Would being pregnant going into intern year have changed your ranking of pediatrics programs?

[Naruhodo]

Hey SDN,

So, hypothetically, say one were to have a positive pregnancy one week before their rank list for pediatrics was due, would this information have changed the way in which you ranked programs? All the programs where you applied were medium to large residencies (>20 residents) and many of them are at academic centers and known to be intense places that work their residents hard. On the interview trail every place said they were family friendly, and then in the next breath recommended waiting until 3rd year of residency to have kids if possible. Of the programs you are most excited about, the closest one to family (who are older and might not be able to help much even if they wanted to) is still a 2hr drive away. Given the timing means giving birth 4 months into residency do you A) Immediately notify your top programs so that they have the option not to rank you if they are a place where it would be miserable to be a pregnant intern, B) Notify the program where you match on match day to start the planning process, or C) Wait until 12 weeks as by that point the risk of early pregnancy loss (which you have previously experienced) will be lesser to notify the program where you matched.

Thanks for any and all thoughts! Please keep it kind

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[SurfingDoctor]

Hey SDN,

So, hypothetically, say one were to have a positive pregnancy one week before their rank list for pediatrics was due, would this information have changed the way in which you ranked programs? All the programs where you applied were medium to large residencies (>20 residents) and many of them are at academic centers and known to be intense places that work their residents hard. On the interview trail every place said they were family friendly, and then in the next breath recommended waiting until 3rd year of residency to have kids if possible. Of the programs you are most excited about, the closest one to family (who are older and might not be able to help much even if they wanted to) is still a 2hr drive away. Given the timing means giving birth 4 months into residency do you A) Immediately notify your top programs so that they have the option not to rank you if they are a place where it would be miserable to be a pregnant intern, B) Notify the program where you match on match day to start the planning process, or C) Wait until 12 weeks as by that point the risk of early pregnancy loss (which you have previously experienced) will be lesser to notify the program where you matched.

Thanks for any and all thoughts! Please keep it kind

They aren’t allowed to ask or know about pregnancy in their ranking. It’s against the rules. They are required to give you maternity leave. It’s in the rules.

Once you’ve matched wherever and they ask for scheduling requests, then you tell them of the pending birth and then they accommodate.

 

[mvenus929]

I would not notify programs now.

I would notify whichever program you match at as soon as they start asking for schedules, even if that is still first trimester. The chiefs will appreciate the heads up and if you do experience a pregnancy loss ( ), it will be much easier to move things around in the schedule than if they build the schedule and then have to redo it because you'll be out on leave for x weeks.

 

[Stitch]

No need to notify them now, but as mentioned above, let the program you end matching to know as soon as possible so they can schedule. Pregnancies happen and they are obligated to make sure you have leave. Chances are you'll also have your schedule changed for someone else's pregnancy at some point. Intern year is pretty busy, so if you end up on bed rest or having complications it may be necessary to make up a rotation or time, but they will best be able to help you plan with as much notice as possible.

 

[Naruhodo]

I went ahead and notified my top five programs just in case (partly to be able to ask some more details about leave, etc.). It surprises me how few places, in peds no less, are actually following the new ABMS guidance of 6 weeks parental/family leave without using up all vacation time or having to extend training.

 

[SurfingDoctor]

I went ahead and notified my top five programs just in case (partly to be able to ask some more details about leave, etc.). It surprises me how few places, in peds no less, are actually following the new ABMS guidance of 6 weeks parental/family leave without using up all vacation time or having to extend training.

My guess, without knowing the specifics, is that it is a reflection in the real world. When you are part of a group of physicians, if one of your partners is out (for whatever reason), the rest of the group has to cover. The options to that are 1) you cut into your vacation to cover your salary or 2) your salary is reduced and given as compensation to those who covered for you. It is kinda an either or situation. You really can't expect others to work on one's behalf without compensation... and money is finite.

 

[Naruhodo]

My guess, without knowing the specifics, is that it is a reflection in the real world. When you are part of a group of physicians, if one of your partners is out (for whatever reason), the rest of the group has to cover. The options to that are 1) you cut into your vacation to cover your salary or 2) your salary is reduced and given as compensation to those who covered for you. It is kinda an either or situation. You really can't expect others to work on one's behalf without compensation... and money is finite.

