Parenting and medical careers
I was pleased to see the article "Parenting and residency: the great balancing act"(June ACP Observer). Internal medicine as a profession has sometimes been regarded as anti-family by medical students, resulting in a rejection of internal medicine as a career. Your article did much to erase this stereotype.
Your article primarily discussed residents with small children. As an internal medicine resident with four teenage sons, I would like to address the area of balancing residency with parenting older children.
My husband and I have found teenagers to be only slightly less time intensive than infants and toddlers. While the overall time spent supervising them is less, their inevitable crises require readily available parents. I was extremely fortunate to find a residency program at Michigan State University that has allowed me to extend my program from three to four years. By taking scheduled leaves of absence at the busiest times of the school year (the end of school, the beginning of school and during some of the children's' vacations), I have been able to be home when the teenage storms are most likely to occur. I have also found that regularly scheduled leaves are readily accepted by other residents, as they do not add to housestaff work load.
There are some physicians in the community who feel that I am "getting off too easy," but I feel my decision to extend my residency is supported by my teaching attendings and my program director. I would like to point out that my program is small compared to the programs mentioned in the article, yet it has proven to be extremely flexible.
I strongly agree with the article's advice that medical students should plan for their families before joining a residency program. But I feel that it is just as important for residents to speak to parent-residents in programs they are considering. They need to find out how the program treats not only housestaff, but their families.
Mary G. McMasters, ACP Associate
East Lansing, Mich.
Your article on parenting is reminiscent of one the same author wrote for the January 1994 issue of ACP Observer. In both pieces, she argues cogently and succinctly in favor of special consideration for physicians who have children. And in both, she conveniently ignores the impact of family leave on other physicians.
The latest article describes a resident who took five weeks off for premature labor and another two months off after delivery. The article quotes one resident as saying: "I think people do kind of resent having to cover for you, even if they don't say so. You get the feeling that people don't understand."
Who covered for her during her extended absence and how were those physicians compensated for the extra duties imposed? If the resident thought about this point then she would perhaps see that she is not the only person in need of understanding. While it is true that some of her colleagues may not understand her situation, she needs to be equally understanding about her colleagues' need for quality time away from work and about the potential for imposing excessive work upon those left behind.
The definition of family is another point worth discussing. Those who benefit from family leave assume that only spouses of children qualify as family. When my mother had a heart attack about four years ago, a colleague refused to come into work two hours early-even though I had often covered for her so that she could leave early when her child had had routine viral illnesses. The physicians quoted in the article may wish to reflect on this type of inequity as a way of gaining further insight into their colleagues' unspoken feelings of resentment.
I proposed flexible benefits as one way to restore equity to this system in an article in the Oct. 23/30 1991 issue of the Journal of the American Medical Association. As an additional step toward equity, perhaps your next story could examine the frustrations of single physicians.
Brian J. Bohlmann, FACP
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