to the editor: Many important points are raised in the “Resident and Student Voice” piece on women in medicine.1 I would like to expand on the challenges facing women physicians when having children. As the author points out, many physicians feel “there is no right time to have a child in medicine.”1 I was one of those who thought that the best time for me to have a child was during medical school, because of the flexibility of leave time and the support of my partner. I was also confident that I would be able to find or create a part-time residency in my chosen specialty of family practice, but I found I was wrong. Although my program was admirably flexible, the infrastructure did not exist to support a part-time residency. Now, as I graduate from residency with two sons who are four and six years old, I feel even more strongly about the need for part-time residencies.
Part-time residencies have been investigated since the early 1970s2 and have been implemented in many different programs throughout Canada, the United States, and the United Kingdom. A survey3 of all medical students at the Medical College of Pennsylvania indicated that 39 percent would probably or definitely apply to part-time residencies if they were available. Moreover, longitudinal data on the outcomes of a part-time residency indicate a higher level of clinical and humanistic skills in the part-time residents.4
Unfortunately, part-time residencies in family practice are hard to find. There are few guidelines for interested applicants,5 and they are put in the position of having to gather information as they are interviewing. The residency directory information regarding part-time residencies is often incorrect or outdated. Also, residency directors may not be in a position to independently create alternative tracks.
I urge the American Academy of Family Physicians and the American Board of Family Practice to investigate and promote the creation of dedicated part-time residencies in family practice. Our match numbers reflect a shift from primary care areas to subspecialization; the 2001 FP program fill rate of 76 percent was the lowest since 1994. Attracting and retaining excellent candidates who may have other personal and professional obligations will help our specialty develop. It is time to incorporate the values of family practice into our actual training programs and to support our residents the same way we train them to support their patients.