Fair enough, but all of these are large residencies (>30 residents per year) where the impact of any new parent (or even multiple new parents) being out for 6 weeks would seem unlikely to cause a staffing shortage. With regards to pay, there is no option to decline your residency salary for 2 weeks (or whatever period) and still graduate on time. At my institution attendings are offered (and generally take) 12 weeks parental leave without negatively impacting their job security or pay, so it seems like a disparity when it comes to resident leave (which is almost certainly less expensive). I think we can strive to do better is all that I am saying.

 

[SurfingDoctor]

Fair enough, but all of these are large residencies (>30 residents per year) where the impact of any new parent (or even multiple new parents) being out for 6 weeks would seem unlikely to cause a staffing shortage. With regards to pay, there is no option to decline your residency salary for 2 weeks (or whatever period) and still graduate on time. At my institution attendings are offered (and generally take) 12 weeks parental leave without negatively impacting their job security or pay, so it seems like a disparity when it comes to resident leave (which is almost certainly less expensive). I thank we can strive to do better is all that I am saying.

Yeah, I’m not really defending the practice, just saying how it is. I think there is plenty of fluff in pediatric residency that could outright be dumped from training and the graduates would be no worse for the wear. But the ABP (and many medical boards) as well as the ACGME are generally inflexible when it comes to things like that.

As far as attendings, they don’t get a salary reduction you’re right, but typically they have togenerate sufficient RVUs to justify their pay. Any person who takes time off for whatever reason (usually family related) has to make it up somehow. All FMLA does is protect an employee from not getting let go. Should residents be held to a different standard? I guess not, but again residency training is governed by external bodies, while attendings are governed by the institution that employs them. Again, I guess one could argue whether that’s fair or not and to whom, but for now, I don’t see things changing.

As far as the 6 weeks thing, are you saying that they aren't following the policy? I mean, the reality of that is that when residents get to evaluate the program, if they feel like the program isn't adhering to the standards put forth by the ABMS/ACGME, they can comment on that. If enough people comment, and the program is determined to be deficient, then in gets reviewed/audited. I guess not giving the 6 weeks (though the website I looked at just said programs were "encouraged", which makes it not sound enforceable) could potentially be viewed similar to duty hour violations.

 

[Naruhodo]

As far as the 6 weeks thing, are you saying that they aren't following the policy? I mean, the reality of that is that when residents get to evaluate the program, if they feel like the program isn't adhering to the standards put forth by the ABMS/ACGME, they can comment on that. If enough people comment, and the program is determined to be deficient, then in gets reviewed/audited. I guess not giving the 6 weeks (though the website I looked at just said programs were "encouraged", which makes it not sound enforceable) could potentially be viewed similar to duty hour violations.

Yup, only one of my top 5 ranked peds programs will be following the standards put forth by the ABMS (ABMS Announces Progressive Leave Policy for Residents and Fellows). I appreciate your suggestion because even if it doesn't directly help me (though I hope reaching out and starting this conversation early will do some good) hopefully it will help residents down the line and normalize it.

To be honest, I experienced some real sadness when I realized 4 of my favorite programs basically had no or minimal accommodations for resident parental/ family leave. I realized I should have asked these questions earlier (so I'd know my 6-8th ranked programs' policies). I thought I would be good by only applying to larger residencies, but clearly this isn't the only factor. Not that we have to justify the timing, but I turn 40 the year I finish residency, we'd already been trying for over a year and experienced a 3rd year of med school miscarriage, and had started the IVF workup so that we could at least have some frozen embryos for when I was done with training.

My partner reminded me that despite these residencies having less than ideal leave policies for residents, there's reasons that they were my favorites. This is just one aspect of life, and not a reason to totally resort my list of programs.

 

[SurfingDoctor]

Yup, only one of my top 5 ranked peds programs will be following the standards put forth by the ABMS (ABMS Announces Progressive Leave Policy for Residents and Fellows). I appreciate your suggestion because even if it doesn't directly help me (though I hope reaching out and starting this conversation early will do some good) hopefully it will help residents down the line and normalize it.

To be honest, I experienced some real sadness when I realized 4 of my favorite programs basically had no or minimal accommodations for resident parental/ family leave. I realized I should have asked these questions earlier (so I'd know my 6-8th ranked programs' policies). I thought I would be good by only applying to larger residencies, but clearly this isn't the only factor. Not that we have to justify the timing, but I turn 40 the year I finish residency, we'd already been trying for over a year and experienced a 3rd year of med school miscarriage, and had started the IVF workup so that we could at least have some frozen embryos for when I was done with training.

