News and Commentary When Parenting and Training Coincide

As many parents of young children likely understand, Halloween is a BIG deal.

One of my most vivid memories from my early years in medicine took place during Halloween festivities in the mid-1990s when my two eldest children were young. The Association of Program Directors in Internal Medicine Fall Meeting took place over Halloween that year, and as a nascent residency program director (and also one of the only female program directors) it was important that I attend. I was disappointed to miss the opportunity to enjoy the holiday with my children but entrusted my husband—also a physician early in his career—with the fun of taking our daughter and son out to trick-or-treat. It was with equal parts gratitude for my husband’s help and astonishment that I learned of their Halloween follies: Sarah as a Disney princess, bare-armed in 40-degree weather with her dress on backwards and a crooked tiara; Ben as Tigger, constantly pulling on his tail, believing it held magic power and he could not get it to turn on. To this day, my children also remember this historic Halloween!

From the costumes to school parties and parades to trick-or-treating—the highly anticipated day involves significant planning and preparation for parents. It is an important day of the year, yes, but so are birthdays, weekends, school breaks, and even just the everyday. The simple act of being present for our children is paramount. For those in the health care professions, being a present parent can—as I experienced—pose a great challenge at any time, but especially during the training years. Healthcare providers are pulled in many directions, and oftentimes these challenges can lead to feelings of depression, anxiety, and burnout.  

The ABMS’s New Leave Policy

The July announcement from the American Board of Medical Specialties (ABMS) regarding a leave policy for residents and fellows marks a step forward for the many trainees who choose to have children during their training; amongst the benefits the policy provides, one of the most important may be the opportunity for trainees to spend time with their young children. A key piece of the new policy requires that all Member Boards allow for a minimum of six weeks of leave without exhausting other allowed time away from training and without extending training. By setting a standard policy for all ABMS Member Boards, while allowing each Member Board the flexibility to create a more specific protocol that best suits the specialty or subspecialty, the ABMS is sending an important signal.

To trainees, the new policy suggests that they—and their time—will be valued and respected by their home institution. Trainees will likely feel less stress about whether starting a family or caring for a loved one will put a strain on their program or their colleagues—a departure from the worry caused by past policies that were not standardized. As governing bodies enact policies that “care for the caregiver,” patients too may reap the benefits of a health care provider who is more confident that they can manage family life alongside professional life.

I applaud the decision of the ABMS and the contributions of the Accreditation Council on Graduate Medical Education in shaping and formalizing this new leave policy. It is a step in the right direction as we seek to encourage a sense of belonging within the clinical learning environments. For many residents and fellows, feeling supported in parenthood by one’s institution is tied to well-being, making this new policy of critical importance.

Looking Beyond Parental Leave

Beyond policies related to parental leave, we must also consider two additional issues that affect those residents and fellows who may wish to have a family during their training:

  1. The confluence of a long training period with the reproductive years and early childhood years
  2. Affordable childcare

The training period for medical residents and fellows can last anywhere from three to 10 years beyond medical school and often overlaps with the reproductive years and early childhood years. However, a recent survey found that 61% of residents chose to delay childbearing due to concerns such as a busy work schedule, desire not to extend residency training, lack of access to childcare, financial concerns, fear of burdening colleagues, and concern for pregnancy complications. Only 38% of those who arrived at this decision to delay childbearing were satisfied with the decision, suggesting that the conflict between the choice to have a child and advancing one’s career needs greater attention. Considerations given to policy and culture changes should also keep in mind issues related to in vitro fertilization, given the prevalence in infertility amongst physicians.

For those who decide and are able to have a child or children during training, the expense of childcare can pose a significant burden. In states where childcare costs are especially high, the average first-year resident may spend more than one third of their salary on such costs. Coupled with the staggering percentage of medical school graduates who report education debt—73%—and the continued high level of such debt, ensuring appropriate child care can be extraordinarily difficult financially.

Parenting During a Pandemic

As highlighted in the recent Women in the Workplace study, released in September by LeanIn.org and McKinsey & Company, at least one in four women is considering downshifting their careers or leaving the workforce due to COVID-19. Mothers, women in senior leadership roles, and Black women are experiencing distinct challenges, the study noted. The coronavirus pandemic only serves to put into relief the strain of balancing family and work lives—and the need for policies that support a work-life balance for those in the health professions.

For those whose work demands that they be on the front lines of health care, especially the nurses and physicians in training who spend a great deal of time with their patients, the worries about issues related to work and family in the midst of COVID-19 are many: concerns about contracting coronavirus and transmitting it to one’s family; day-to-day demands of simply working while also trying to meet the education needs of young children schooling at home; and finding ways to compassionately care for patients in new, distanced settings. An August “Perspectives” piece in The New England Journal of Medicine captures some of these struggles in its heart-wrenching description of a physician couple sending their young son to live with his godparents. While a single policy such as the one issued by the ABMS may not have the ability to lessen the struggle parents are facing during the pandemic, I am heartened to see organizations such as Mount Sinai acknowledging the distinct challenges and offering tips and resources for its healthcare workers who are also parents.

Caring for Patients, Families, and Ourselves

For many, a career in the health professions is deeply meaningful, fulfilling, and rewarding. Being a parent is also tremendously rewarding. To be in either position is a privilege; to be in both, an honor. That said, these roles have days that can be challenging, if not overwhelming and even seemingly impossible. The health professions community must continue to listen to the needs of its members and seek to establish policies and cultivate learning environments that support parents and caregivers, especially for those in training. We at the Macy Foundation are eager to work with those who have ideas and proposals aimed at supporting career satisfaction for women and parents training in the health professions, and invite you to submit your ideas to President@MacyFoundation.org.

This Halloween will certainly be a memorable one for many of us. Trick-or-treating—just like nursing, doctoring, parenting, schooling—will be reimagined to ensure the health of all those involved. Given the creativity and resilience I have witnessed in so many settings over the last eight months, I have great hope that parents and children alike will make the most of the holiday, just as I have hope that the health care professions will continue to progress in supporting the health and well-being of their trainees.  

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