Maternity/paternity leave in Residency

[kinemed]

I know I can get this information from my PD, admin, or provincial residency union, but I'd rather keep these thoughts quiet for now since it's nothing that going to be a reality any time soon, and don't need to alarm anyone in my program yet haha.

 

When you take maternity or paternity leave in residency, how does it affect your PGY? I know you have to make up the time you take off, but do you get moved through as if you had completed that time?

 

E.g. female resident has baby mid-way through PGY-3 and takes 6 months mat leave. When she returns to work in July, she would be a PGY-4 if she had taken no time off. Does she come back as a PGY-4 or continue to be a PGY-3 for 6 months, and transition to PGY-4 in January.

 

I have a feeling these forums are not rife with residents who have children, but maybe someone out there knows, since I can't seem to find this info anywhere.

[tooty]

I heard that you can take up to 3 months off without having to make up time. Any more than that, you'd have to repeat the whole year. I have never confirmed this myself.

 

This might help

http://www.myparo.ca/Pregnancy_FAQ

[NLengr]

Queens and Ottawa make you make up every single day I believe. Which is ridiculous since the royal college says you can miss up to three months and still write the exam.

 

I know a fellow in Ottawa whose paperwork was a week late for him to start, and the university hounded him to work till July 7 or they wouldn't sign off on his fellowship being completed.

 

I'm not sure why the schools have these policies except to ensure they get the maximum amount of cheap labour. The RC has a much better idea of what it takes to make a competent physician. I find the over-ruling of the RC policy to be extremely arrogant on the part of the universities.

[Laika]

I think most (?all) programs in Toronto let you take 3 months off without making it up.

 

I know a few people who have taken mat leave in residency.  They've all taken a full year, and just joined the year 'below' them.

[kinemed]

Thanks, everyone. I'm still a bit confused about the logistics of it (e.g. a resident in my program has taken 2 x 4-month mat leaves...what does that mean for her?) but I think I'd have to ask residents who has personally dealt with it or just address it with my program when it becomes a more pressing issue.

[Renin]

Our residents who have taken leave are "staggered" - so there are some PGY3's that are actually PGY4's that have taken some time off. That means they're on their own cycle and aren't cycling with the rest of the residents. Depending on your program, this can be easy or hard. For us, it's fairly chill and everyone in my year (basically with the exception of three) have some kind of staggering.

[DarkGhost]

I personally find it more confusing that RCPSC will let you miss three months with no repercussions. If those three months have no intrinsic value to your training as a competent physician/surgeon, then what's the point of anyone doing them?

[rmorelan]

I personally find it a more confusing that RCPSC will let you miss three months with no repercussions.  If those three months have no intrinsic value to your training as a competent physician/surgeon, then what's the point of anyone doing them?  

 

well we are moving in general to a competency based education system where questions like that may not matter as much. You could say that there is some buffer time in the program to that even the moderately weak can learn everything by the end, and you can play catch up if you lost some time.

[DarkGhost]

well we are moving in general to a competency based education system where questions like that may not matter as much. You could say that there is some buffer time in the program to that even the moderately weak can learn everything by the end, and you can play catch up if you lost some time.

 

I have to say, they can't transition to a competency based training program quickly enough.  'Buffer space' is a huge waste of resources and tax payer dollars... It actually makes me cringe just thinking about it. 

[rmorelan]

I have to say, they can't transition to a competency based training program quickly enough.  'Buffer space' is a huge waste of resources and tax payer dollars... It actually makes me cringe just thinking about it. 

 

well we have had it at every single level of education since kindergarten - why stop now?

 

all seriousness aside it isn't really much a waste of resources I think - our time yes, but resources not really that just mean that a more skilled doctor is stuck running around doing basically full service medicine but paid at residency levels. Better medicine is being done - patients have quicker turn over, diagnosis is done faster, on call you have a more experienced person at the helm.... because a "master" is stuck doing it all rather than advancing to full practise (and of course we are not in a shortage situation anymore so the pull we had 10 years ago to get people out there). The person that loses in all of this is the resident - which is reason enough to change it. I just don't see a huge tax savings here - residents generally contribute way, way more than we cost.

