Pregnant & can't start new residency on July 1st

[heychloe]

I'm a MS4, pregnant w/ due date of June 28th 2019... few days prior to residency start date.
I am already near the end of my interview trail so I'm planning on matching this year to IM.

I've done my searches through the thread about the options w/FMLA, sick days etc. (Since I definitely would not have worked a full year w/ my new employer, I am not covered under FMLA)
However it seems the fact that I can't start residency on July 1st complicates the picture quite a bit.
Residencies can terminate the contract if I can't start, and I am unable to find anywhere if there's any protection for pregnancy.

I would like to match this year mostly for the fear of reduced match rate if I defer a year especially since I need to match in the most geographically competitive area in order to not be separated from my spouse (different job for spouse is not an option for financial reason). Also, I've already done all the interviews and everything so having to go through this again is quite a dread... but if I don't have any other choice well then I guess I'll have to suck it up.

My best hope is that the residency program I match into would allow me to start ~6 weeks after birth. I don't care if it delays the completion of my residency training.
But am I completely under the mercy of the individual program since I can't start on July 1st? Do I have any legal rights?
I plan on matching in the state of California. Am I eligible for Pregnancy Disability Leave even if I haven't started my work yet?

If you could tell me what are my rights as well as where I can find assistance, I would really appreciate it.

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[atomi]

You will be allowed to start late. You may be required to make this time up at the end of residency depending on your residency, how late you start, and acgme minimum requirements (whether or not you should have to make it up is a different conversation).

However, it is definitely worth consideration of sitting out at least a year to spend that important time with your newborn. Unlikely anybody will fault you for that, and many will praise you for it.

 

[DokterMom]

The timing of your pregnancy and due date is about as inconvenient as it could possibly be.





That said, it seems at best you really only have two options:

• Option One - Start your residency late, if a program allows you to do that.
  
  • I have to admit though, that if I were a PD, I'd be furious at being put into that position without advance warning -- meaning if you didn't tell me before rank lists were prepared. (I can buy that maybe you didn't know you were pregnant when you interviewed, but not that you didn't know in February. Not telling seems deceitful.)
    
  • And on the flip side, if I knew you were due around July 1 and would need to start off-cycle with a newborn, your position on my rank list would drop WAY FAR down if not all the way to DNR. (You're talking California here - no shortage of good candidates with no known complications.)
  • And of course, the near unimaginable stress on you of having a newborn at home and being both six weeks (or whatever) post-partem and sleep-deprived along with being six weeks behind your peers in everything you do during what is arguably the very most difficult year of your professional life. Frankly, I couldn't imagine a recipe for a more difficult time. Your odds of a successful intern year under those circumstances are very low.
• Option Two - Delay a year
  • If you're willing to just plain write off your interview cycle, you could withdraw from the match, potentially delay your graduation a year, do some meaningful research that would enhance your candidacy next year, and have a very defensible reason for the five-year plan.
  • That would also allow you the flexibility to be a much better mother to a newborn while not permanently sabotaging the rest of your life.

 

[rokshana]

can you on an extra year as a med student? then you can withdraw from the Match this year and still re enter the Match next year still as a med student. Yes, you will need to explain the extra year, but your story is good and as DokterMom notes in her post, you have a bit of a perfect storm there with your due date so close to residency start date and having a brand new (presumably 1st) baby...that's exhausted on exhausted, on exhausted...even if you have a village to take care of that baby...the bonus on the extra year is you probably can do electives or research and have a fairly regular schedule for the 1st year of your baby's life...win win for both of you.

 

[Medstudent9]

The OP shouldn’t have to sit out a year if she doesn’t want to. If I were OP, I would tell immediately after match and ask for accomodations re start date.

What Doktormom states about changing the rank of a pregnant applicant is completely illegal and discriminatory. However, I personally wouldn’t feel comfortable enough as an applicant to disclose prior to the Match for that reason. So waiting until immediately after you know where you match is completely reasonable and normal.

There’s never gonna be an ideal time to have kids. You just have to live your life. I would work on making sure you have good childcare arrangements in for when you actually start. You likely need two nannies (1 won’t work 80 hours) or daycare plus nanny or family member plus nanny.

 

[hamstergang]

There’s never gonna be an ideal time to have kids.

Sure, but some times are worse than just about any other. The OP doesn't have to withdraw from the match this year, but it would make life easier for nearly everyone.

 

[Medstudent9]

Sure, but some times are worse than just about any other. The OP doesn't have to withdraw from the match this year, but it would make life easier for nearly everyone.

Sure. But her question wasn’t “should I plan my IVF cycle for 10 months prior to internship?”

She’s already pregnant and already in the Match. And she wants to proceed. So I think she should expect some bumps, have a good child care plan, and proceed with her life (and let her program know after the Match).

She shouldn’t have to put her life on hold for a year. New mom residents extend their training by 1-2 months all the time. Making those the first couple months isn’t ideal but that’s what’s happening, and she and the program can work that out.

 

[rokshana]

The OP shouldn’t have to sit out a year if she doesn’t want to. If I were OP, I would tell immediately after match and ask for accomodations re start date.

What Doktormom states about changing the rank of a pregnant applicant is completely illegal and discriminatory. However, I personally wouldn’t feel comfortable enough as an applicant to disclose prior to the Match for that reason. So waiting until immediately after you know where you match is completely reasonable and normal.

There’s never gonna be an ideal time to have kids. You just have to live your life. I would work on making sure you have good childcare arrangements in for when you actually start. You likely need two nannies (1 won’t work 80 hours) or daycare plus nanny or family member plus nanny.

They don’t have to re accommodate for her if she can’t start July 1st and just say that they will release her from the match commitment...will they? Probably not but she would either have to be scheduled for vacation up front or on some sort of elective ...but it would still require her to show up fairly soon after July 1...they are not likely to give her a month or 2 off in July...

I doubt there is daycare out there that takes a baby less that 6-8 weeks old so either there would need to be a lot of family help or hubby takes parental leave with fmla from his work (which might not be a bad idea) and even then what happens if she goes past her due date...though she may then actually be able to take maternity leave if she has actually started work.

It’s not a shouldn’t have to, but may actually be a beneficial one...one can always be an intern even if it’s a year later, but you dont get that 1st year of your child’s life back.

 

[deleted480308]

I would likely tell programs now and stay in the match or sit one out

I wouldn’t hide it but I can see how that would be tempting

Good luck op

 

[LucidSplash]

What is your health insurance situation? For me this would have bearing on what I decided to do. There was a resident in my program who was a couple years ahead of me that ended up with a due date of July 1st. The biggest stressor for her was getting there and getting onto the residency health insurance before delivering. If you have insurance then this doesn’t matter.

