Spouses and Relationships

[Doc Spouse]

My wife had a fellow resident who stayed an additional 2 months with the program to make up the hours lost during maternity leave.  It was explained to her  that the program accreditation required the training minimums to be met.  It wasn't a 1:1 ratio in terms of hours lost, but rather training/procedure milestones requiring completion.  She was out for 3 months of maternity, but only needed to make up 2 months of training.  The cynic in me also wonders about the hospital's revenue models.

On the flip side, during an interview for a postdoc position, my wife was told flat out that women were considered a dangerous hire because of pregnancy time lost. She had to assure the interviewer that wasn't going to be a problem and wasn't in our plans.  I was livid about it when she told me later that evening - not necessarily over it being a factor for hiring (because it is one that must be weighed), but because of the sheer stupidity of the interviewer for saying it out loud.  There's a lawsuit coming sooner or later in their future.

[Doc Spouse]

pulmdoc wrote:

What is much harder to protect against is subjective downgrading of female residents who have kids in the eyes of their evaluators. I know women who did residencies and fellowships at prestigious programs, and they were told by fellow residents right away that having a kid during residency was a guarantee for “meh” letters of recommendation and 0 career support from senior faculty. Leaves a bad taste in the mouth, but impossible to prove.

Click to expand...

Nailed it.  I'd go so far as to say it is impossible to protect against that, but there could be ways of mitigating it.  As WCI does, just assume it's going to happen and work that possibility into the scheduling and revenue forecasts.  Very few companies do this, however.

[MPMD]

Doc Spouse wrote:

pulmdoc wrote:

What is much harder to protect against is subjective downgrading of female residents who have kids in the eyes of their evaluators. I know women who did residencies and fellowships at prestigious programs, and they were told by fellow residents right away that having a kid during residency was a guarantee for “meh” letters of recommendation and 0 career support from senior faculty. Leaves a bad taste in the mouth, but impossible to prove. 

Click to expand…

Nailed it.  I’d go so far as to say it is impossible to protect against that, but there could be ways of mitigating it.  As WCI does, just assume it’s going to happen and work that possibility into the scheduling and revenue forecasts.  Very few companies do this, however.

Click to expand...

Yeah, that's the kind of ************************ you just can't legislate away.

 

[q-school]

Not to worry since the millennials apparently want paternity leave equal to maternity leave. . That will solve some of the discrimination concerns but obviously leave more coverage concerns.

[The White Coat Investor]

pulmdoc wrote:

Having a resident on pregnancy leave is no different than having a resident out because of a torn ACL, or because dad is dying of cancer, or died in a car accident, or because their embassy failed to renew their visa in time due to a terrorist attack and the resident couldn’t travel back to the US when they planned to. All those things took residents off rotation during my training, and faculty and residents alike stepped in without saying boo.

Click to expand...

Uhh....I don't know that it's EXACTLY the same. You know about contraception, right?

[LizOB]

The White Coat Investor wrote:

pulmdoc wrote:

Having a resident on pregnancy leave is no different than having a resident out because of a torn ACL, or because dad is dying of cancer, or died in a car accident, or because their embassy failed to renew their visa in time due to a terrorist attack and the resident couldn’t travel back to the US when they planned to. All those things took residents off rotation during my training, and faculty and residents alike stepped in without saying boo.

Click to expand…

Uhh….I don’t know that it’s EXACTLY the same. You know about contraception, right?

Click to expand...

It should be EASIER to accommodate since you know it's coming, unlike an ACL

[janettebournes]

Doc Spouse wrote:

My wife had a fellow resident who stayed an additional 2 months with the program to make up the hours lost during maternity leave.  It was explained to her  that the program accreditation required the training minimums to be met.  It wasn’t a 1:1 ratio in terms of hours lost, but rather training/procedure milestones requiring completion.  She was out for 3 months of maternity, but only needed to make up 2 months of training.  The cynic in me also wonders about the hospital’s revenue models.

On the flip side, during an interview for a postdoc position, my wife was told flat out that women were considered a dangerous hire because of pregnancy time lost. She had to assure the interviewer that wasn’t going to be a problem and wasn’t in our plans.  I was livid about it when she told me later that evening – not necessarily over it being a factor for hiring (because it is one that must be weighed), but because of the sheer stupidity of the interviewer for saying it out loud.  There’s a lawsuit coming sooner or later in their future.

Click to expand...

I've had similar experiences

My former residency program is in the same city as another very prestigious hospital / residency program. My co-residents routinely griped about how they wished they were at that program instead of this program. That is, until they caught wind of the maternity leave policy. Any residents who took maternity leave at that prestigious program were required to repeat the year. I'm in a field known for its short and cushy residency so apparently residents were trying to game the system by getting pregnant twice within residency to minimize time missed as an attending.