 

One of the big problems with competency based medicine from a system post of view is it is hard to manage staff levels you need. Say for example 1/2 of the 5th years in radiology vanished a year early somehow (actually very hard in radiology to actually finish early but let's go with it  ) - does that mean the remaining 5th years have to do more call to make up the gap? Someone is doing that call? Worse in something like surgery where potentially senior people leave - how do you plan out the 5th year schedule when people can leave at some point - you need coverage to run the hospital and schedules are made up ages in advance (6 months easy for staff, a year ahead for residents in terms of where they will be) but you cannot predict when someone masters everything that precisely. What is the point in ending early if all the fellowships start in July anyway - or do we just have those as well starting all over the place? Will a new form of competition show up where finishing early is a good for selection on the next steps (career, fellowships)? If so does that add stress to residency?

 

Don't forget of course that residency can easily be EXTENDED under these schemes - same problem now only in reverse - let's say you are 3 months late, do you have wait until the following year until you can write the test to actually practise? Did you just miss the fellowship start (something you arranged 1.5 years prior)?

 

Ha - not saying this isn't something we will have to figure out - and systems can change, but this is going to add a whole new dimension to things that makes things very interesting!

 

On other extra wrinkle - as a part of competency training you will very likely have to continuously re-certify for your licence through out your career. That means say every 5 years (a range I have seen thrown around) you get to basically redo the exam (and pay a nice fee I am sure to do so). That will add an additional change as we go forward - not bad to continuously check things but it is tricky in medicine where we often a) select an area to really master and b ) refer people outside of that area to other places. For instance if I become a interventional neuroradiologist (ahh the brain) then I don't want to be tested forever on emergency oby/gen ultrasounds which I will never look at again. Technically though as a licensed radiologist I would be allowed to read them and thus be required to be tested on that ability. Extend this away to your specialty of choice

[NLengr]

Competency based residency will bring very little benifit to residents. Be prepared to do an extra year of "supervised practice" at resident pay if you pass the exam in 4th year. The government will not look kindly on losing cheap labour (either will your staff).

 

The 3 months isn't a buffer. It's just a short period of time you can miss because the RC realizes issues may come up requiring missing a short period of times without effecting your ability to pass the exam.

 

I haven't heard anything about re certification exams but that would be terrible, especially if it's a redo the RC exam every 5 years. Re-Passing the RC exam every 5 years means every 5th year you are gonna be studying pretty much every waking free hour 7 days a week (that's the pattern for studying people use for my specialty's exam). I'd be looking to retire pretty early. The vast majority of opinion out of the states where they re-cert. every 10 years is that it's a huge waste of time/money. Of course, down there you don't need your board exam to practice so failing wouldn't be a massive life crisis deal. In Canada, where you do need RC cert. to practice, failing a re-cert could very easily lead to bankruptcy etc as you suddenly can't work anymore until the next exam in a year.

[DarkGhost]

well we have had it at every single level of education since kindergarten - why stop now?

 

all seriousness aside it isn't really much a waste of resources I think - our time yes, but resources not really that just mean that a more skilled doctor is stuck running around doing basically full service medicine but paid at residency levels. Better medicine is being done - patients have quicker turn over, diagnosis is done faster, on call you have a more experienced person at the helm.... because a "master" is stuck doing it all rather than advancing to full practise (and of course we are not in a shortage situation anymore so the pull we had 10 years ago to get people out there). The person that loses in all of this is the resident - which is reason enough to change it. I just don't see a huge tax savings here - residents generally contribute way, way more than we cost.

 

One of the big problems with competency based medicine from a system post of view is it is hard to manage staff levels you need. Say for example 1/2 of the 5th years in radiology vanished a year early somehow (actually very hard in radiology to actually finish early but let's go with it  ) - does that mean the remaining 5th years have to do more call to make up the gap? Someone is doing that call? Worse in something like surgery where potentially senior people leave - how do you plan out the 5th year schedule when people can leave at some point - you need coverage to run the hospital and schedules are made up ages in advance (6 months easy for staff, a year ahead for residents in terms of where they will be) but you cannot predict when someone masters everything that precisely. What is the point in ending early if all the fellowships start in July anyway - or do we just have those as well starting all over the place? Will a new form of competition show up where finishing early is a good for selection on the next steps (career, fellowships)? If so does that add stress to residency?