 

[DokterMom]

The OP shouldn’t have to sit out a year if she doesn’t want to. If I were OP, I would tell immediately after match and ask for accomodations re start date.

What Doktormom states about changing the rank of a pregnant applicant is completely illegal and discriminatory. However, I personally wouldn’t feel comfortable enough as an applicant to disclose prior to the Match for that reason. So waiting until immediately after you know where you match is completely reasonable and normal.

There’s never gonna be an ideal time to have kids. You just have to live your life. I would work on making sure you have good childcare arrangements in for when you actually start. You likely need two nannies (1 won’t work 80 hours) or daycare plus nanny or family member plus nanny.

If you were a program director @Medstudent9 and found out immediately after the match that one of your brand new residents would not be able to start work as promised on July 1st due to a known-to-her (but not to you) temporary disability -- How would you feel about that resident? How would you feel about her professionalism? How would you feel about her appreciation for the importance of teamwork and transparency? And fair-dealing? And importantly for the OP, how might your feelings (and those of her over-burdened future teammates) translate into how her future colleagues regard her and treat her?

I'm not a lawyer, but what is your basis for claiming that lowering her ranking would be illegal? It is not illegal for an employer to insist that an applicant be able to perform the tasks necessary for the job, and showing up July 1st and working for 45 days is explicitly stipulated in the employment contract. The OP already knows that she is almost certainly unable to fulfill the terms of the contract. I'd sooner argue that signing a residency contract under those terms would be fraudulent.

It's true that there's never an ideal time for a career woman to have children. I've been there, have the scars to prove it, and am as pro-working-mom as you're ever going to find. But some circumstances are simply untenable.

 

[Piebaldi]

What is your health insurance situation? For me this would have bearing on what I decided to do. There was a resident in my program who was a couple years ahead of me that ended up with a due date of July 1st. The biggest stressor for her was getting there and getting onto the residency health insurance before delivering. If you have insurance then this doesn’t matter.

I'm a MS4, pregnant w/ due date of June 28th 2019... few days prior to residency start date.
I am already near the end of my interview trail so I'm planning on matching this year to IM.

I've done my searches through the thread about the options w/FMLA, sick days etc. (Since I definitely would not have worked a full year w/ my new employer, I am not covered under FMLA)
However it seems the fact that I can't start residency on July 1st complicates the picture quite a bit.
Residencies can terminate the contract if I can't start, and I am unable to find anywhere if there's any protection for pregnancy.

I would like to match this year mostly for the fear of reduced match rate if I defer a year especially since I need to match in the most geographically competitive area in order to not be separated from my spouse (different job for spouse is not an option for financial reason). Also, I've already done all the interviews and everything so having to go through this again is quite a dread... but if I don't have any other choice well then I guess I'll have to suck it up.

My best hope is that the residency program I match into would allow me to start ~6 weeks after birth. I don't care if it delays the completion of my residency training.
But am I completely under the mercy of the individual program since I can't start on July 1st? Do I have any legal rights?
I plan on matching in the state of California. Am I eligible for Pregnancy Disability Leave even if I haven't started my work yet?

If you could tell me what are my rights as well as where I can find assistance, I would really appreciate it.

As someone else said, from a legal standpoint, I believe they must give you maternity leave, so they will likely give you the 6 weeks off. obviously it's needless to say taht this will inevitably screw over your co-interns, and they will be taking more call, and working harder right from the get go, which will be unpleasant. It will also put you at a disdvantage as you will be starting residency 6 weeks late, and as a new mom, which will make things stressful for you, both from the fact that you are having a new infant to take care of, but also the need to learn a new system, being behind everyone else, with the potential for higher expectations since you will be compared to your co-residents who started before.

Also 6 weeks is more vacation than is given per year, so you will have no vacation for the rest of the year, and will likely have to extend your residency. You don't have to take the 6 weeks - as much as it sucks. Hopefully you have a supportive spouse who will help out.

Good luck!

 

[Piebaldi]

The OP shouldn’t have to sit out a year if she doesn’t want to. If I were OP, I would tell immediately after match and ask for accomodations re start date.

What Doktormom states about changing the rank of a pregnant applicant is completely illegal and discriminatory. However, I personally wouldn’t feel comfortable enough as an applicant to disclose prior to the Match for that reason. So waiting until immediately after you know where you match is completely reasonable and normal.

There’s never gonna be an ideal time to have kids. You just have to live your life. I would work on making sure you have good childcare arrangements in for when you actually start. You likely need two nannies (1 won’t work 80 hours) or daycare plus nanny or family member plus nanny.

Yes this holds true to some extent. For us women it's a challenge and like you say it's never technically a good tiem to have kiddos. During undergrad, many women are not yet married - I certainly wasn't, and you have the whole stress of getting into med school. It's certainly a stressful time to have kiddos during med school, especially with the steps. Then it's a bad time to get pregnant as you are finishing because exactly of this issue. Then of ourse there is residency - no matter how benign the program, it will be stressful, even if you have a helpful spouse. Then of course after residency you might potentially do fellowship - again stressful. After that you start working and if you want to be a partner taking a bunch of time off might be seen as problematic.

While I agree with whoever said that it's probably the worst time to have a kiddo right before residency, it's never truly ideal to have a kid at any point for a female doctor. With that said, most of us want kids, so they will need to come at some point - even if inconvenient.

I would definitely not wait out a year - I think that's a terrible idea. Especially because it will decrease matching chances, and OP has already mostly finished intervieweing. I would simply take a smaller leave of absence. Maybe 3-4 weeks. You can use vacation time, or perhaps be scheduled in an elective - I know in some programs for example, during intern year some people would be scheduled in electives like Derm or Rheum where the extra intern is not essential, so it would not lead to massive anger from the rest of the interns and put you that far behind.

I know our schedule sucked during 4th year when one of the 2nd years dropped out and we all had to cover. It also sucked during my intern year when one Medicine intern dropped out mid year - and I was only 1 out of 2 interns for ICU- when typically there were 3. It was one of the worst months of my life.

 

[LucidSplash]

As someone else said, from a legal standpoint, I believe they must give you maternity leave, so they will likely give you the 6 weeks off. obviously it's needless to say taht this will inevitably screw over your co-interns, and they will be taking more call, and working harder right from the get go, which will be unpleasant. It will also put you at a disdvantage as you will be starting residency 6 weeks late, and as a new mom, which will make things stressful for you, both from the fact that you are having a new infant to take care of, but also the need to learn a new system, being behind everyone else, with the potential for higher expectations since you will be compared to your co-residents who started before.

Also 6 weeks is more vacation than is given per year, so you will have no vacation for the rest of the year, and will likely have to extend your residency. You don't have to take the 6 weeks - as much as it sucks. Hopefully you have a supportive spouse who will help out.