For fellowship, I was also asked at almost every program (despite being told these were illegal questions under the ACGME) if I was married, if I had kids, and if I had planned on having kids. I was also warned that answering the questions incorrectly would drop me on the rank order list since they could not afford to lose their fellow during the 1 year fellowship. I was also surprised at how brazen they were in both how they asked the question and how they threatened the female applicants.

[The White Coat Investor]

LizOB wrote:

The White Coat Investor wrote:

pulmdoc wrote:

Having a resident on pregnancy leave is no different than having a resident out because of a torn ACL, or because dad is dying of cancer, or died in a car accident, or because their embassy failed to renew their visa in time due to a terrorist attack and the resident couldn’t travel back to the US when they planned to. All those things took residents off rotation during my training, and faculty and residents alike stepped in without saying boo.

Click to expand…

Uhh….I don’t know that it’s EXACTLY the same. You know about contraception, right?

Click to expand…

It should be EASIER to accommodate since you know it’s coming, unlike an ACL

Click to expand...

I agree it is easier to accommodate given the notice, but I also agree that people are more likely to resent having to cover it, since it is preventable, unlike the ACL.

[HLM]

I had my first child during residency (right at the start of my final year of training) and I would NOT recommend doing so just because it's brutal to work that many hours as a parent (I'm sure it's awful for many now but was even worse when I trained prior to the hour restrictions put into place in 2003). It's not good for your sanity, your parenting, or your marriage. And my husband actually quit his job to stay home with our son while I finished residency which did makes things a bit easier but it was still crazy making.

I'm a pediatrician that trained in a medium sized program so it was no problem setting up my rotations so that I wasn't "missed" while I was on leave. I also had an amazing program director that allowed me to use my elective month that year as part of my leave. He figured that lots of my fellow residents used their elective months in some fairly cush way which had little to nothing to do with enhancing their peds knowledge. At least I was learning first hand all about newborns! Clearly not something that would be relevant for other areas of medicine but pretty relevant to peds!  

I also elected to finish a month later to make up the time not covered by the maternity leave policy and my "elective". That made perfect sense to me that I wouldn't get to finish residency by doing less than my fellow residents.

Having said that, it's frustrating (though not at all surprising) that people "resent" that women doctors have babies during residency.

When is the "right" time to have a baby? During fellowship? As a new attending? Whenever a woman has a baby, her colleagues are going to need to cover her hours in some way while she is on maternity leave. Sure, it's an "inconvenience". But it seems like being a decent, rational human would be acknowledging that biology dictates that women get pregnant and need recovery time after delivery. And as LizOB pointed out, you have tons of lead time to figure out how to cover that absence.

I don't know...there are lots of things to grumble about in medicine, but to actually waste emotional energy being upset that woman have the audacity to makes babies because it is inconvenient to others working with them just seems like navel gazing self absorption.

I have been on both sides. I've covered a colleague's maternity leave and I've been the resident working 120 hour weeks with a 3 month breastfeeding infant. Can you guess which scenario was more "inconvenient"?

 

[Kamban]

HLM wrote:

Having said that, it’s frustrating (though not at all surprising) that people “resent” that women doctors have babies during residency. When is the “right” time to have a baby? During fellowship? As a new attending? Whenever a woman has a baby, her colleagues are going to need to cover her hours in some way while she is on maternity leave. Sure, it’s an “inconvenience”. But it seems like being a decent, rational human would be acknowledging that biology dictates that women get pregnant and need recovery time after delivery. And as LizOB pointed out, you have tons of lead time to figure out how to cover that absence.

Click to expand...

I don't think that anyone is saying that women should not have babies in med school, residency or fellowship. That is their right.

But what happens is that the program director has not accounted for it and he expects all others to pitch in. And that includes non pregnant females and males. No one minds one or two extra calls. But if it becomes frequent one in 2 calls or extra weekends the resentment occurs. As a single male for a long time who took extra calls when some one was out during pregnancy or someone had family events and people assumed that a single male was not expected to have their own non-negotiable time, I have felt the resentment from time to time.

If a person cannot pay back a call for any reason ( pregnancy, family emergency or child sickness etc) then they should offer money to someone who is willing to take that extra call. After all, fellows and residents are always looking for extra money. And that call money should be built into the residency budget.

 

[CM]

HLM wrote:

Sure, it’s an “inconvenience”.

Click to expand...

When I was a resident I worked a 32 hour call shift with a raging fever, nausea and severe malaise. That might have been a bad idea, but I did it because I wouldn't ask someone else to cover my call. I knew how upset I would be if someone called me in on my day off. I wouldn't do that to someone else.

