped milk (trust me). If there's any chance you'll be back in a couple months, you've got to get some sleep.

 

[AdmiralChz]

I'm not sure I had much constructive to respond to this post. I'm glad you feel like you are able to leave your wife with the baby after 2 weeks. It sounds like she is probably having a tough time of it. No -- let me correct myself -- I am very SURE she is having a tough time of it. My sympathies to her. Regrettably, taking the shortest possible paternity leave doesn't make you a hero in my eyes, hopefully it does in hers.

Woah! Hot dang! I could have taken longer, but I have no interest in prolonging fellowship and, as I’m not eligible for FMLA (I’m a male, can I even go there?), I need to keep an income to support the family. But please, tell me how my wife really feels about me haha.

I’m sorry you haven’t gotten the support you were looking for here. Many have been through worse, unfortunately. I work with several older male CT surgeons - they tell crazy stories about how they were real “house officers” living in the hospital when the covered the ICU for 6 weeks or so. One had a friend cover him for 3 hours so he could see his newborn daughter. Didn’t see her again for 4 weeks!

 

[IM2GI]

Woah! Hot dang! I could have taken longer, but I have no interest in prolonging fellowship and, as I’m not eligible for FMLA (I’m a male, can I even go there?), I need to keep an income to support the family. But please, tell me how my wife really feels about me haha.

I’m sorry you haven’t gotten the support you were looking for here. Many have been through worse, unfortunately. I work with several older male CT surgeons - they tell crazy stories about how they were real “house officers” living in the hospital when the covered the ICU for 6 weeks or so. One had a friend cover him for 3 hours so he could see his newborn daughter. Didn’t see her again for 4 weeks!

Don't bother. This person is not looking for solutions but wants to be a victim. This is despite staying at her home program and certainly knowing what it was like for the current batch of fellows. Attitude and language are clear. Stop "mansplaining" things to her.

 

[WasteofMyTime]

If your program really has a track record of multiple people quitting over a few years, that is very abnormal. You won't be violating the match to quit. If you're an AMG, you'll have a decent chance to go back later somewhere else since it's not one of the most competitive fellowships.

also, your husband could do one late night bottle of pumped milk (trust me). If there's any chance you'll be back in a couple months, you've got to get some sleep.

They do have this track record. But I think I am literally violating the match though, since it's in my match agreement? I actually think it's very unlikely that I'd match elsewhere despite getting great interviews first time around (interviewed at 13+ places). First of all, I don't have the energy to re-interview, secondly I think my field is competitive enough despite not being cards or GI. And I'm not sure I'd want to chance something like this happening again.

Yeah, I was thinking of the late night pumped milk but it's technically difficult for a few reasons, not least of which that my milk supply is suffering with the constant nights on call and being away from my baby 26 days out of 30 (and spending the other 4 writing notes). The more she direct feeds, the better my milk supply. I really just need to get her to take solids consistently and we are so, so, so close...

Woah! Hot dang! I could have taken longer, but I have no interest in prolonging fellowship and, as I’m not eligible for FMLA (I’m a male, can I even go there?), I need to keep an income to support the family. But please, tell me how my wife really feels about me haha.

I’m sorry you haven’t gotten the support you were looking for here. Many have been through worse, unfortunately. I work with several older male CT surgeons - they tell crazy stories about how they were real “house officers” living in the hospital when the covered the ICU for 6 weeks or so. One had a friend cover him for 3 hours so he could see his newborn daughter. Didn’t see her again for 4 weeks!

Oh you don't "want to" prolong fellowship? You must think I wanted to prolong fellowship for funsies. Sure. OK. If you have a newborn and are doing any part of the parenting involved, surely you must realize how much pure survival is involved and of course I took as much leave as I could. I had a number of completely new medical issues, consequences of childbirth, that kept me in the hospital for over a week. I hardly had an option.

