How medical schools can better support students through pregnancy and parenthoodBMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1155 (Published 22 May 2023) Cite this as: BMJ 2023;381:p1155
- Christina Staroschak, incoming first year resident in psychiatry,
- Danielle L Sawyer, fifth year doctorate of medicine and philosophy student
- Twitter: @daniellesawyer_@Staroschak
The purpose of medical school is to train people to practise medicine so that they can provide excellent care to patients. Yet the care and support for pregnant people and new parents in medical school is severely lacking in the United States. Medical students do not have the same protected maternity, paternity, and adoption rights as employees, nor do they always have access to the same accommodations. Medical schools should formalise their policies and resources so that students who become parents during medical school are given adequate support. This would also help to usher in a cultural shift that normalises conversations about pregnancy planning and parenthood during medical training.
The average age of US matriculating medical students is 24.1 Many people training to become physicians delay having children until later in their careers because of the demanding hours and lack of time outside of training.2 But medical schools shouldn’t assume this decision is universal—they need to consider how they can accommodate students who have, or want to have, children. A 2021 study evaluated the policies of nearly 200 medical schools and determined that only one third of schools (65) communicated their policies on parental leave.3 Most of these policies were not adjusted or shaped around specific academic stages, instead they consisted of vague guidelines that lacked further resources for students.
No safety nets
If a medical student in the US wants to take time out of their course to spend time with their newborn child, they must take a leave of absence, which can harm their application for residency programmes. During a leave of absence, the amount of financial aid that students receive can be reduced, yet students might still have to pay tuition costs or other fees depending on the length of their absence.4
Many medical schools do not offer students any options for health insurance coverage for dependent children, despite this being recommended by the Association of American Medical Colleges.5 Medical schools failing to provide these financial and healthcare safety nets can add to the stresses and financial burdens of students who become parents.
Pregnant medical students face several difficulties, but first generation and low income medical students—who are under-represented in medicine and who often have less social capital, educational support, and financial resources—encounter extra challenges.6 Data show that first generation and low income medical students are more likely to take a leave of absence than their peers, putting these applicants at a disadvantage for opportunities for residency training.7 Medical schools must establish equitable policies for pregnancy and parenthood that factor in the relative disadvantages that some students might face and that uphold the wellbeing and health of all students and their families.
An outdated paradigm
This lack of support extends beyond medical school, as physicians face several barriers to becoming parents during residency training. Interviews for residency programmes have been known to feature potentially discriminatory questions about applicants’ desire to have children during training.8 Some residency programmes offer support for new parents and those trying to conceive, but many do not have such welcoming environments. This is particularly true of specialties like surgery where the lack of family policy and punishingly long hours discourage pregnancy and family planning.9 The perceived incompatibility of having a child while meeting the demands of residency training can make physicians feel stressed and overwhelmed. Residency programmes should consider how this might harm the mental health of trainees and worsen physician burnout.
Medical education often relies on an outdated paradigm that does not serve its increasingly diverse trainees. All medical schools must have a clear parental policy that is easily accessed by students. This policy should be signposted to all matriculating medical students, with clear advice on where to go if they need further support. It must provide specific benefits (including options for healthcare insurance for dependents) and resources (such as institutional points of contact), as well as accommodations for before, during, and after pregnancy, with plans that are specifically designed for each stage of training. This improvement in medical schools will hopefully be a catalyst for change in residency programmes too, so that better support is offered to parents at all stages of medical training.
The experience of becoming a parent and a doctor at the same time requires immense planning and resources and is accompanied by a raft of time consuming bureaucracy that could be simplified. Currently, students are largely left to navigate this alone, with the lack of policies feeling almost intentionally isolating. Medical schools can considerably lighten this load for physicians in training by providing more support, thereby enabling the success of trainees and strengthening the care of their patients.
Competing interests: none declared.
Provenance and peer review: commissioned; not externally peer reviewed.