On my post about how women are ruining medicine, one of the comments was the following:
"For me as a resident, when my female colleagues go out on maternity, we get pulled off our vacations, electives and otherwise down time to cover for them, and this infuriates me. Doesn't seem fair that I should have to suffer. Pregnancy is a choice, so just plan wisely and think about those your decisions might effect [sic]."
I was going to respond to this as a comment, but I realized I didn't have a post scheduled for today, so I figured I'd make it an entry so others could weigh in. Plus it turns out I had a lot to say on the matter!
First, I think this is a super common sentiment among male residents as well as among the female residents who don't get pregnant, even if they don't say it. I applaud the commenter for being honest. Let me respond:
A lot of people argue that covering for a pregnant woman is different from covering for other illnesses (which we all love doing, of course) because pregnancy is a choice.
Is it though?
I haven't seen any stats on this, but I have to wonder how many residency pregnancies are intentional? A resident friend of mine got pregnant while on birth control. Even sterilization isn't 100% and many methods have far less efficacy. And say a resident was just careless and missed their birth control for a night? Does that still make you angry about covering? As angry as it would make you to cover for a resident who chose to go skiing, then broke his leg? If not, why? Both constitute taking risks and having an unexpected outcome.
Isn't a lot of life based on choices? If you choose to live further away from the hospital and then get in a car accident, wasn't it due to your choice? If you stayed up too late and get a bad cold, maybe you shouldn't get coverage then.
But if you break a leg skiing, there's no way to unbreak your leg. Should a resident who gets pregnant by accident have an abortion to avoid inconveniencing others? Does anyone think that?
Of course, it's different with pregnancy because it's a happy event, as opposed to an illness. And it's true, there is certainly usually a happy element to a birth. But for most women, your body feels pretty much wrecked after a birth. After having a major surgery, most people have the luxury of lying in bed and taking care of themselves. After a C-section, you have to spend your recovery caring for a helpless newborn baby. I think what childless men don't realize exactly how women feel physically during that recovery period, no matter what the method of delivery.
I think that men may feel resentful, not because women make the choice to have a baby, but because it's a choice that they simply don't have. Keep in mind guys, that you also don't ever have to do nine months of residency with swollen legs, an aching back, and carrying 30 pounds of baby and fluid around with you everywhere you go... doesn't sound as bad now, does it?
Someone once suggested to me that men should get a 6 week vacation in lieu of a maternity leave. That suggestion is a bit of an insult to the amount of work that a woman must do during a maternity leave. But at the same time, I do think there should be a more lenient policy for taking time off. Most residents will work when they're sick, will work when close family members are ill, etc. Maybe if men felt that they could take time off when they needed it, they wouldn't feel as resentful?
The comment states that "we get pulled off our vacations, electives and otherwise" to cover for maternity leave. Considering you should have like seven months of advance notice, it doesn't seem like anyone should get pulled off anything, unlike when there's an unexpected emergency. Every resident is guaranteed a certain amount of vacation time, no matter what. If pregnant residents aren't letting their programs know early enough about their condition, maybe it's because they're so fearful of the attitudes expressed here.
Finally, the comment states that women should "plan wisely and think about those your decisions might effect [sic]". If that's the case, then when can a working female have a baby without it affecting anyone else they work with? Is it worse during residency, when coverage is spread out over 20+ residents? Or worse later in practice, when there may be only one or two other attendings available to cover? Should a female physician simply never have children out of fear of inconveniencing others?
Some would probably say the answer is yes.
Sadly, you are right. Some WILL say yes, women docs should just stay childless. I have seen moms experience the same sentiment in my non-medical profession.ReplyDelete
As for me, I myself am childless. Not by choice, but because of a serious medical condition (one caused by bad genes, not bad lifestyle choices). So instead of getting crapped on by my co-workers and boss for pregnancy or child-raising, I get crap for my illness from my (mostly male) co-workers. Just yesterday, I told my boss I was taking a vacation day (we get 10 paid vacation days a year, I have only taken 2 so far) and he immediately started up with me about the number of sick days I took this year (6 or 7 total, which is quite good considering my disease is currently not well-controlled, despite my and my doctor's best efforts) and essentially questioned whether I had the right to take a vacation day because of the numerous sick days I have taken. I do just as much work as my co-workers, and have repeatedly worked overtime for the past few years, against medical advice. Sure, on occasion, when I am out of the office someone has to cover for me. But I cover for them when they are out on vacation and living their fabulous, exciting, healthy lives, so I don't see the problem.
But it apparently IS a problem for certain people. This is to be expected, I guess. Some people will always think they work harder than others, or don't get the same perks as others, blah blah blah.
If I could do this without antagonizing my antagonists (because that would only bring me more harassment at work), I would ask them if I should stay working and continue to "exploit" my situation by daring to take a vacation or sick day from time to time, quit my job and go on welfare so their taxes can subsidize my unemployment, or should I just jump off a bridge and rid society of my burdensome self? I would not be surprised if they offered me directions to the nearest bridge.
