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Most program directors misinterpret leave policies for residents
Most internal medicine program directors do not fully understand ABIM’s leave policies for graduate medical students, according to a study published in the Annals of Internal Medicine.
“A misunderstanding of the policies could result in a resident being unnecessarily required to extend their training beyond the usual 3-year period,” Furman McDonald, MD, MPH, senior vice president for academic and medical affairs at ABIM, told Healio Primary Care. “This might delay the start of fellowship or career. It’s a challenging time in health care, and it’s important that when patients need care there are highly-skilled physicians ready to treat them.”
ABIM currently has two policies for residents regarding leave for illness, vacation, parental and family leave. The first — the Leave of Absence and Vacation policy — allows residents to take a month of leave each year. However, ABIM intended a month to mean 5 weeks, or 35 days. The second — the Decits in Required Training Time policy — permits an additional month of leave without additional training if the resident is deemed competent after an assessment by a clinical competency committee.
McDonald and colleagues conducted a national survey of internal medicine program directors to evaluate their understanding of ABIM leave policies by asking them specific questions about the policies. They also asked the directors to apply the policies to specific scenarios.
Among 279 participating programs, 51% of directors reported that they understood the “1 month” Leave of Absence and Vacation policy. However, just 4.3% of program directors knew that the policy defined a month as 5 weeks.
When asked about the Deficits in Required training policy, 65.2% said they were aware of the policy, but 3.6% knew 5 weeks was the time allowed.
The rates of correct responses to specific scenarios ranged from 1.5% to 52%. For a scenario in which a resident requested 8 weeks of maternity leave, 6.5% of program directors correctly applied ABIM policy and did not extend training, whereas 82.7% reported that they would extend the resident’s training because they thought it followed ABIM policy. Those who said they would extend training said they would create home electives or require the resident to come in for clinic.
As a result of these findings, McDonald said that ABIM and the Association of Program Directors in Internal Medicine worked together to identify the most misunderstood aspects of the policies and clarified them on their website.
“ABIM then re-surveyed every program director of internal medicine and all the internal medicine subspecialties and found that the vast majority — 82% — found the new language to be clearly stated and understood as intended,” he said.
In addition, he said the organization is working with the Alliance for Academic Medicine to communicate the leave policies with program directors to help them “be more aware of the leave policies and how they should be applied.” – by Erin Michael
Disclosures: McDonald reports receiving compensation as an author, paid to Mayo International Health Program. Please see study for all other authors’ relevant financial disclosures.
Perspective
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I think for some years now there has been confusion and sometimes misinterpretation of what the rules are regarding leave for parents, and how that impacts resident physicians eventually being able to sit for their boards. I was glad to see that they did this study, which showed that there are misconceptions among program directors, but also that the board has now clarified that on their website to make it clearer for everyone involved what needs to happen to make sure that resident physicians are doing the right thing when they need to take time off for parental leave. A challenge is that each board — whether it’s the board of internal medicine, general surgery or pediatrics — has different requirements and different allowances if people need to take time off either for being ill or for having a child or for any other leave of absence. It can be confusing to make sure that you’re abiding by those rules for the resident physician.
There have been some proposals to make a common policy across all graduate medical education programs to make it clearer what needs to happen. Just as the internal medicine board has now done after this study, I think it’s important to have all of the various specialty medicine boards review their policies and ensure that they’re as clear as they can be, so residents and their program directors know what is expected. I would also add that many universities or many hospitals have disparate parental leave policies. While I don’t know if an organization such as the Accreditation Council for Graduate Medical Education will ever come out with a standard policy, that would make it easier to say to everyone who is in graduate medical education across the country, “if you take parental leave, this is what is permitted, this is what is allowed.” I don’t know if they’re going to do that or not; they’ve been very supportive of well-being in general and of residents and fellows who are parents. For instance, they have rules around accommodations for breastfeeding, which have moved the needle around making that be something that is more acceptable and easier to do if you’re a nursing mother and a physician.
It’s unfortunate that residents are not getting the time that they could get, and that some choose to make up extra time, although it sounds like in several of these cases they didn’t actually need to make up the time. That is hard because many people are hiring in July when people graduate, or many people are moving on to further fellowship training. Delaying that start time can be challenging, and sometimes they even have to wait another year before they can start again. The misinterpretation of the leave policy can result in residents spending more time in training than they need to. Another problem is that sometimes people choose to take less time off so that they don’t have to make up time, and I think what this study has found is that sometimes that isn’t the case, and they are able to take more leave than what the program director thought was allowable. As we know, and as the study alluded to, there are definitely benefits for both parents — the birthing parent and the other parent — and the child if parents to have more time off.
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