The Case for On-Site Child Care in Residency Training and Afterward

Abstract

Individuals in residency and fellowship training work long, often unpredictable hours, including nights and weekends, and residency training typically occurs during individuals' childbearing and child-rearing years. However, it is unclear how residents with children arrange child care that accommodates the 80-hour resident work week. Additionally, during the past 40 years, the proportion of women in medicine in the United States has increased dramatically. Historically, parental leave and child care have been considered women's issues, but they affect both men and women, especially for dual-professional and dual-physician couples. Additionally, residents often face repayment of educational debt while earning a limited salary, which can limit the affordability of child care options. The lack of child care options for residents may have a broader impact on the training and growth of the physician workforce. Due to many factors, including the growth of an aging population and the limited number of entry positions into graduate medical education, a shortage of physicians (both generalists and specialists) is predicted for the United States within the next 10 years.1 Compounding this, a significant proportion of the physician population is working part-time. According to a national survey of 5704 physicians, 13% of US physicians work part-time, including 22% of female physicians and 9% of male physicians.2 Female physicians working part-time are more likely to be married and have young children.2 Similar trends in part-time employment are noted internationally as well. A study from Switzerland reported that the most prevalent career arrangement for a male physician with young children is full-time employment with a spouse unemployed or working less than half-time.3 However, the most common arrangement for a female physician with young children is 50% to 69% part-time employment with a full-time working partner.3 The authors suggest that in the era of physician shortages, availability of child care facilities in hospitals could encourage a higher work participation of physician mothers.3 A study of dual-physician marriages reported that as many as 87% of women and 59% of men arrange their work schedule to accommodate child care responsibilities.4 Among male and female surgeons married or partnered to another physician, nearly 40% reported that their career advancement had been slowed owing to child-rearing responsibilities. In addition, surgeons with a physician partner were twice as likely to miss work for sick-child care as surgeons with a nonphysician partner.5