It's true. Nobody wants to cover for ANYONE, no matter what the problem. I took shit from my chief about calling out sick with laryngitis, which was so bad that my attending had to send me to the primary care clinic upstairs to get antibiotics then straight home because I couldn't speak at all.Delete
I worked my Christmas shift without a voice (I whispered like an 80 year old smoker) because a) I couldn't find anybody to cover me and b) Christmas is not part of my religion or rituals, so it's not as big a deal to me as everybody else, and c) a girl covered for me as an emergency the previous night because I was way sicker and I didn't want to make the only person who agreed to cover work two nights in a row. It was a rough night. I see no issue covering for someone for their wedding / wife's birthday / anniversary / broke leg skiing / having a depressive episode. It's part of medicine. As long as they do it for me, but that doesn't seem to be the case...... Frustrating. We're supposed to be the caring, empathic people of this society? Certainly not to each other....Delete
Well Fizzy, obviously if your co-workers don't have really bad laryngitis, and you do have really bad laryngitis, then your really bad laryngitis was a choice! :)ReplyDelete
What I love the most is when my healthy co-workers get something relatively minor like a cold, they are such babies about it. And you bet they take a sick day for that. And here I am literally fighting against permanent disability and/or premature death every day, and I am have the audacity to sometimes take a sick or vacation day? How selfish of me!
No one is calling me back to resident duty from my vacation for ANY reason. I'd take that to the GME office. Pregnancy or illness, it's unacceptable, period.ReplyDelete
Why would you ever get called back to residency duty from a vacation due to "pregnancy"?Delete
Anyway, I've never heard of anyone being asked to come back from a vacation for coverage. A lot of people travel and simply can't do it. There is usually a coverage schedule and it never involves a person on vacation.
I could see a scenario where the pregnancy and one illness were covered by the "jeopardy" residents, but then another person got sick, and there was no more backup, so someone could conceivably get called in from vacation (I've heard of this happening). However in that case, why is it the pregnant person's "fault" and not the "fault" of the people who got sick. Or the "fault" of government for not paying for adequate residency slots. Or the "fault" of the people who schedule rotations? Or the "fault" of God/Buddha/Allah who made the other people sick at an inconvenient time?Delete
I'm fairly sure that nobody can get pulled off of an actual vacation to come in during residency.... at least, they can't force you to do this. I mean, what if you are in another country or whatever? But I have had days off, like on an ER rotation, where I was on jeopardy call, and had to come in. So you could lose a day off, but that wouldn't be a vacation. Either way, it's not the fault of the planned pregnancy.Delete
The opening quote in the post is from someone who claims to have been called back from vacation. You used that quote to start your discussion, so you can't just stipulate that it never happens and ridicule his obvious anger about it.Delete
I'm in favor of making residency a "pregnancy friendly" place, but there are lines you can't cross. All I'm saying is that anyone who has been pulled off their vacation for any reason, including another resident's pregnancy has a right to be royally pissed off. I don't think it's fair to discount it like you seem to.
I understood the opening quote to mean something different. If, say, at the beginning of the year, a resident has a vacation scheduled in June and this is when another resident's pregnancy is due, then the vacation might be moved. Or a resident might be restricted when they can schedule a vacation. But I cannot even fathom a situation in which a resident would be asked to come back in the middle of their vacation time to cover a scheduled delivery. That's just impossible. So if that's his gripe, it's not a legitimate one.Delete
Anon, I cannot imagine you are a current resident if you are not aware of this.
And for the record, I did address his complaint but I don't think I at any point "ridiculed" him. I felt that I was respectful.
Pregnancy is currently causing me to work overtime but it's not direct...ReplyDelete
My reg's wife is pregnant and has a fever so he is at home with the kids while she is admitted with IV ABs.
This means that the Cardiology unit at my hospital is being run by two RMOs (one year up from interns). I am seeing the people in ED, seeing the consults, managing the ward patients. I am doing the work of a reg, not getting paid, feeling incredibly under-supervised and dangerous.
My point is, there needs to be more people available to cover unexpected leave. It's not OK for a whole week for people to just "cope without". Maternity leave wouldn't be a problem if there was more cover built into the system.
Re maternity leave: I kinda side with the people who say everyone should get 6 weeks of paid leave every 3 years. What you choose to use it for is your business. Pregnancy is a choice like sex is a choice. The Mirena is about as effective as sterilisation in females and the new spermatic cord fillers are super effective too. Some people may chose to keep an unexpected pregnancy, but this is a choice they are making.
I know I won't convince you of my point of view, but if you'd like to email me an extended explanation of why you feel it's a selfish choice not to have an abortion when your birth control fails, I will print it here.Delete
I know of a perinatologist attending physician who got pregnant with TWINS with a Mirena (by a reproductive endocrinologist husband!)Delete
Even though IUDs are incredibly effective as far as birth control goes, a failure rate of less than one percent multipled by tens of thousands of female residents still means pregnancies.
Sex is a choice, but keep in mind it is a choice that almost every single human being embraces on as regular a basis as they can. Having children is a choice (considering 50% of pregnancies are unplanned and abortion is frowned upon, not covered by insurance and hard to access. So, very arguably a choice) that 85% or more of women choose during their reproductive years. Trying to phrase this as some sort of alternative or aberrant choice is extremely disingenuous to say the least.
