Planning
When should I have children?
Incentives
When and how to start your family is a very personal choice but many residents start their families during their residency. There are many advantages to having children during residency. For many physicians, residency is the only time in their career that they expect to have parental leave and employment insurance covering at least part of their leave. Many provinces are now offering a Maternity Leave Benefits Program; for more information on this please visit:
www.bcma.org – members only area
http://www.bcmj.org/pulsimeter-20 – 3rd to last article
It takes a significant amount of time to become a fully certified physician and by the time you are “done” your gametes may be past their prime. To avoid fertility issues related to delayed reproduction, having children in your twenties and early thirties can be advantageous. To achieve this timeframe, many physicians will have children during their residencies.
Challenges
Though there are many compelling reasons to become a parent during residency is also very challenging. Residents are busy and often have very little control over their schedules. They `routinely have heavy call schedules making pregnancy and balancing family time even more challenging. Residents are not yet at their peak income and so careful financial planning can be necessary to budget for additional members of your family.
Is residency the ideal time to become a parent? Probably not, but most physicians will admit that combining parenting with a career in medicine is always going to be tricky and residency is as good a time as any. The Society of Obstetricians and Gynecologists of Canada (SOGC) published a committee opinion in 2000 on “Pregnancy and Parental Leave in Canadian Obstetrics and Gynecology Residency Programs”. This article provides some excellent principles that can be applied to any residency program to help promote a balanced approach to pregnancy during residency.
Please see: http://www.sogc.org/guidelines/public/99E-CO-November2000.pdf
Can I afford to have a child in Residency?
Yes! If you managed to budget your way through your undergraduate degree(s) and medical school, you can budget for a child.
Babies are big business and there is a lot of marketing to suggest that every baby accessory, clothing item and toy is essential to rearing a happy, healthy and brilliant child. Instead of buying the majority of your baby stuff before the arrival of your child, consider stocking up on some simple essentials and then seeing what your children need as they grow. One wonderful (free!) resource is “Baby’s Best Chance”, a book published by the province of BC:
http://www.health.gov.bc.ca/library/publications/year/2005/babybestchance.pdf
Friends and family are great resources for preparing for your baby. If people ask what you need, it is often helpful to suggest clothing in sizes over six months to avoid the upfront oversupply. People are also often eager to lend out their baby things, and babies grow so quickly that most items get minimal wear. If you are contemplating a big ticket item it is useful to ask a friend who already has that item if you can come over and try it out.
Thrift stores and child consignment shops are a good place to get clothing and accessories at affordable prices. Craigslist is also good resource for baby things and you can often get great deals on strollers and cribs. The one item you may want to appraise carefully is an infant car seat, due to frequently changing safety regulations. Models outdate within 5 to 8 years so if you would like to check if items have any safety concerns or have been recalled, please visit the Health Canada website:
http://cpsr-rspc.hc-sc.gc.ca/PR-RP/home-accueil-eng.jsp
Health Canada also has several pertinent sites that may be useful:
Child safety (http://www.tc.gc.ca/eng/roadsafety/safedrivers-childsafety-index-53.htm)
Crib safety (http://www.hc-sc.gc.ca/cps-spc/pubs/cons/cribs-lits_enfants-eng.php)
Toy safety (http://www.hc-sc.gc.ca/cps-spc/child-enfant/toys-jouets/index-eng.php)
Childcare equipment (http://www.hc-sc.gc.ca/cps-spc/child-enfant/equip/index-eng.php_)
How much can I expect to earn while on leave?
How much you earn will depend on your income (and thus PGY level) and whether you choose to work part-time (moonlight, etc) or have other income sources. The basic benefit rate is 55% of your salary (although the maximum salary is $42,300 and all full time residents will pass this cut off). In other words, given you’re “maxed out”, you can receive a maximum payment of $447 per week from EI. This amount is “topped up” to 85% of your salary for biological mothers for weeks 1 – 17. Excerpted from the Service Canada website: http://www.servicecanada.gc.ca/eng/ei/types/special.shtml
- If you work while on maternity benefits, earnings will be deducted dollar for dollar from your benefits.
- If you work while on parental benefits you can earn the greater of $75 or 40 % of weekly benefits. Any earnings above that amount will be deducted dollar for dollar from your benefits.
Example – You are a full-time, PGY-1 (base salary $48,500/yr) resident who has met the criteria for EI. You plan to not work at all during your year of maternity/parental leave.
