Parental Leave During Residency Training
- Any parental leave plan utilized by a family medicine residency program must:
- Safeguard the health of the parent and child,
- Assure that the resident fulfills all educational requirements, and
- Assure that the patient care is uninterrupted by the resident's absence.
- There are a number of factors which will affect the specific provisions in a parental leave plan, and which must be taken into consideration in developing the plan. The factors include:
- The American Board of Family Medicine has established requirements with respect to the amount of time a resident may be absent from his or her training program in any 12-month period and still retain eligibility to make application for the ABFM examination. An excerpt from the ABFM's Information Manual for Family Medicine Residency Program Directors containing the most current version of these requirements is enclosed as Appendix A.
- Some residency programs may be subject to various federal and state laws, including the Family and Medical Leave Act (FMLA). These laws may impose certain requirements on parental leave plans utilized by family medicine residency programs and may guarantee certain rights for residency programs and for residents taking parental leave.
- Subject to applicable law, the AAFP recommends that the following be incorporated in residency programs parental leave plans:
- Expectant mothers must be allowed the same sick leave or disability benefits as other residents.
- Expectant partners and adoptive parents should be allowed the same leave or disability benefits as other residents.
- The category of leave credited (sick, vacation, parental, short-term) should be specified.
- Whether leave is paid or unpaid should be specified.
- The duration of parental leave for residents should be based on the written recommendations of the physician(s) caring for the resident and infant and/or state and federal laws.
- Residency programs are encouraged to allow residents to design home-study or reading electives which should comply with Review Committee - Family Medicine (RC-FM) requirements, for use around the estimated delivery date (EDD) or adoption and after delivery to minimize the time needed away from the residency. Such home study electives would be likely to include some Family Medicine Center (FMC) time weekly in order to meet RC-FM continuity requirements for the FMC.
- The expectant or adoptive parent should notify the program director and those responsible for scheduling of rotations and call as soon as pregnancy or adoption is confirmed. Coverage of responsibilities during the leave should be arranged as early as possible.
- Efforts should be made to schedule the most demanding rotations earlier in the pregnancy, allowing for the least strenuous rotations to be performed around the time of the resident's EDD.
- The rotation performed around the time of the EDD or adoption should be one in which the resident is not essential to the service and which would allow time off without jeopardizing patient care or disadvantaging the other residents in the program.
- The expectant or adoptive parent's call schedule should be arranged to have no call around the time of EDD or adoption and while on leave. The resident is expected to make up call before or after the leave, so other residents aren't disadvantaged.
- Residents taking parental leave must be able to return to the residency within a reasonable period of time without loss of training status.
- Provision for the continuation of the resident's insurance benefits during the leave should be made and who pays for the premiums should be specified.
- Communication to each resident should be made regarding how the leave will impact the resident's graduation and ability to sit for the American Board of Family Medicine exam.
- The mechanisms available for making up time, or extending or delaying training should be verified.
- It should be verified if the extended training or make-up time will be paid.
- The expectant or adoptive parent(s) should notify the program director and covering residents when labor and/or FMLA time begins.
- Expectant mothers must be allowed the same sick leave or disability benefits as other residents.
Appendix A - Except from American Board of Family Medicine's Information Manual for Family Medicine Residency Program Directors, Absence from Residencies, 2005.
Absence from the Residency
The requirements for continuity of care and the Family Medicine Center (FMC) experience are defined by the ACGME in its "Program Requirements for Graduate Medical Education in Family Medicine."
A resident is expected to be assigned to one FMC for all three years, but at least throughout the second and third years of training. The total patient visits in the FMC must be met, and residents must be scheduled to see patients in the FMC for a minimum of 40 weeks during each year of training.
Residents are expected to perform their duties as resident physicians for a minimum period of eleven months each calendar year. Therefore, absence from the program for vacation, illness, personal business, leave, etc., must not exceed a combined total of one (1) month per academic year.
Vacation periods may not accumulate from one year to another. Annual vacations must be taken in the year of the service for which the vacation is granted. No two vacation periods may be concurrent (e.g., last month of the G-2 year and first month of the G-3 year in sequence) and a resident does not have the option of reducing the total time required for residency (36 calendar months) by relinquishing vacation time.
The Board recognizes that vacation/leave policies vary from program to program and are the prerogative of the Program Director so long as they do not exceed the Board's time restriction.
Time away from the residency program for educational purposes, such as workshops or continuing medical education activities, are not counted in the general limitation on absences but should not exceed 5 days annually.
Absence from residency education, in excess of one month within the academic year (G-1, G-2 or G-3), must be made up before the resident advances to the next training level, and the time must be added to the projected date of completion of the required 36 months of training. Absence from the residency, exclusive of the one month vacation/sick time, may interrupt continuity of patient care for a maximum of three (3) months in each of the G-2 and G-3 years of training. Leave time may be interspersed throughout the year or taken as a three-month block.
Following a leave of absence of less than three months the resident is expected to return to the program and maintain care of his or her panel of patients for a minimum of two months before any subsequent leave. Leave time must be made up before the resident advances to the next training level and the time must be added to the projected date of completion of the required 36 months of training. Residents will be permitted to take vacation time immediately prior to or subsequent to a leave of absence.
In cases where a resident is granted a leave of absence by the program, or must be away because of illness or injury, the Program Director is expected to inform the Board promptly by electronic mail of the date of departure and expected return date. It should be understood that the resident may not return to the program at a level beyond that which was attained at the time of departure.
Leaves of absence in excess of three months are considered a violation of the continuity of care requirement. Programs must be aware that the Board may require the resident to complete additional continuity of care time requirements beyond what is normally required to be eligible for certification.
While reaffirming the importance of continuity of care in family medicine residency training, the Board recognizes that hardships occur in the personal and professional lives of residents. Accordingly, a waiver of the continuity of care requirement or an extension of the leave of absence policy may be granted when a residency training program closes or when there is evidence of the presence of a hardship involving a resident. A hardship is defined as a debilitating illness or injury of an acute but temporary nature, or the existence of a threat to the integrity of the resident's family, which impedes or prohibits the resident from making satisfactory progress toward the completion of the requirements of the residency program.
A request for a waiver of the continuity of care requirement or an extension of the leave of absence policy on the basis of hardship must demonstrate:
- that the absence from continuity of care does not exceed 12 months;
- the mature and extent of the hardship;
- that excused absence time (vacation/sick time) permissible by the ABFM and the program for the academic year has been reasonably exhausted by the resident;
- that a medical condition causing absence from training is within the Americans with Disabilities Act (ADA) definition of disability.
For absences from training of less than 12 months, the amount of the 24-month continuity of care requirement completed prior to the absence will be considered a significant factor in the consideration of the request.
When the break in continuity exceeds 12 months, it is highly unlikely that waivers of the continuity of care requirement will be granted.
In communicating with the Board, the program should indicate the criteria it will use, if any, to judge the point at which the resident is expected to reenter. The resident may NOT be readmitted to the program at a level beyond that which was attained at the time of departure, but the resident may reenter the program pending a final decision by the Board on the amount of additional training, if any, to be required of the resident. (2000) (2012 COD)