When you’re never off call: returning to residency as a new parent

By Dr. Richelle Schindler

Residents are steeped in grueling hours, being awake at any time of day, sleeping anywhere at any opportunity and giving a little bit extra even when we thought there was nothing left to give. We nurture and grow and learn alongside our patients and share deeply in these journeys that are not just our own. Essentially, the things that make us great residents also set us up to be great parents. And if parenting is in your plan, why would you not want to start during residency?

For many physicians, residency is the only time in their careers where they have maternity and parental leave benefits. You have protected duty hours if you’re going to be pregnant. The prospect of financial stability is finally on the horizon. You’re going to be training for two to five years (or more – Hey, Fellows!), so you have time. So you sign up for that journey with open eyes – you know it will be hard, but it’s worth it, right?

As someone who has been doing both formal and informal work in the physician wellness space since med school, people come to me with stories. No one has ever told me that it wasn’t worth it, but I don’t think anyone is ever prepared for what coordinating being a new parent and a physician means.

Leave Pay

The Resident Physician Agreement (page 8) lays out the benefits for residents who are parenting and it’s a pretty great deal – 17 weeks of paid maternity leave for residents who give birth, with top ups to 90% of your salary and up to 18 months of protected parental leave. Here’s the thing though, the Agreement doesn’t state when or how that top up payout happens and AHS policy is that it gets paid as a lump sum at the end of the maternity leave portion of your leave – approximately four to five months into the leave. You still get your EI payments, but they max out at around $2000/month.

One resident I talked to was the family’s breadwinner and had been planning a pregnancy for years. She had everything budgeted out, knew where they could cut back and how much savings they would need to use, only to find out weeks before the baby was born that she was going to have EI alone – and her student loan payments were going to immediately eat up half of that. She had called AHS HR and they told her, “Sorry, that’s the policy, we can’t do anything.” That’s when she texted me in a panic. After talking with other residents who had taken maternity leave, I found out that the Physician Affairs office could make monthly payments happen, but only if the resident requests it. She finally got in touch with the right people and was able to go back to focusing on the important stuff!

Leave Time

How much time to take is a deeply personal decision, but for many people it doesn’t feel that way. One new parent out of University of Calgary highlighted in the recent Gender Equity in the Department of Medicine report this:

“[I was told] women who [are] more focused tend to take shorter mat leaves. I left feeling like I better take a short mat leave because I don’t want to be perceived as someone who’s just not as focused. I don’t think it was intended that way but left with a bit of pressure to make sure I don’t stay away too long.”

People also can feel pressure to return before the one year because of finances, obligations to their colleagues, desire to graduate sooner, not wanting clinical skills to lapse or as the above woman felt, desire to be taken seriously professionally. The first resident I talked about had planned to return to work once the maternity benefits ended specifically because doing EI only for a year wasn’t feasible for her family. Many programs are under a service crunch and when they’re away, parenting residents can feel responsible for shifting more work onto their colleagues. I’ve talked to residents who were being asked to increase their call duties beyond what the Agreement allows because of someone starting on maternity leave much earlier than expected and it is hard on everyone. If you’re being asked to take more service duties than the Agreement allows, please reach out to us, we can help!

Breastfeeding/Chestfeeding

In prenatal classes and resources, one of the things that’s taught is that you should make a plan for breast/chestfeeding. This is a great idea. You should also be completely ready to toss it out the window. We’ve all had the benefits of human milk hammered into us in med school, but I’m going to buck medical dogma (sorry World Health Organization) and say that a fed baby, not breast, is best.

Residents who are chestfeeding their babies should plan to express milk for 10 minutes every three to four hours while at work to prevent decreased supply, which means having:

  • a private space (potentially with a plug if it’s not a battery operated pump)
  • a pump & assorted equipment
  • a pumping bra so you can have your hands free
  • a place to wash your hands and equipment (C. diff is everywhere, y’all)
  • empty sterile bottles to fill with ice packs and freezer bags to keep them cold
  • clothing that you can easily pump in
  • time (?????)

Lactation spaces are standard in public health clinics and some hospitals have them for patient use, but finding one where you are practicing can be a real challenge. Talk to your PME office, but many residents are having to find these sort of ad hoc. Even if you do find a space, there’s no guarantee that the baby will cooperate.

Although new parents are often warned that artificial nipples can lead to babies refusing to chestfeed, there’s little warning for the opposite, which is far more challenging for your return to work, as one of my preceptors found out. Her daughter had been fed both ways since birth, when suddenly at around five months old, she refused anything but chestfeeding, despite numerous purchases of other types of bottle/nipple. Not only did this disrupt her work days, but also meant that despite having a supportive family, she was the only one who could get up with the baby at night. She ended up pumping during the day to maintain supply and started the baby on solids early to get her through the work days. You can’t plan for everything, so find other parents and ask what they’ve done.

Still being a rock star resident

Some of the most discouraging advice that gets floated around is that parenting and being a physician means that you need to choose to be good at only one of them or mediocre at both. I don’t think that this is true at all, as some of my favourite mentors have had children either during residency or as new staff physicians.

Parenting in residency does mean learning to have strong boundaries. Say no to the extra project work and pass it off to a colleague who would do an excellent job. Ask your co-parent or family or friends to help with the background work of parenting so when you can be around, you are engaged with your family and creating meaningful moments. Be willing to adapt to your changing circumstances – maybe now you podcast on the way in to work rather than burying yourself in textbooks. Build a community of people who have your back and don’t be afraid to call for help. Thank the people who make doing both parenting and residency possible – meaningfully and often. And perhaps most importantly, be willing to feel like it’s not enough. It’s okay to feel guilty. It’s okay to not do it perfectly. It’s okay to fumble through and feel like day one of clerkship all over again some times. I promise you that it is enough, that you are not mediocre, and that you will find the rhythm of the new normal.

What if things aren’t going well?

Everyone struggles sometimes and learning the balancing act is challenging for everyone. Have open and honest conversations with colleagues that are supportive. Seek out mentors who have done this before you. Use every community support offered to you. Access crisis resources, even if it doesn’t exactly feel like a “crisis” yet.

You may be stressed out and sleep-deprived, but you’ve done all that before. You’ve got this – and if you ever feel like you don’t, we’ve got you.

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Dr. Richelle Schindler is a Public Health and Preventative Medicine resident physician at the University of Calgary.