Parental leave is a critical issue that is garnering more attention across workplaces, but perhaps none more challenging than residency programs in medicine. Any policy enacted must comply with both legal and regulatory requirements, provide for continued staffing of clinical services, and ensure trainees achieve clinical competence and remain board eligible.
Leaders of the Mass General Brigham Neurology Residency recently revised its parental leave policy to better embody equity, fairness, transparency, and wellness values. In Neurology, they discuss the impact of the updated policy and offer suggestions for other programs that wish to implement a parental leave policy with similar goals.
The authors are Sarah Esther Conway, MD, a neurologist in the Department of Neurology at the Neurosciences Center at Brigham and Women’s Hospital, and Sashank Prasad, MD, director of the Mass General Brigham Neurology Residency Program and vice chair for Education in the Department of Neurology, and colleagues.
Development of the Policy
Revised in 2018, the policy now:
- Allows for a 12-week paid parental leave, exclusive of vacation at another time during that year, to be taken within six months of birth or adoption
- Applies to both childbearing and non-childbearing parents
- Does not require an extension of training and explicitly states how parental leave will be created with proportionate reductions of elective time and clinical rotations while maintaining compliance with requirements of the Accreditation Council for Graduate Medical Education for each year and each track of the residency program
The paper details how program leaders ensured compliance with legal requirements, secured institutional financial support, and developed ways to maintain appropriate staffing of clinical services despite changes to residency rotations.
Putting the Policy to the Test
In the program of 54 residents:
- 2019–2020 academic year—Five 12-week leaves were accommodated (three childbearing and two non-childbearing), with three leaves occurring simultaneously
- 2020–2021 academic year—Six 12-week leaves were accommodated (four childbearing and two non-childbearing), three simultaneously
Each leave used a balance of canceled clinical time, reduced elective time, preserved vacation outside the leave, and required reassignment of two or fewer calls. No leave was extended residency training.
Measurement of the Policy’s Impact
Residency program leaders sent an anonymous online survey to 221 former and current residents: 150 who graduated before June 2018, when the revised policy was implemented, and 71 whose graduation date was June 2019 to June 2022.
80 men and 62 women responded. The percentage of female residents (44%) mirrored the number of female residents in the program both before and after policy implementation.
35 respondents (25%) said they had or adopted a child during residency: 24 in the pre-policy group and 11 in the post-policy group (P=0.55). The median leave duration was four weeks pre-policy and 12 weeks post-policy (P=0.009).
The individuals surveyed were asked about their perceptions of the parental leave policy in place during their residency:
- The policy was transparent and clearly communicated—24% of residents pre-policy vs. 80% post-policy (P<0.0001)
- The policy was implemented consistently—48% vs. 80% (P=0.002)
- Program leadership was supportive of parental leave—60% vs. 86% (P=0.002)
Of respondents in the pre-policy group who did not have or adopt a child during residency, 22% said a 12-week paid parental level policy would have influenced their plans. Of those who did have or adopt a child during residency, 100% said they would have taken a longer parental leave if possible at the time.
Strategies for Success
The authors also offered tips for other programs to implement a viable policy:
- Provide a clearly written document that details how leave is scheduled—this promotes transparency and equity, increases support for the policy, and facilitates its implementation
- Ensure that program directors and/or chief residents have the responsibility of arranging clinical coverage, not the trainee planning a leave
- Mitigate the burden of call responsibilities on other residents in the program—limit the number of calls on electives and other rotations that can be used for parental leave and rely on advance practice providers, where possible, to help with clinical coverage