Policy Will Offer Trainees More Flexibility, Reduce Stress, and Increase Autonomy in Making Life Decisions
CHICAGO — July 13, 2020 — The American Board of Medical Specialties (ABMS), the leading not-for-profit organization that oversees physician certification in the United States, announced the adoption of a progressive leave policy that will offer residents and fellows more flexibility, reduce stress, and increase autonomy in making life decisions, especially with regard to family and parental leave.
Starting in July 2021, all ABMS Member Boards with training programs of two or more years duration will allow for a minimum of six weeks away once during training for purposes of parental, caregiver, and medical leave, without exhausting time allowed for vacation or sick leave and without requiring an extension in training. Member Boards must communicate when a leave of absence will require an official extension to help mitigate the negative impact on a physician’s career trajectory that a training extension may have, such as delaying a fellowship or moving into a full, salaried position.
“The growing shifts in viewpoints regarding work-life balance and parental roles had a great influence in the creation of this policy which fosters an environment that supports our trainees’ ability to care not only for patients, but also for themselves and their families,” stated Richard E. Hawkins, MD, ABMS President and Chief Executive Officer. “Several ABMS Member Boards have already adopted policies ensuring residents and fellows have the flexibility to manage their training commitments ‘when life happens’ and not unduly delay achievement of board certification. All of our Member Boards will extend these opportunities to residents as they implement the new policy during the next year.”
The development of the new “ABMS Policy on Parental, Caregiver and Family Leave” was initiated following a report from the Accreditation Council on Graduate Medical Education’s (ACGME) Council of Review Committee Residents in June 2019. An ABMS Task Force on Parental Leave was established and included Jo Buyske, MD, President and Chief Executive Officer, American Board of Surgery (ABS) and Carolyn Kinney, MD, Executive Director, American Board of Physical Medicine and Rehabilitation, both members of the ABMS Board of Directors Member; Nancy Rose, MD, representing the American Board of Medical Genetics and Genomics; and Julius Hamilton, MD, a cardiothoracic anesthesiologist and a member of the ABMS Stakeholder Council. ABMS and ACGME co-sponsored a workshop on resident and fellow parental and family leave in early February 2020 that brought together more than 80 multidisciplinary stakeholders to explore this issue and make recommendations for improvement.
“It is gratifying to see the high level of engagement and commitment from ABMS Member Boards to address an issue that is so important to physicians in training,” said Dr. Kinney. “Through Member Boards’ compassionate and creative efforts, we see that it is possible to maintain high standards for physician training while preserving trainees’ physical and emotional well-being.”
The newly approved policy offers ABMS Member Boards the flexibility to create a parental, family or medical leave protocol that best suits the training required for their specialty and/or subspecialty. Examples of this tailored approach include the American Board of Anesthesiology’s (ABA) recent addition of 40 additional days (8 weeks) of absence from training over and above the existing 60 days absence permitted, subject to approval by the ABA, without extending training, and ABS’ six-year residency option, under which a resident may take up to 12 months leave during the training period if needed. The American Board of Obstetrics and Gynecology allows a resident to take up to a total of 24 weeks (six months) of leave over the four years of residency, not to exceed 12 weeks in a single year.
Kristy Rialon, MD, one of the authors of the ACGME report, welcomes this change. “By virtue of their ages, residents and fellows—male and female—often find themselves having and raising children, as well as serving as family members’ caregivers,” said Dr. Rialon, Assistant Professor of Surgery at Baylor College of Medicine and the Texas Children’s Hospital. “By adopting more realistic and compassionate approaches, the ABMS Member Boards will significantly improve the quality of life for residents and fellows. This also will support our female physicians, helping to narrow the gender gap in their career advancement by allowing for greater leave flexibility.”
ABMS Policy on Parental, Caregiver and Medical Leave During Training
Effective July 1, 2021
ABMS Member Boards establish requirements for candidates to become eligible for Initial Certification, including standards for training. Member Board policies that accommodate reasonable leaves of absence from residency and fellowship training for personal or familial needs, including the birth and care of a newborn, adopted, or foster child (“parental leave”); care of an immediate family member (child, spouse or parent) with a serious health condition (“caregiver leave”); or the trainee’s own serious health condition (“medical leave”) can support trainee well-being while maintaining Member Boards’ responsibility to establish high standards for training and the shared responsibility of Member Boards and training programs for assessing a candidate’s suitability for Initial Certification.
This policy applies only to Member Boards with training programs of 2 or more years duration.
This policy applies only to Member Board eligibility requirements for Initial Certification and does not supersede institution or program policies and applicable laws.
- Member Boards must have a written and accessible policy that clearly states the training requirements for candidates to become eligible for Initial Certification. This policy should clearly state how much time in training is required for candidates to become eligible for Initial Certification.
- Member Board eligibility requirements must incorporate time away from training for purposes of parental, caregiver, and medical leave in addition to allowed time away for vacation.
- Member Board eligibility requirements must allow for a minimum of 6 weeks of time away from training for purposes of parental, caregiver and medical leave at least once during training, without exhausting all other allowed time away from training and without extending training. Member Boards must allow all new parents, including birthing and non-birthing parents, adoptive/foster parents, and surrogates to take parental leave.
- Member Boards can accomplish the above-stated goals by adding to existing allowances for time away from training for vacation, allowing accrual or averaging of time over the course of a training program, or other mechanisms.
- Member Board policies must clearly state when time away from training for purposes of parental, caregiver and medical leave will require an extension of training in order to become eligible for Initial Certification.
- Member Boards may establish guidelines for candidates requesting accommodation for parental, caregiver or medical leave. Examples include: requiring the candidate’s program director and clinical competency committee to document how the candidate’s clinical experiences and educational objectives will be met, or to attest that competency has been achieved without an extension of training.
- Member Boards may limit the maximum amount of time away from training a candidate may take in any single year or level of training.
- Member Boards must make reasonable testing accommodations for candidates who extend training, for example, by allowing candidates to take the relevant examination so long as the candidate completes all training requirements by a clearly specified date.
This additional guidance is intended for consideration of ABMS Member Boards and should not be interpreted as requirements:
Member Boards that are exempt from this policy are encouraged to consider accommodations for parental, caregiver and medical leave consistent with the spirit of this policy.
Irrespective of time away from training, training is expected to be extended when the clinical competency committee has determined that competency has not been achieved.
In the interest of trainee well-being, Member Boards are encouraged to establish eligibility requirements that allow for at least 6 weeks away from training for purposes of parental, caregiver and medical leave at least once during training while preserving at least 2 weeks of vacation time. Member Boards with requirements that allow for more than 6 weeks of time away from training for any purpose including parental, caregiver and medical leave are in compliance with the above policy.
Member Boards are encouraged to have examination policies that foster flexible scheduling and exam delivery to reduce disruption or delays in career progression for physicians taking parental, caregiver and medical leave.
Member Boards should encourage subspecialty fellowships to foster start dates after the end of July to accommodate physicians who extend training.
Member Boards are encouraged to work with testing centers and other related organizations to facilitate reasonable accommodations for pregnant, peripartum and breastfeeding candidates to accommodate lactation or breast-feeding during certification examinations, such as lactation rooms, more flexible breaks and longer testing periods.
ABMS and Member Boards should collect data on the use of parental leave policies after implementation to study their effect, including data on the impact of parental, caregiver, and medical leave on certifying exam pass rates.
ABMS supports the GME community in investigating and moving towards competency-based training and integrating competency-based criteria such as milestones achievement, targeted (focused) assessments, learning analytics, etc. prior to the implementation of comprehensive competency-based programs.
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