Pregnancy and the need for maternity leave are about as "fact of life" as it gets. It is anti-family, anti-woman and anti-human, in my opinion, to constantly reframe this as some sort of selfish individual choice on the part of thoughtless women.
Yes, it is a little hard to look at sex with your spouse as a choice. It is unusual to be in a long term romantic relationship with another person that never involves sex. "Normal" human behavior involves sex.Delete
I think calling people "anti-human" who think reproduction is a selfish choice is right on the mark!
Oh, and the new spermatic cord fillers are fascinating, but not available in the US unless you are part of a small clinical study, as far as I know. Other than that, I only know of them being available in India. Is that where you are?Delete
Also, I think it is very unreasonable, bordering on unethical, to expect people to stay childless by avoiding sex or by using certain methods of contraception. There are many men who would have a serious problem with anything going near their precious testicles, especially something new and experimental, even if it was available. Many women are uncomfortable with IUDs (I am not one of them- huge fan, and I think the evidence supports their safe use in most people) for many reasons, and they are contraindicated for some women.
On a fundamental level, telling other people around you when and how to control their reproduction is crossing serious boundaries, and it horrifies me how often people seem to think it's ok.
I'm not a proponent of eugenics or anything... but shouldn't we as a society encourage the intelligent, well-educated people of the world to have children and raise them accordingly? It seems off to suggest that if you're a working woman who has put time and energy into getting a high degree of education, you should not be allowed to raise children because (obviously) you invested too much into yourself.ReplyDelete
I'm going to have to concur. The problem really does seem to be an inadequate number of residency spots and pipeline of students to feed them. There should be reasonable maternity and paternity leaves. Educated people in careers that will afford them the income to raise their children should be encouraged to do so. More slots and more doctors makes more sense than making a new class of celibates.Delete
The amount of agreement I have for this post is too much to express in a post. People that can afford children should be allowed, and encouraged, to do so.Delete
I so wholeheartedly agree with you, Abigail! I'm a third-year resident in Spain, and my ER shifts have been adapted to my situation, because they encourage a healthy pregnancy, and wouldn't like to put their residents at risk. The best part is, during my upcoming maternity leave, no other resident will have to "suffer" for it, because it shouldn't have to in the first place. I do understand that each service has to adapt to whatever may come, because people bitch about having to suffer because of other people's pregnancy, but I'm pretty sure they wouldn't do so if it were for some life-threatening condition (unless they were just plain selfish A-holes). I decided to become pregnant now because I figured it's the best moment...I'm not going to do it when I start as an attending, and then later on excuses will just pile up and then it'll probably be too late for me to try. I'm a doctor, but I'm also a wife and a soon-to-be mother. No reason to resent me for trying to have a healthy, stable life!Delete
I was with Natasqi for the first 4 paragraphs. To say your last paragraph fires me up would be an understatement. It's a choice to keep a child from an unplanned pregnancy vs. have an abortion so as not to put your co-workers through undue hardship?ReplyDelete
As for the Mirena, I've dx two suprise pregnancies in the past month despite its presence. Out of the ER.
Not sure whose residency pulls people off vacation for a forseeable event. Most PDs have about 5-6 months to rearrange the schedule. In our program, they looked for volunteers to trade elective months (but always got the elective month back, just at a different time) or trade shifts/vacation. In four years and 8 pregnancies, I know of no one "forced" into unreasonable changes. That is a Program issue to be brought to the CME office or ACGME, not a uterus issue.
It just goes to show that a lot of people believe that pregnancy is always a choice, and to keep an unwanted pregnancy is a more selfish choice that not wanting to move your vacation plans.Delete
As you said, if a program plans correctly, nobody should ever have to change their vacation anyway. People may have to move an elective, but I've never heard of anyone not getting that time paid back to them. It's usually the pregnant resident who loses elective time and may not get it back.
"Maybe if men felt that they could take time off when they needed it, they wouldn't feel as resentful?"ReplyDelete
I think this is pretty spot on.
I think you don't really grasp just how incapacitating giving birth and having a newborn is. In fact, if a male resident suffers the same degree of incapacitation and can't work, he also would get time off.Delete
The delivery part, for me, wasn't incapacitating. I would say that I was physically ready to return to work after about two weeks (but I didn't have a C-section). But the care a newborn baby needs, as OMDG said, is enormous. And most childcare places won't even accept a baby younger than 6 weeks.Delete
Career women should probably wait to have kids until their late 40's or early fifties - or perhaps sixties if work demands. By then, life settles down and they don't have to worry about what their reproductive choices will do to their co-workers. You can't expect workplaces to bend their practices to archaic reproductive patterns that have existed for millions of years. Besides it's always precious to be at school events with your children and have everyone so excited that "grandma" managed to make it out to the event.ReplyDelete
You're joking, but it amazes me how long women wait to have kids these days.Delete
Whew, I'm glad this was a joke, but it prompted me to add another comment that was brewing in my head.Delete
I know of an attending physician who is in obstetrics. When she began her residency years ago, she was on a team of six female interns. They all put IUDs in each other in the beginning and made a pact to not remove them until the end of residency. (talk about a malignant program!)