Good luck!

My question wasn’t based on the legal standpoint of them hiring her or not, it was a question about where her insurance was sourced. It had zero to do with the program. If I had insurance through my partner, then I might wait a year to start if I had that option. If I didn’t, then I’d make sure I had cobra and hope like hell I didn’t go into labor until after I was on my residency plan.

 

[Piebaldi]

My question wasn’t based on the legal standpoint of them hiring her or not, it was a question about where her insurance was sourced. It had zero to do with the program. If I had insurance through my partner, then I might wait a year to start if I had that option. If I didn’t, then I’d make sure I had cobra and hope like hell I didn’t go into labor until after I was on my residency plan.

Regardless I think it's a terrible idea to wait out a year. I think she should just start later even if not ideal.

 

[LucidSplash]

Regardless I think it's a terrible idea to wait out a year. I think she should just start later even if not ideal.

I should have qualified that Id withdraw from the match and delay graduation a year if that was an option. I would not delay a year if I couldn’t delay graduation.

But that’s what I would do in her situation. I’m looking back at this from the benefit of being nearly done with training. I don’t know if I would have offered the same thing back on the day. But just my 2 cents.

 

[gutonc]

If the OP had mentioned the specialty she was applying to this discussion could be a bit more helpful.

If we’re talking about an IM program with 40-50 other interns, this will annoy the PD but will totally be manageable. If it’s an integrated plastics program where she may be 1 of 2 or 3 total residents, then it’s a heaping helping of nope.

As to the legal aspects of the case, the Match agreement includes a clause that the applicant will be able to assume the position (pun intended) in 7/1 and that, if they are unable to do so for any reason, the program may invalidate the Match contract. Pregnancy is no more a protected class in this case than any other medical issue. If the OP were to get admitted to the ICU with DKA , or the trauma unit post MVC with a skull fracture, the program would still be well within their legal rights to anull the contract.

Now...what will actually happen if the OP proceeds in the Match, gets a spot and then has to manage the outcome, is a total wild card.

As has been pointed out, there are basically 3, or maybe 4 options for how to deal with this situation.

1. Ask permission.
Tell programs what’s up now and hope they still rank you

2. Ask forgiveness
Rank as you wish and when/if you Match, immediately email/call the PD where you matched and explain the situation.

3. Gap year
Graduate on time and re-apply next year. There’s a good story when asked.

4. Ask to stay on for another year
It will cost you a fair amount of money. But if you’re focusing on a particular region for your partner’s job prospects, then what’s $30-50K in tuition and another $50-60K in lost income for PGY1 (never mind the $200-X00K in downstream lost attending income for a year) between friends.

 

[heychloe]

Thanks for the replies everyone. I'll try to answer the questions asked above but please forgive me if I miss anything.

First of all, I am a nontrad student in my late thirties who has been trying the IVF for the past 3 years and it had miraculously worked out after many many failed attempts. Given my age, I could not wait much longer. I was still hoping I'd get pregnant at least a month earlier but it just didnt work out that way.
After talking with residents who has given birth during residency, I thought that I would be less of a burden and screw up my fellow residents schedule(and be less hated) if I take the time off at the very beginning rather than middle of intern or resident year. I plan on contacting the program coordinator as soon as I match to work out a schedule. Luckily, my #1 choice is a larger program and has excessive number of prelims as well as transitional internships(they are double the number of categorical interns) that I don't think my absence for first few months as intern would be that problematic. But please correct me if I'm being naive.
Less importantly, I prefer my fetus to be less exposed to excessive stress hormones of residency if I could help it.

I do have a very supportive spouse who makes a sustainable income for all of our family members along with excellent health insurance. My parents will be living with us for a little while after child birth to help us at least until the baby will be big enough to go to daycare.
Having to make up for missed time and extend my training by couple months is not an issue since I don't think I will be applying for fellowship.

As mentioned in my original post, matching in this specific geographical location is the most important factor for our family because my spouse cannot get a job elsewhere(complicated long story). Getting separated while having a small infant is the biggest nightmare above all. So in order to ensure that I match in this specific geographic area, I did an insane amount of audition rotations, received great feedback, and even received an interview after subI at a site that initially rejected my application. I have heard that thanks to the number of subI's I've done I am at least as competent or sometimes more competent as MS4 than fellow interns. So I feel confident that starting late by a month or two will not make me less competent than other interns, especially since I've already worked at the specific program(ideally). But if I do wait out a year, I may get quite rusty.

Another factor in wanting to pursue this cycle is that I'm quite certain of my chances of getting a residency in targeted geography thanks to the insane 6months I've had w/ excessive subi's, but all of this could be diluted if I seat out another year. I am a much better candidate in person than on paper, and don't think I will get more subI's from same programs next year. Also, my school doesn't have an established '1 year research elective' , so I may end up graduating this year anyways then sitting out a year doing nothing. I am terrified of blowing away my chances and the hard work I have put in to ensure my family stays together.
I am not trying to dismiss some of your heartful concerns and I apologize for how rigid my situation seems to be.

As far as I know, programs asking about family planning and pregnancy status during interview is against ACGME rule for the precise reason that Doktermom stated. Therefore nobody asked me about it, and I don't plan on volunteering the information that would predispose me to disrimination. As I don't think its immoral to not volunteer the plans to have family during residency, I also dont think its immoral to not voluntarily inform them that I am pregnant.

The main reason I wrote this post is to understand my rights and get directed to resources that I could look at to understand my rights. I am especially interested in understanding my rights regarding California's pregnancy disability leave, and who can I contact for my legal protection. Eg., should I contact the resident labor union for my region for consult?

I am also very interested in hearing some opinions from a program director or coordinator.

 

[heychloe]

If the OP had mentioned the specialty she was applying to this discussion could be a bit more helpful.

I mention that I am applying for IM in the first paragraph of the original post but I understand it can be easily burried in the sea of words..

Yes I am very concerned about contract annullment and had discussed with my obgyn about doing an early c-section so I can at least show up on day one so I can be protected under california's pregnancy disability law. My obgyn disagreed with such elective c section and thinks it shouldnt be a problem to get a little delayed start...

Honestly, if I wasnt so constricted by geography, I would take option One or three..

 

[Piebaldi]

I mention that I am applying for IM in the first paragraph of the original post but I understand it can be easily burried in the sea of words..

Yes I am very concerned about contract annullment and had discussed with my obgyn about doing an early c-section so I can at least show up on day one so I can be protected under california's pregnancy disability law. My obgyn disagreed with such elective c section and thinks it shouldnt be a problem to get a little delayed start...

Honestly, if I wasnt so constricted by geography, I would take option One or three..