 

Don't forget of course that residency can easily be EXTENDED under these schemes - same problem now only in reverse - let's say you are 3 months late, do you have wait until the following year until you can write the test to actually practise? Did you just miss the fellowship start (something you arranged 1.5 years prior)?

 

Ha - not saying this isn't something we will have to figure out - and systems can change, but this is going to add a whole new dimension to things that makes things very interesting!

 

On other extra wrinkle - as a part of competency training you will very likely have to continuously re-certify for your licence through out your career. That means say every 5 years (a range I have seen thrown around) you get to basically redo the exam (and pay a nice fee I am sure to do so). That will add an additional change as we go forward - not bad to continuously check things but it is tricky in medicine where we often a) select an area to really master and b ) refer people outside of that area to other places. For instance if I become a interventional neuroradiologist (ahh the brain) then I don't want to be tested forever on emergency oby/gen ultrasounds which I will never look at again. Technically though as a licensed radiologist I would be allowed to read them and thus be required to be tested on that ability. Extend this away to your specialty of choice

 

Ah, you forced me to pick up my laptop to read your reply, haha 

 

My initial thought was building off the idea of maternity/paternity.  If you're allowed to take leave at anytime during your training and if it's under three months, then RCPSC will theoretically say, 'okay, you don't have to make up that time.'  That response says to me one of two things, either every single rotation is 'buffered,' or they just don't care about their residents.  I'm going to assume the former for now, because it makes the most logical sense.  But, if that's the case, then countless resources are being wasted per resident.  Not that the residents themselves are a wasted investment, but that training times may be prolonged unnecessarily... 

 

Now, I was thinking about this yesterday, and yes it's true.  A rigid timetable to train residents is much easier to implement and guarantee quality outcomes for every resident.  Also, as you mentioned, the structure in residency makes scheduling shifts/call, board exams, and fellowships infinitely easier.  Although, I don't think competency based programs need to be complete scheduling anarchy where residencies could end any day of the year.  But, I can't deny that it'd take infinitely more work to do competency based training well; micromanaging in particular would require lots of resources.  

 

I think your last point taps another vein as well.  At what point do we start to say, sub-specialist X is no longer qualified to make a diagnosis in his general specialty without proving competency?  I don't know the answer to that, but it's interesting.

[NLengr]

Few points:

 

More would be wasted if we ran multiple RC exams per year so that people could write as soon as they are ready.

 

People should also remember that residency isn't just pure education. There is a huge "service" component to it. It's not like its wall to wall education everyday. There is lots of "wasted" time there. Far more than 3 months if added up.

 

Three months isn't enough time to sweat things being "prolonged unnecessarily". Extra time is gonna exist when you are running a large national training program like the RC essentially does. I could see your point if it was a full year or something.

 

In most programs substantial portions of the last year are mostly limited duties with lots of study time.

 

The royal college still requires people to prove they are doing CME. And people are motivated to do the same in general. It's not like people pass the exam then never have to show the RC how they are maintaining competency.

[DarkGhost]

Competency based residency will bring very little benifit to residents. Be prepared to do an extra year of "supervised practice" at resident pay if you pass the exam in 4th year. The government will not look kindly on losing cheap labour (either will your staff).

 

The 3 months isn't a buffer. It's just a short period of time you can miss because the RC realizes issues may come up requiring missing a short period of times without effecting your ability to pass the exam.

 

You may correct me if I'm wrong, but isn't that the definition of a buffer in this instance?  Extra time that's being allotted "just encase" something comes up.

[NLengr]

You may correct me if I'm wrong, but isn't that the definition of a buffer in this instance? Extra time that's being allotted "just encase" something comes up.