She had significant problems getting pregnant as an older woman. She had to take time off for fertility treatments and complicated pregnancies due to increased comorbities. One of her children was born with a serious birth defect (which had an increased risk because of her advanced maternal age). She had to take more time off when this child needed surgery. You think a program suffers when a lowly intern is out on maternity leave? How about when an attending is gone?
Argh, I could write a book on this topic.
Great comments, momTFH. I talked to an ob/gyn attending who told me that she and her female co-residents all waited until after residency to get pregnant. She had no problems, but some of the others did. She said, "You really just don't know who's going to have the problems."Delete
I still feel insecure about my decision to get pregnant very young (young = 27). I got judged, judged myself, and it did make life harder for me. Yet at the same time, I see so many married women these days waiting and waiting, well into their mid-thirties, and I can't help but wonder how they can stand to take that risk. I've written about this before, but like you, I could write a book on the topic.
I used to get my medical care from a practice that was a residency program for Internal Medicine.ReplyDelete
The first resident who was my doctor got pregnant, intentionally, a year into the program. She was the best of the doctors I saw there, and, sadly, the next year decided to switch out of IM and changed her residency to something boring like ophthalmology.
The second resident got pregnant, intentionally, in her second year. So did the third one.
When I started with the fourth, I asked her up front, "Are you planning on getting pregnant before you graduate?" and explained why I asked. She laughed and said no.
I ran into her a year after she graduated. She was very, very pregnant, and I said something brilliant like, "oh my god, you're *pregnant*!" She laughed and said, "Hey, I told you I would wait until I graduated!"
Shall we now tackle the issue of who stays home with the sick child who cannot go to school/day care because they are contagious? This always starts fur flying among the childless. (Of course, the childless are also not living with these little germ-buckets.) Not all of us have a ready and willing grandparent or neighbor to take over on a moment's notice. Many people do not realize the coverage issues that parents have.ReplyDelete
Also, I used to go to work with a cold, or conjunctivitis, or another viral ailment and tried to avoid handshaking, etc, because I was tough; I was needed; I was responsible. Now, I am not so sure that this is best practice. When we go to work, we infect others (some who might become sicker than you are), we cannot concentrate as well, and we are exhausted at the end of the day. Stay home for a day, drink tea and chicken soup, wrap yourself in a blanket, watch daytime TV, and feel sorry for yourself. You will come back to work feeling better and more energized and you might not have to cover for someone else who caught your cold! Tricia
I entirely agree with you in theory, Tricia. But in practice, nobody in medicine is understanding when you call out sick. People who call out sick a lot (and when you have kids in daycare, you're always sick) are thought of as unreliable. When I came in one day during residency and announced to my attending (who told me I looked green) that I had spend the whole morning vomiting with a stomach bug, he didn't tell me to go home... he said, "Good for you for coming in!"Delete
Ain't it the truth, unfortunately. I am no longer clinical (I mixed my medical knowledge with some law and voila!) so it is easier now to take the day off when needed. However, we did have one instance of what now qualifies as an emergency in my life and I finished what I needed to do before driving myself to the ED with a small bowel obstruction. I guess we never really change, do we? TriciaDelete
As a child-free woman, I would rather you stay home with your children and not infect everyone else. Those of us who do not spend much time with children are very suceptible to the random illnesses brought in by their parents.Delete
My husband and I chose not to have children and took steps to make sure of our choice. I am in my mid-fourties and am still happy about my choice. Parenting is better left to those who have the personality for it. We have cats instead.
Over the years, I have watched many co-workers go through pregnancy without resentment nor jealousy. Several have had a very difficult time due to age, medical issues or just not having a body built to be pregnant. One in particular was way too tiny (both frame and weight) before becoming pregnant then gained a huge amount of weight (her doctor told her she gained too much too fast). She had serious issues carrying the weight and had multiple other issues (gestational diabetes and hypertension along with pre-eclampsia). I'm sure I mis-spelled that, but then again I am a researcher not a doctor. The diabetes and hypertension remained after delivery along with lots of other problems from the weight which she cannot lose. The baby was born last fall. I certainly am not jealous and have great sympathy for the medical issues. Additionally, her supervisor decided she was "not a reliable worker" and passed her over for promotion. I confronted him about it and asked if he was refering to the time she was pregnant. She was essentially punished for having a difficult pregnancy.
I have seen others return to work after less than two weeks because they are paid hourly and have run out of sick and vacation leave. No work=no pay. Some of these folks are paying for their medical bills out of their own pockets because they have chosen not to have medical insurance in order to save the premium.
I am a strong advocate for socialized medicine and protections for mothers and fathers that are seen in other countries. Our insurance doesn't pay for pregnancy unless you buy the pregnancy rider.