Yes, you indeed mentioned IM.
IM is not that competitive - perhaps in CA it is? I don't know, as I don't know anything about CA really.

in my very large program of 30 or so people, we only had 2 female residents have kiddos during the program while I was there - I can't comment on the issues that the first one created on the schedule as it did not affect me and I was an intern but for the second one, the schedules of numeorus residents had to be re-arranged which was a pain. Even for those people that had no kids but other personal issues there still had to be schedule rearrangements, which created a ton of stress to the rest of the class , and or program.

So I would not disocunt the effect it will have on your classmates. Yes, there will be some roughened feathers without a doubt - not only because you will start late so you will inevitably be less competetent than your fellow interns who started earlier (there is a tremendous ramp up that occurs in the first 3-4 months of residency), you will not only start late but also have an infant to worry about, be sleep deprived (it's awsome that your parents can help though!), you will have to likely take MORE call in order to make it fair to others who have had to absorb your calls, so it will inevitably be stressful for you and for others

I think gutonc brings up a good point though - there is an inherent contract that if you match with a program, you should start on July 1, and that they can annul the contract and get a waiver if you can't.
With that said, I had to start my internship late by a bit for personal reasons, (I am an AMG), and the PD was very very gracious and did not make an issue out of it.
So while that can certainly happen, there inherently is no guarantee that it WILL.

If i were in your shoes, I would
1- graduate on time (especially if you are in your late 30's already)
2- have the kid safely per your OB's recommendations - you have gone through a lot it seems, now it's the time to make it to the finish line appropriately
3- rank programs as your preference - from what you are saying it seems you want to stay in CA for your husband's job and won't consider any other state
4-hope that your PD is nice enough to allow you to start late, if not, realize that there might be a possibility that your contract may be annulled. it's a gamble, but definitely not a 100% no either
5-be ready to work super hard once you start - again you will start late, be less competent initially than your fellow peers, have the stress of new baby, will have to take more call, and likely extend your training and won't have vacation - so get mentally prepared

good luck!

 

[Helpful Troll]

I'm a MS4, pregnant w/ due date of June 28th 2019... few days prior to residency start date.
I am already near the end of my interview trail so I'm planning on matching this year to IM.

I've done my searches through the thread about the options w/FMLA, sick days etc. (Since I definitely would not have worked a full year w/ my new employer, I am not covered under FMLA)
However it seems the fact that I can't start residency on July 1st complicates the picture quite a bit.
Residencies can terminate the contract if I can't start, and I am unable to find anywhere if there's any protection for pregnancy.

I would like to match this year mostly for the fear of reduced match rate if I defer a year especially since I need to match in the most geographically competitive area in order to not be separated from my spouse (different job for spouse is not an option for financial reason). Also, I've already done all the interviews and everything so having to go through this again is quite a dread... but if I don't have any other choice well then I guess I'll have to suck it up.

My best hope is that the residency program I match into would allow me to start ~6 weeks after birth. I don't care if it delays the completion of my residency training.
But am I completely under the mercy of the individual program since I can't start on July 1st? Do I have any legal rights?
I plan on matching in the state of California. Am I eligible for Pregnancy Disability Leave even if I haven't started my work yet?

If you could tell me what are my rights as well as where I can find assistance, I would really appreciate it.

California Pregnancy Leave FAQ's Will you be an employee before the birth of your child? If not, you may not be eligible for the leave. The FAQ's include who to contact with additional questions.

 

[Crayola227]

Using family planning or pregnancy in hiring/firing decisions is absolutely illegal discrimination.

The rules on whether or not the Match is "binding" or not is separate from what is/is not legal to use in making those decisions.

I can see that her not being entitled to FMLA, or not meeting the requirements for a binding match might be in play.

HOWEVER that does not make specifically using the knowledge of her pregnancy to impact those decisions any more legal.

 

[Crayola227]

There is a fitness for duty medical eval thing that happens with HR. That would be one time to choose to disclose this to them, and to the program.

I know someone that had a medical issue there were aware of, come up in this process, and the program then was made aware at that point because it was going to impact the resident starting.

The program was clearly not thrilled about making accommodations, however it was also clear (it was a fairly understanding PD) that they understood and respected that resident's legal and moral right to go through the Match without disclosing information that programs were not legally entitled to, that could have been used to illegally discriminate against the student (and we all know that while illegal, it happens anyway and there is no protection against this beyond not disclosing), and that this was a self preservation move that they likely had used through the whole process with any and all programs, and so was not anything directed at them, but probably something anyone, themselves included, would have done. Indeed, the Dean of the medical school told the student not to disclose because it would likely just lead to discrimination. And this Dean was themselves not thrilled about accommodating this student. Yet, that was the advice.

The downside of not disclosing to programs in advance, is that you can match somewhere that doesn't give a damn vs everyone going into this eyes wide open. But then you risk not matching at all or matching somewhere horrible. This is the sad truth.

If you have a medical condition or are a woman that breeds, you will always face being regarded as an imposition to others. There is nothing you can do about that short of shrivelling up and dying. Do your best to mitigate what negative impact you can have on others, but it's OK to do what you need to do for yourself.

Obviously the issue of a medical condition vs a pregnancy, the law re: ADA and FMLA, the binding of the Match, are not all the same issues.

The point is, it's complicated. It's OK to try to arrange Matching and then to arrange how everyone is going to work this out.

Yes, if you don't work X number of days and all that, there is a chance the Match will not be binding, and that will be that. There is a chance that they will just seek to fill the position in some other way. There is a chance they would have you start late, or if you're lucky, maybe just let you defer a year.

The timing of disclosure and how this all shakes out, plus a thousand other factors, it's hard to say what will happen or the best way to handle this or the best time to disclose.

The later to the start time you disclose, the more hassle it will be for the program to accommodate, and the more likely they may do more to accommodate you, because the closer to the start date, the more difficult it is for them to find another resident to fill the slot, and having an empty spot for the year is generally worse than having to work with a less than ideal resident situation. OTOH, this could backfire in terms of resentment, or that by disclosing late you end up backed into a corner rather than the program, and with little time to figure out something else.

Personally, I would Match, and then bring it up after. I can't say exactly when. Then there will be time for everyone to sort out the chips falling.

Hopefully, if you can't start with the program and they won't let you defer a year, you could add on a year with your school. Sometimes you can work out research or an MPH or MBA or a year of biostats, something where you could even do that year semi-long distance learning, if being tied to the school's location is an issue.

Are you getting advising from your school on how to handle all this?? How they can help you with the different ways this could go sideways?

 

[Crayola227]

And honestly, it's OK to call a spade a spade.