Shockingly, my income also matters to my family. No, I was not paid by my fellowship when I took leave, but as it turns out, I lived in a tiny box, saved money, got a merit scholarship for my MCAT score, and so I don't have any loans and can afford to do whatever the heck I please with a leave of any sort.

But I'm not judging you for your choices or asking you "why do you expect sympathy for your financial situation?" I'm explaining why I need what I need for my situation. I don't need "support", I'm not an emotionally-stunted child - I need practical solutions and others' experiences as to how to apply for a leave of absence. I got some good advice from aPD and I'm curious if others have done this or if I'm the only woman in existence to have a baby in fellowship and struggle with the hours and constant demands, or if others have taken a LOA for any other reason.

I'm curious how those CT surgeons recovered from their c-sections, their pre-ecclampsia, or managed breastfeeding while they were in the ICU all day and night. Oh wait, they didn't. (Sorry, their experience is just not comparable).

I agree, speculating about how your wife feels about you really was a pretty low blow and definitely beneath me, despite more than adequate provocation.

Don't bother. This person is not looking for solutions but wants to be a victim. This is despite staying at her home program and certainly knowing what it was like for the current batch of fellows. Attitude and language are clear. Stop "mansplaining" things to her.

I figured the term mansplaining would go over well with this crowd, but regrettably, that is exactly what AdmiralChz did. I just call'em like I see'em. I'm not a victim at all - I'm empowered to do whatever I want including leave my fellowship. I just want to try to take a LOA first and if I must make a full break, do it as cleanly as possible.

 

[Ladholyman]

Cleanest way is probably to just quit outright. You don't sound very happy at all at your program.

 

[captaincrunch]

This is a hard situation. It sounds like the OP's program is pretty intense, which would make it hard for mothers (or fathers, for that matter) to succeed with young kids at home. I realize that training is always difficult with kids, but some programs are unnecessarily malignant and could potentially lose good fellows because of this. If the OP was sick with complications of pregnancy, programs should make an effort to be accommodating. If the other fellows are really overworked, would it really kill the attendings to cover an occasional call or clinic without a fellow? When I help colleagues, I don't expect to paid back. I think of more as a "pay it forward" kind of thing. It looks like they did allow FMLA leave, but not much else. I've seen interns pumping at work while rounding, needing two shifts of nannies to make work possible, etc. I don't think this level of intensity is needed to make good doctors.

To the OP, if you otherwise have a good relationship with your PD, can you approach him/her asking for advice? You could ask for a sit-down meeting and explain your struggles with your program and your inability to continue as things are. You could say that you love the field/hospital, but are burning out and could be happy as a general internist too. You could explain that you are willing to leave the fellowship if that ends up being the best for the program and for yourself, but that you respect his/her opinion and would like advice on what to do. This would put the ball in their court. I would stay away form mentioning your other fellows and what is fair/unfair. If they're willing to make some allowances for you, they would make it clear. If you decide to quit, just make sure that you give adequate notice and that you provide high-level clinical services until you leave. You don't owe them anything more beyond this. I've known fellows who quit and then worked in the exact same hospital as hospitalists (without any ill feelings).

 

[NotAProgDirector]

Home call does count as hours in my book.

Since there's been some debate about this on the thread, the rules from the ACGME are as follows:

Time spent on patient care activities by residents on at-home call must count toward the 80-hour maximum weekly limit. The frequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four weeks.

At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.

Residents are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. These hours of inpatient patient care must be included in the 80-hour maximum weekly limit.

So, the entire shift of home call doesn't count, but technically any time spent on the phone, or using the EMR, etc, all count towards the 80 hour limit. Certainly any time that you actually have to go in counts. The middle point, that is shouldn't be so taxing to preclude rest, is pretty soft and hard to define.

I looked at my contract and it DOES say they can make me make up whatever "educational obligations" they want to within that year, but not work hours. Getting called in the middle of the night for med refills is really playing fast and loose with the definition of "education." I'm very sure our home call could theoretically be covered by PAs or NPs. How hard is it to say "sure I'll refill your neurontin" and "we will have someone call you with a followup appointment in the morning"? That's really the majority of our calls.