My partner reminded me that despite these residencies having less than ideal leave policies for residents, there's reasons that they were my favorites. This is just one aspect of life, and not a reason to totally resort my list of programs.

Sorry to hear about your issues. Yes, unfortunately medical training (and medicine in general) can be inflexible. But on the upside, training is finite.

 

[mvenus929]

Fair enough, but all of these are large residencies (>30 residents per year) where the impact of any new parent (or even multiple new parents) being out for 6 weeks would seem unlikely to cause a staffing shortage. With regards to pay, there is no option to decline your residency salary for 2 weeks (or whatever period) and still graduate on time. At my institution attendings are offered (and generally take) 12 weeks parental leave without negatively impacting their job security or pay, so it seems like a disparity when it comes to resident leave (which is almost certainly less expensive). I thank we can strive to do better is all that I am saying.

The key is graduating on time--you need to have a certain amount of experience and if you're out for 6-12 weeks, you're going to be at a disadvantage compared to someone who is not.

That said, extending training by a couple weeks isn't the end of the world. We have multiple people who have come into fellowship (or leave fellowship) slightly off-cycle and it's no big deal. One took I think 6 weeks off at the start of intern year to care for a dying parent, and I don't think they regret taking that time even if it caused some complications starting fellowship. We have another who took a full 12 weeks of maternity leave (covered by a combination of sick time, vacation time, and short-term disability), but had to extend fellowship by another 6 weeks, I think. She'll just start her attending job later.

For attendings, they usually get their salary covered by short-term disability insurance in large institutions--that's what our attendings do. They certainly aren't fired, because it'll cost significantly more to replace them than to wait for them to return. But if you're in private practice, you don't really have a short-term disability option--you literally take home what you bill, so if you're not seeing patients, you aren't billing, so you lose that income. I see many women in the women physician finance groups on FB talk about how they're saving up so they can take a real leave, knowing that they'll be without an income for 3 months.

FWIW--the same is true for non-parental leave. One of our fellows has a sick child and is trying to navigate the leave issue without losing income because they are the sole breadwinner for the family. They can legally take 12 weeks of FMLA, but they won't get paid for it.

 

[PTPoeny]

ABP is actually very flexible. You have to complete 33/36 months with the right set of rotations and clinics in those 33 months. The programs could all be giving everyone 12 weeks of leave, they are choosing to do otherwise.

 

[Naruhodo]

ABP is actually very flexible. You have to complete 33/36 months with the right set of rotations and clinics in those 33 months. The programs could all be giving everyone 12 weeks of leave, they are choosing to do otherwise.

This is my understanding too - though what is likely complicating things is that I applied to combined programs that have already trimmed peds training to 24 months. The specific wording is that "vacations, leave, and meeting time will be shared equally between both programs. Absences exceeding 4 of 48 months will have to be made up at the end of training." So this would seem like it would allow time for a 6 week parental leave, as long as one took 2 weeks less vacation the following year, right?

 

[HemeOncHopeful19]

This is my understanding too - though what is likely complicating things is that I applied to combined programs that have already trimmed peds training to 24 months. The specific wording is that "vacations, leave, and meeting time will be shared equally between both programs. Absences exceeding 4 of 48 months will have to be made up at the end of training." So this would seem like it would allow time for a 6 week parental leave, as long as one took 2 weeks less vacation the following year, right?

I saw it frequently in my residency program where someone would take extra maternity leave and shave a week of vacation off in future years so they could still graduate on time.

 

[DO2015CA]

Did you happen to match into the program that was accommodating

 

[Naruhodo]

Did you happen to match into the program that was accommodating

No, I didn't ask for the details early enough to change my rank list in time (my advice to future applicants is to really nail down the way parental leave works at each of your top ranks even before you're pregnant if it's something you're thinking about for the near future). The program where I matched falls in the middle ground - they sent me a potential leave schedule that would give me 8 weeks with baby, use all my vacation, and only delay my graduation from residency by 3 weeks. Not ideal, but better than the program where you max out leave at 6 weeks (using all vacation/sick leave) and have no ability to take more/ delay graduation. The best program in terms of leave allows 6 weeks of leave, 4 weeks of a newborn care elective, without dipping into vacation time or delaying graduation. If future applicants are facing this and want program names send me a direct message (though I hope that better leave policies like the last example, will become standard with time).

 

[SurfingDoctor]

Probably should just scrap behavior/development as a rotation. If you’re having a kid... you’ll get that experience first hand, continuously.