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.
References
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.
3Pearson ACS1, Dodd SE2, Kraus MB3, et al. Pilot Survey of Female Anesthesiologists’ Childbearing and Parental Leave Experiences. Anesthesia & Analgesia. 128(6):e109–e112, June 2019
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Thank you, ABA, for your support of residents and fellows in anesthesiology!
A full 6 months off? No more training than a CRNA at this point.
This new policy only grants an additional 8 weeks of leave above and beyond the old policy. That means up to four weeks of vacation/leave per year plus this. While that does in fact equate to 6 months total over 4 years, given the hours that we put in and the work that we do your statement cheapens the hard work of all residents and anesthesiologists. All milestones, case logs, etc still will be met (and likely exceeded) by everyone going through residency, even with this 8 week cushion—which is needed.
What a positive movement to allow PDs and Chairs to assess a residents’ competency while allowing for their improved ability to function as a human being, in terms of recovering from illness or parental/caregiver leave. I think the tricky part is assessing junior residents’ ability to be competent in the future. For example, if a CA1 requests extended leave to care for a parent who has an acute illness, will I be able to assess that when he is a CA3 he will be ready to graduate on time? In the past system, days were made up day-for-day but competency in training is assessed on a 6 month basis. We may need some way to extend training in less than 6 month chunks as needed. A lot of variability and uncertainty in the system, which stresses us all out, but a much needed more towards humane medical training! Thanks, ABA.
The ABA cannot justify the loss of overall training time. Instead of requiring extension of training by up to 40 days, the ABA has diluted the training experience to the point it may allow board certification of potentially poorly trained or unsafe anesthesiologists. Time in training does matter.
It’s great to see the ABA recognizing and supporting its residents’ and fellows’ needs beyond the ORs. Thanks for this commitment to your physicians and their families.
As someone who had to return to work just seven days after giving birth to my first child during my surgical intern year, and give up all of my vacation with my second during my anesthesia training, I applaud this new ABA policy. I am proud to say that the ABA recognized an important issue that was negatively impacting residents and made positive changes to improve their quality of life and ultimately the type of doctors they will be after training.
Let’s be honest. 99% of this is about maternity leave. Why shouldn’t a resident be expected to make this time up? I say new parents should have all the reasonable leave they need but should also be expected to make that time up. If a female co-resident took 6-10 weeks off for maternity leave and didn’t have to make it up I would be pissed. Expecting this time off and not having to make it up later is incredibly arrogant. Taking the time off is reasonable. Not making the time up is just unreasonable.