In January 2006 issue of the GME E-Letter , we wrote, "As the holiday season recedes, we would like to hear how you and your staff accommodate religious holidays and observances among your residents and fellows. Besides major religious holidays, we are most interested in how you accommodate more frequent religious worship such as weekly Sabbath for Jews and Christians and daily prayers for Muslims.
"Two resolutions (308 and 316) at our 2005 annual meeting called for the AMA to help ensure that residents can honor their religious beliefs and practices, including religious holidays and observances, without discrimination. In addition, the AMA Council on Medical Education and Council on Ethical and Judicial Affairs are writing a report on this topic for the 2006 meeting.
"So we would like to hear from as many of you as possible about how your programs balance accommodating the religious practices of your residents with the practical and ethical concerns of continuity of care and obligation to patients. practical and ethical concerns of continuity of care and obligation to patients?"
Below are the responses we received, with identifying information removed
I appreciate the intent of these resolutions and would do everything in my power to uphold the principles of nondiscrimination. Unfortunately, these resolutions do not take into account the vast complexity of labor laws. I would suggest careful study is needed before the AMA adopt this oversimplification. I would also suggest that there are great deal of regulations insuring non-discrimination. I am not sure this endeavor is worth our time and effort if we are going to delve into the issue too deeply. I would suggest we affirm a position of tolerance and respect.
We have approximately one Sabbath-observant Jew per year in our program. To accomodate this person, we set up their vacation schedule to cover the major holidays, which generally fall in Sept/Oct and then in April (a 2-week vacation block over each). For other holidays that fall outside these blocks, we put the resident on elective and they may miss a couple of days, which we can make up by taking a couple of days from the vacation blocks that they did not need to be off for and having them come in to make up the elective days. As for the Sabbath observance we never put them on call Friday night (changed to Thursday night) for floors and units, and when a 24-hour Saturday call would have occurred, we have them come in Saturday night to Sunday night so that it is still a full day. We have had zero complaints from other housestaff with this setup. As long as the Sabbath-Observer is seen as "pulling their own weight" it is not a problem.
We have several Muslims that need to pray Friday from 1:30-2 (ish?). We have set aside a room in one of the buildings for prayer, and they are given their two afternoons in clinic on other days than Friday. When their holidays fall out we let them have the day off and they again can make the day up by taking a day off of one of their vacation blocks.
I have not had anyone Christian ask me for any special scheduling (Christmas is a hospital holiday, and we make sure they are not on call that day) so it is harder for me to answer to that area.
As a recent internal medicine resident and current nephrology fellow, I have to wonder what the AMA is concerned about with respect to "more frequent religious worship such as weekly Sabbath for Jews and Christians and daily prayers for Muslims." Perhaps discrimination does occur at some institutions, which is a cause for concern.
As a Christian I can say that at my institution we do work some weekends including Sundays, although the majority of weekends including Saturday and Sunday are off. I have never felt discriminated against. There are a mixture of Christian, Jewish, and Muslim fellows at this institution. If I were able to complete my work I feel confident that I would be allowed to attend a short service on Sunday if I chose to do so. Taking time during the day to attend church during a call weekend when there were patients who had not been seen and work to be done would likely be frowned upon, and I can say that I would never dream of compromising patient care in this way. Although I am not Muslim, I am confident that I would be allowed to take the brief periods needed for daily prayer. In fact, I can say that we are given freedom throughout the day to the extent that I could already be doing this.
We are able to and continue to make special accomodations for fellows who for various reasons (INS issues, legal proceedings, family emergencies, etc) need time off. This time is typically taken from leave time, with other fellows filling in for the absent fellow. To the extent that someone might want to observe additional religious holidays they could do so in this manner. There is no mechanism in place, or practical way of implementing one, that would for instance ensure that every Christian has every Sunday free of clinical duties.
In our program the schedule is made by the chief resident. Therefore, any resident requests for time off for religious reasons are handled by the chief. We have a very cohesive group of residents and have been able to maintain a good balance. Our residents know their schedule one year in advance, and have ample time to make arrangements for coverage.