In my next statement,I include fathers because I do know some who take time off to be with sick children or allow their wives to return to work quicker. By penalizing parents, we are reducing the viable workforce. This is not an advantage for anyone. I feel the same about penalizing ANYONE who has the capability to do the work.
I felt the urge to weigh in from the corporate world because I think the resentment has little to do with whether pregnancy is a choice or not.ReplyDelete
As Fizzy said, you have plenty of warning when a woman is pregnant, more than enough time to provide coverage. Of course, in the corporate world, no lives will be endangered by a maternity leave--maybe that is an issue in medicine?
I have noticed that the real barometer of whether there will be grousing and resentment over filling in for someone on maternity leave (which, interestingly, even occurs in cases of illness or accident) is how well the person is liked. As a friend of mine said, "I hate smokers, but I find I mind it less in the people I like."
I'm from the corporate world as well. In my experience the pregnancy or illness is what CAUSES the employee to not be liked. Has happened to virtually everyone I know who has been through it. One day they are in the "in" crowd, then after pregnancy or illness, they are persona non grata.Delete
The thing I hate about some women with kids is that they expect all the holidays off. The ladies I work with now are not so bad (you can tell they hate it, but they don't make me feel bad about it), but at my job before, they expected me to cover Christmas, Halloween, Easter, etc. because, "Holidays are for the kids, you know, and since you don't have a family . . ." I don't mind covering my fair share of holidays, but the fact that they assumed that since I didn't have a kid I didn't have holiday plans was infuriating. Then when I wouldn't cover, they would whine the whole time leading up to the holiday about how depressing it was not to be with their kid. You know, it's pretty depressing to me to be with my family too, even if they didn't spring my womb. I don't stand around complaining about it, because someone has to work.ReplyDelete
Well, the one reason that a person with kids may want priority for holidays is that schools/daycare are closed. And nobody wants to babysit on a holiday, so it can be a scramble to figure out what to do for childcare on those days. But since my husband didn't work holidays, I never had an issue with working holidays during residency. I don't think it's fair to claim holidays just because you "have a family."Delete
Not all programs are like this. I was called in to be on the hurricane coverage team. I was the only person who didn't volunteer out of the team. There were several other childless people to ask to fill the other slot. I am a single mother. I accepted the appointment without complaint. One of the other members of the team pointed out to the chief that I am a single mother and...really? Hurricane coverage? The chief said I could bring the kids in, I guess (*eyeroll*) if I really had to. I pointed out I was already at the hospital, so it was a little late for that - I wasn't exactly going to drive home during the storm to get them, when I had already arranged for their Carr.Delete
I didn't even whine about being a single mom and wanting "special treatment" and I still got the eyeroll and the attitude. Please remember that there are parents who don't stand around complaining, either.
*care, of course, not their Carr, whatever that is, stupid autocorrect.Delete
I talked to a man colleague at lunch one day and asked why he quit his old job. He said it was aggravating to have to cover several MD's in his hospitalist practice that went on maternity, extended sick leave, and one on military duty. I was pregnant at the time, then proceeded to have major surgery weeks after baby. It was nice to know when I was dealing with my sudden medical diagnosis and a newborn that my colleague (s) was (were) already hating me. Sure enough I was served with my colleagues decision to make me "pay back" all call they (as a big group) shared for me. Yet, at least for that hospitalist group when you loose 3-4 MD's just hire help. Yeah, pregnancy is a lonely experience.ReplyDelete
Did you have to pay it back monetarily or by serving calls? That is a LOT of payback.Delete
If one of them had a heart attack and missed several weeks of work, would they have to pay it back? Probably not. Even if the heart attack was caused by their *choice* to eat unhealthy food their whole life.
It was in training. I had more calls going in since I started fellowship 2 months late, and I paid back all my call for missing first 2 months. Then I finished first fellowship year 2 months late, obviously while taking same load of calls as first year fellows take. the baby and surgery happened in the second fellowship year, and I returned calls for my surgery time off. In retroscpect I had more calls than any fewllows in my first 12 months of training. They were just vicious group of women in that program. I only had 3 weeks post-partum, and call was well, on the phone only.Delete
I completely agree with you, Fizzy. I can't believe people actually feel that way. Is there really ever a good time to become pregnant?ReplyDelete
About the whole coming to work even when you're sick thing- I always found this to be ridiculous. We're supposed to be good role models of health and we're showing up to work sick/infectious and spending time around immunocompromised patients. How is this acceptable? It's always very obvious when I'm sick (I have to blow my nose non-stop and my voice sounds horrible), I can never hide it too well. What do you do when you're around patients? Do your patients ever notice or get upset?
I'm just an MS2, but I've been curious as to what to do about this when I reach my clinical years.
There is certainly an irony that we, who treat the sick, are never allowed to be sick.Delete
When I'm sick, I practice even more aggressive handwashing than usual and I wear gloves during all exams. I also suppress my sneezes as much as I can and pretend not to be sick. I don't usually wear a mask, because they make me kind of claustrophobic and I just can't function that way.
And yes, I have had patients notice I was sick and kick me out of the room.