No easy answers here. Sure, they could hire someone to cover these calls at night. And some of the calls are probably educational. But someone has to pay for them. Would you be willing to work harder during the day to generate some additional revenue to pay for them? Not saying that only the fellows should be responsible for this, but likely would be a shared responsibility for the practice (This is a rhetorical question, no answer is needed).

I need a LOA that doesn't make me accrue more call days that I have to make up in an increasingly shorter period of time. I guess the benefit to my employer is that they won't have to give already tired other cofellows even MORE additional call as compared to me leaving outright??

From their viewpoint, this may not be a benefit at all. They might think that having you leave and then hiring a new fellow would be the best outcome.

If you're going to honor FMLA with huge asterisks (**subject to making up overnight, weekend and home call) then just be straightforward about it BEFORE I even leave, not right when I get back.

I agree it's best to be 100% clear about this. Its what we do for residents in the program who take an LOA for any reason.

... as I’m not eligible for FMLA (I’m a male, can I even go there?)

Yes, men can take FMLA just as women can, up to 12 weeks in the first year after birth / adoption. Women can sometimes claim medical disability after giving birth, which usually is a paid benefit. NY just passed a paid FMLA law, so it will be interesting to see how this affects things. Apparently several states already have a paid family leave, and I haven't heard of any disasters yet.

But I think I am literally violating the match though, since it's in my match agreement?

No. Technically you need to stay in your fellowship for 45 days, and because it's not spelled out, your time on leave probably counts. Plus, even if your program were to try to "force" you to stay (which they won't), you'd be able to get a match waiver. So the only issue is whether another fellowship will give you a chance, after you've quit one.

 

[IM2GI]

You don't sound very happy at all at your program.

fixed that for you

 

[rokshana]

1. Not totally comfortable answering. Less competitive than cards/gi, more competitive than rheum/nephro/ID if that’s what you’re asking.
2. 9 fellows
3. Yes frontloaded


1. I was entitled to and took full 12 weeks of FMLA.
2. If I take an additional leave and continue to accrue additional call to be completed in an increasingly shorter period of time, it will only be harder every time I come back. I’m not sure how much time I “need” or how I would even begin to figure that out. I need to not work 100 hours per week right now, period - the fellowship is going through some growing pains and these work hours might be better in the future with more NPs and fellows. But no guarantees.

All this to say, I need to leave and NOW; I might try to come back IF they are willing to have me. I wasn’t confused about not being able to do my subspecialty if I take this leave. Maybe I would rather be a subspecialist but some things just aren’t worth it, though.


1. I have and did take FMLA


1. Not to be rude - but I don’t give a tiny rat’s behind who was supposed to make up my call days or, for that matter, who is sympathetic to my cause. Sympathy is pretty useless right now lol. Hire an NP or PA if need be to make up the call — OR make it clear that as a program, you don’t have the resources to support FMLA so I can decide to go elsewhere or become a hospitalist. Either is fine with me. I was supposedly allowed to extend my training by 3 months, I don’t see why call is different. I’m sorry that my 8 other cofellow s had to take additional call during my absence but as far as I’m concerned they’re getting a sh11t deal, too, and instead of saying “oh gosh, the program doesn’t have enough resources to support maternity leave” the dialogue is “what the h311 is wrong with [me]?”. Don’t offer FMLA that you can’t follow through on.
2. I don’t expect them to offer me a LOA, which is exactly why I posted about how to approach this.
3. I clearly did want to be a subspecialist but everything comes at a cost. And I never minded hospitalist work...


