Parental Leave for Residents

I run the risk of pissing a lot of people off here but this study just gives me pause. Here is what it found:

Leave policies for residents who become new parents are uneven, oft-ignored by training boards, and provide less time off than similar policies for faculty physicians.

 Though all 12 schools provided paid childbearing or family leave for faculty physicians, only 8 of the 15 did so for residents (JAMA. 2018 Dec 11;320[22)]:2372-4).

In programs that did provide leave, the average of 6.6 weeks of paid total maternity leave for residents was less than the 8.6 weeks faculty receive.

Okay, this is interesting. For one, I agree that there has to be some unpaid maternity leave for ALL schools. I get that. But who says that it has to be equal to the faculty? This is their full time job. This is their careers. The others are in training. They are residents. They are not equal. I know this sounds harsh in this politically correct climate but not everything has to be the same. Should a surgery resident in his third year get 8 weeks for a his first kid’s birth while the other seven residents get destroyed on their rotations? I know we are trying to be more kind to this situation but there is a bigger picture here. There is only a finite amount of residents doing a ton of work. It’s just not that simple. Residents are just not equal to faculty members. Am I being too harsh here? I would love your thoughts on this.

EDITOR’S NOTE: Obviously this hit a nerve. I want to point out a couple of things. One, see the second line in the paragraph above. “For one, I agree there has to be some unpaid maternity leave for ALL schools”. Ladies, I am on your side!!! My real question is whether residents, who are in training, are the same as faculty in the AMOUNT of time needed off. Should they be equal? Should they get the same pay? The same amount of vacation? The same days off for maternity leave? Or what about paternity leave? Is that different?

Lastly, are we at a point that a question can not be asked without being hammered? People now claim they lost respect for me. What? I openly asked for your thoughts. Can we do this in a civil manner?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  37 comments for “Parental Leave for Residents

  1. Adrienne
    February 19, 2019 at 12:30 am

    The short answer is yes: I do believe that residents deserve maternity/paternity leave equal to what an attending would get. This question, in my mind, is a basic test of empathy. Are residents any less human than attendings? Do they bleed less? Do they have capacity to heal faster, or pick up breastfeeding more quickly? No? They’re also human? Then maybe we should have some empathy and compassion and treat them with the basic human dignity that we would one of our patients. As an obstetrician, if someone asks me when to return to work after a delivery, I don’t ask if they’re a resident or an attending.

    Caring for our fellow human beings can sometimes, unfortunately, come at a cost to us. Maybe it’s in terms of free time spent on outside interests, or in terms of sleep, or in terms of time spent with family. If you speak with ANY physician who also happens to be a parent (especially a mother), we make this calculation EVERY SINGLE DAY. How much time and emotional energy can I give to my patients and still have enough left over for my spouse and children? And will there be any time left for self care? (probably not) But there are times when some of us have more to give, and times when some of us are struggling. As one who has been a resident without children, a resident with one child, an attending with one child, and an attending with two, undoubtedly the toughest time was having a child as a resident. Upon reflection, it was even tougher than I perceived it at the time.

    The title of your blog is “Authentic Medicine”. Unfortunately, this is truth — this is an authentic version of what most female residents encounter. Fellow residents joking, “How was your vacation?” when you return, not fully healed, not even close. The heart of this is that our parental leave system is not set up to realistically support parents — instead, it forces coworkers to turn against each other and decide who deserves time off and who doesn’t.

    And no, you can’t get out of it by saying “Ladies, I am on your side!” If you were, you wouldn’t even be asking this question. This is not the question that an advocate of women would ask, which is likely why you’re getting this unexpectedly negative response. I urge you to reflect on this experience and ask what an advocate would ask, which is: “How can I help?”

    • Doug Farrago
      February 19, 2019 at 6:39 am

      Sorry, I disagree and I am not trying to get out of anything. Sorry you thought that. If I wanted to get out of anything I would delete the post. And yes, I can ask ANY question I want. It is a free county and my blog. I will not be bullied into not asking questions. What you bring into your response is your own baggage and doesn’t even address the question I asked. What if faculty gets 16 weeks and you were offered only 12 as a resident? Is that fair? That was my point. Are we in a time where residents, who are millennials, think they should get all the perks of faculty? And you don’t even bring up the example of the MALE surgery resident wanting parental leave that I used. No one wants to defend him. Isn’t that hypocritical. Maybe you should read the blog without so much anger next time.

