Position paper on family or personal leave, including pregnancy, during residency

Gender Equity in Medicine and Dermatology in the United States: The Long Road Traveled and the Journey ahead

Over the past 50 years there has been an increase in the representation of women in medicine with similar rates of men and women graduating from medical training today. Nevertheless, gender gaps in leadership, research publications, and compensation persist. Herein, we review trends in gender differences among leadership positions in academic medicine with a particular focus on dermatology, evaluate the roles of mentorship, motherhood, and gender bias on gender equity, and discuss constructive solutions for addressing gender inequities that persist in academic medicine today.

Parental Leave Policies in Residency: A National Survey of Internal Medicine Program Directors

PURPOSE

To characterize the existence, accessibility, and content of parental leave policies, as well as barriers to program-level policy implementation among internal medicine (IM) program directors (PDs) and to assess the willingness of PDs to implement a national standardized policy.

METHOD

In 2019, the Association of Program Directors in Internal Medicine conducted a survey of 422 IM PDs. Along with other content, 38 questions addressed 4 primary outcomes: parental leave policy existence, accessibility, content, and barriers. The authors compared programs with and without a program-level policy and applied qualitative content analysis to open-ended questions about barriers to policy implementation and openness to a national standard.

RESULTS

The response rate was 69.4% (293/422). Of responding programs, 86% (250/290) reported a written parental leave policy with 43% (97/225) of these originating at the program level. Program-level policies, compared with policies at other levels, were more likely to address scheduling during pregnancy (38%, 36/95 vs 22%, 27/124; P = .018); peer coverage (24%, 21/89 vs 15%, 16/109; P = .037), how the duration of extended training is determined (81%, 72/89 vs 44%, 48/109; P < .001), and associated pay and benefits 61%, 54/89 vs 44%, 48/109; P = .009). PDs without program-level policy reported lacking guidance to develop policy, deferring upward to institutional policies, and wishing to retain flexibility. More than half of PDs (60%, 170/282) expressed agreement that a national standard for a residency program-level parental leave policy should exist. Those not in favor cited organization equity, lack of resources, implementation challenges, loss of flexibility, and potentially disadvantaging recruitment.

CONCLUSIONS

While existing program-level policies included important content, most PDs reported not having them. A national standard to guide the development of program-level parental leave policies could be embraced if it provided flexibility for programs with limited resources.

Parenthood, Parental Benefits, and Career Goals Among Pediatric Residents: 2008 and 2019

OBJECTIVES

Examine reported availability of parental benefits for pediatric residents and impact of parenthood on reported importance of characteristics of post-training positions and career goals in 2008 and 2019.

METHODS

We analyzed data from American Academy of Pediatrics surveys of graduating residents in 2008 and 2019 querying (1) parenthood, (2) benefits during residency, (3) importance of parental benefits and job characteristics in post-training position, and (4) subspecialty career goal. Logistic regression was used to estimate independent effects of gender, partner status, and parenthood via derived predicted values (PVs).

RESULTS

Of 1021 respondents, three-fourths were women. Respondents in 2019 were less likely than in 2008 to have children (24.5% vs 33.8%, P < .01). In 2019, respondents were less likely to report availability of maternity (PV = 78.5% vs 89.5%, P < .001) or parental leave (PV = 42.5% vs 59.2%, P < .001) and more likely to report availability of lactation space (PV = 77.8% vs 56.1%, P < .001.). Most residents reported control over work hours, family considerations, and number of overnight calls per month as essential or very important characteristics in post-training positions. Controlling for resident characteristics, parenthood was associated with importance of family considerations and overnight calls in post-training position. Parenthood did not associate with subspecialty career goals, but gender did.

CONCLUSIONS

Residents are less likely to report availability of parental benefits during residency training in 2019. Most residents, both those with children and those without, consider parent friendly characteristics important in post-training positions. Parenthood does not correlate with subspecialty career goals independent from gender.

Childbearing Decisions in Residency: A Multicenter Survey of Female Residents

PURPOSE

To characterize how female residents make decisions about childbearing, factors associated with the decision to delay childbearing, and satisfaction with these decisions.

METHOD

In 2017, the authors sent a voluntary, anonymous survey to 1,537 female residents enrolled across 78 graduate medical education programs, consisting of 25 unique specialties, at 6 U.S. academic medical centers. Survey items included personal, partner, and institutional characteristics, whether the respondent was delaying childbearing during residency, and the respondent's satisfaction with this decision.

RESULTS

The survey response rate was 52% (n = 804). Among the 447 (56%) respondents who were married or partnered, 274 (61%) were delaying childbearing. Residents delaying childbearing were significantly more likely to be younger (P < .001), not currently a parent (P < .001), in a specialty with an uncontrollable lifestyle (P = .001), or in a large program (P = .004). Among self-reported reasons for delaying childbearing, which were not mutually exclusive, the majority cited a busy work schedule (n = 255; 93%) and desire not to extend residency training (n = 145; 53%). Many cited lack of access to childcare (n = 126; 46%), financial concerns (n = 116; 42%), fear of burdening colleagues (n = 96; 35%), and concern for pregnancy complications (n = 74; 27%). Only 38% (n = 103) of respondents delaying childbearing were satisfied with this decision, with satisfaction decreasing with increasing age.

CONCLUSIONS

Decisions to delay childbearing are more common in certain specialties, and many residents who delay childbearing are not satisfied with that decision. These findings suggest that greater attention is needed overall, and particularly in certain specialties, to promote policies and cultures that both anticipate and normalize parenthood in residency, thus minimizing the conflict between biological and professional choices for female residents.

Parenthood During Graduate Medical Education: A Scoping Review

PURPOSE

To conduct a scoping review of the literature on parenthood during graduate medical education (GME) and to develop a conceptual framework to inform policy and guide research.

METHOD

The authors searched PubMed and Embase for articles published from January 1993 through August 7, 2017, using a query framework that combined the concepts of "person" (e.g., "trainee") and "parenthood" (e.g., "breastfeeding"). They included studies describing parenthood or pregnancy of trainees in U.S. GME training programs. Two authors independently screened citations and abstracts and performed kappa coefficient tests to evaluate interreviewer reliability. Two authors performed a full-text review of and extracted data from each included article, and 4 authors coded data for all articles. The authors used descriptive statistics and qualitative synthesis to analyze data.

RESULTS

Ninety articles met inclusion criteria, and nearly half (43/90; 48%) were published between 2010 and 2017. The authors developed 6 themes that surround resident parenthood: well-being, maternal health, others' perceptions, relationships, program preparation, and policy. They mapped these themes by relationship of stakeholders (e.g., infant and family, institutions) to the resident-parent to create a conceptual framework describing parenthood during GME.

CONCLUSIONS

The findings from this scoping review have implications for policy and research. Those authoring parental leave policies could collaborate with national board leaders to develop consistent standards and include nontraditional families. Gaps in the literature include the effect of resident parenthood on patient care, postpartum health, and policy execution. Research in these areas would advance the literature on parenthood during residency.