1. The people/PD/attendings are incredibly nice but seem completely unable to help the work hours situation.


1. I have plenty of support at home. Literally every meal is made for me by family, my husband changes every diaper, all I do is the breastfeeding.
2. Very sure that I will have better hours. I’ve interviewed for hospitalist jobs before in this area.
3. I’m sorry for your difficulty understanding. I already took a chief year for this purpose — I’m not sure how familiar you are with the reproductive system, but you can’t always choose when your baby comes, particularly when you’ve been trying for over a year. I feel like I’m not dealing with people who are particularly educated about FMLA or leave — had I chosen a different program I would not have qualified for FMLA (look up the guidelines and come back to me if you have questions).

I think there may be some confusion as to the nature of maternity leave. I wasn’t sitting on my tush doing nothing and not taking call - I actually got very sick during childbirth and it took a long time to recover. I guarantee you I took and passed my ABIM boards on less sleep than others had.

All of this to say - my question is how to ask for a leave of absence. Not whether I should have known better, or should I be able to handle my current workload, or do I understand I can’t be a subspecialist, or did I think about hiring a nanny.

Just “how would you approach the mechanics of asking for a leave of absence.”

So sorry that you think everyone else should have to take up the slack for you and make it easier for you to have your baby... just quit already and go be a Hospitalist and even better the sahm that it sounds like you want to be...sounds like your program has tried to be accommodating to you and yet you want more.
You need to decide what is important to you and base you decision on that...but don't expect places to take you back with welcoming arms after you bail on them.

 

[PTPoeny]

I don't have any specific suggestions for you other than commiserating that the first year of fellowship with a newborn really sucks. I felt like I wasn't a good mom or doctor and I felt like I wasn't learning anything because I was so tired. Sleep training saved me. My son still woke up twice a night to feed but went right to sleep with no fuss afterwards changing it from me being up many hours a night to less than 1 hour. My program did things very differently but we don't have enough fellows to have a fellow on every night anyways so my calls in no way affect my co-fellows calls.

Will you have no calls at all during the 3 months at the end of your fellowship past when you would have finished if you started on time?

 

[Crayola227]

I see what the OP likely means, hours spent on home-call do not count towards the ACGME limit rule, BUT

from a personal perspective, if you are consistently woken up several times during home call, it will sure as **** feel like you've worked 100 or however many hours

it's ridiculous to assert because the hours don't "count" to ACGME that they don't "count" to the person working them

 

[Gastrapathy]

It matters because it provides the context of what the program HAS to do and it's hard to imagine her program doing more.

 

[Apollyon]

Ah yes, the "angry woman" trope "banging your fists" "callous and shortsighted" and the "we have it worse" trope. I'm not angry in the slightest, but thank you for mansplaining my feelings to me - I asked about how to take a leave of absence, remember?

I figured the term mansplaining would go over well with this crowd, but regrettably, that is exactly what AdmiralChz did.

It's a bit more than ironic that the username you created was "waste of my time", and, coincidentally, had a traffic accident recently. This is because, on one hand, the point you raise, and your resistance to see anything but your own opinion, leads to this thread being a waste of my time, but, like a car accident, it's strangely attractive, to see how much further you will go. To paint everyone with the same brush (as in "this crowd"), as you have done, shows that you think everyone else is of the same ilk. And, when you think everyone else has the problem, YOU have the problem.

 

[WasteofMyTime]

So, the entire shift of home call doesn't count, but technically any time spent on the phone, or using the EMR, etc, all count towards the 80 hour limit. Certainly any time that you actually have to go in counts. The middle point, that is shouldn't be so taxing to preclude rest, is pretty soft and hard to define.

No easy answers here. Sure, they could hire someone to cover these calls at night. And some of the calls are probably educational. But someone has to pay for them. Would you be willing to work harder during the day to generate some additional revenue to pay for them? Not saying that only the fellows should be responsible for this, but likely would be a shared responsibility for the practice (This is a rhetorical question, no answer is needed).

Yeah, I'm not sure how you define "precluding rest" but I have never gotten fewer than 6 calls on any given night and it does a pretty darn good job of precluding my rest. I would be willing to work harder during the day if there were additional day hours for me to work.

