15.11.2014

Pregnancy during emergency medicine residency

The challenges for the residents themselves and the challenges for residency training programs are quite different. Consider the use of locum tenens to fill gaps when residents are out for family leave of any type. Create a climate free of fear of becoming pregnant.  A climate of fear is harmful to a culture of quality, and certainly should not be part of the already large emotional burden a resident faces. Another issue is the explanations of not just why you think this is a bad idea from the perspective of the resident making the decision, but why you think it is a bad idea for, basically, all of medicine. I can also add the perspective of someone who actually has had kids in both medical school and residency. Finally, I want to address directly the idea that you should delay having kids until you’re a junior attending because being pregnant and then having young kids make you dumb.
Your post on pregnancy during residency inspired me to write my own post about my pregnancy in 1981 at an ivy league graduate school.
Medicine can be a ruthless career, and it is one where often the student or new physician pays their dues up front so to speak by working long hours with grueling demands placed upon them.
May I gently suggest that what many residency program directors say in front of their female residents, and what they say behind closed doors to colleagues, may be very different.
As much as strongly vouch for the decision to have children to be personal, it is true that many young women are not sure what they are getting into, when they decide to have babies during a tough residency. Then there are those, who are trying their best to be that great mom and the best resident and an excellent care provider for their patients, but are somehow not fortunate enough to make it work (I specifically use the word fortunate because that is the difference between life circumstances that work and those that don’t).
If women want real opportunities to lead and influence medicine, we need to step up to the plate, not demand special privileges. Maybe in the future, technology will allow us to freeze our 20-year-old eggs and time pregnancies whenever it suits us.
Perhaps these comments are true in the field of anesthesia, or perhaps they are a reflection on your individual experience in residency leadership; but I wanted to add a contrasting viewpoint.
I am in my 8th year as faculty in a family medicine residency and am the mother of two children (born after my residency).
However, I have not experienced the resentment and hidden criticism that you describe towards pregnant residents in training.
Certainly for some people the combination of pregnancy, motherhood and residency is untenable and their evaluations and recommendations should reflect this.
I believe that as the next generation of women physicians become leaders in our respective fields, the culture of medicine will grow to demonstrate a greater respect for each individual’s ability to assess his or her own values, capacity and priorities.


As long as the financing of residency programs is so dependent on Medicare funding, it will be hard to change the fundamental nature of this problem no matter how much the culture of medicine might change. Second, it seems to be overly simplified to suggest that residency programs are incapable of change because they are held hostage to Congressional funding decisions. I can speak only for myself, as the wife of a surgical resident that has had to sacrifice the little time we have together as a couple, sleep, studying time, his research elective, and vacation to cover for fellow residents on maternity leave. You must see how the way your life played out prevents you from understanding a pregnant resident’s point of view.
Full disclosure: I am a veterinarian in a path residency, so my existence is a little different.
As a non-trad with a career but no husband or med school until 30, I am considering a baby during med school and potentially another one during residency. The University of Washington’s Emergency Medicine residency provides an outstanding clinical experience in emergency ultrasound, well rounded by rotations through the pediatric emergency department and community affiliate hospitals.
Throughout each year, the ultrasound group provides monthly didactics along with quarterly hands-on workshops for residents and faculty in the Division of Emergency Medicine.
During the four years of EM residency, we anticipate that each EM resident will meet the American College of Emergency Physicians standards for emergency ultrasound credentialing.
Dietrich Jehle, MD, Director of Ultrasonography, is directly involved with training emergency medicine residents in ultrasound use in the emergency department. Advanced Ultrasound ElectiveThe Advanced Ultrasound Rotation is an elective offered during PGY-2 or PGY-3.
The problems you raise here, like strained relationships and the expense of children, are certainly not unique to medicine.
I trained pre-work hour rules and share your feeling that certainly during my residency having a child was unthinkable, at least to me. I have personally re-worked call schedules, written many letters of recommendation, ordered rank lists, and advised countless residents and students and would never dream of calling into question the work ethic or competency of residents who choose to become mothers. Without having a crystal ball to tell me if my ovarian function would still be adequate to do IVF at 34 years old, my husband and I chose to pursue getting pregnant just before the start of residency. Our emphasis is on providing comprehensive hands-on scanning experience, along with training scholars and future researchers in the field of emergency ultrasound. FAST exam in ~60 seconds)Satisfactory performance of  at least 50 studies in each major anatomic area (female pelvis, cardiac, abdominal)During their first year, each resident will complete a one month ultrasound rotation.
Siebert, I would have liked to hear about your experiences as a mother of a young child during medical school and residency, rather than second- and third-hand complaints about other residents’ pregnancies.


He is in a program with only three residents per class, and the loss of one even for a few weeks is devastating.
It is no surprise that when I was younger, unmarried, and childless, I saw no reason for veterinary students, interns, or residents to start families during this demanding time in their career.
Given that I won’t be finished with residency until the age of 34, my REI physician advised against waiting that long.
Then I found myself graduating at 34 and facing postponing pregnancy until I finished my residency at 38…and that would be our first child. We are actively working on a new 4th year elective in Emergency Ultrasound -- stay tuned for more details!
Jehle also authored the first studies of Ultrasound by Emergency Physicians in the diagnosis of blunt abdominal trauma, intrauterine pregnancy vs. My residency program director actually encourages us to get pregnant during residency if that’s what we want to do. Again, I make the point that if we could expand these residency programs without limit, then maternity or paternity leaves would be less of a problem, but we can’t do that. To each their own, but there needs to be some recourse for putting such a strain on your fellow residents.
I understand that residents are essentially indentured servants that help the bloated hospital system run, but it’s not fair to pit residents against one another because God forbid someone wanted to have a baby before she got too old to do it. You get older, it might get harder to get pregnant and in the end, more expensive, if you need to pursue artificial reproductive technologies for assistance.
4)Alternative tracks in residency- for example, offering all residents an option for extended leave, but those who take it are required to provide extended service. I understand that if you are older then there is little choice, but there are those that are sacrificing starting a family because it would put other residents out and there is only so much they can do before they breakdown. In residency, you do have a guaranteed amount of time off with pay, whereas as a practicing attending, it might actually be harder to take time off and away from the RVUs you would otherwise be earning.



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