By Jon Steinmetz, DO
Parental leave policies for medical trainees have improved dramatically over the last decade. This is in large part due to a larger focus on eliminating physician burnout and improving overall well-being. We are nearing the one-year anniversary, in July, of the new institutional leave requirements put into effect by the ACGME (Accreditation Council for Graduate Medical Education). These new policies for accredited institutions mandated a minimum of six weeks paid parental (or medical and caregiver) leave. This was established as part of the ACGME’s larger commitment to resident and fellow wellness.
I was the first trainee in my fellowship program to utilize the newly instituted parental leave policy. My wife and I were soon welcoming our first child when I first learned of the time away I would be afforded, and surprisingly, I was torn. My wife, who is not in the medical profession, was thrilled. She could have the appropriate support and assistance needed in those first foggy sleepless weeks. I, however, was conflicted. Could I really take the full amount of time off?
I knew that I was not alone in these apprehensions.
I asked myself why I, like many other medical trainees in this country, felt a sense of abandonment and guilt in spending time away from work. I was lucky enough to be a part of a program led by supportive physicians and graduate medical education staff. Trainee wellness is at the forefront of the messages we receive throughout the year, not just during the Residents and Fellows Appreciation Week.
I felt guilty about needing colleagues and friends to cover shifts for me; this has been a well-documented concern for many trainees in the past.1 I felt a responsibility toward my seriously ill patients. I liked to think that this was the noble cause of my unease. As a medical school applicant, I wrote essays and answered interview questions expounding on my desire to care for the sick or the underserved, and talked about the sense of duty I felt to give back to my community. Was I abandoning this responsibility by caring for my own family?
Ultimately, is it some sort of generational trauma? We often hear previous generations of physicians harken back to their grueling relentless training years, stories prefaced with the requisite “when I was a resident” or other similar expressions. While we are in a much better place today as medical trainees, we still experience stigmas when it comes to support, well-being, and safety. I myself, a fellow who completed internal medicine residency training just under two years ago, might be overheard at a residency morning report spouting those same unwanted remarks.
Even with support from my colleagues, co-fellows, and attending physicians, all reinforcing that I should be spending this time with my growing family, it was, as it often is, an interaction with a patient that helped me get past these concerns.
When I first began my fellowship training, I encountered a patient, Mr. B., whom I had not seen previously. He had been receiving treatment for metastatic colon cancer for several months at that point, and his disease was completely stable on the most recent imaging.
I finished asking about his previous cycle of treatment and was about to auscultate his lungs when he stopped me. Mr. B asked, hopeful, “My children and grandchildren are going away on vacation for 10 days soon. Do you think I would be able to go with them? It would delay my next treatment.”
I stammered, unsure, “Well, I’ll have to ask my attending. Your regimen has you receiving treatment every two weeks, and it’s very important for you to stay on schedule.”
When my attending walked in and heard the question, he rather emphatically answered, “Of course! We will push your treatment cycle off a couple of days. You need to be with your children—we’ll still be here when you get back.”
I slunk back into the exam room corner, shoulders dropping in a way that was probably only perceptible to myself, learning another in a long line of lessons in the art of medicine.
I have since heard many variations of these questions from patients. “Is it alright if I go to my niece’s wedding in Canada? My grandson’s sixth birthday, out of state? I’ve been looking forward to this for such a long time.”
There are of course many things one needs to consider in that situation—goal of treatment, frequency of therapy, infection risk with travel—but no one should have to wait until they have a terminal illness to be told that they should be spending time with their loved ones. It is through them that we first learn empathy and compassion.
And it is something we need to consider for ourselves, as caregivers and providers in this profession. Even with all the well-being retreats, picnics, outings, and softball games, it remains easy to at times become hardened in this profession. Allowing time for you to care for your loved ones, and certainly for yourself, will only make you a kinder and more patient physician.
Now, watching my son begin to laugh and crawl and bob his head up and down to my off-key singing each morning before heading to clinic, I am reminded of the later conversations I had with Mr. B. I only saw him one or two more times, and all I can recall from those visits was the glow of his face discussing that trip with his grandchildren.
On the toughest days, memories of Mr. B remind me why I wrote those medical school applications years ago and chose to forge this path for myself. Moreso, they remind me that we cannot let the guilt of temporary unavailability impede caring for ourselves and our own loved ones.
Dr. Steinmetz is a current second year hematology-oncology fellow at the University of Connecticut. An ASCO member since 2019, he developed his interests in improving health care literacy and communication while completing his internal medicine residency at University of Connecticut. Follow him on Twitter @JonSteinmetzDO. Disclosure.
- Murphy B. How does parental leave affect physician resident performance? AMA Medical Resident Wellness. Nov 15, 2022. Accessed Jun 22, 2023.