Weeks 1 – 2
SEB: ~$1240Weeks 3 – 17:
EI: $894 + SEB:~$350 = $1240 q 2 weeks
Weeks 18 – 52:
EI: $894 q 2 week
**this is a rough estimate and should be used as a guide ONLY**
Finding a Family Physician
Starting a family should give you the push to put finding a family physician at the top of your list.
- A joint effort by the Physician Health Program of BC, the BCMA, and the BC College of Family Physicians has developed Doctors For Doctors, a listing of physicians willing to accept physicians as patients (link in site).
- In the lower mainland, the BCCH site has a list of doctors (http://www.bcwomens.ca/Services/PregnancyBirthNewborns/MaternityAndFamilyCare/FindaDoctor.htm) accepting maternity patients.
- In the lower mainland, the BCCH site has a list of midwives (http://www.bcwomens.ca/Services/PregnancyBirthNewborns/MaternityAndFamilyCare/Midwife ryCare/default.htm) accepting maternity patients.
Some of these physicians may also accept you and your family as general patients down the road. When choosing a maternity care provider, you may want to consider where they have hospital privileges (teaching vs. non-teaching hospital).
Workload
Residents have a unique workload, including long hours, potentially violent or hazardous exposures and physically demanding procedures. Accommodating the demands of residency with the physical changes of pregnancy can be tricky but not impossible. The current PAR-BC Collective Agreement includes a Memorandum of Understanding on Workload during pregnancy (link in site).
Scheduling Rotations
When you sit down with your residency director to discuss your upcoming maternity leave, it is also important to review the rotations you will complete while pregnant. Be realistic about how you will be feeling during your first, second and third trimesters and consider moving rotations to best suit your physical state.
Fatigue and nausea are common in the first trimester, most women feel quite well during the second trimester, and the third trimester is marked by fatigue, leg swelling and difficulty bending. Consider tailoring your rotations to make your heavier rotations during the second trimester.
It is worth thinking about the exposures we deal with during the course of our training and how they will relate to your pregnancy. You may choose to defer a rotation, for example, in pediatrics emergency during the peak of flu season to avoid excess infectious exposures. Think about rotations with increased infectious, radiation and toxic exposures and discuss these concerns with your program director and occupational health services at your local health region.
Talk to your residency director about what the department policies are regarding pregnant residents. Many departments will have a cut off point at which night call is no longer expected (this is usually around 30-32 weeks). When you discuss your end of work date, set a date that you are comfortable with but remind your director (and yourself!) that everything will depend on how the pregnancy unfolds.
Complications During Pregnancy
Should you have to stop work early due to complications of your pregnancy you should be aware that, under the current PAR-BC Collective Agreement, this time should be considered sick leave, not maternity leave (link in site, article 10.01)
If you have disability insurance you may be entitled to disability compensation through your insurer. Women generally pay a slightly higher rate for disability insurance due to the risk of pregnancy related disability leave so if you should find yourself in that position do not hesitate to claim — you have already paid for this situation. Consider arranging a research elective if you need to go on bedrest or reduced activities to minimize time missed from your residency.
Termination of a Pregnancy
When a pregnancy terminates within the first 19 weeks of pregnancy, it is considered an illness under EI. Since that is the case, sickness benefits may be paid as long as the qualifying conditions for sickness benefits are met (http://www.servicecanada.gc.ca/eng/ei/types/special.shtml#Sickness3)
On the other hand, if the pregnancy terminates in the 20th week or later, the claim for benefits can be considered for maternity benefits if the qualifying conditions for maternity benefits are met. (http://www.servicecanada.gc.ca/eng/ei/types/special.shtml#Maternity3)
Day-to-day Advice
Biologically, you are the same as regular mortals despite your superhuman schedule. Remember to eat frequently; take your bathroom breaks. If you have not tried them before, compression stockings, especially on call, can make a big difference to leg swelling and fatigue. Prescription stockings are covered by the resident health plan but for 15-25 dollars you can pick up a pair from medical supply drugstores to see if they are helpful to you.
Pregnancy is tiring and you will require more sleep. Take naps in the evening if you need them and get into the habit of sleeping post call. You will have regular medical appointments throughout your pregnancy and the frequency will increase to once a week by the end of your third trimester. Talk to your program director about the best times to book your appointments. Some people find appointments right after half day, on post call days or at the end of the work day are the least inconvenient.
