Maternity leave in a post-COVID world

I am a female surgical resident. I signed up for this. I chose four years of medical school, five years of residency, two years of research, a year of fellowship, and finally attending surgeon life. I’d choose it again.

And I want this road to be hard. I want my training so tough that I don’t wonder while a patient’s on the table if I’m good enough. I want to know it.

To make us resilient, strong, capable surgeons, the American Board of Surgeons (ABS) and the Accreditation Council for Graduate Medical Education (ACGME) instituted rigorous requirements dictating the number and specific varieties of surgeries we must perform, hours we must work, and limitations on our non-clinical time. We’re told these are essential to become a good surgeon. Female residents know these requirements will place more pressure on us than our male counterparts, but one thought prevails: I want to be a damn good surgeon. So we rise up and meet them.

And yet.

The coronavirus pandemic has done more than shatter our economy and kill tens of thousands of Americans. The ingredients we were previously told make a good surgeon are disappearing as resources are redeployed to fight this virus. Non-emergent cases are canceled. Efforts to distance residents from one another and to safeguard the workforce mandate we minimize who comes into the hospital each day. Teaching conferences on Zoom stand in for hands-on patient care.

The ABS and ACGME recognize that these training opportunities are disappearing. Rather than insisting we all continue to meet prior requirements, they’ve relaxed them. Instead of 48 clinical weeks, 44 will do. A 10% reduction in case volume will be accepted, no questions asked. Apparently, we’ll still be good surgeons.

Huh.

Now that coronavirus is straining hospitals and training programs, we’ve quickly made allowances, but we continue to resist making these same allowances for female residents requiring maternity leave. Weeks into canceled cases and didactic-driven learning, it’s becoming more apparent that Family and Medical Leave Act (FMLA)-compliant maternity leave policies won’t make us sub-standard surgeons.

The current residency maternity leave model is far from ideal. Despite the FMLA mandating employers offer eligible employees 12 weeks of parental leave, residency programs, on average, offer 6, which includes a resident’s four weeks of annual vacation time. That’s two weeks of dedicated leave. Who would find this policy reasonable?

The ABS, which is responsible for certifying surgeons, specifically stipulates that trainees must work for 48 weeks per year, with the option of an additional two weeks of leave for extenuating circumstances. Any extra time needed – regardless of why – extends training past the standard graduation date, which can delay eligibility to sit for board certification exams or to start fellowship training. Unless we want to risk disrupting our careers, we just plan to return to work, hoping we don’t need those precious few weeks of leave prior to birth or endure complications that cause delays.

Beyond compromising career trajectories, archaic maternity leave policies compromise the health of residents and their children. Pregnant residents have higher rates of preeclampsia, preterm labor, and fetal growth restriction. Limiting leave further compromises infant health and development: A JAMA study reported that over half of female surgical residents sampled stopped breastfeeding because they didn’t have access to private pumping spaces or couldn’t leave the operating room to do so.

During my five years in a residency program, I have been lucky enough to be surrounded by strong female peers who have acquiesced to these rules-that-could-not-be-changed. These rock stars who could operate for hours on end, round on patients, and teach in between struggled to return to work 4 to 6 weeks after the birth of their children. I saw them discreetly try to pump in open cubicles in public workspaces. Pagers screamed at them to return to work, to show that they were unaffected by their new-mommy status, to be resilient, strong, and capable surgeons. Was this lack of consideration offered to post-partum residents unnecessary?

It looks that way.

Critics of liberalizing policies point to questions of patient care and equity. Beyond undergoing training to become future surgeons, residents provide crucial patient care services. These critics argue that policies allowing longer leave could compromise the ability of departments – particularly small departments – to meet patient care needs. Extended leave might also create inequity within programs since other residents who do not have children would not be afforded the same leave or may need to cover the gaps in patient care. True enough. But we ought to seek other solutions to these challenges rather than use them as a weak rationale for ongoing unnecessary resident abuse.

Moving forward, the ACGME and ABS should amend its policies by clearly articulating allowances for medical and parental leave. These policies must protect trainees from punishment for having a family by specifically permitting them to graduate on time, take board exams, and start fellowships without delay.

We need a new normal for residents, a normal that respects the drive, grit, and ambition of doctors-in-training while recognizing our shared humanity. We all signed up to be great surgeons; we don’t need to return to work four weeks after a Caesarian to show it.