Most women in the United States have children when they are in their 20s and early 30s, the same time they are training to become physicians and medical specialists. They shouldn’t have to choose between the two.
“It’s time to normalize pregnancy during training,” stated Deborah Gomez Kwolek, MD, FACP, FAMWA, NCMP, Immediate Past-Chair of the Society of General Internal Medicine‘s (SGIM) Women and Medicine Commission, and co-founder of its Workgroup on Parenting.
Launched in 2020, this workgroup is designed to support trainees from medical students to junior faculty throughout their pregnancy and as they adjust to being physician-parents. The purpose is to form a community for networking and provide a safe space for members to vent, troubleshoot, share experiences, and feel supported. The workgroup provides residents with information about their rights during pregnancy and hosts the bi-monthly Nighttime Parenting in Medicine Café, bringing together physician-parents to meet virtually and hear from invited speakers.
On a larger scale, the workgroup sponsors SGIM programming around parenting issues at its national meeting. It also works with SGIM leaders to increase their support for parents at their institutions and identify strategies for helping physician-parents to succeed. “At SGIM, we have access to people in leadership positions, such as division chiefs, department chairs, and program directors, who can help influence internal medicine, but also other specialties,” said Dr. Gomez Kwolek, who stressed that the workgroup is open to all, not just SGIM members.
“We want to help change the culture at institutions to be accepting and supportive of pregnancy and parenting in medicine, during residency and beyond,” she added. “We want to raise awareness of the struggles that parents, particularly first timers, go through.” It’s not just about giving birth. Women can have complications in the third trimester of pregnancy and after the birth of their child, noted Dr. Gomez Kwolek, who is an Assistant Professor of Medicine at Harvard Medical School and Lead of the Women’s Health and Sex- and Gender-Based Medicine Program at Massachusetts General Hospital.
People in their 20s and 30s often become parents and they should be accommodated instead of being treated like they are asking for special favors, made to feel guilty for burdening others, belittled through micro-aggressions, and having their career path be negatively affected, all because they chose to become parents, she said. Dr. Gomez Kwolek co-founded the workgroup because she faced hardships when she had her two children during residency and even as a junior faculty with young kids. “I pledged when I attained a senior position, I would advocate for my young colleagues,” she said.
Increasing support
Dr. Gomez Kwolek believes the tide may be turning as more national and state laws are promoting family leave. While the federal Family Medical Leave Act provides up to 12 weeks of unpaid leave during a 12-month period to care for a newborn, adopted or foster child; a family member; or an employee’s own serious medical health condition, 11 states and the District of Columbia currently offer paid family and medical leave.
She is grateful to the American Board of Medical Specialties (ABMS) for requiring its Member Boards to allow for a minimum of a six-week leave policy for parental, caregiver, and medical leave. “Having this policy come down from the top, from ABMS, is a powerful statement,” Dr. Gomez Kwolek said. “There is so much variability in leave policies across institutions. It often depends on who is in charge and what is the institutional culture,” she added. The ABMS policy has been helpful at the local level where institutional policies may not be as generous.
Dr. Gomez Kwolek is also encouraged by the Accreditation Council on Graduate Medical Education (ACGME) for requiring those six weeks to be paid time off. In 2024, ACGME is expected to evaluate all its training programs to determine whether they have implemented its policy. “If the programs know that they will be held accountable, they will comply,” she said, adding, “I’m optimistic that in a couple of years, we will see big progress.”
In the meantime, training programs should develop a plan to cover the inevitable. It shouldn’t be a surprise given that more than half of medical students are women and this is the normal time for them to get pregnant or grow their family through adoption or foster care, Dr. Gomez Kwolek said. “We’re doctors. We know where babies come from. We should expect this, plan for it, and actually celebrate it.”
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