"I wasn't trying to put the program in a difficult spot, but the advice from my school regarding Matching was not to disclose information that could be used to illegally discriminate against me, or even just subconsciously. I don't think anyone is trying to be a bad guy here. I was told the only protection against that was not to disclose information I was not legally obligated to disclose that had a high potential of letting me go un-Matched. I'm sorry if this was an imposition to the program, but I hope you can understand the position I was in and that I wanted to be ranked by programs independent of this medical issue/pregnancy as per my advising."

They can hate you after this little speech, but in my experience most docs are rational and adult enough to just deal with this. Cross your fingers you don't get boned, but basically it is what it is, and might as well clear the air. They'll know this is essentially what you did even if you don't come out and say so. At least this way hopefully you can help to frame it from your point of view and get some compassion for that at least.

 

[rokshana]

As someone else said, from a legal standpoint, I believe they must give you maternity leave, so they will likely give you the 6 weeks off. obviously it's needless to say taht this will inevitably screw over your co-interns, and they will be taking more call, and working harder right from the get go, which will be unpleasant. It will also put you at a disdvantage as you will be starting residency 6 weeks late, and as a new mom, which will make things stressful for you, both from the fact that you are having a new infant to take care of, but also the need to learn a new system, being behind everyone else, with the potential for higher expectations since you will be compared to your co-residents who started before.

Also 6 weeks is more vacation than is given per year, so you will have no vacation for the rest of the year, and will likely have to extend your residency. You don't have to take the 6 weeks - as much as it sucks. Hopefully you have a supportive spouse who will help out.

Good luck!

No this is the US , there is no mandatory maternity leave...and more importantly her employment doesn’t start until July 1st...if she can’t show up for work on July 1st, they can then say she is not able to Fufill her requirements and can break the contract and let her go.

 

[Piebaldi]

No this is the US , there is no mandatory maternity leave...and more importantly her employment doesn’t start until July 1st...if she can’t show up for work on July 1st, they can then say she is not able to Fufill her requirements and can break the contract and let her go.

Yes I mentioned the whole July 1st thing in my other post.
I would be surprised though if a PD was not willing to accommodate though.

 

[rokshana]

Thanks for the replies everyone. I'll try to answer the questions asked above but please forgive me if I miss anything.

First of all, I am a nontrad student in my late thirties who has been trying the IVF for the past 3 years and it had miraculously worked out after many many failed attempts. Given my age, I could not wait much longer. I was still hoping I'd get pregnant at least a month earlier but it just didnt work out that way.
After talking with residents who has given birth during residency, I thought that I would be less of a burden and screw up my fellow residents schedule(and be less hated) if I take the time off at the very beginning rather than middle of intern or resident year. I plan on contacting the program coordinator as soon as I match to work out a schedule. Luckily, my #1 choice is a larger program and has excessive number of prelims as well as transitional internships(they are double the number of categorical interns) that I don't think my absence for first few months as intern would be that problematic. But please correct me if I'm being naive.
Less importantly, I prefer my fetus to be less exposed to excessive stress hormones of residency if I could help it.

I do have a very supportive spouse who makes a sustainable income for all of our family members along with excellent health insurance. My parents will be living with us for a little while after child birth to help us at least until the baby will be big enough to go to daycare.
Having to make up for missed time and extend my training by couple months is not an issue since I don't think I will be applying for fellowship.

As mentioned in my original post, matching in this specific geographical location is the most important factor for our family because my spouse cannot get a job elsewhere(complicated long story). Getting separated while having a small infant is the biggest nightmare above all. So in order to ensure that I match in this specific geographic area, I did an insane amount of audition rotations, received great feedback, and even received an interview after subI at a site that initially rejected my application. I have heard that thanks to the number of subI's I've done I am at least as competent or sometimes more competent as MS4 than fellow interns. So I feel confident that starting late by a month or two will not make me less competent than other interns, especially since I've already worked at the specific program(ideally). But if I do wait out a year, I may get quite rusty.

Another factor in wanting to pursue this cycle is that I'm quite certain of my chances of getting a residency in targeted geography thanks to the insane 6months I've had w/ excessive subi's, but all of this could be diluted if I seat out another year. I am a much better candidate in person than on paper, and don't think I will get more subI's from same programs next year. Also, my school doesn't have an established '1 year research elective' , so I may end up graduating this year anyways then sitting out a year doing nothing. I am terrified of blowing away my chances and the hard work I have put in to ensure my family stays together.
I am not trying to dismiss some of your heartful concerns and I apologize for how rigid my situation seems to be.

As far as I know, programs asking about family planning and pregnancy status during interview is against ACGME rule for the precise reason that Doktermom stated. Therefore nobody asked me about it, and I don't plan on volunteering the information that would predispose me to disrimination. As I don't think its immoral to not volunteer the plans to have family during residency, I also dont think its immoral to not voluntarily inform them that I am pregnant.

The main reason I wrote this post is to understand my rights and get directed to resources that I could look at to understand my rights. I am especially interested in understanding my rights regarding California's pregnancy disability leave, and who can I contact for my legal protection. Eg., should I contact the resident labor union for my region for consult?

I am also very interested in hearing some opinions from a program director or coordinator.

I doubt any program will let you have 2 months the off at the beginning of your intern year...maybe 2 weeks...a month at best...frankly it would have logistically better if it was in the middle of the end of the year because they would have been stuck with the situation and you would have been an employee...

If you decide to continue with the match, it will be important that you let them know ASAP...they may be able to figure something out if they have a few mo this to figure out something...vacation may be possible but that at best will be 4 weeks...any longer and you will need to make up the lost time since you can only miss 4 weeks per year to get credit for the year.

 

[Piebaldi]

I doubt any program will let you have 2 months the off at the beginning of your intern year...maybe 2 weeks...a month at best...frankly it would have logistically better if it was in the middle of the end of the year because they would have been stuck with the situation and you would have been an employee...

If you decide to continue with the match, it will be important that you let them know ASAP...they may be able to figure something out if they have a few mo this to figure out something...vacation may be possible but that at best will be 4 weeks...any longer and you will need to make up the lost time since you can only miss 4 weeks per year to get credit for the year.

She mentioned 6 weeks, not 2 months. I agree with you though that 6 weeks is still too much. Ideally she should take 4weeks off, which would essentially be 1 rotation - so she can maybe be scheduled for an elective, which obviously someone has to start with anyways. Many electives are call free so it would not screw everyone over if that's the case. I started more than 2 months later due to personal issues and was accommodated. So it can happen.

 

[AMEHigh]

2 anecdotes:
An intern couldn’t start on time last year (not pregnancy related) and everyone in our program was supportive.
A coworkers spouse was recently in a similar situation. Due date mid July. Everything worked out fine and from what I have gathered her program was fine with it and she didn’t tell them until after the match.

I absolutely wouldn’t tell any programs until after the match. Ultimately you have to do what’s best for you and sitting out a year because you don’t want to hurt anyone’s feelings is not a good idea. I’d tell your program as soon as you match.
Good luck!

