For those who become pregnant during training, there are many facets of life and work that must be addressed. These include safety as the pregnant person while working, balancing new responsibilities as a parent in addition to a physician, lactation for those who decide to breastfeed, the ever-stressful search for flexible childcare and navigating parental leave. The latter can be a complex process given a multitude of policies. The simplest way to consider these policies is to break them into three categories: policies that 1) protect your employment, 2) pay you and 3) ensure Board eligibility.

Policies That Protect Your Employment
The Family Medical Leave Act (FMLA) was instituted in 1993 for all employees who have worked for an employer of 50 employees for less than 12 months. FMLA offers job security for 12 weeks of parental/medical leave. Some states have options to extend this for up to 16 weeks. Trainees are a unique group of employees and at most institutions, are an exception to this policy. Therefore, if you are at a new institution and need to take parental leave within your first year of employment, reach out to your Graduate Medical Education office to see how they would navigate your specific situation.

Policies That Pay You
In July 2022, the Accreditation Council for Graduate Medical Education (ACGME) updated their parental/medical leave policy so that all trainees, regardless of how long they had been at that training program, receive six weeks of paid parental/medical leave. A large area of conflict is often assigning a pregnant person or their partner to receive vacation time around when the baby is due. However, this is strictly against this policy. Vacation time cannot be used within these six weeks of paid parental/medical leave per ACGME policy. Additionally, the institution (when they select how to pay a trainee) can only select one option (i.e., parental/medical leave or vacation or sick time) – therefore you cannot be on vacation and ACGME paid leave simultaneously. This can be a source of conflict for trainees as they negotiate parental leave, however, it can also be an opportunity for self-advocacy and ensuring you receive the benefits you deserve. Following utilization of the six weeks given by ACGME policy, vacation and sick days are implemented. For any time needed after vacation and sick days, short term disability should be used.

Policies That Ensure Board Eligibility
As cardiovascular disease (CVD) fellows, we are boarded by the American Board of Internal Medicine (ABIM). The ABIM re-worded their parental leave policy in January 2020 to help reduce confusion over its implementation after a study was published that demonstrated only 8% of program directors were able to utilize the policy correctly. There are three policies/procedures that Internal Medicine (IM) and IM sub-specialty trainees need to know:

1. Leave of Absence and Vacation Policy
2. Deficits in Required Training
3. Utilization of the training deadline

The Leave of Absence and Vacation Policy (LAVP) indicates a CVD fellow has 105 days (i.e., 15 weeks) to be used for medical leave and/or vacation during a three-year training period. Most training programs give three to four weeks of vacation per year of training (9-12 weeks of vacation during fellowship). The Deficits in Required Training (DRT) allows for an additional 35 days (i.e., five weeks) to account for other interruptions to training. To implement this policy, program directors may request that ABIM apply the DRT if they feel the trainee is competent to complete training by June 30th of their final year. Therefore, if a trainee remains competent, they can take at a minimum 8 eight weeks of parental leave (assuming four weeks of vacation per year – 12 weeks of vacation total plus three weeks afforded by LAVP plus five weeks from DRT). However, if there are extenuating circumstances or a trainee requires more time away, training would need to be extended past June 30th. This does not automatically require trainees to delay sitting for boards. If all clinical training requirements are completed by October 31st (i.e., the training deadline), the trainee can sit for boards in the year following graduation.

CVD subspecialty training can have additional exceptions. While shorter programs within CVD training (i.e., interventional cardiology, advanced heart failure) are covered by ACGME policy for six weeks paid plus one week of vacation, taking all that time away from training may require you to extend training to achieve competence in a shorter program and should be discussed with your program director. Non-accredited programs (i.e., structural interventional cardiology, advanced imaging) are not covered by ACGME or ABIM policies.

You may notice differences between the length of time each of these policies offer, which is usually the largest source of confusion – FMLA offers 12 weeks, ACGME offers six weeks paid parental leave and then ABIM offers 20 weeks including cumulative vacation – this is often what brews confusion for trainees.

Ultimately you will need to decide what is best for you and your family, but I hope this overview clarifies why there are differences between policies.