      • Elizabeth
        February 19, 2019 at 7:33 am

        Parental leave is not a perk. That is where your thinking is flawed. We aren’t talking about vacation or a healthcare spending account or a parking spot.

        • Doug Farrago
          February 19, 2019 at 7:42 am

          Okay, if that is true, then what amount is appropriate that would make you happy? 8 weeks? 12 weeks?

  2. OrthoMom
    February 18, 2019 at 9:48 pm

    Wow. So residents are not real people? Not humans? I had a baby in residency. Senior ortho resident. Finished grant proposal during my induction. I rounded postpartum day 3. I was in the lab with my baby in a carrier week 3. I went back full time after 5 weeks but was in and out the entire “maternity leave”. To say residents cannot have equal leave because they are slave labor and it’s harder for everyone else is bullshit. I’m supposed to do 4 years Med school, 5 years residency and a fellowship and NOT have a baby during the entirety of my fertile life? Fuck that. I worked my ass off my entire pregnancy to not put anyone out. I took more call, did the hardest rotations and never complained. I was up every 2-3 hours for an entire year breastfeeding, pumping every spare minute during the day while never letting a patient beat me to the OR.
    To say I’m not equal because I am a resident is the most ridiculous thing I’ve ever heard.

    • Doug Farrago
      February 19, 2019 at 6:41 am

      But you’re not equal. You’re in training. We now have millennials in residency. Some believe they should get the same pay as faculty. Is that fair?

  3. Lilliana
    February 18, 2019 at 3:36 pm

    Uteruses are not aware of the medical hierarchy. The baby of a resident does not need less time with their mother because she is a resident. A grown up adult in training can suck up extra hours. A baby needs their parents.

  4. Jamie
    February 18, 2019 at 3:07 pm

    Residency is both a job that pays and also training/education that is “paid for” by the individual. The individual is only accepting such low pay for such long hours and hard work because they are acknowledging that they are receiving training/education in exchange, rather than receiving more robust pay. I think all residents deserve at least 6-8 weeks of paid parental leave and deserve a choice in taking another 6-8 weeks of unpaid leave beyond that. (Of course, I think 12 weeks of paid leave for all would be great, but as a business owner, I know there are budgets and limited resources.) I think if faculty in a program receive 8 weeks of paid parental leave, then residents should receive 8 weeks of paid parental leave. The faculty will be paid at their full and much higher rate for their paid parental leave. The resident will be paid at their full and much lower rate for their paid parental leave. It is true, residents are not faculty, and that is why they only make an average of $10/hour (my estimate). But they should be offered the same parental leave benefits because they are not only training, they are also performing work for the health systems in which they train. Residents are still salaried professional staff in the system and so parental leave for all salaried professionals should be the same. My opinion.

  5. Jennifer Hollywood
    February 18, 2019 at 2:09 pm

    I found out that I was pregnant the first week of intern year. I told my chief resident ASAP and they arranged the schedule so I would be out on “elective” type rotations during my delivery time that I could make up any time. That way there was minimal impact on the other residents. I felt bad for inconveniencing others, but everyone was so nice. I was back at work after 6 weeks. Some paid time and some unpaid time. My choice to return. Plus the daycare wouldn’t take the kids before 6 weeks time. My husband only got one week off work from a regular job. And all of it was unpaid. I knew what I was getting into when I got pregnant. I did NOT expect the same benefits as an attending physician. I had to extend my residency at the end for 2 months to make up for time missed, but it was all fine. I don’t think that residents are entitled to the same benefits as attendings. The residents are sort of a temporary long term employee whereas the attendings are there truly long term as a career.

  6. Anjali
    February 18, 2019 at 2:09 pm

    What makes you think that it is different for attendings? Their colleagues have to do extra while that person is gone as well. Residency is the perfect time to learn how to take care and help your colleagues, because in fact, this will most certainly occur as an attending.