 

[Piebaldi]

2 anecdotes:
An intern couldn’t start on time last year (not pregnancy related) and everyone in our program was supportive.
A coworkers spouse was recently in a similar situation. Due date mid July. Everything worked out fine and from what I have gathered her program was fine with it and she didn’t tell them until after the match.

I absolutely wouldn’t tell any programs until after the match. Ultimately you have to do what’s best for you and sitting out a year because you don’t want to hurt anyone’s feelings is not a good idea. I’d tell your program as soon as you match.
Good luck!

Yes I would agree - I would not tell programs that they are pregnant or that they are due just before starts.

 

[Stagg737]

What Doktormom states about changing the rank of a pregnant applicant is completely illegal and discriminatory.

Keep in mind that if she was discriminated against and her rank was changed, she would have to prove that her rank was changed due to her pregnancy status. While we could argue as to whether that would be legal or not, it would be very difficult to actually prove in a court of law.

I doubt there is daycare out there that takes a baby less that 6-8 weeks old so either there would need to be a lot of family help or hubby takes parental leave with fmla from his work (which might not be a bad idea) and even then what happens if she goes past her due date...though she may then actually be able to take maternity leave if she has actually started work.

In my area no accredited daycare will take an infant under 12 weeks old and many will not take children under 6 months or 1 year. So for her to go back to work in 6 weeks would likely require family/spousal help, though this certainly could be different in other areas of the country.

 

[Crayola227]

Keep in mind that if she was discriminated against and her rank was changed, she would have to prove that her rank was changed due to her pregnancy status. While we could argue as to whether that would be legal or not, it would be very difficult to actually prove in a court of law.

I think we all get that, the point is that just because someone will be upset that they didn't get to illegally discriminate against you and don't know until it is too late to, is hardly a compelling reason to disclose information that could just be used to screw you illegally. Life isn't fair, yes, but for that reason I hardly blame someone for trying to protect themselves in a way that even society's laws acknowledge is frakked up. If this kind of discrimination wasn't real, I doubt there would be such laws in place. It's probably some logical fallacy I'm using here, but the point is still there.

The law isn't a reason to disclose and then assume it will all end up OK. The law is something in place to protect people because the risk is real. Using your legal right to protect yourself and your privacy is therefore reasonable in my view. The only people who will blame you for this are the very ones you needed protection from.

The reality is that once an employer is "tricked" into hiring you based on your abilities and qualifications and not illegal BS, they often will make the necessary accommodations. Or, there's a fair higher likelihood than if they had just thrown your app in the trash because they knew ahead of time.

We know that a great deal of protecting people in these situations is even getting their foot in the door. And even then, as we are discussing, all bets will be off.

Discrimination is extraordinarily difficult to prove in so many instances, that it also makes sense to get your foot in the door, and once hired hope that the threat of a lawsuit you probably wouldn't even win, is enough to get an employer to follow the law.

 

[anonperson]

I'm a MS4, pregnant w/ due date of June 28th 2019... few days prior to residency start date.
I am already near the end of my interview trail so I'm planning on matching this year to IM.

I've done my searches through the thread about the options w/FMLA, sick days etc. (Since I definitely would not have worked a full year w/ my new employer, I am not covered under FMLA)
However it seems the fact that I can't start residency on July 1st complicates the picture quite a bit.
Residencies can terminate the contract if I can't start, and I am unable to find anywhere if there's any protection for pregnancy.

I would like to match this year mostly for the fear of reduced match rate if I defer a year especially since I need to match in the most geographically competitive area in order to not be separated from my spouse (different job for spouse is not an option for financial reason). Also, I've already done all the interviews and everything so having to go through this again is quite a dread... but if I don't have any other choice well then I guess I'll have to suck it up.

My best hope is that the residency program I match into would allow me to start ~6 weeks after birth. I don't care if it delays the completion of my residency training.
But am I completely under the mercy of the individual program since I can't start on July 1st? Do I have any legal rights?
I plan on matching in the state of California. Am I eligible for Pregnancy Disability Leave even if I haven't started my work yet?

If you could tell me what are my rights as well as where I can find assistance, I would really appreciate it.

I know there was a few positive anecdotes but I should at least share a true negative one.

While I was a fellow , a lower level resident was fired/contract not renewed. She had to delay her start of intern year because of child birth (may have had a c section). I heard that this did not put her in the most positive light among other residents and faculty. Caused her to be under a microscope so any screw ups were magnified etc.

She is suing the program now and is claiming that the program unfairly targeted her because of this (in addition to other things).

You also need to realistically assess starting residency with a new born after delivery. I know 4 weeks has been thrown around but if you have a difficult delivery or c section, you may need more time to physically recuperate. Only you can answer if you will be ready to be an intern under those conditions

I sympathize with the situation because you can't put your life on hold for a job but know that some programs can be petty.

 

[Crayola227]

I would likely tell programs now and stay in the match or sit one out

I wouldn’t hide it but I can see how that would be tempting

Good luck op

Don't you usually love talking about the law?

It is not hiding something to protect yourself and your personal life by not sharing the status of your plans for reproduction with a *potential* and not actual employer.

There is no "hiding" something when you don't tell someone something you are not legally or morally obligated to that should not be used against you, yet probably would.

I never went around with a sign on my forehead that I would abort a fetus/keep a fetus at any point in my medical training, wherever I was on that spectrum of decision-making, whether or not that would be a boon or bust for my training programs. Whether or not I was pregnant was also no one's business up until the point that your ability to meet the essential functions of your training are not affected. In this case, yes, her pregnancy appears to pose a situation that will need accommodation. Depending on the circumstances, accommodation may be perfectly reasonable and the OP would have a right to pursue that if she was legally entitled to it. She might not be, and that's fine too. None of that means that she is "hiding" something at this time. I get why people might think that, but then I think they need to get their heads screwed on straight about what people's legal and moral rights to privacy are.

But to act like her not disclosing this to programs, WHO HAVE NO RIGHT TO THIS INFORMATION on a legal or even moral level, is "hiding" something or deceitful, is ridiculous.

Not telling someone something that is NOT their business, they are NOT entitled to know legally, at the time that that is true, is not hiding or deceit.

Just in case anyone is actually reading this, YOU DO NOT HAVE TO DISCUSS YOUR PERSONAL HEALTH before being hired. I get why employers would like to know (gee, I wonder why, so they can NOT hire you, and that's illegal), but that doesn't make it their right or right for them to want to. It doesn't make people wrong to choose to exercise their legal rights to privacy. Oh believe me, I know there are consequences to invoking those rights, just as there are to not invoking them.

