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Reasonable Work Accommodations During Pregnancy

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  • Hank Hank 
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    Honest question: do you make significantly more as a PICU subspecialist compared to being a regular pediatrician to justify the additional time in training?  Is this fellowship important to career advancement as an academician?

    From what I’ve heard third-hand, it seems like some pediatric sub-specialities actually have relatively low compensation, despite years spent in additional training.

    I’m a butthead.  I’d insist on strict compliance with the full 12 weeks allowed under FMLA, then file a formal complaint with ACGME if the fellowship staff retaliated against the pregnant fellow.  Might also file a discrimination lawsuit against the institution and name individual staff members personally as defendants.  Then again, lawyers are less likely to go along and get along than pediatricians.

    #214616 Reply
    Avatar GraceisOTL 
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    Status: Physician
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    Joined: 04/19/2019

    How is this even meeting the duty hour rules? I thought that for an ACGME accredited program, a day off must be 24 hours free from duty. So if she works a 28 hour shift starting Sarurday at 6am, she shouldnt be on duty again until 10m on Monday. ??

    #214617 Reply
    Avatar Tim 
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    Status: Accountant
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    Joined: 09/18/2018

    @hank,
    ACGME has some different hours rules for fellowship as well. Things like 14 hrs off get down into a lot of detail like “scheduled” or did she run over the schedule.
    Sure in 6 months the paperwork will start. I would suggest she have specific sections for fellowship guidelines documented and the attempts made to correct it. As well as any retaliation. They will interview, document, and look for a PATTERN of violations.
    Fatigue mitigation and the 80 hr AVERAGE over 4 weeks is the guide. The results are not to fix her issue, it will address the program. Years of careers and accreditation can be jeopardized as it should. None of this will help her, she is at 35 weeks. Three year program with graduation dinner in mid June. Is this her problem or is it a program problem? Is it a retaliation law suit or discrimination? Two different things entirely.
    My point is litigation and accreditation are last resorts. Expensive and disruptive to both parties.
    No offense intended, pregnancy issues don’t discriminate based upon specialties or compensation!

    #214623 Reply
    Avatar SValleyMD 
    Participant
    Status: Physician
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    Joined: 05/12/2016

    If you want an actual job after 13-14 years of school/training than I would be very very careful with getting too carried away with threatening or dropping the ACGME bomb or getting too riled up with anything quite frankly.

    Bottom line you have to tread very carefully as it would be hard to get a first job in North Dakota without your programs support let alone a job in the small subspecialist Peds world. “Entitled. Difficult to work with. Not a team player” gets thrown on those mandatory recommendation letter and you have an uphill battle on your hands.

    That’s the kicker. Anyone has the power to blow up a program by dropping complaints with an ACGME but those Program directors have an INCREDIBLE amount of power/influence over your career (at least when starting out) and they’re the ones that hold the cards when it comes to you individually-

    #214624 Reply
    Avatar Panscan 
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    It’s averaged over the month, not per week for the acgme hours stuff. Also not sure about the day off being 24 hr thing, I’ve never heard that.

    #214627 Reply
    Liked by Tim
    MPMD MPMD 
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    Status: Physician
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    Joined: 05/01/2017

    It’s averaged over the month, not per week for the acgme hours stuff. Also not sure about the day off being 24 hr thing, I’ve never heard that.

    Click to expand…

    For residents it is. Has to be 24h free from clinical duty. Not sure about fellows.

    It prevents programs from making you do a week of nights where you end up having to stay until noon and then calling your 9 hour sleep coma your day off.

    My guess would be that the rules are relaxed for fellows but I don’t deal with fellows. I know that one thing that the ACGME was pretty clear on was that more jr trainees are treated more like students and more senior trainees more like attendings. You’d have a lot easier time justifying a work hour violation for a surgery chief during a mass casualty event for example than trying to argue that your interns need to work 15 hour shifts for educational purposes.

    #214671 Reply
    Avatar Panscan 
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    Joined: 03/18/2017

    Interesting although none of this stuff means anything imo in reality. Numerous programs with rampant violations. Are you going to report your own program, face backlash and possible probation and scrutiny on program? It’s a bad predicament to be in for resident. Real answer is moving residency from being as service based as it is and more about learning.

    #214679 Reply
    Avatar MSooner 
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    Joined: 02/25/2016

    Honest question: do you make significantly more as a PICU subspecialist compared to being a regular pediatrician to justify the additional time in training?  Is this fellowship important to career advancement as an academician?

    From what I’ve heard third-hand, it seems like some pediatric sub-specialities actually have relatively low compensation, despite years spent in additional training.

    I’m a butthead.  I’d insist on strict compliance with the full 12 weeks allowed under FMLA, then file a formal complaint with ACGME if the fellowship staff retaliated against the pregnant fellow.  Might also file a discrimination lawsuit against the institution and name individual staff members personally as defendants.  Then again, lawyers are less likely to go along and get along than pediatricians.

    Click to expand…

    Even in radiology it isn’t a popular fellowship due to the idea (mostly misconception, at least in rads) that it is lower paying than other options. I’m truly thankful for the pediatric subspecialists (and heck pediatricians) out there.

    Hope the OP gets some accommodation. I’m about as far along in my pregnancy and I’m definitely at the “b$%[email protected] eating crackers” stage without those hours! Even when I was working, my desk job let me work from home the last two weeks because everyone knew how miserable it was.

    #214734 Reply
    Liked by Tim
    Avatar Tim 
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    Status: Accountant
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    Joined: 09/18/2018

    “Real answer is moving residency from being as service based as it is and more about learning.”

    Some programs are “workhorse” and some are more “scholarly research”. Both have different fundamental approaches. Of course some in between. Some attendings provide more observation and guidance while some use more demonstration. Each program will swear it’s all with the intent of providing the “best training “.
    https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRFellowship2019.pdf
    Section VI F applies for fellowships time.
    Highest praise to MPMD. He outlined that ACGME expects judgement to be applied. Situations come up, was it appropriately addressed? If yes, your fine. If not, then address the issue in certain amount of time. He probably deals with situations weekly that one party could claim it’s a “violation”.
    Multiple institutions have expressed differing opinions, they know that “stuff happens” , deal with it.
    Burnout and well being are addressed. No guidance on specific needs.

    Bottom line, she needs to take care of her and the baby’s health. Good luck.

    #214746 Reply

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