Timing life

I need to preface this editorial with a huge disclaimer: I am wholly unqualified to opine on the subject of mothers in medicine. Let’s see if I can write this without putting the proverbial foot in the mouth.

I teach second-year family medicine residents as part of their mandatory 8-week rural rotation. Although my practice is located on the periphery of Metro Vancouver, my type of practice has many of the characteristics of a rural family practice and is considered by the UBC Faculty of Medicine to be a suitable alternative for family medicine residents who are not able to leave the Lower Mainland due to medical or personal reasons. As a result, many of my residents are pregnant or new parents. I am happy to accommodate them, but now I have started to wonder how accommodating our profession is to mothers in medicine as a whole.

I have done an informal survey of some residents and colleagues on this topic. It seems that there is little accommodation if you are pregnant in medical school. Residents have expressed to me that they have been discouraged from having a baby during medical school. Although universities may now have official policies on this, the prevailing perception is that it’s not a great idea from an academic standpoint. One resident told me that she was only allowed to take a maximum of 6 weeks of medical leave. There was no maternity leave a few years ago. Now, I believe, some medical students returning after maternity leave do a weekly review of concepts and clinical skills and are able to shadow an attending physician for a while.

It is not uncommon for residents to choose residency as the best time for getting pregnant. Again, there are policies to guide administrators and program directors. I think we are ahead of our US counterparts in this area, especially in the surgical disciplines. In practical terms, however, residents feel that exactly how much accommodation is made for them is often up to their program director and site director.

There were some common themes that arose from our discussions: maternity leave can be very isolating for residents, reentering residency can be very challenging, residents usually return to residency off-cycle so their program needs to be tailored to suit them, some of them may need to pump breast milk while working and time needs to be set aside for this. As a side note, apparently, BC Women’s and Royal Columbian Hospitals have facilities on site for staff to pump.

Program directors need to be considerate and flexible toward residents who are returning from maternity leave. Although many program directors may be from the “when we” generation, it would not be a good idea for them to consider this issue in the light of their own experiences but rather to deal with residents in the enlightenment of today and, perhaps, tomorrow.

This also got me thinking about residents coming back part-time to complete their residency. Apparently this is not a new idea and does exist in some residency programs. I think this is an excellent idea for some residents, considering that many doctors may choose to work part-time when in practice. This may also allow programs to expand their number of residency positions and have one slot filled by two half-time residents. This obviously prolongs their training and may be more challenging in some programs, but it is a good way for residents to balance all of their responsibilities.

It is obviously very important for residents to know their rights, advocate for themselves, and be proactive. Getting advice from colleagues who have been on similar journeys is very useful. Drs Cynthia Verchere (www.bcmj.org/editorials/biology-vs-career) and Jeevyn Chahal (www.bcmj.org/editorials/quest-superdoc) have written great editorials in this journal that are pertinent to the discussion. 
—DBC