I think there's a happy medium to be struck re. leave. I think men (shock horror) need to be encouraged to take a more active role in the early care of their children, and paternity leave should properly be introduced to cover this. If you have someone there for you who's prepared to put as much into it as you are, I think this probably means you are capable to return to work sooner.ReplyDelete
Of course in the immediate future a policy like this might lead to some men doing very little work. But for equality in areas like this, I don't think it hurts its progression to be encouraged by some governmental/business policies.
I definitely think men should be given a paternity leave. Maybe not as long as what women get, but I don't think a month is unreasonable.Delete
A woman can choose when she tries but when she gets pregnant is up in the air. Sadly, having a family requires getting pregnant (or adoption; not easy, not convenient and not always a choice. But we don't stop people from dating, or getting married. At the end of the day, the male doctor can go home to his children and family and completely ignore the way that that happened for him because his wife did the work. Life is for living. Being in your 20s and 30s is when we should have kids and if that time is sacrificed to your job when you want kids, it doesn't make you a better doctor. None of my dying patients are sorry that they didn't work more or harder, but I've had several women sorry that they never "made it inconvenient for others" and have children. Besides maternity time is to allow for mothers to recover and for the care of the newborn, not for the mom to goof off. Frankly, I wouldn't want a non-sleeping stressed out new mother deciding anything important especially medical treatment.ReplyDelete
If it's a legitimate pregnancy your shifts will cover their self...ReplyDelete
This made me laugh :)Delete
I'm feel a bit different. Its always a bit annoying covering for others, but way less than covering for a sick co-intern who comes in and then cant do the job, and then takes longer to recover. Just stay home and get better and come back healthy.ReplyDelete
With all due respect, I think you really missed the mark with the suggestion that male residents should get 6 weeks of vacation too (and my critique is not based on length of time suggested). In order to promote gender equality and fairness to the situation, I think men should get paternity leave as well.ReplyDelete
I think the points about residents working while themselves or family members are sick are valid points but unrelated to this discussion. This issue affects both male and female residents, equally. I think pregnancy is a separate issue.
I understand the frustration other residents have about the increased workload and call they are burdened with when a colleague goes on maternity leave. However, if they have nerve to do more than grumble about it to themselves, I would almost question what kind of doctors they really are, and I would not hesitate to assume they may be ones lacking empathy and insight into caring for their patients as a whole person not the disease.
Finally if the wives of any of these male residents became pregnant and received this kind of discrimination in their work place, I hope these men would be very upset.
You made a great point that there's no good time to have a baby. And no woman is trying to screw over her fellow residents. It may not work out exactly fair in residency with the amount that some people covered for others, but I think throughout everyone career's it all evens out - he covers you, you cover her, she covers for the next guy, etc. / pay it forward. something like.
Maybe we need to send these guys back to first year medical school interviewing class and discuss empathy again?
The suggestion about 6 weeks of vacation for everyone was made to me by natasqi above, who is a female who has no interest in having children. She feels that people who don't want to have kids, rather than just men, are screwed over by this system. I agree that it misses the mark and I don't think it's a good idea.Delete
Paternity leave actually IS available. According to this website (http://www.babycenter.com/0_paternity-leave-what-are-the-options-for-dads_8258.bc), most employers are required to give *anyone* 12 weeks of family leave for the birth of a child. The leave is unpaid, but so was my maternity leave. But as I'm sure you know, most men wouldn't take that kind of time off, at least partially because it's not socially acceptable.
Incidentally, there was a male resident at my program who arranged to take one month off after the birth of his child and nobody gave him any problems, as far as I know. Other male residents simply tried to line up their vacations with the birth of their kids, and that wasn't a problem either. I personally absolutely would not have minded moving my own vacation or elective time so that a male resident could be off for the birth of their child.
In your post you seem to be saying that, because a strict threshold cannot be drawn, then one should not try to draw a threshold at all (i.e., in terms of getting mad at people for making certain choices). If a resident starts missing work _regularly_ because of broken legs (e.g., because she rides a motorcycle recklessly to work every day) or because of frequent colds (e.g., because she volunteers at an orphanage any spare hours she happens to have), then a program director would and _should_ sit her down and describe to her the effect that her choices are having on others in her program.ReplyDelete
I also agree that women complain about this as well. In my wife's ob/gyn program, which is 100% women, pregnancies are greeted with public smiles -- but privately, everyone SEETHES. This is because they now have be in two places at once during the day to cover the resident's daytime duties, and the resident's night calls have to be distributed among the remaining residents.
In my opinion, the problem could easily be solved by having residents pay back the calls that they missed when they come back from maternity leave. If they get pregnant during their PGY4 year, thereby precluding payback, then they could pay forward by taking care of all the calls that they will be missing during maternity leave. There is only a certain amount of advance preparation that can be done (e.g., "what if she gets pregnant during her PGY4 year but she goes into labor prematurely", etc) but I think they should do their best to try.
Alternatively, the pregnant resident could just pay her fellow residents for taking the call for her. It would be expensive, and having a child is expensive, but I think one of the things that got lost in the Anne-Marie Slaughter "having it all" debate is that there is no such thing as "having it all". You have to make choices, and each choice has its own set of costs and benefits.Delete
The problems I see with the payback system are as follows:Delete
1) Why is maternity leave special? Would other people who miss calls have to pay them back too? If not, I don't think that would be fair.
