Medical Student Health

Most medical schools don’t have defined leave policies

Brendan Murphy , Senior News Writer

Roughly two-thirds of medical schools lack defined parental leave policies. Without explicit, equitable leave time, students are forced to make difficult decisions about family planning and other family and personal matters.

At the residency and fellowship levels, a 2021 requirement from the Accreditation Council for Graduate Medical Education calls on accredited programs to offer six weeks of paid leave to all residents and fellows for medical, parental and caregiver leave. The American Board of Medical Specialties requires certification boards to allow six weeks of leave during residency or fellowship training in their specialty without extending the training time required for meeting eligibility for board certification.

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Compassionate-leave polices are equally undefined across the spectrum of training. It’s unclear whether any medical schools have a compassionate-leave policy. Residency programs may follow compassionate-leave policies of the host institution, but the number of days and requirements may vary.

There is a lack of national guidance on leave in medical education and medicine, frustrating both learners and physicians, according to an AMA Council on Medical Education report whose recommendations were adopted at the 2023 AMA Interim Meeting in National Harbor, Maryland.

The newly adopted policy aims to give guidance that assures patients have physicians who are trained to meet the high standards expected by the public while meeting the needs of physicians in training for leave time to address family and personal demands and avoid burnout.

“The AMA recognizes the importance of leave policies for medical students, residents, fellows, and  physicians,” says the council’s report. “Such policies may positively impact one’s physical, mental, and emotional health, thereby reducing stress and burnout, improving satisfaction, and ultimately uplifting patient care.”

Citing a need for medical schools, residency programs and smaller physician practices—those with under 50 employees are not subject to minimum standards required by the Family and Medical Leave Act (FMLA)—to offer, at the very least, leave options that are consistent with state, federal and institutional polices, the AMA House of Delegates amended existing policy in several ways.

First, delegates voted to “recommend that medical practices, departments, and training programs strive to provide 12 weeks of paid parental, family and medical necessity leave in a 12-month period for their attending and trainee physicians as needed, with the understanding that no parent be required to take a minimum leave.”

Delegates also amended AMA policy to encourage:

  • All specialties within the American Board of Medical Specialties (ABMS)—in order to accommodate leave protected by the FMLA—to allow graduating residents to extend training after the traditional residency-completion date while still maintaining board eligibility in the event of leave beyond six weeks.
  • Specialty boards to develop flexible policies for board certification for those physicians who take leave beyond the minimum of six weeks of family or medical leave (per ABMS policy) and whose residency programs are able to certify that residents meet appropriate competencies for program completion.
  • Medical schools to develop clear, equitable parental leave policies and determine how a 12-week parental, family or medical leave may be incorporated with alternative, timely means of completing missed curriculum while still meeting competency requirements necessary to complete a medical degree.

Delegates also voted to “support the concept of equal compassionate leave for death or loss (e.g., pregnancy loss and other such events impacting fertility in a physician or their partner) as a benefit for physicians, medical students, medical trainees, and physician residents and fellows, regardless of gender or gender identity.”

The House of Delegates also urged medical schools, the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation, residency and fellowship training programs, their sponsoring institutions, and the Accreditation Council for Graduate Medical Education to incorporate or encourage development of compassionate-leave policies.

Such compassionate-leave policies should consider inclusion of extensive travel and events impacting family planning, pregnancy or fertility. That includes pregnancy loss, an unsuccessful round of intrauterine insemination or of an assisted reproductive technology procedure, a failed adoption arrangement or a failed surrogacy arrangement, the amended policy says.

These compassionate-leave policies should also include whether the leave is paid or unpaid, outline what obligations and absences must be made up, and provide medical students, residents or fellows with alternative, timely means of achieving curricular goals when absent from curricular components and to meet the competency requirements necessary to complete a medical degree or to achieve independent practice and board eligibility for their specialty.

Medicine’s “the patient comes first” ethos can also lead to negative attitudes and discrimination against physicians who temporarily step back from patient care to take leave to address family and personal demands, even though self-care improves patient outcomes as well as physician well-being. Due to societal expectations that women assume most caregiver duties in a family and household, discrimination toward physicians taking leave has a disproportionate impact on women physicians.

Citing that data and a need for protections for physicians who do take leave, the House of Delegates adopted policy to:

  • Oppose any discrimination related to physicians taking protected leave during training and medical practice for medical, religious and family reasons.
  • Encourage relevant stakeholders to survey physicians and medical students who have taken family leave, in an effort to learn about the experiences of various demographic groups and identify potential disparities in career progression trends.

Read about the other highlights from the 2023 AMA Interim Meeting.