Despite progress in work-life integration at academic medical centers and hospitals, healthcare professionals continue to face parenting-related challenges while striving to succeed in their professional lives. These challenges became even more visible during the COVID-19 pandemic, as parents struggled to remain professionally productive in the setting of reduced school and child-care support.¹ Although many healthcare professionals face parenting-related challenges, residents are disproportionately affected because of long work hours and reduced flexibility with their schedules.

To better understand parenting challenges and solutions during residency, Dr. Shrivastava interviewed Dr. Willett (lwillett@uabmc.edu), a professor of medicine and vice-chair for education, who has served as a program director at Tinsley Harrison Internal Medicine Residency Training Program, University of Alabama at Birmingham for eight years. She is a clinician-educator dedicated to medical education, focusing on issues related to women residents and career decisions regarding pregnancy, the impact on resident duty hour changes, and innovative curricular design and evaluation.

Throughout this interview, we highlight her experience supporting residents with parenting during their residency training, specifically during the recent COVID-19 pandemic, and identify ways that academic medical organizations and SGIM can support residents’ parenting roles.

What are your thoughts on parenting during residency?

Parenting is an absolute joy, yet it is a challenge because of the enormous responsibility. Trainees have less control over their schedules, which makes parenting even more challenging. Despite this, if trainees want to have children, they should not delay it because of their training. The decision to be a parent should be driven by personal desires, priorities, relationships, and resources.

Can you describe your experience with supporting residents during pregnancy or the postpartum period and the challenges you faced?

I sit down with every resident who is pregnant or planning a pregnancy and go over the American Board of Internal Medicine (ABIM) and the local UAB policies. I want them to have all the information to confidentially and privately make the best decision for themselves and their family.

I assure all of my residents that the program will be flexible and supportive. We adjust their schedules with appropriate advance notice. We never want someone to be on the night shift or the intensive care unit during the third trimester or immediate postpartum period. Postpartum, we usually bring them back to an ambulatory month with weekends off or a rotation with no night calls.

One of my residents was assigned to the emergency department (ED) when his wife was expecting a baby. We adjusted his shifts in advance for his paternity leave. As a surprise, the baby came a month early, and with the support of the ED, we were able to re-adjust his schedule without problems. Another one of my residents is on an ABIM research pathway, which is two years of categorical internal medicine residency and then fellowship. Due to this track’s requirements, she worried she would need to use all her vacation for her parental leave so that she wouldn’t have to extend her residency training time. Fortunately, the ABIM had recently clarified their Deficits in Required Training Time Policy.³ I did not know if this policy would apply to this unique training track, so I reached out to the ABIM about her situation. They supported me to apply the policy, and she was able to take both parental leave and her planned vacations. I am thankful for ABIM’s support in recognizing that through competency-based assessment, we can allow her to have the important time to be both a mother and a trainee.

Can you give an example of what challenges you face with residents who are parents? Did they have any difficulties managing their parenting and training responsibilities during the COVID-19 pandemic?

Residency programs have a closed coverage system, meaning there are no “extra” people who are not residents to provide clinical coverage when someone is out on medical leave. The biggest challenge is to have a schedule that works and feels fair for all involved. In our program, residents are generous and support each other, covering their peers for parenting emergencies. We did not have any significant COVID-19 pandemic related parenting issues. One of my residents has school-age children, and I am sure the pandemic is difficult for her. We talked with her, checked in often, and asked if she needed any accommodations from the program. Since her husband was able to work from home, she did not require changes made to her schedule. But, programs need to be intentional when scheduling residents with parenting needs. Schedule changes are not always possible, but one should always try.

What changes would you like to see locally, regionally, or nationally so that you can better support your residents who are already parents and who want to be parents?

I am delighted to see the ABIM’s policies become more transparent about the flexibility allowed for parental leave without extending training time. Many female trainees are primarily concerned about not extending their training.² I would love if there were an effective and equitable way for residents to take paid prolonged leave if they had any medical complications or by choice. It also would be great to find solutions for residents who extend their training without jeopardizing their fellowship aspirations.

We need to make a shift from viewing maternity leave as a burden. We also need to include men in our parental leave policies. We all need to break the stigma of not accepting female trainees in our programs because they might have children and need prolonged clinical coverage. This disparity in how male and female residents are treated regarding parenting needs should change, and parental leave policies should apply to all genders.

There also needs to be a greater awareness of the fertility issues that female physicians face; countless physicians have struggled with infertility because they delayed starting their families until after training. That is probably what saddens me the most—children are wonderful! Residents who want families should not feel they need to put their family on hold for their careers, delay childbearing, and, therefore, risk infertility. There are opportunities for growing families and careers simultaneously.

In what ways do you think SGIM can support residents who are parents or in the process of becoming parents?

SGIM can support residents by providing awareness and support to their members since many of their members are also internal medicine faculty in training programs. For example, if more SGIM members know about the flexible ABIM policy, they could share this information with trainees. Junior faculty need to hear from senior faculty that it is acceptable to have children, to put their families first, not feel intense pressure to always prioritize work early in career. In 2020, most institutions want well-rounded, happy, and successful faculty who can stay in academics, balancing their careers and family.

Do you have any final words of wisdom for residents, program directors, or senior leadership at other programs across the country?

We have offered to pair trainees who are pregnant with junior faculty or senior residents, who recently had children, like a “pregnancy or parenting mentor.” These mentors can help answer questions, such as taking time off for pediatric visits and finding daycare and nanny organizations that can be trusted. There is plenty of information on the internet and social media platforms, but we can easily create these resources locally and provide trusted mentors.

Importantly, we need a culture change in medical training—trainees should feel comfortable and supported to have children when it is right for them based on their priorities and resources. Residency programs need to have the culture, structure, and policies to be most supportive and helpful since people in Internal Medicine make excellent parents. Children are an essential part of many of our lives.

Supporting residents’ aspirations to have children is equally important as nurturing their professional ambitions for their overall success and wellbeing. Residency programs, institutional leadership, and national organizations can increase awareness, provide updated information, and increase training flexibility to create a supportive system for the residents. Educational leaders and residents can refer to the full list of ABIM’s special policies⁴ and can contact ABIM’s academic affairs department via their customer service contact number for any additional inquiries.