A resident's workload is extreme (at least it was in the 80s). Extra call is much more than an inconvenience. It can push an already overworked physician over the edge. There isn't any slack built into a resident's schedule to accommodate another resident's extended leave.

If a program is going to have residents on leave, whether for pregnancy, 3-month sabbaticals, religious missions, or to count blades of grass, then the program needs to hire surplus residents to handle this--or the attending physicians need to pick up the slack. It is unfair to ask the other residents who don't take leave to work even more to cover for those who do.

[HLM]

Of course shifts covered by others need to be made up. I never suggested otherwise.

I suppose really small programs with frequent call and no months of vacation or back up will run into problems when anyone needs large chunks of time off.

Although this may not have been true in the 80s and may still not be true for small programs, most current medium to large size programs give residents some vacation time (I started my residency 17 years ago and our program gave us 4 weeks a year of vacation which most residents took in two 2 week blocks spread throughout the year, I lumped mine together my third year as part of my maternity leave). We also had a month during an outpatient rotation with no scheduled call but with back up call divided amongst the residents and a woman on maternity leave could just be moved out of back up call during leave and then moved back in. I took extra call in the NICU when I came back to make up for it which was painful (I hated the NICU) but also seemed reasonable to me.

I wonder if there are any programs that allow women to take as much time off as they like with no expectation that they make up whatever time has required others cover for them? People seem to be bitterly suggesting that is the case. I just wonder how wide spread that is.

And I also wonder if providing coverage gets easier out of residency. I had my second child several years after residency while working as a hospitalist as part of a small group of 5 docs. Although in theory someone could have hired a locums to fill that spot (I told my boss about my pregnancy at 12 weeks in), no one did. Between my maternity leave, another woman's maternity leave at the same time and another person leaving to do a fellowship, there were two of my colleagues who got stuck working every other 24 hour shifts for several weeks during part of my maternity leave. My post-residency colleagues suffered way more than any of my fellow residents did as a result of my maternity leave. That's awful--no doubt about it. But doesn't that fall to the administration to try to make some reasonable effort to plan for a not uncommon event (women in their 30s having planned pregnancies?)

I guess if I had any point to make, it's that being pregnant is a part of a woman's life during the early years of her medical career and that while no woman should expect others to pick up her work, the resentment seems misplaced when it aimed at the pregnant woman instead of the system that ignores the reality that young women will get pregnant.

 

[Kamban]

HLM wrote:

I wonder if there are any programs that allow women to take as much time off as they like with no expectation that they make up whatever time has required others cover for them? People seem to be bitterly suggesting that is the case.

Click to expand...

But as you can see from another poster, it happens quite often. I can see the other point of view also. A new mother with a new baby and sleepless nights may not be physically able to pay back the calls others took on her behalf.

Then when those residents get back it’s very difficult for their colleagues to get paid back as it were and it leads to all sorts of bad blood.

[Kamban]

HLM wrote:

the resentment seems misplaced when it aimed at the pregnant woman instead of the system that ignores the reality that young women will get pregnant.

Click to expand...

I agree that it is misplaced but trying to resent the Program director or his staff is a bad idea if you want good references for work or fellowship interviews.

[CM]

HLM wrote:

there are lots of things to grumble about in medicine, but to actually waste emotional energy being upset that woman have the audacity to makes babies because it is inconvenient to others working with them just seems like navel gazing self absorption.

Click to expand...

Jane and Joe are riding up to the CCU in an elevator. Jane turns to Joe:

"Joe, I've decided to do something that will greatly enrich my life. It won't benefit you in the least and you have no say in the decision, but -- and this is the really great part  -- you will have to pay for it."

Joe: "Huh. What?!"

Jane: "I don't want to hear any complaining, Joe. I've already decided that this is a trivial inconvenience for you. More importantly, this is my right. I am entitled to impose this on you. If you were a decent human being you would just bend over and take this."  

 

You have every right to choose to become pregnant, but it is "navel-gazing self absorption" and an amazing sense of entitlement to think that someone else is obligated to do your work to enable it. 

If you have electives that won't require anyone to cover for you, and you can make that up with extra time later, and you can string together vacation time with elective time so that no one is burdened, then that is terrific; everyone wins.

If the organization has hired surplus staff to accommodate pregnancy leave (just as it does to allow for regular vacation time), then great; everyone wins. (In my experience, this never happens.)

Perhaps there should be a law that organizations have to hire surplus staff to handle this sort of leave, but that law would be unfair unless everyone is granted the same leave, pregnancy or not.

HLM wrote:

being pregnant is a part of a woman’s life during the early years of her medical career and that while no woman should expect others to pick up her work,

Click to expand...

No one is going to object to a pregnancy if they don't have to pick up extra work. Instead, everyone will be happy for the pregnant doctor and offer congratulations.