2) Paying calls forward is not really a great idea, because obviously you can't know for sure if you're going to get pregnant, and during pregnancy is the absolute worst time to be q2 or q3. I could just barely do my regular calls. We don't want to set residents into premature labor.
3) Most women have to make up the time they missed at the end of residency. So does that mean that they have to pay back all the calls AND do extra time AND take calls during that extra time?
Ultimately, I think you're right that such a system would reduce resentment. It's just logistics that are tricky.
Maternity leave is special because you can make the argument that not everyone is subject to the same risk of pregnancy. Sometimes pregnancy is a chance event, but more often than not it is planned. Coming down with a cold, getting into a vehicular accident, etc. are generally not planned events and everyone is more or less (assuming away the special circumstances I described in my first comment) subject to the same risks. Most medicine programs have a jeopardy system where you call in jeopardy if you get sick. In general you are not responsible for paying back the jeopardized days, e.g., out of your vacation time (although one can certainly make an argument, as you suggest, that this should be the case), because it is understood that you stand an equal chance of getting jeopardized yourself in the future and that it all evens out. With pregnancy there is no such evening out. Twenty-five year-olds fresh out of medical school who do not have significant partnerships are much less likely to be planning on pregnancy compared to 30 year-old women who are married to partners with a stable job and who already have one other child.Delete
I agree with limitations you describe in #2 and #3. You just have kids when you think it is the right time for you and your partner, and f#$% the impact on the other residents because there is never a good time for having children and d@#$ed if you are going to wait until residency is over just so you can spare your co-residents a few extra calls. You think I am joking, but that is how one of the women in my wife's program described her thinking about pregnancy.
That's why the current system subjects single people to a disadvantage when it comes to this: if your co-residents screw you, you have no way of screwing them back.
Well, everyone subjects themselves to different risks. If someone partakes in a risky sport and breaks a bone, would they then have to pay back all the calls in the same way? If your spouse or child got a serious illness and you took a leave to care for them, would that need to be paid back in the same way? And I wouldn't say that pregnancy is planned "more often than not." A LOT of the residents I know got pregnant by accident.Delete
In my residency, several residents were interviewing for fellowship. I was not. This involved them flying out and missing lots of days and having the schedule altered for them. They used "academic days" for this, and I spent a lot of time covering for interviewing residents. Is this more fair than asking someone to cover for a resident on maternity leave?
I think that woman in your wife's program is shortsighted. If she thinks she's getting screwed over now, wait till she's in practice with only 2-3 other people and one of them women is gone for 12 whole weeks (rare to take that long in residency).
I think a big issue is that people see pregnancy as a choice. But I don't see something that sustains the human race as a choice. I think it's something we all need to get used to as there are more and more women in medicine, and make it *easier* for women to take leave, not create more hoops to jump through.
I agree with you, Fizzy, that residency programs need to prepare/plan for jeopardy call/coverage, particularly as more and more women (of childbearing age) enter medicine. I think it is so touchy because a lot of programs don't have set rules and many people (including the scheduling chief resident at my program) don't want to have to "accommodate" pregnancy. There were 4 female residents in my internal med class who all got pregnant our last year of residency, and we managed to a) rearrange vacation/research months for maternity leave, as to not "inconvenience" our fellow residents, and b) we all made up call. I'm very conscious of not "causing more work for other people" so I took call and clinic when I was pregnant so that this issue you talk about precisely didn't come up. I'm not saying that everyone should do that, but rather, arrangements should be made to accommodate everyone (ones with and without family) as best as possible and as long as everyone does their share, who cares? My program culture was such that jeopardy/call was usually made up (for illness and fellowship interviews and such), so there wasn't as much grumbling as the previous commenters seem to have noted at their programs. But really, you're right in that everyone sees pregnancy as "a choice", so that you end up feeling obligated to make up call anyway. I do have to say though, I do know of a pregnant resident that totally took advantage of this- ie, missing entire days for 8am doctor's appointments (completely healthy pregnancies) on their afternoon clinic days so that she didn't have to come back to work after the appointment (and went shopping and hung out at home instead- as seen on Facebook!)... so I can see why some people end up very riled up about this issue. As long as pregnant residents still put forward the effort- and program directors/residency administrations try to equal out the workload, this should end up being a non-issue...ReplyDelete
Not just in medicine, also in most male dominant fields. I was asked if i had completed my family at interview, i told them i had a date for my sterilisation and i was given the position on the strength of that - along with my ability to do the job of course. I worked shifts and if my children fell ill and the childminder refused to accept them i would have to take a sick day or swap shifts with collegues which was a royal pain in the butt. How do you stop a child getting chicken pox or viruses?ReplyDelete
It was always different for the dads, people would be sympathising for thier lost sleep etc. Mums were just expected to be able to operate on no sleep. Dad takes a evening shift off for little Johnies first school concert - wow what a great Dad, i take a day off short notice as my son has developed a blood disorder and has to go to hospital for tests.. couldnt you arrange it for when you were off? Have they never heard of an emergency? Would they have been at work when thier child had been bleeding from everywhere due to some whacky immune resonse to a virus? I think not. I took holidays only when i could not get others to cover shifts, i only took sick days when i was unable to speak,which is kind of necesary for air traffic control!