Pregnant people and people with other health conditions or even disabilities, are also entitled to privacy and accommodations under certain situations, under the law. Just because it's inconvenient for other people doesn't make it OK to marginalize those people from the workplace, at least as far as the law protects them.

Implying dishonesty on the part of people merely exercising their legal rights and their right to privacy about something as personal as the state of their crotch, just so that they do not face illegal or harmful discrimination, is just, I can't even.

 

[Crayola227]

If the OP had mentioned the specialty she was applying to this discussion could be a bit more helpful.

If we’re talking about an IM program with 40-50 other interns, this will annoy the PD but will totally be manageable. If it’s an integrated plastics program where she may be 1 of 2 or 3 total residents, then it’s a heaping helping of nope.

As to the legal aspects of the case, the Match agreement includes a clause that the applicant will be able to assume the position (pun intended) in 7/1 and that, if they are unable to do so for any reason, the program may invalidate the Match contract. Pregnancy is no more a protected class in this case than any other medical issue. If the OP were to get admitted to the ICU with DKA , or the trauma unit post MVC with a skull fracture, the program would still be well within their legal rights to anull the contract.

Now...what will actually happen if the OP proceeds in the Match, gets a spot and then has to manage the outcome, is a total wild card.

As has been pointed out, there are basically 3, or maybe 4 options for how to deal with this situation.

1. Ask permission.
Tell programs what’s up now and hope they still rank you

2. Ask forgiveness
Rank as you wish and when/if you Match, immediately email/call the PD where you matched and explain the situation.

3. Gap year
Graduate on time and re-apply next year. There’s a good story when asked.

4. Ask to stay on for another year
It will cost you a fair amount of money. But if you’re focusing on a particular region for your partner’s job prospects, then what’s $30-50K in tuition and another $50-60K in lost income for PGY1 (never mind the $200-X00K in downstream lost attending income for a year) between friends.

Great reply. Quick question, what does "assuming the position" on 7/1 entail to meet the requirements for the match being binding? As in, what if she shows up for everything, and then bails on 7/2? or is it 30 or 45 days in? I can't recall the details anymore.

 

[deleted480308]

Don't you usually love talking about the law?

It is not hiding something to protect yourself and your personal life by not sharing the status of your plans for reproduction with a *potential* and not actual employer.

There is no "hiding" something when you don't tell someone something you are not legally or morally obligated to that should not be used against you, yet probably would.

I never went around with a sign on my forehead that I would abort a fetus/keep a fetus at any point in my medical training, wherever I was on that spectrum of decision-making, whether or not that would be a boon or bust for my training programs. Whether or not I was pregnant was also no one's business up until the point that your ability to meet the essential functions of your training are not affected. In this case, yes, her pregnancy appears to pose a situation that will need accommodation. Depending on the circumstances, accommodation may be perfectly reasonable and the OP would have a right to pursue that if she was legally entitled to it. She might not be, and that's fine too. None of that means that she is "hiding" something at this time. I get why people might think that, but then I think they need to get their heads screwed on straight about what people's legal and moral rights to privacy are.

But to act like her not disclosing this to programs, WHO HAVE NO RIGHT TO THIS INFORMATION on a legal or even moral level, is "hiding" something or deceitful, is ridiculous.

Not telling someone something that is NOT their business, they are NOT entitled to know legally, at the time that that is true, is not hiding or deceit.

Just in case anyone is actually reading this, YOU DO NOT HAVE TO DISCUSS YOUR PERSONAL HEALTH before being hired. I get why employers would like to know (gee, I wonder why, so they can NOT hire you, and that's illegal), but that doesn't make it their right or right for them to want to. It doesn't make people wrong to choose to exercise their legal rights to privacy. Oh believe me, I know there are consequences to invoking those rights, just as there are to not invoking them.

Pregnant people and people with other health conditions or even disabilities, are also entitled to privacy and accommodations under certain situations, under the law. Just because it's inconvenient for other people doesn't make it OK to marginalize those people from the workplace, at least as far as the law protects them.

Implying dishonesty on the part of people merely exercising their legal rights and their right to privacy about something as personal as the state of their crotch, just so that they do not face illegal or harmful discrimination, is just, I can't even.

I don’t think we need a law either way.

I’m not saying the programs have a right to her due date but when one is entering an agreement to start work on a certain date, I find it morally relevant to mention if you know the entire time that you won’t be there (the reason being irrelevant).

We might just disagree on this and I can accept that

 

[VA Hopeful Dr]

Keep in mind that if she was discriminated against and her rank was changed, she would have to prove that her rank was changed due to her pregnancy status. While we could argue as to whether that would be legal or not, it would be very difficult to actually prove in a court of law.



In my area no accredited daycare will take an infant under 12 weeks old and many will not take children under 6 months or 1 year. So for her to go back to work in 6 weeks would likely require family/spousal help, though this certainly could be different in other areas of the country.

It is, daycares here will start at 6 weeks if vaccinated at that age.

 

[deleted480308]

It is, daycares here will start at 6 weeks if vaccinated at that age.

This important part is they will also charge enough to cover rent for an baby that age, and residents don’t get loan increases for daycare.

>$800 month in daycare adds up

 

[Bronze Medal]

Sent PM

 

[Crayola227]

I don’t think we need a law either way.

I’m not saying the programs have a right to her due date but when one is entering an agreement to start work on a certain date, I find it morally relevant to mention if you know the entire time that you won’t be there (the reason being irrelevant).

We might just disagree on this and I can accept that

Does it make a difference that she doesn't actually know if she won't be there or not? She doesn't know she won't be able to, and sincerely intends to be. Again, I don't think there is an issue for her to match, accept a position, and then plan for the case that things don't work out as everyone hopes. It makes zero sense to me for that to be something she addresses with an employer before they are even her employer.

What if, God forbid, she miscarries? She could give birth early. Something could happen and then an early c-section is indicated. She could deliver late. No one knows, and disclosing this at the point that this is not even entirely relevant to the negotiation of employment, makes no sense to me. This is why at this stage of the game, this sort of discussion is illegal. They are to be assessing one another's suitability for employment based on qualifications and abilities, not prognosis. She is agreeing to start 7/1. This pregnancy may or may not be a factor in that happening, but that's all that needs to be in place legally speaking at this point. Since no one can say for certain she cannot start, matching is in good faith and would not be non-binding based on bad faith.

The point is not that she is accepting a position knowing the whole time she won't be there. The point is that this pregnancy (and at least according to the law, reasons for these decisions are relevant) is not appropriate for programs to consider in how they rank applicants. The end.

As far as how this affects her employer at the time that it is their legal right to know, that is a different story. When they are entitled to the information, they should have it and be able to plan accordingly. But not before.

I find it morally relevant that medical training is structured in this way, that it is discriminatory to the extreme for people for having basic life functions or malfunctions, but that's a different debate I suppose.