Currently, at the physical medicine and rehabilitation program for which I am director, we do not have defined policies regarding religious observances. We handle requests for time off on a case-by-case basis. Usually, residents use their vacation time for such purposes. We have not had any issues with this practice
As a nephrology program director, I am very interested in this issue, both as an observant Jew and as the father of an observant first year medical student. To my knowledge, Orthodox Jews are in a somewhat unique position in that although adherents of every religion would like to be with their families and communities during religious holidays and observances, only Jewish residents and fellows may have to violate their religious laws in order to work on certain days.
Fellows have 3 weeks of vacation, and any requests to take vacation on major holidays would be honored, regardless of which rotation they were on. This occurs annually on the Muslim observances at the end of Ramadan and the Haj observance. Our Muslim fellows are given time to regularly attend Friday afternoon prayers that are held in the hospital chapel should they desire. We do not have any observant Jews in our program, and I am not certain how we would deal with a request to have all Saturdays off. It would probably not be possible given our need to have 2 fellows in house on Saturdays and Sundays unless it was mandated by a higher authority, but we would certainly do what we could to minimize the number of Saturday calls in favor of Sunday calls. I think it would largely have to depend on how much other residents objected to the relative shift of Saturday vs Sunday calls. I would also try to modify the routine as much as possible to minimize the number of infractions of the Sabbath rules as possible (eg, allowing fellows should they desire to write routine notes after sunset, making a call room available for them to stay Friday night even if their shift doesn't start until Saturday).
We have an orthodox Jewish resident. We do not place him on call on Friday nights or Saturday. To "pay back" his fellow residents, he takes call on Christmas, Easter, etc. He also took additional call during his first year. He uses personal leave/vacation time to take time off on several of the Jewish holidays
No, we don't have any policy yet, but this issue came up during the internal review of clinical neurophysiology when one of the fellows complained that there was no place to pray. The program director has made accommodations for time to pray, which include leaving the attending alone in clinic. The fellow noted that the institution where he is located had no place to pray (which is true).
As director of an ACGME-accredited craniofacial fellowship, I have had Muslim and Orthodox Jewish residents who rotated through our service, and have never had any particular problem.
I did have a woman plastic surgeon arrive from Saudi Arabia who planned to stay with me for 6 months. We did run into some problems here which we could not resolve, and she left after several weeks,
The issue of her prayers, which needed to be performed on a rug a number of times during the day, could be resolved by finding her a private place where she could put down her prayer rug. The issue that could not be resolved was how to have her be able to scrub on cases. Her arms needed to stay covered at all times and not be seen uncovered by any man, and we were simply not able to convince her that she could scrub and gown away from the presence of any males
People are allowed days off for appropriate holidays. Mostly that has been Jewish days, and rarely done here at our university, but they can take them as often as they want
Basically we simply respect and acknowledge all our residents and fellow's religious observances, and no one ever abuses, resents, or dishonors it.
A physician who is free to honor his higher authority demonstrates far more compassion to his neighbor and their beliefs.
Thank you for your interest in this problem. This has become an issue this year for us as we have acquired an Orthodox Jew who needs to honor the Sabbath. The issue for him is twofold.
First, the emergency cases are not as big of an issue. What is, however, is interpreting nonemergent exams during the Sabbath, ie, out patients. This could be a problem for us. He has no problem making arrangements for his call during the Sabbath even though they are burdensome.
Second, I am concerned that if I make special concessions for him to observe his holiday, what is to say that others should not have certain holidays off? This includes Christians, Muslims, and Hindus etc....
