To the Editor:
We thank Webb and colleagues for their Invited Commentary on parental leave during medical training.1 We wanted to emphasize the importance of the training environment in supporting residents and students who take time away from their education after the birth of a child. Institutional parental leave policies are necessary but not sufficient. For example, 2 different residency programs may technically allow 6 weeks of paid leave using short-term disability. However, at one program, the majority of new parents take this leave, while at the other program, the residents do not take the full leave time they are allowed. In our experience with resident education, there is a wide difference between the amount of leave taken—even at programs with similar policies.
A recent survey of residency program directors in family medicine2 found wide variation in whether female residents who were new parents extended their training. Program characteristics associated with extending training included urban location, larger residency programs, having a female residency director, and having a residency director with children under age 18.2 These findings suggest that the division of resident workload may contribute to some, but not all, of this variation. Another recent study has echoed the role of program culture, showing that whether residents used their available maternity time correlated with whether faculty at the same program tended to use available benefits.3 The findings concur that program culture, as influenced by a program director (or perhaps the same culture that enabled hiring a female leader who is also a parent) impacts the amount of leave taken.
Parental leave policies are a first step that can be taken by training institutions and encouraged or mandated by accrediting bodies or specialty boards. However, a supportive program culture is also a necessary ingredient to allow new parents to actually participate in these policies and take the time to fully care for their families.
Heather L. Paladine, MD
Assistant professor of family medicine, Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, New York; email@example.com; ORCID: https://orcid.org/0000-0002-4918-8302.
Andrea Wendling, MD
Professor, Department of Family Medicine, and director of rural medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.
Julie Phillips, MD
Associate professor, Sparrow-MSU Family Medicine Residency Program, Department of Family Medicine, and assistant dean for student career and professional development, Michigan State University College of Human Medicine, East Lansing, Michigan.
1. Webb AMB, Hasty BN, Andolsek KM, et al. A timely problem: Parental leave during medical training. Acad Med. 2019;94:1631–1634.
2. Morris LE, Lindbloom E, Kruse RL, Washington KT, Cronk NJ, Paladine HL. Perceptions of parenting residents among family medicine residency directors. Fam Med. 2018;50:756–762.
3. Wendling A, Paladine HL, Hustedde C, Kovar-Gough I, Tarn DM, Phillips JP. Parental leave policies and practices of US family medicine residency programs. Fam Med. 2019;51:742–749.