  7. Cristina
    February 18, 2019 at 2:09 pm

    Wow, this should not even be a topic to he discussed. ALL mothers and fathers should be able to have maternity leave, prolonged for the breastfeeding mother!! I did NOT have a baby in residency, have had 2 as an attending and will tell you residency was a piece of cake, no amount of call compares to the exhaustion of having a newborn and working (came back to work after ONLY 7 weeks with my second and boy do i wish i could have stayed at home longer), thankfully at 4 months my newborn and her 3 yo brother finally decided to start sleeping through the night, cause i will tell you i RUN on coffee and live exhausted (with a cushy 8-4 Mon-Thurs office job).

    You are at residency to learn and wor while learning, if no patients to see no residency, so if you need to see a few more for 2 months, big (insert your word of preference) deal, the resident who actually had a baby and lives twice as exhausted as you will make up her time and finish later.

    Grow up.

    #millenials

    • Pat
      February 18, 2019 at 6:13 pm

      Cristina, what makes a pregnant resident more special than any other? What gives you the right to use your anger to make choices for those who didn’t have your baby?

      Stop whining.

      #accountable

      • Anjali
        February 18, 2019 at 9:32 pm

        A pregnant resident is bringing a human being into the world. She is literally carrying on the human race, and by the way doing everything you do. So grow up, take a few extra calls, and learn that your few extra calls will never compare to what she is doing. #stopcomplaining

      • Anjali
        February 18, 2019 at 10:12 pm

        Ummm a pregnant resident is bringing a human into the world while doing everything you are- she is perpetuating the human race. The fact that you have to cover for a couple of months is a joke compared to what she is doing. #stopwhining #accountable #growup #showsomehumanity

  8. Tatiana
    February 18, 2019 at 1:57 pm

    First, let me preface by saying I have HAD a lot of respect for you. I remember listening to you talk at a DPC conference and recommended your book to others multiple times and loved your motivational journal. I am very disappointed to read this post. I was one of those residents who had not only one but TWO kids during residency. I only had 4 weeks after having my first one, and 3.5 months after the second one. You know what, I don’t regret taking those 3.5 months (even though I had to extend my training) but I still feel guilty I only took 4 weeks with my first baby. I will also let you know that I had all my core, call heavy rotations scheduled so my leave won’t affect others. And yes, it meant I was in ICU taking 36 hour calls at the beginning of my 3rd trimester. And no, I don’t feel guilty for having kids and taking time off, even tough, according to you, I shouldn’t have been allowed to do. Even more, I will mention, there is NEVER a perfect time to have a baby. When you are an attending, there are problems with coverage as well.

    • Doug Farrago
      February 18, 2019 at 2:09 pm

      Tatiana, I guess you missed my point. Please re-read it. All I asked is whether residents should get the same amount of time as faculty. In other words, are residents equal to the faculty? I never said there should be NO time off. That was the question I posed. If I lost your respect for asking a question then there is not much I can do.

      • Julie
        February 19, 2019 at 5:43 am

        Of course residents are “equal” to attendings in their needs to recover, bond with their baby, enjoy those precious first moments as a family.

        • Doug Farrago
          February 19, 2019 at 6:54 am

          That wasn’t my question…at all. What about the male surgery resident who wants the full 8 weeks off? No one is defending him. Are they equal to faculty as far as pay? Vacation? This was made into an attack on women and it wasn’t. What if the faculty get 16 weeks off but the residents only get 12. Is that fair?

  9. Rachel
    February 18, 2019 at 1:38 pm

    I had my first child as a third year resident. I was on bedrest for a few weeks and went back to work 3 weeke after a c-section. I wouldn’t wish that on my enemy. I felt bad about missing time and pushed myself beyond what I should have. In the end I graduated on time… and also had a wound dehiscence. I think we are humans trying to balance work and family and we as a whole need to learn to support this. I am forever grateful to my fellow residents who helped whenI couldn’t work. I did my best to reciprocate. We aren’t robots. We are highly trained individuals who, in my opinion, needa better system of support in place to prevent burnout

  10. Doug Farrago
    February 18, 2019 at 12:05 pm

    Has anyone answered my actual question of whether residents should have the same time off (or benefits) of faculty?

    • Rachel
      February 18, 2019 at 1:28 pm

      Residents earn less than 1/4 of what faculty make and work more hours (and thus have to pay for more childcare), so paid leave is crucial is doesn’t cost that much for low earners.

