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Reasonable Work Accommodations During Pregnancy

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  • Avatar wideopenspaces 
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    Oh gosh, I can’t even imagine trying to work those hours being not pregnant, let alone 35 weeks. That is pure misery. Do they change rotations at the beginning of every month? I would ask for an “easier” rotation for June, for sure, if she’s unwilling to do anything about the current schedule. I understand why she doesn’t want to speak up but I agree nothing in medicine will change if we never advocate for ourselves. I was pregnant third year of med school and was going to be allowed 4 weeks off after I delivered. This was unacceptable to me. I, along with another classmate who was also pregnant asked for a full year off. We had to take it up the ladder but eventually we got a policy put in place at our medical school that anyone in good standing could take up to a year off after delivery. So change is possible and I know others have benefited from our willingness to challenge the status quo.

    I also agree that she is entitled to 12 weeks of FMLA time and given her grueling work schedule, she is going to need every single week she can get before going back to work. As hard as residency and fellowship are, nothing is as intense as the first year, and especially the first few months, of parenthood. It would be painfully difficult to try and function on the amount of sleep she’ll be getting at 6 weeks.

    Avatar MSooner 
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    if its a brutal fellowship then why get pregnant during fellowship? going to have like multiple levels more magnitude control over schedule as an attending.

    I’m with you about changing rotations around and etc but some of this is a self-made problem

    Click to expand…

    Because no birth control is 100%? Because maybe they have been trying for years or have medical reasons to start sooner rather than later? Because who on earth wants to start a long term job and then immediately go on maternity leave if they can avoid it?

    This year my husband had an accident and ended up non-weight bearing on crutches for 6 weeks. His program didn’t bat an eye about making accommodations (granted, his specialty helps), even when he finished up with weekly PT. It was technically a “self-made problem.” He was the one that had the accident (heck, it was on a bike). Yet the mindset is totally different. It shouldn’t be.

    wonka31 wonka31 
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    I’m a guy (so not pregnant), never take off work and have had one sick day in nine years (should have taken a few more). I used to be of the mindset to ‘power through’ and still have that to a pretty high degree, sometimes wrongfully so. I don’t understand why we can’t take a sick day if needed without it being frowned upon or can’t have a reasonable schedule during unique circumstances (i.e. pregnancy).

    Panscan-My post wasn’t meant to directly attack you, I apologize if it came through that way. The gist of your post and mindset make reasonable asks, as mentioned in my above paragraph, less possible. I simply don’t think it’s too much to advocate for a person’s health or the health of an unborn baby. If you meant switching around call, shifts, etc. that’s a very reasonable thought process. Unfortunately, many places are not understanding of this, which is unfortunate.

    #214169 Reply
    Avatar Tim 
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    OP mentioned two significant points:
    1) I don’t think she should have to work less hours than her colleagues, but I think they can easily be redistributed to research months, etc.
    This is clearly NOT about not carrying an equal share of the “work” portion.
    2) She is a fellow, not a resident. Much easier from a scheduling standpoint. The mutual goal is her advanced skills training. Cutting the OT won’t impact that a bit. The assigned attending has plenty of assets to pick up the slack.
    3) If she needs extra time off, so be it. No questions asked. From a training perspective, she might need to extend it a month or whatever. No need to force a month now vs later.

    Accommodations can clearly be made to allow her to work safely and productively. She needs to have a discussion with the PD. Accommodations will benefit both sides. It’s not “whining or special treatment “. It’s how she can give 100% to the program. That’s a good thing.

    #214186 Reply
    Vagabond MD Vagabond MD 
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    A version of this scenario gets posted regularly on this forum. I would guess that if there is/were a closed forum of residency and fellowship program directors, it would be the among the most common topics. Interestingly, when I was in training about a generation ago, it was very rare to have pregnant colleagues (both fewer women and rare pregnancies in those women), and the medical establishment has had the ensuing 25 years to get this correct.

    The wife of the OP should not be working a grueling schedule at 35 weeks. It’s not good for her, the unborn baby, the patients, or the care team. But she did not become 35 weeks pregnant without warning last week. In fact, there have been somewhere between 23 and 29 weeks to make a reasonable plan to make the necessary accommodations so that the OP’s wife would not find herself in her current work schedule circumstances.

