In collaboration with the American College of Surgeons (ACS) Resident and Associate Society, the Young Fellows Association, and the Association of Women Surgeons, the ACS Board of Regents recently developed and approved an updated statement on parental leave policy for surgical trainees on August 11, 2020, following its June meeting. It is an update of the former Statement on Parental Leave issued February 2016.
Editor’s note: This statement addresses standard policies of parental leave for both women and men in surgical training who require time away from clinical activities to accommodate childbearing or adoption needs. In conjunction with a statement recently released by the American Board of Medical Specialties (ABMS), and an anticipated statement on this topic from the Accreditation Council for Graduate Medical Education (ACGME), the ACS statement is expected to provide guidance to surgical training programs with the goal of promoting the well-being of trainees.
The ACS recognizes that a successful surgical career should not preclude a surgeon’s choice to be a parent. This issue is particularly pertinent to surgical trainees who have relatively long residency programs that occur during peak childbearing and family development years. Surgeons and surgical trainees who choose to have children (whether through a pregnancy of the surgeon or the surgeon’s partner, a surrogate, or adoption) have made an equivalent commitment and investment in their surgical careers as individuals who chose to forgo having children. Choosing to become a parent does not detract from one’s full professional commitment or ability to train as a surgeon. The ACS is supportive of healthy pregnancy outcomes and emphatically condemns imposition of punitive repercussions or bias toward surgeons who choose to have children.
Parental leave terms should be explicitly included in all resident and fellow contracts.
The ACS strongly urges each ABMS Surgical Specialty Board and each Accreditation Council for Graduate Medical Education Surgical Specialty Residency Review Committee (RRC) to develop clear and consistent policies regarding parental leave. These policies should provide appropriate allowances for parental leave time as suggested in this statement. The ACS also urges the surgical boards and RRCs to frame these policies to allow parental leave time without requiring additional training time unless time away from training extends the six weeks prescribed in the Family and Medical Leave Act of 1993 (FMLA). Furthermore, the ACS urges the surgical boards and RRCs to collaborate in developing functionally similar policies that allow equitable application and individual impact across specialties and programs.
The following guidelines provide a framework for parental leave policies:
- Parental leave should be provided equally for individuals who are new parents through pregnancy, surrogacy, fostering, or adoption.
- The trainee should inform the residency program director of an impending pregnancy or anticipated adoption in a timely fashion to allow for accommodation of anticipated absence from professional duties and educational rotations.
- The residency program is responsible for supporting the medical needs of the trainee and for ensuring the confidentiality of health care information.
- The residency program should create a schedule that is flexible and equitable for the trainee to take leave, while accounting for those health care professionals who are affected by their absence.
- The College strongly endorses at least six weeks of paid parental leave for either or both parents.
- In accordance with the FMLA, the ACS suggests that residency programs may also voluntarily allow new parents the opportunity to take a leave of absence for up to an additional six weeks (12 weeks total), acknowledging that an extended leave will likely require an extension of training time as required by the surgical boards and RRCs.
- Trainees should not be required to make up call coverage for the period of parental absence.
- Parental leave should not be a factor in decisions regarding trainee progression, trainee assessment and evaluation, access to leadership or research positions, and promotion or graduation.
The following guidelines offer a framework for support of a pregnant trainee and workplace accommodations:
- The ACS encourages individualized assessment of requests for reasonable accommodations of pregnancy-related conditions, in accordance with applicable federal and state laws.
- It is appropriate to consider accommodations to call schedule, duty hours, and operative schedule late in the third trimester.
- A complicated pregnancy may need additional accommodations and modifications of schedule as determined by the trainee and her physician.
- Trainees who intend to breastfeed should be allowed flexibility to support expressing breast milk. Nursing mother break-time provisions are a patient protection in the Affordable Care Act of 2010, which amended Section 7 of the Fair Labor Standards Act, which requires covered employers to provide eligible employees with reasonable break time in a private, safe, and convenient place (other than a bathroom) to express milk for one year following the birth of a child. Access to a safe, hygienic, and convenient place for the storage of pumped milk also should be provided.
- The formalization of guidelines to support trainees who choose to pump at work is recommended. Individuals should have protected time several times per day and have clinic and operating adjustments without bias or penalty.