Authors: Amanda Kirzner, D.O., S. Maggie Coffield, D.O., Amy Pearson, M.D.
The field of anesthesiology presents a set of unique challenges regarding leave of absence during residency training. It can be argued that each rotation that a resident experiences is a critical learning period for them. The ability to take time off for parental leave, illness or family obligations, however, is necessary to promote work satisfaction, career longevity, and residents’ health and wellness. It is important that a balance between the ability to take leave and the ability to become competent in the planning and procedural skills required to become an anesthesiologist be reached.
Employers and specialty societies are recognizing that the ability to take a leave of absence is important not only for the health and longevity of an individual, but also of the physician workforce. The American Society of Anesthesiologists recently published a Statement on Personal Leave, which states that “a successful career in anesthesiology should allow for the opportunity to respond to personal or familial needs.”1
This is a timely statement for anesthesiology, as recent publications have called attention to our specialty’s challenges regarding the leave-of-absence experience for qualifying events. For example, anesthesiology has the highest rate of maternal discrimination (odds ratio [OR], 1.92, P<0.001) among specialties, considerably higher than surgery or internal medicine.2 Additionally, in a pilot study of women anesthesiologists, 56% of women who gave birth during residency or fellowship needed to extend their training. Less than half of all mothers were satisfied with their colleagues’ and superiors’ handling of maternity leave and lactation needs, and only about half felt that their leave was adequate.3 While maternity leave is the most well-studied leave experience in anesthesiology, there is concern that unfavorable experiences may also exist for paternity leave, caregiver leave and personal medical leave.
As of July 1, the ABA implemented a new policy for leave of absence during training. The previous policy was fairly succinct: over three years of clinical anesthesiology training (CA1-3 years), a trainee could be absent no more than 60 working days. Additionally, a trainee could miss up to five more working days in an academic year to attend scientific meetings. Absence from training during the clinical base year was up to the discretion of the training institution. Any absence longer than 60 working days over those three years would require a trainee to make up the time prior to graduation.
The new policy affords the same 60 working days of permissible absences during the CA1-3 years as well as five academic days for meeting attendance. Newly, the ABA will consider requests for absences of up to 40 additional days away from training. Approval from the ABA must be requested within four weeks of the resumption of training following the leave. The request must include the reason for absence as well as documentation of how all clinical experiences and educational objectives will still be met. This request needs to be signed by the trainee, the program director and the chair of the department. Any absence beyond the 60 days + 40 days will require an extension of training.
With the new policy, now residents with absences due to conditions covered by the Family and Medical Leave Act could potentially qualify to graduate with their peers. However, this additional leave is subject to approval by the department chair and program director. Since implementation of this policy is at the discretion of the training program, it is unknown whether equally qualifying residents would be subject to different applications of this policy based on their institution.
While the ABA’s Absence from Training Policy represents a major shift in medical and family leave during anesthesiology training, the American Boards of Surgery, Pediatrics, and Internal Medicine also have similar mechanisms in place to allow additional medical leave without extension of training. As medical education is trending toward milestone-based over time-based graduation targets, this policy helps to customize training to the learner’s needs while still maintaining the ABA’s standards for competence as an anesthesiologist. It is the hope that this policy will support a healthy and competent workforce and ultimately ensure a solid future for our specialty.
1Committee on Young Physicians. “Statement on Personal Leave,” American Society of Anesthesiologists. Oct. 17, 2018
2Taiwo Adesoye, MD, MPH, Christina Mangurian, MD, MAS, Esther K. Choo, MD, MPH, et al,Perceived Discrimination Experienced by Physician Mothers and Desired Workplace Changes. JAMA Intern Med. 2017 July; 177(7): 1033–1036.