Most ABMS member boards do not have accommodations for lactating physicians

Most American Board of Medical Specialties member boards do not have official lactation-specific examination accommodation policies for female physicians, researchers reported in JAMA Internal Medicine.

The AAP recommends that infants receive breast milk until the age of 1 year, Kevin T. Nead, MD, MPhil, an assistant professor in the department of epidemiology at The University of Texas MD Anderson Cancer Center, and colleagues wrote noted.

According to Nead and colleagues, up to 22% of female trainees deliver a child during postgraduate studies, and nearly 59,000 female physicians are in residencies or fellowships in the United States — a large group potentially affected by board exam lactation accommodations.

Nead and colleagues conducted a cross-sectional study, contacting American Board of Medical Specialties (ABMS) member boards by phone and email from Aug. 3 through Sept. 10, 2020.

“Any ABMS member boards were considered to have official lactation-specific examination accommodation policies if a board representative verified the existence of an active examination accommodations policy specific to lactation,” they wrote.

Additionally, the researchers posted a cross-sectional convenience survey on social media that targeted female physicians from July 15 to Nov. 5, 2020.

Participants were eligible if they were aged 18 years or older, female, and had taken or planned to take an ABMS member board exam and indicated they had been lactating when preparing to take or had taken a board exam within a year of childbirth.

The authors successfully contacted all 24 ABMS boards, either by telephone (n = 5; 21%), email (n = 8; 33%) or both (n = 11; 46%). Of all ABMS boards, 10 (42%) indicated having official lactation-specific accommodation policies.

All 24 boards included additional break time for lactating women from 20 to 60 minutes. The authors reported that seven boards provided private spaces, yet six of these seven spaces were deemed “if available.”

Most boards required 1 to 8 months of notice to request accommodations, and three boards required medical documentation of lactation.

The 292 respondents represented 19 ABMS member boards. The median board examination year was 2019, and 178 respondents (61%) reported difficulty determining lactation accommodations, whereas 255 respondents (87%) reported anxiety surrounding lactation and preparing for sitting for the exam.

A total of 199 respondents (68%) reported that lactation accommodations were inadequate. Reasons included insufficient dedicated space (n = 140; 70%), the number of breaks (n = 74; 37%), and the duration of those breaks (n = 72; 36%).

Of the 218 physicians who sat for an exam while lactating, 51 (23%) used testing time to express breast milk, and 91 (42%) experienced symptoms of breast engorgement from inadequate or delayed breast milk expression.

The researchers recommend that ABMS member boards have an official lactation-specific examination accommodation policy, policies readily available on ABMS member websites, accommodation-request deadlines as close to the exam date as possible, accommodations for additional break time and frequency, and guaranteed private space.