Incidentally, I talked to my PD today - he seemed pretty sympathetic and even apologized for my horrible schedule and said that the fellowship hadn't approached my schedule the way they should have -- which was really unnecessarily nice of him. I guess he really wants to know what I specifically need to either keep going to transition to a different job.

Will you have no calls at all during the 3 months at the end of your fellowship past when you would have finished if you started on time?

Thanks for the commiseration - some day my baby will sleep, haha. We're working on it. Yeah when my kid is 3 years old, no more calls. The problem is I need that time now, and not 3 years from now. We'll see, I think my PD might work with me, after talking with him.

I see what the OP likely means, hours spent on home-call do not count towards the ACGME limit rule, BUT

from a personal perspective, if you are consistently woken up several times during home call, it will sure as **** feel like you've worked 100 or however many hours

it's ridiculous to assert because the hours don't "count" to ACGME that they don't "count" to the person working them

Yeah, I work on average 14 hours a day, sometimes more. I also work 4 weekend nights per month for which I do an additional 10 hours overnight; as you say, it is true I am not literally awake all 10 hours even thought it feels awful.

But then again I'm also not literally working when I go to the bathroom during the day or take care of any other personal needs like washing my hands, and no one in their right mind is like "BUT WERE YOU WORKING WHEN YOU WENT TO THE BATHROOM"?

-----

Sorry I didn't answer everyone else but it's time to stop answering the crazypeople posts. If I didn't answer you directly, I'm SURE you have more BS to offer up. Bring it on.

 

[WasteofMyTime]

It's a bit more than ironic that the username you created was "waste of my time", and, coincidentally, had a traffic accident recently. This is because, on one hand, the point you raise, and your resistance to see anything but your own opinion, leads to this thread being a waste of my time, but, like a car accident, it's strangely attractive, to see how much further you will go. To paint everyone with the same brush (as in "this crowd"), as you have done, shows that you think everyone else is of the same ilk. And, when you think everyone else has the problem, YOU have the problem.

Ooh sorry I couldn't resist responding - did the "mansplaining" part of my post not go to your liking? ;-)

My sense is that you may have heard that term before, hahaha.

 

[Keona]

The best thing is going to be to explain to your program director or advisor that you cannot keep going at this pace. It sounds like lack of sleep is the big thing for you right now? I have multiple children and am in residency and I remember how exhausting it was when they weren’t sleeping or they were sick as an intern and I was working crazy hours. I cannot imagine having to also be taking home call at the same time. Can you take a night and sleep for several hours and re-evaluate the situation? I would take one night a week every week or so where my husband would give baby a bottle and I’d sleep until I woke up. (I pumped in the car as well to increase amount of milk available and I pumped right before I fell asleep so he would have enough milk). I can not describe how much more human I felt after one of these breaks.

I have no idea what your home call system is or how frequently. Also not sure if there is a triage phone person in place (as in to say no you can’t get a med refill of Tylenol at 2 am) but that might be a concrete suggestion to suggest that would help all of you all. (We do call where there is 0 screening process to what calls come through, it’s my fantasy each call night to have it go through a screening center of some sort).

 

[Apollyon]

Ooh sorry I couldn't resist responding - did the "mansplaining" part of my post not go to your liking? ;-)

My sense is that you may have heard that term before, hahaha.

No, God's honest truth, I've heard it, but it's NEVER been applied to me, and I can't honestly define it.

 

[GoSpursGo]

The whole situation sucks. I'm so glad we had our child during 2nd year and not 1st year of fellowship, I can't imagine my wife and I trying to deal with our newborn right now when I was a 1st year.