We see this as a real problem, one which we are trying to resolve through the GME office
We guarantee nothing but make every attempt to accommodate residents religious needs whenever possible. If a day off is required the resident must take it as a holiday or personal day if they have been otherwise scheduled for routine duty. Obviously, depending upon the number of residents belonging to a given group, the job of accommodation is more or less difficult. I feel very strongly that one’s religion should in no way affect residency requirements or a given individual's need to perform up to expectations for their peers
We accomodate all religious holidays as they are required
At our family medicine program, I currently have Christian, Muslim, and Hindu faiths among my faculty and residents. I have found that most international medical graduates tend to suppress their faith once they come to the USA, meaning, the Muslims do not pray 3x/day on a prayer mat, etc... Hindus and Muslims have dietary preferences but generally we all work very well together covering our patient care responsibilities.
I generally have no trouble whatsoever with folks working/taking call on religious holidays. People get MIs 24/7, 365. As such, docs need to be ready 24/7, 365. Having said that, flexibility helps make everyone's life easier.
There is no discrimination. We do our best to honor people's requests, but nothing is guaranteed.
We formally trade holidays, ie, Jewish residents cover Easter and Christmas and Christian residents cover the major Jewish holidays, setting these in advance at the beginning of the academic year so that there is no confusion. Muslim residents also covered the same way. We have made it clear to our applicants before matching that we do not yet have the resources to allow any one resident to have a guaranteed day off per week (like the Sabbath) because it would pose an excessive burden to all of the other residents. However we are looking at a new system to see if it is feasible.
I think that it is wrong to mandate such action; programs need to work within their own limitations, such as total number of residents, division of these numbers by "religion" or "need," etc. You cannot mandate that I "must" allow a resident to have off on a particular day if all residents need or request the same day off. Or should I then pick my residents according to religion? I believe that this breaks the law. Muslims in prayer: Do I rearrange all of my didactics to accommodate? What happens if all of our GME programs do this? Now I do not have enough conference rooms to handle all of the programs who need space only during "nonprayer time." Programs should be encouraged to support their residents, yes; but they should have the autonomy to decide how and if it will work.
We have a small nephrology program. We have accommodated requests for “time off” for Muslims to attend Friday prayers on a weekly basis. That amounted to about an hour every Friday afternoon. We have never been asked to accommodate daily prayers. We have never had a Jewish trainee who asked for the Sabbath off
Since we have a majority of international medical graduates in our program, we do make it possible for all the different cultures to practice their religion. We are very vigilant of the meals that are catered in so that those with meat restrictions still can enjoy a meal. Those who fast during Ramadan are allowed to take their share home to eat later. I do not know of any written policy on this but the department does in fact make it possible for all of our residents to observe their religious and cultural practices
We tell everyone UP FRONT that medicine is a 24/7, 365 days a year profession and our program (residents and faculty) must cover all of our services all the time. People get sick on Christmas and Ramadan and MLK day. Anyone who wants special consideration for personal time off (including holidays) must submit a written request. The chief residents and I consider all of those requests and try to accommodate as many as possible. We have enough diversity that we are usually able to accommodate. However, there was a time when all the residents were Christian and someone still had to work on Christmas, and this is true for everyone if the service needs arise. I think having the expectations up front and a fair system for all is the important point. We are also a state institution and medical center. Our state holidays include MLK and Christmas, but not Ramadan, etc. The residents know that I cannot change or declare new holidays within the state system, so, we have to work within their requests for personal time.
Core service (ie, call) needs to be fair and unbiased. We honor all religious holidays, unless people are on call. Then they have the right to trade, which has never been a problem but is the resident’s responsibility. We only schedule electives on Saturday or Sunday, and only minimally, so no resident has to come to weekend events. We’re not aware of any problems with this approach.
At this point, we have not been faced with the need for formal policies on these issues, with respect to observance of Jewish or Muslim holidays. We consider these issues matters of common courtesy, respect, and professionalism. All religious faiths have the opportunity to take whatever time they need to satisfy their individual needs and obligations. We have a very collegial and open approach, so that coverage for clinical activities is easy to arrange, and everyone is able and willing to flex, bend, and accommodate others in need, no matter what the particular need is. In my opinion, these are not issues that require policies or mandates, and are really part of the principles of professionalism.
We just give the resident the day off.
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