S. T. Lumpkin1, M. K. Klein1, S. Scarlet1, M. Williford1, K. Cools1, M. C. Duke1 1University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA
Introduction: In 1993, the Family and Medical Leave Act (FMLA) required 12 weeks of unpaid, job-protected leave. Residency training is inherently demanding and inflexible. While 40% of residents anticipate having a child during training, taking leave to care for personal and family needs may delay residency graduation, board certification, and fellowship initiation. Our hypothesis is that a 12-week (FMLA) leave would delay board certification and fellowship training with the current specialty board training requirement policies.
Methods: We categorized the primary specialties recognized by the Accreditation Council for Graduate Medical Education (n=24) into surgical (n=10) and non-surgical (n=14) specialties. We excluded secondary specialties and specialties with fewer than 100 active residents nationwide. From May 2018 to August 2018, we examined the specialty leave policies to determine the impact of leave on the duration of residency training, board eligibility, and fellowship training. We compared our findings to a similar study of policies published in 2006.
Results: Across all specialties, the mean maximum leave allowed per year was 4.9 weeks (range 4-8). Among surgical specialties, the mean maximum leave per year was 5.3 weeks (range 4-8), compared to 4.6 weeks (range 4-6) among non-surgical specialties (p=0.38). Only five (21%) specialties have specific policy language regarding parental leave, and four (16%) regarding medical leave. Since 2006, seven specialty boards have substantially changed leave policies. In 2006, a 6-week leave would cause a delay of one year in board eligibility in 6 specialties; whereas in 2018, a 6-week leave would not result in delayed board eligibility for any specialty. A minority of specialties offer strategies to mitigate the impact of a 6-week leave, including taking leave during elective or non-clinical rotations (n=2), averaging leave across multiple years (n=8), extension of chief year (n=2), merit-based advancement (n=3), and exclusive program director discretion (n=2). In 2018, a 12-week (FMLA) leave during residency would extend training by a mean of 4.1 weeks (range 0-8) and delay board eligibility by a mean of 2.25 months (range 0-12). A 12-week leave in 17 specialties (71%) would delay fellowship training by at least one year.
Conclusion: Residents training in surgical and non-surgical specialties have similar allowable time for leave, although this is less than half of the FMLA requirement. Overall, there has been minimal change in the maximum duration of leave since 2006, but the impact of such leave on board eligibility has been mitigated. Unfortunately, a 12-week, FMLA-eligible, leave would cause significant delays in training, board eligibility, and entry into fellowship. The long-term effect of extending the duration of training may affect the decision to pursue fellowship, decrease the protected time to study for boards, and ultimately increase physician burnout.