      As far as coverage, I both had a baby in residency as well as “covered” for many coresidents who had babies. Switching rotations around is way easier than making up for an attending partner who’s out, not to mention that waiting until after residency to have children may mean missing that biological window. When did continuing the human race become a “selfish” individual endeavor? And I assume everyone complaining about it has never cared for a newborn before, because it’s exhausting, and when your coresidents do come back and are working 80 hours a week and waking up multiple times at night to take care of a baby, you should be glad they got as much “rest” as they did.

    • Pat
      February 18, 2019 at 6:15 pm

      My answer: NO! They are not faculty and should not get favoritism.

    • Julie
      February 19, 2019 at 5:48 am

      Yes, they should have the same benefits and the same if time off as faculty. And they should have the same amount of respect. This is a blog about “being the change we want to see in the healthcare system”, right?

      • Doug Farrago
        February 19, 2019 at 6:32 am

        I’m not sure I agree. A resident doesn’t get the same respect as faculty. That is earned. Benefits? Nope. Faculty, and I am not one, are in their end career. They get the vacation, pay, and CME amount commensurate with that level. The caveat, as I am hearing people say in this blog, may be for maternity leave. Okay. But my blog points out a male surgery resident as an example and no one says a word in his defense.

    • Kevin
      February 19, 2019 at 9:48 am

      Yes Doug. Everyone has answered your question. They just haven’t agreed with you and so you’re doubling down on a bad post. My recommendation is to give birth to a baby and then reassess, or else stop explaining maternity leave to the female doctors on here.

      • Doug Farrago
        February 19, 2019 at 10:42 am

        Yeah….uh, no. Not moving on. Sorry, dude, but you can move on. Thanks for explaining how insensitive I am. Wow, you are so enlightened. If we live in a world we can’t ask questions then I understand. But we don’t. Otherwise, my sandbox.

  11. Aruna
    February 18, 2019 at 12:05 pm

    There is so much wrong with the original post and the responses from make docs. For the greater good, we all have to make sacrifices. Women do it all the time and as women become more of a fixture in our working economy, men have to do the same. This is also an issue of the next generation. We as a society should invest not only in women but also our future, the babies that we bring into this world….giving time for the new mom and baby to bond and allow the mom to heal in mind and body is great not just for the residency but for the society as a whole. As women when we ask for equality, we are not sacrificing our womanhood and everything that comes with it. I was pregnant in residency and took 3 months off. 6 weeks paid and 6 weeks unpaid. Do you know that the sleep deprivation and the stress of childbirth causes cognitive dysfunction that can adversely affect clinical outcomes? As for the lady who came back in 2 weeks, my sympathies for her kids. This is simply the case of men not being able to walk in a pregnant or nursing womans shoes. Finally, how is it that the Scandinavian nations are able to afford great maternity and paternity leaves and yet have a healthy and happier population and a thriving economy….

  12. February 18, 2019 at 11:52 am

    There are always multiple sides to every story and every situation. I wrote about this recently, responding to a fellow female physician who waited to have kids (and now hasn’t) and told my story of having my first during internship (and not getting any extra time off). It’s a pretty awful situation to be in. http://www.randdiab.com/2019/01/05/having-kids-in-residency-a-perfect-storm/

  13. Amanda
    February 18, 2019 at 11:50 am

    Interesting the only people commenting are men who won’t have to wait till they are 35 to have kids or go back to work 2 weeks after having major abdominal surgery. I hope you are more compassionate to your wives after they gift you a child. It’s a lot more than staying home after giving birth.

  14. Jeanie Princw
    February 18, 2019 at 11:16 am

    Oh my goodness! You have GOT to be kidding me. I’m a female physician who did not happen to get pregnant during residency. However? I never begrudged those who did. There is never a perfect time. Do you think it’s better when you are an attending? As if there is an ideal time? It’s sad that female physicians are made to female that they are putting a hardship on others by this. For goodness sakes suck it up! Attending a can certainly make up the difference so that residents don’t feel more overwhelmed or go over their “hours”. Shame on anyone who is more interested in themselves and how it affects them. It’s not like it’s a vacation. Being up every hour and a half breastfeeding isn’t a party and believe me when I say that no new mom feels rested. We chose medicine. We are all tired at times (and yes i did residency in the era of working your ass off without time limits). I’m not advocating for making residents work more hours. Just have some compassion. Residencies can figure it out and should.