 

[Stagg737]

This important part is they will also charge enough to cover rent for an baby that age, and residents don’t get loan increases for daycare.

>$800 month in daycare adds up

Lol, there are no daycares near me anywhere near that cheap and I'm in a very cheap COL city...

 

[deleted480308]

Does it make a difference that she doesn't actually know if she won't be there or not? She doesn't know she won't be able to, and sincerely intends to be. Again, I don't think there is an issue for her to match, accept a position, and then plan for the case that things don't work out as everyone hopes. It makes zero sense to me for that to be something she addresses with an employer before they are even her employer.

What if, God forbid, she miscarries? She could give birth early. Something could happen and then an early c-section is indicated. She could deliver late. No one knows, and disclosing this at the point that this is not even entirely relevant to the negotiation of employment, makes no sense to me. This is why at this stage of the game, this sort of discussion is illegal. They are to be assessing one another's suitability for employment based on qualifications and abilities, not prognosis. She is agreeing to start 7/1. This pregnancy may or may not be a factor in that happening, but that's all that needs to be in place legally speaking at this point. Since no one can say for certain she cannot start, matching is in good faith and would not be non-binding based on bad faith.

The point is not that she is accepting a position knowing the whole time she won't be there. The point is that this pregnancy (and at least according to the law, reasons for these decisions are relevant) is not appropriate for programs to consider in how they rank applicants. The end.

As far as how this affects her employer at the time that it is their legal right to know, that is a different story. When they are entitled to the information, they should have it and be able to plan accordingly. But not before.

I find it morally relevant that medical training is structured in this way, that it is discriminatory to the extreme for people for having basic life functions or malfunctions, but that's a different debate I suppose.

We could all be hit by a bus today and die.

But when I decide what it takes for me to face the mirror each morning I couldn’t enter an agreement saying I would start 7/1 if I knew I’m almost 100% not starting 7/1. Legality isn’t at all relevant to that for me.

But despite our near complete disagreement on this thread we do agree that hospitals should not staff in a way that residents are necessary to keep the place running

 

[Piebaldi]

Lol, there are no daycares near me anywhere near that cheap and I'm in a very cheap COL city...

Let's keep in mind that OP said that her parents would be moving in to help - so perhaps daycare issues are a null subject

 

[Dave1980]

I think it is important to tell the program before the match for your own benefit. You will need a program director and program culture that will be accommodating to you and your needs.

You will be so much happier and more successful if you go somewhere that is not a pressure cooker and values work-life balance.

 

[rokshana]

She mentioned 6 weeks, not 2 months. I agree with you though that 6 weeks is still too much. Ideally she should take 4weeks off, which would essentially be 1 rotation - so she can maybe be scheduled for an elective, which obviously someone has to start with anyways. Many electives are call free so it would not screw everyone over if that's the case. I started more than 2 months later due to personal issues and was accommodated. So it can happen.

She actually mention the “first few months “ in the post I quoted.

 

[DokterMom]

Not telling someone something that is NOT their business, they are NOT entitled to know legally, at the time that that is true, is not hiding or deceit.

If her due date were June 1st or August 15th (If I recall, the contractual work period is 45 days) then I would agree completely as she would have reason to believe she could meet the technical requirements as agreed in the contract.

I’m not saying the programs have a right to her due date but when one is entering an agreement to start work on a certain date, I find it morally relevant to mention if you know the entire time that you won’t be there (the reason being irrelevant).

Pretty much this --


OP - You're asking LEGAL questions and there are conflicting legal principles in play here. Quite simply, you need legal advice from a legal professional -- AKA lawyer.

 

[atomi]

If you were a program director @Medstudent9 and found out immediately after the match that one of your brand new residents would not be able to start work as promised on July 1st due to a known-to-her (but not to you) temporary disability -- How would you feel about that resident? How would you feel about her professionalism? How would you feel about her appreciation for the importance of teamwork and transparency? And fair-dealing? And importantly for the OP, how might your feelings (and those of her over-burdened future teammates) translate into how her future colleagues regard her and treat her?

I'm not a lawyer, but what is your basis for claiming that lowering her ranking would be illegal? It is not illegal for an employer to insist that an applicant be able to perform the tasks necessary for the job, and showing up July 1st and working for 45 days is explicitly stipulated in the employment contract. The OP already knows that she is almost certainly unable to fulfill the terms of the contract. I'd sooner argue that signing a residency contract under those terms would be fraudulent.

It's true that there's never an ideal time for a career woman to have children. I've been there, have the scars to prove it, and am as pro-working-mom as you're ever going to find. But some circumstances are simply untenable.

I typically disagree with your posts, but you are spot on in this case. If you’re applying for a job that has a specific start date and can’t start on that date, you need to make that clear.

I think the options here are:

1. Email every program coordinator and director and tell them you love their program and really want to go there but are due July 1st and will have to start late and want them to know this up front before they rank you. Some programs might drop you from the rank list, yes. But you probably didn’t want to go there anyway. Some PDs are flat out anti-family and anti-pregnancy, and we all know that. Others will be supportive. I can’t imagine a female PD being too hostile about this and would probably appreciate your candor and view it as a positive speaking something about your character. You may even get moved up the rank list.
2. Sit out the match this year. If you are applying to a small competitive field requiring inpatient call coverage, this may be the best option.

Keeping it a secret is risky. But ultimately I think if you did this you would be allowed to start late. PDs are not going to want the drama of people saying they fired a resident because she was pregnant. It’s not exactly a good way to start your residency though.

 

[dpmd]

Regardless I think it's a terrible idea to wait out a year. I think she should just start later even if not ideal.

She is not legally entitled to starting later so her option is to wait a year or potentially be a match violator if her program is not nice to her.

 

[Piebaldi]

She is not legally entitled to starting later so her option is to wait a year or potentially be a match violator if her program is not nice to her.

A match violator? Not being able to start is not a match violation. Its not that uncommon - i even started late and it was not that big of a deal.

 

[rokshana]

A match violator? Not being able to start is not a match violation. Its not that uncommon - i even started late and it was not that big of a deal.

actually it can be construed as a match violation if the matched applicant "decides not to honor the commitment to his/her matched program, i.e. is a "no show" for the matched program".
by not being able to work on July 1st, it can be taken as a no show, and the program can decide to report it if they want to and void her match agreement...everyone who participates in the Match signs that they will follow the requirements set by the NRMP. They do note serious hardships as something that can offset, but pregnancy is not one of them.

will a program actually do this, its hard to say how strict they will be...would depend on how much of an impact it has on the program...program that has 10 interns will be impacted differently than one with 50.

OP have you talked to your home PD or aPD? after all they have to be aware /will be that you are pregnant...maybe they can give you some insight.