I'll begin by stating that I'm 100% in favor of covering for all the residents in my class for whatever the reason, pregnancy or otherwise. I don't need the person to do two calls to make up for my one - heck, if there was no call make up at all, I'd be ok with it. In the big picture, what's an additional 1 or 2 call shifts if you can help out? Call it "paying it forward", but I feel that we're all dealing with the same daily crap and struggle, we should support each other as much as we can.ReplyDelete
Frankly, I'd much rather provide coverage for a pregnant woman than I would for someone who broke his/her leg skiing (especially if that person shirked clinical responsibilities to go skiing) or someone who drank too much and called in sick with gastro (both of which have happened to me). In my experience, the women who leave residency to give birth end up coming back quickly to work without missing a step - it's not like they become less of a doctor.
What I don't like is the lack of paternity leave at many programs. If I have kids, I want to be there helping my wife and newborn, not sitting in the hospital. I've known guy friends who had to change their vacation schedules to coincide with the birth of their children. I don't think in 2012 that we can cling on to outdated beliefs that the mother is the primary care giver, thus paternity leave shouldn't exist.
"Keep in mind guys, that you also don't ever have to do nine months of residency with swollen legs, an aching back, and carrying 30 pounds of baby and fluid around with you everywhere you go... doesn't sound as bad now, does it?" While I'm not trying to minimize how physically taxing pregnancy is or that some women get hit harder than others, 9 months? I think we can all agree that you're not carrying around 30 extra pounds with swollen legs at 12 weeks in.
Yeah, at 12 weeks I was just vomiting daily :) Seriously though, I felt fairly lousy through my entire pregnancies.Delete
I completely agree about paternity leave. Part of maternity leave is infant care, so why shouldn't men get that too? I do think that when residents whine about covering for maternity leave, that does not lead to policies that encourage paternity leave. But as I said in another comment, one guy in my program did it without difficulty. Frankly, I think it's a matter of pride among men... they feel like they shouldn't take leave, so they don't bother to ask.
Interesting post. I think the 6 week mat leave in the US is a big part of the issue... when it's just 6 weeks of coverage the programs seem to have a big problem with coverage (based on the posts above).ReplyDelete
In Canada where many resident physicians take the full year off, it's a different issue. You're not trying to just "cover a few weeks of call shifts". I took a year in my R1 year (a bit longer than I wished, actually, but it was easier that I was just out the whole year, scheduling wise). Most of my friends did the same although the surgical residents I know were more likely to take less. My obs/gyne friend took 4 months with #1 (R1 year) and 6 months with #2 (R3 year) and has done very well - she's well synced back in again after 2 kids.
The programs do need to be flexible when multiple residents are off at one time - particularly small ones - but the big ones like internal (40 residents per year) or family (12 per year in each site) seem to do just fine at our institution and NO ONE (in those programs at least) are doing extra call / getting pulled from vacation.
I've even heard of hospitals WITHOUT RESIDENT COVERAGE (shocking, I know!) when there are just aren't enough residents to go around and the attending just does their job without residents.
Anyways, with baby #2 due as a now practicing physician I don't have the same financial options to take a year (only paid for a 4 month mat leave, instead of 12) and so it will be a shorter leave with #2. I feel pretty lucky to be North of the border, I must say :)
It was actually a big issue at my program that attendings didn't want to chip in to help out when residents were out. For example, in the musculoskeletal clinics, there were generally 10 patients scheduled in an afternoon and there would be two attendings and two residents. If one resident wasn't there for whatever reason, the remaining resident would be forced to see all 10 of the patients.Delete
When I was in residency, the majority of women who had babies were very sensitive to the issues related to call and coverage. They would either "make up" the calls they would miss during the first or second trimester of their pregnancy (a few were still going pretty strong that last couple of months) or after returning from maternity leave. The weeks they were out, it affected the rest of us but not any more than residents who had to take time off due to medical problems or other issues.ReplyDelete
Frankly as a resident and then later as an attending, there was more tension between the childless and the ones with children who were toddlers and up (both male and female residents). It was a very small minority that caused problems but still I get more frustrated by those who always claim they should have major holidays, consistently leave early (not emergencies like a child being sick or having a special once a year recital but 2-3 times week for soccer practice or such). The justification that they have "a real family" is frustrating. Again, it is only a small minority that acts this way but it can be a problem.
im an associate at a practice (just changed from temp after 2.5 yrs) and pregnant. i didnt tell for a while (and continued doing fluoro) because i felt guilty. oddly EVERYONE has been super supportive. it helps that it is a huge group. we are the same as other medical groups... calling out sick isnt done but... this is in advance.. anything more than 1 month or so in advance is awesome cause the schedule isnt made yetReplyDelete