I'll try not to get into the whole "what's fair for your co-fellows" thing, since it's pretty clear that doesn't seem relevant to what you're asking. It's nice that your PD is trying to work with you. I have to say, I'm skeptical about what exactly he can do, and it may be that he's just trying to do/say whatever he can to keep you around since it sounds like the program has already lost a number of fellows for reasons like yours; if you're still going to be made to make up the calls later in the year, then I don't really see the point in taking another LOA unless you really believe that you'll feel differently when your baby is hopefully old enough to sleep longer. In any event, all I can offer is that I had multiple residency classmates who were gung-ho about fellowship on day 1 of residency and then figured out by the end that, actually, they were ready to be done with training and the number of hours that demands of you. One of my classmates figured it out halfway through first year of fellowship. And it's OK if that's you too. It turns out there is a lot that can still be very rewarding in medicine even if you're not a sub-sub-sub specialist.

 

[WasteofMyTime]

Just wanted to update for other women reading this thread who are in a similar position (and maybe for other men who are interested in listening). I really have to thank aProgDirector for helping me to re-think and re-frame what I needed to ask for. That was really very much the point of this thread and it was very helpful to me.

- The PD made some changes to the structure of our program that took away some of the call burden from ALL of the fellows so that we all have it better. As I said in my first post, it's been tough for everyone, I just happen to be more sensitive to some of the difficult work hours than other people.

- The PD was willing to let me defer some of my call until the next year without putting the burden of my existing call this year on other already-tired fellows. He was understanding that forcing other people to cover my call doesn't constitute accommodations (nor does it do much for my popularity with other fellows, obviously).

- The PD also specifically stated that a LOA would be ok if I needed it. I am very hopeful with the above changes that I won't need it after all and I can just keep going.

I hope this gives a bit of hope to other women who are struggling with a similar situation. Just remember if you've come this far and worked this hard you HAVE proven yourself and should be entitled to at least SOME degree of assistance during such a sensitive period of your life. If you are struggling, there is a chance others are, too. And just remember you will 100% never get the accommodations you don't ask for.

 

[hallowmann]

Just wanted to update for other women reading this thread who are in a similar position (and maybe for other men who are interested in listening). I really have to thank aProgDirector for helping me to re-think and re-frame what I needed to ask for. That was really very much the point of this thread and it was very helpful to me.

- The PD made some changes to the structure of our program that took away some of the call burden from ALL of the fellows so that we all have it better. As I said in my first post, it's been tough for everyone, I just happen to be more sensitive to some of the difficult work hours than other people.

- The PD was willing to let me defer some of my call until the next year without putting the burden of my existing call this year on other already-tired fellows. He was understanding that forcing other people to cover my call doesn't constitute accommodations (nor does it do much for my popularity with other fellows, obviously).

- The PD also specifically stated that a LOA would be ok if I needed it. I am very hopeful with the above changes that I won't need it after all and I can just keep going.

I hope this gives a bit of hope to other women who are struggling with a similar situation. Just remember if you've come this far and worked this hard you HAVE proven yourself and should be entitled to at least SOME degree of assistance during such a sensitive period of your life. If you are struggling, there is a chance others are, too. And just remember you will 100% never get the accommodations you don't ask for.

This is honestly the best thing that could have happened. I'm glad that it did. I think with these changes, you could go from things being unbearable to maybe being manageable. It works out for your program, because they don't have to deal with yet another lost fellow, and it works out for your colleagues, because from the sound of it call is better all around.

I don't think its fair to say that you "just happen to be more sensitive to some of the difficult work hours", because honestly by your description a number of previous and current fellows had problems with the work hours or at very least the way it was arranged. If these changes result in better fellow retention, than you've done a service to your program.

As for your PD, kudos to them for stepping up and taking your concerns seriously in a productive way.

On a separate note, I think you should really talk to that one fellow that kept talking about suicide. See how they are doing, and see if they need some more help, from a friend or a professional. They may have been struggling just as much as you, but may not have the support system or voice to advocate for themselves as much as you were able to.

Good luck, it sounds like you might start getting some sleep!

 

[Crayola227]

yeah, in my experience med students/docs that "joke" about suicide in any sphere are usually, at "best," really hurting

99% of the time there's some real pain behind it,
1% of the time a hyperbolic joke alone