The difference I suppose is it's not specifically designed as a policy to buffer things happening. It's just a realization that some people could miss a small portion of time and not repeat the year. That's not to say everyone can since the RC makes your program sign off on you before writing. The RC would like everyone to do all the months if at all possible. But they realize making someone repeat a full year because the missed a short period for some reason (illness, injury etc).

 

Either way, it's 3 months if you want to say its a planned buffer. No big deal. There are much bigger sources of waste in residency. The last month of residency after the exam is pretty much a write off anyway.

[DarkGhost]

The difference I suppose is it's not specifically designed as a policy to buffer things happening. It's just a realization that some people could miss a small portion of time and not repeat the year. That's not to say everyone can since the RC makes your program sign off on you before writing. The RC would like everyone to do all the months if at all possible. But they realize making someone repeat a full year because the missed a short period for some reason (illness, injury etc).

 

Either way, it's 3 months if you want to say its a planned buffer. No big deal. There are much bigger sources of waste in residency. The last month of residency after the exam is pretty much a write off anyway.

 

To be fair, three months is usually an entire rotation.  So, to me, that raises some serious red flags in regards to its importance if you can just skip over it and carry on..

 

You must have to make up that time in some way.  I just can't imagine that not being the case.  

[NLengr]

School dependent. Like I said, the only ones that make you make up the time that I am aware of are Ottawa and Queens.

 

Your program has to clear you to write the exam and the RC needs to also clear you. If you missed a major component of training with those three months (aka IM person who missed all of ID or something) you may be blocked from writing it. But many specialties do not do blocks once they are out of years 1 and 2. For example, in my current year I could have easily missed the period of July/Aug/Sept without majorly affecting my ability to practice (summer meant fewer and typically less complex ORs, plus fewer clinics).

 

You may see some red flags for whatever reason, but the RC has been managing world class training programs for decades and they've made a clear policy. It's not like we have had some huge issue with physician quality.

[DarkGhost]

School dependent. Like I said, the only ones that make you make up the time that I am aware of are Ottawa and Queens.

 

Your program has to clear you to write the exam and the RC needs to also clear you. If you missed a major component of training with those three months (aka IM person who missed all of ID or something) you may be blocked from writing it. But many specialties do not do blocks once they are out of years 1 and 2. For example, in my current year I could have easily missed the period of July/Aug/Sept without majorly affecting my ability to practice (summer meant fewer and typically less complex ORs, plus fewer clinics).

 

You may see some red flags for whatever reason, but the RC has been managing world class training programs for decades and they've made a clear policy. It's not like we have had some huge issue with physician quality

 

Oh no, I don't think it was ever an issue of physician quality, rather why make residents do extra months/years of training if it's not necessary to produce quality outcomes?

[NLengr]

As I said before, some of that has to do with only running the exam once a year. You can't run the exam every time a program thinks someone is ready to write. Likewise you can't run it monthly or quarterly. The exams (at least the Osce portion) require bringing dozens of licensed specialists per specialty to Ottawa for a few days, renting space etc. It's a tremendous expense, so cost limits how often it's offered.

 

The logistics of training will always mean that some people are ready to write earlier and thus are doing "extra" time although truth be told I have never heard a 5th year say they were ready for the exam 3 months before it. Usually people are cramming and terrified right up to the night before.

[DarkGhost]

As I said before, some of that has to do with only running the exam once a year. You can't run the exam every time a program thinks someone is ready to write. Likewise you can't run it monthly or quarterly. The exams (at least the Osce portion) require bringing dozens of licensed specialists per specialty to Ottawa for a few days, renting space etc. It's a tremendous expense, so cost limits how often it's offered.

 

The logistics of training will always mean that some people are ready to write earlier and thus are doing "extra" time although truth be told I have never heard a 5th year say they were ready for the exam 3 months before it. Usually people are cramming and terrified right up to the night before.

 

I reread my posts and I can see I made the mistake of arguing two separate issues simultaneously without clarifying what I was talking about.  I apologize.

