Taking Leave in Residency: Tips and Traps

Marcia L. Frellick

Disclosures

December 08, 2017

From needing to care for an ailing family member to tending to a personal illness, there are various reasons to step away from medical training. Yet Kimberly Manning, MD, who directs the Transitional Year Residency Program at Emory, says maternity and paternity leave are by far the most common reasons residents take time off.

The decision to step away from training is a highly personal one, Dr Manning told Medscape. Specifically in terms of starting a family, she described that, in her experience, "there's never a good time to have a kid...but it's also a wonderful, wonderful thing. Who am I, as your program director, to try to say anything to discourage that?" she said. "When someone comes in and says, 'I'm pregnant,' the response is 'Congratulations,' and we mean it."

Dr Manning explained that it helps that her program has 24 residents. With smaller programs, when a resident takes leave, the burden is much higher. She also acknowledged that in such residencies as surgery and ob/gyn, the call demand is much tougher to accommodate during a leave.

In all cases, Dr Manning advises anyone considering stepping away from residency to tell program leadership early, so that schedules can be rearranged. In her program, she said, schedulers can front-load the blocks with essential patient care—such as those in intensive care units and inpatient units—and leave the electives for closer to the birth. The biggest drawback for residents, she said, is that interrupting academics will probably delay graduation, and that often discourages residents.

There are many aspects to consider when contemplating an interruption in medical training; some are specific to those who are starting a family, and many apply to anyone considering taking leave.

'You Do What You Need to Make It Work'

Swathi Krishna, MD, had her first baby in her second year of psychiatric residency. She had her second baby in her fourth year of residency in May.

The decision wasn't the first time that Dr Krishna bucked tradition. She left a marketing career to study at American University of Antigua College of Medicine and started residency at age 32. Starting later in life made her decision to build a family and complete her medical training at the same time even clearer for her. With her second child, she was able to finish clinical rotations before the birth and then work from home doing research with childcare help from a part-time nanny. She used vacation and sick leave so that she didn't have to extend her residency. However, the first pregnancy put her off-cycle.

That's a consideration for those considering taking leave, Dr Krishna said, because it can potentially put a resident at a disadvantage for landing fellowships. Now 36, she began a fellowship at Emory University School of Medicine in Atlanta, Georgia, in November. She told Medscape that one key to managing the stress was switching off nighttime feedings with her husband so she could regularly get 6 hours of sleep.

"I am a high-energy person. I can do anything as long as I have sleep," she said. "You're in survival mode, and you do what you need to do to make it work."

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