  15. Randy
    February 18, 2019 at 8:23 am

    “Should a surgery resident in his third year get 8 weeks for a his first kid’s birth while the other seven residents get destroyed on their rotations?”

    This really hits at the crux of the matter. The current societal climate says that the other seven residents should just shut up and get killed.

    The problem is the same in small groups. When it’s just 2 or 3 docs sharing coverage, it’s a big deal when somebody leaves for two months. If you complain then you’re the bad guy.

    • Sangeetha Kolluri
      February 18, 2019 at 1:56 pm

      having completed a 5 year residency in surgery, I’m in a pretty good place to strongly disagree with you. Nobody complains when the male resident breaks his femur skiing, or when he gets appendicitis and it turns out his appendix was gangrenous and he needs a longer recovery with a percutaneous drain, or when a resident is diagnosed with multiple sclerosis or a seizure disorder and needs intermittent leave. All of these are health issues that require time for recovery. You said earlier that “if you complain, you’re the bad guy”. What kind of person would complain when the above scenario has happened? It would be heartless to do so.

      Like all parents, I chose to have kids. But I didn’t choose to be the parent with the uterus and the breasts. And unlike the above scenarios, women giving birth are able to give several months of notice to allow for accommodation. I belong to a group of over 80,000 female physician parents worldwide who all disagree. And I belong to a group of 2,000 female surgeon parents who all disagree and would add a few extra choice words.

  16. Thomas Guastavino
    February 18, 2019 at 7:31 am

    Each program should hire one extra resident. If a resident takes off for family leave then the other residents get the same time off either for their family leave or as an unpaid vacation. The biggest issue is the extra workload for the other residents , hence the extra resident.

    • Eliza Bruscato
      February 18, 2019 at 10:59 am

      Amen!

  17. Pat
    February 18, 2019 at 7:19 am

    One of my best friends in residency got pregnant early in 1st year, and toughed it out till the end, 2 weeks off, then back to it. We respected her for it, and didn’t hear any whining for special considerations. But there is a big difference between 2 weeks and 6.

    Which is what I think most mandated maternity leave is, special consideration. In the middle of a busy workload, why the hell should the other residents have to pick up the slack for unfilled call rotations and extra patients, just because one of them wants to be home with a newborn? I call bullshit. It was the individual’s choice, and punishing the others without their consent as a matter of policy is wrong. And any other resident complaining about it will look like a jerk, so they’ll have to keep quiet.

    This is just emblematic of the larger issue of paid family medical leave soon to be mandated by government. Call me hard-hearted, but I think individual’s should do the extra heavy lifting for their own decisions, not foist it upon co-workers and employers.

    • Kelly
      February 18, 2019 at 11:20 am

      LOL Pat! Have you birthed a child? I’m thinking that is a big fat “no”.

      Residency is a picnic compared to maternity leave. Try breastfeeding a screaming baby every 1-2 hours on 4 hours of sleep while you bleed into your mesh underwear and it hurts to move. Then go back to calls and rounding while you are still bleeding because you only managed to get a few weeks off. Try answering a pager overnight while your baby is still waking up every 3 hours. Boo hoo you have a few extra calls (which by the way most programs make us make it up anyways)

      Yes, this is a choice (to some people it was not a choice and before you comment on that, it takes 2 to make a baby) but hello, how do you think you got here? Babies don’t make themselves and men aren’t able to birth them. Thus it falls on us, the women. And yes, women are and will be in medicine whether you like it or not.

      P.S. I’m a damn good doctor and mother and I make no apologies for any of it

    • Jess
      February 18, 2019 at 12:24 pm

      Wow, I’m glad my co-residents were more supportive than Pat. I had a baby during residency. I took 8 weeks off (4 weeks unpaid). I will make up 4 weeks at the end of residency. I also made up all of my missed calls. Men and women in my program have babies and understand that it’s not a vacation. It’s hard freaking work.

      Yes, I think residents should get the same amount of time off. does that have to be paid time? No. But it should be the same length. If a resident had a chronic illness, should they get less time off than a faculty member for treatment just because they are “in training”? I hope not.

      Sorry if this response has any errors or run on thoughts. I’m trying to workout (yes, as a resident!), on my post call day, while my child naps.

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