 

In regards to competency based training, I agree that multiple things would need to change to make it realistic.  As you mentioned previously, if they just label it "competency based" but force residents to finish the remaining time anyway, that's meaningless.  I also agree that it doesn't make sense for residencies to finish 'any day of the year,' they'd need to coincide with the preceding years exams.  That would definitely mean enduring extra time for some residents, but I don't think that's a huge issue.

 

My other argument that I tossed in here without rationale was that clearly some residencies just shouldn't be as long as they are.  As you already pointed out, there are literally months you could have missed with little to no repercussions.  In that case, why make it a part of training at all?  That's when the time/resources being lost starts to annoy me.  However, my vision is definitely coloured by the fact the majority of my peers and supervisors are in neurosurgery.  A specialty that not only has a long residency (recently even longer in the USA), but demands multiple fellowships.  I understand the need to maintain quality, but does it seriously take more then a decade of clinical exposure to be competent?  Perhaps I'm just jaded though, haha, by the time I'm done my MD/PhD it'll be this ten year residency and you'll need six fellowships and a post doc to practice in this country.  I'm half joking of course, but at what point do you start to say the length of training is too damn long!  

[rmorelan]

I reread my posts and I can see I made the mistake of arguing two separate issues simultaneously without clarifying what I was talking about.  I apologize.

 

In regards to competency based training, I agree that multiple things would need to change to make it realistic.  As you mentioned previously, if they just label it "competency based" but force residents to finish the remaining time anyway, that's meaningless.  I also agree that it doesn't make sense for residencies to finish 'any day of the year,' they'd need to coincide with the preceding years exams.  That would definitely mean enduring extra time for some residents, but I don't think that's a huge issue.

 

My other argument that I tossed in here without rationale was that clearly some residencies just shouldn't be as long as they are.  As you already pointed out, there are literally months you could have missed with little to no repercussions.  In that case, why make it a part of training at all?  That's when the time/resources being lost starts to annoy me.  However, my vision is definitely coloured by the fact the majority of my peers and supervisors are in neurosurgery.  A specialty that not only has a long residency (recently even longer in the USA), but demands multiple fellowships.  I understand the need to maintain quality, but does it seriously take more then a decade of clinical exposure to be competent?  Perhaps I'm just jaded though, haha, by the time I'm done my MD/PhD it'll be this ten year residency and you'll need six fellowships and a post doc to practice in this country.  I'm half joking of course, but at what point do you start to say the length of training is too damn long!  

 

Ok but with neurosurgery it is not just that the training is long, it is also that there are no jobs - those fellowships etc are to make yourself in part a) competitive for the few jobs there are and b ) put you in a holding patter where you get some income and maintain your skills until said job does appear. A better question might be is it logical to actually train as many neurosurgeons currently

 

Also in the few places trailing competency training so far we actually have had people finish early and walk out of the program. The idea that you will be chained to the program for cheap labour has a couple of issues - first the hospital isn't actually paying either the staff doctor or the resident - the province is - so as long as the work is done by the combination of the two the hospital doesn't care as it doesn't affect their budget. They province again would but they are arms length in the process.  Second the residents then are of course going to be eager to make sure that don't happen and will push back (we are not helpless - particularly when you get to the senior level). Third the programs that are good enough to have people graduate early I would think we be perceived as better programs (at least in one way) and will attract candidates as a result - the program wants to attract high quality applicants so has an incentive not to be unreasonable etc.

[DarkGhost]

Ok but with neurosurgery it is not just that the training is long, it is also that there are no jobs - those fellowships etc are to make yourself in part a) competitive for the few jobs there are and b ) put you in a holding patter where you get some income and maintain your skills until said job does appear. A better question might be is it logical to actually train as many neurosurgeons currently

Of course, the main problem with the current job market is that it doesn't accurately reflect the current demand, nor the work that still needs to be done... I can't say this for certain, but I think 'the hospital' would be heavily burdened if all their neurosurgical fellows suddenly disappeared tomorrow. They do carry a lot of weight, with some subspecialties being almost entirely maintained by fellows.

 

I entirely agree with all your points regarding competency based programs.