    It would be optimal if she could leave the clinical service late in pregnancy and return after a generous post-natal recovery period, but the question remains, who is charged with getting the work done? Other fellows on research or other puff rotations (what if one or more is also pregnant or recovering from delivery? what if one is recovering from an ACL tear from playing ultimate frisbee?)? How deep is the bench of fellows to cover? Can the attending step in and do the work? How deep is the attending bench? Should the fellowship be extended to make up for time off?

    Someone naively posted early in the thread that these problems are more easily solved when you are attending. This may or may not be true, depending on your circumstances. Ultimately, the work must get done, and if you are off the schedule for a period of time, be it for pregnancy (typically early in the career) or bypass surgery (typically later in the career), many practices lack the resources and policies to gracefully accommodate. This is one of the many reasons why I think it is good to have some part time people in the mix. In a pinch, your workforce can expand to assist for short and intermediate term absences.

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    hatton1 hatton1 
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    I totally agree with VagabondMDs above comments.  This issue has percolated through medicine for my entire career of 31 years.  There is no one size fits all solution.  There is never an ideal time to have a baby.  Someone will feel screwed over because they are working extra whether you are in medical school, residency, fellowship, or practice.  I also heard the same type of complaints from my OB patients who were in competitive law practices trying to become partners.  I have seen people try to “hide” the fact they were pregnant until it was obvious.  I think being upfront and trying to figure out some accommodation and schedule adjustments early on is a good idea.  As hard as you try to plan the pregnancy may decide to derail your plans by delivering at 30 weeks.

    #214202 Reply
    Avatar Tim 
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    “many practices lack the resources and policies to gracefully accommodate. ”

    Part time people is one solution.
    Locums is another.
    Temporary help is another.
    Floaters is another.

    Most positions in any organization don’t have the bench strength to cover for a week, let alone months. Backups cost money. Work will wait or be delegated until a point of refusal is reached. That’s why the FMLA was passed.
    She needs to work within the system. How effectively she did that is in the past. Actually, I didn’t catch where she has made any requests other than around the delivery. Not everyone get Thanksgiving, Christmas and New Years off. If you have good enough reasons, they might say yes. Sometimes the person has the responsibility for making the request.
    It’s not the business’s responsibility to “be a mind reader”. Was anything denied? Not that I noted. That would be on her, not the organization. Alternatives are available, she didn’t ask and is suffering the consequences.
    That is a possibility.

    #214205 Reply
    Avatar LizOB 
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    1. I can’t just put someone on bedrest or write to be out of work for no medical reason. In fact, there are very few (if any) evidence-based reasons for bedrest in pregnancy. I have written notes requesting more frequent bathroom breaks, or to not work more than 40 hours in a week, though admittedly I don’t know how successful those notes are. I also haven’t taken care of residents/fellows because I do not practice at or particularly close to any training hospitals.

    2. FMLA allows 12 weeks off (unpaid) after delivery, however it only applies to employees who have worked for a year. So if she is a first year fellow and didn’t do her residency there, FMLA may not apply. The ACGME has its own rules about whether training would need to be extended based on time off, which of course is a separate issue.

    3. Delaying pregnancy is a terrible idea. No individual has any idea when her ovaries may crap out, but it becomes more likely the longer you wait. I have had women in their 40’s with oops pregnancies, and women in their early 30’s with infertility due to decreased ovarian reserve. There are no guarantees and it is really tough if not impossible to predict. Not to mention, many women desire multiple children so delaying the first pregnancy delays all the others too and makes infertility for subsequent attempts more likely. Additionally, no method of contraception is 100% effective. So let’s not blame anyone for the timing.

     

    Avatar fasteddie911 
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    That sounds like a terrible schedule to work at 35wks.  However, in fairness to the program, this is on you/your wife for not saying something earlier and giving them a chance to be accommodating.  Pretty much every resident/fellow I know who got pregnant had no issues changing things around, either with help from the program and/or co-residents.  If her program truly has a negativity about pregnancy, and it’s not her reading too much into things, that’s unfortunate and is something that should be told to incoming applicants or I’m not sure if a complaint can be made to ACGME.  The 12wk FMLA thing has been brought up already, but if she’s getting 4wks paid (this part wasn’t clear) w/o using any vacation/flex days, she should feel lucky, lots of workplaces don’t offer that.

    #214217 Reply
    Vagabond MD Vagabond MD 
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    “many practices lack the resources and policies to gracefully accommodate. ”

    Part time people is one solution.
    Locums is another.
    Temporary help is another.
    Floaters is another.

    Most positions in any organization don’t have the bench strength to cover for a week, let alone months. Backups cost money. Work will wait or be delegated until a point of refusal is reached. That’s why the FMLA was passed.
    She needs to work within the system. How effectively she did that is in the past. Actually, I didn’t catch where she has made any requests other than around the delivery. Not everyone get Thanksgiving, Christmas and New Years off. If you have good enough reasons, they might say yes. Sometimes the person has the responsibility for making the request.
    It’s not the business’s responsibility to “be a mind reader”. Was anything denied? Not that I noted. That would be on her, not the organization. Alternatives are available, she didn’t ask and is suffering the consequences.
    That is a possibility.

    Click to expand…

    You say “Locums…temps….floaters…” as if there is a ready pool of people that can jump in with short notice and get the job done. Unless you are paying people to be idle, and nobody is, nothing could be further from the truth. A PICU subspecialist is pretty rare. They do not grow on trees.

    And where is the money coming from? Who is going to volunteer to take less compensation to pay this unicorn?

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #214250 Reply
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    Lithium Lithium 
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    One year freeze on new positions and raises in the C suite. Or just mandate that costs for clinical staff rise in concert with administration. That might help them “find the money.”

    #214255 Reply
    Avatar Tim 
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    “And where is the money coming from? Who is going to volunteer to take less compensation to pay this unicorn?”

    That’s exactly the point. No one does. Daycare has the same problem a lawn service too. Hiring permanent or temporary is extremely distruptive to any business.
    Medicine is different? My point is 35 weeks in is really late to be making a request. A lot of this should have be addressed by the fellow much much sooner. Yes medicine is different from the licensing and availability.
    The hospital seems to have given her everything she requested. The hospital hasn’t said “no” yet.
    Now it’s the hospital’s fault? Her plan is causing a coverage problem that will land unfairly on the other staff. My question would be why hasn’t she communicated? It’s too late to avoid a scramble. She needs to bring up the issue ASAP. Sounds like she signed up for a full load with no accommodations requested. Bad choice.

    #214283 Reply
    Avatar Kamban 
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    A version of this scenario gets posted regularly on this forum. I would guess that if there is/were a closed forum of residency and fellowship program directors, it would be the among the most common topics. Interestingly, when I was in training about a generation ago, it was very rare to have pregnant colleagues (both fewer women and rare pregnancies in those women), and the medical establishment has had the ensuing 25 years to get this correct.

    Click to expand…

    And unfortunately such threads get locked after a few pages due to hardened views of both sides.

    6AM-7Pm is brutal in PICU and it looks like too tight a ship with no slack. I guess the other fellows have the same schedule and there is no way they can work extra. One cannot pull people from research areas at a day’s notice and make them work for weeks, neglecting their own research. Especially if they have already gone through this schedule.

    I wonder if she spoke to the PD early in the pregnancy and no solution could be found. Or she thought she could manage it and now finds it a brutal schedule. No easy solutions.

    #214308 Reply
    Avatar Tim 
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    No easy solutions.

    Click to expand…

    OP is smart not filling in details.

    ACGME is a landmine. What did the program do except let you continue working according to your actions? The Med School and university HR and attorneys are going to be very please with a mandatory investigation.

    #214318 Reply
    Avatar Dusn 
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    What happens if she delivers early, does the program have backup to cover for that?

    To the OP– it sounds like your wife and/or you may have initially not realized the difficulty of the last few weeks of pregnancy. Which is understandable, this is your first baby.   But post-pregnancy is generally way harder, especially if your wife has any goals of breastfeeding.  I would try to get as much time off (for both of you) as possible and as much help as possible.

    As a philosophical aside, doesn’t the gov’t/medicare provide the salaries for residents and fellows and then pay the hospitals extra on top of that?   I think the goal from the government’s prospective is to educate future doctors, not provide academic hospitals with free labor so that they can cut back on hiring fully trained physicians.  If a hospital doesn’t hire enough attending physicians to take care of its patients, whose fault is that?

     

    #214321 Reply

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