HAVING A FAMILY DURING RESIDENCY
What you Need to Know
If you are pregnant or planning to start a family, you likely have questions about how maternity leave and/or parental will impact you as a Canadian medical resident. This resource contains information to help you prepare for maternity leave and/or parental leave, scale back your professional duties, obtain financial supports, and re-enter the workforce as a resident. We’ve also provided recommended resources for parents, including websites, blogs, and podcasts.
Please note that each province and program will have unique policies and supports that you should look into. We have provided links to many of these as well.
If you are planning to start a family or are already pregnant, be sure to attend to the following things:
- See your family doctor or find a family doctor if you don’t have one already. Most provincial medical associations have support programs that will assist you with the process of finding a family doctor.
- Notify your residency program director if you are planning on taking maternity and/or parental leave as soon as you are ready to do so. In most cases, earlier is better. For birth mothers, it can be helpful to do so before you are through the first trimester, in order to facilitate planning your rotations, maternity leave, and coverage of call during your second and third trimester. Sit down with your program director and have a look at upcoming rotations. In many cases, adjustments to rotations with heavy on-call requirements and high physical demands may be needed especially in the third trimester.
- Plan for child care, as the process of securing child care can take upwards of a year. Particularly if you are considering putting your child in day care or hiring a foreign nanny, start putting your name on the wait lists or get connected with a hiring agency as soon as possible. Although many residents find childcare towards the end of their parental leave it can become a significant source of angst and worry.
- Notify your Post Graduate Medical Office.
- Contact the wellness office at your university for local resources and to help guide you through the process.
- Notify the Canadian Medical Protective Agency (CMPA) if you are taking maternity and/ or parental leave and they will pause your coverage while you are away from work.
- Apply for Canada’s Employment Insurance (EI) though Service Canada or QPIP (Quebec) once the baby is born, or sooner if you’ve elected to start maternity leave prior to your due date.
Maternity and/or Parental Leave Suspends Your Practice
Note that, when you are on maternity and/or parental leave, your clinical privileges are essentially suspended, including extender licenses. While on leave, you are not legally covered to be involved in any kind of patient-care activities.
Common day-to-day exposures in medicine can present increased risks to pregnant individuals and fetuses. The actual risks of many exposures are largely based on animal studies and they are not likely to be studied in a randomized fashion in humans. Therefore, as a pregnant resident you are recommended to gauge your own comfort with substances and situations encountered as part of your job.
In many circumstances, you may avoid the exposure by adjusting your rotation schedule or having a colleague see a patient. The National Center on Birth Defects and Developmental Disabilities (NCBDDD) website provides a list of exposures you should consider, with links to information that can help you make an informed decision.
Heavy lifting and prolonged standing are associated with increased risk of preterm labour, preterm birth, low birth weight, or a small-for-gestational (SGA) infant.
- Heavy lifting is defined as repetitive lifting or carrying or lifting greater than 23 kg.
- Excessive standing or walking is defined as standing for greater than three to four hours a day.
- The Alberta Perinatal Health Program’s consensus is that eliminating heavy lifting by the 20th week of pregnancy, and eliminating excessive standing by the 24th week of pregnancy, reduces the risk of adverse perinatal outcomes to those of unexposed persons.
- If you are expecting multiples, speak with your physician. You may be advised to abstain from call duty earlier than during a singleton pregnancy.
Provincial Policies for Pregnant Physicians
Each province and program has unique policies regarding on-call and extended shifts during pregnancy. The table below shows the number of gestational weeks at which a pregnant physician is no longer required to fulfill extended shifts and on-call duty in each province. Links to each province’s complete policy are also given.
Table 1: Summary of Provincial Policies on Reduced Workload for Pregnant Physicians
|Province:||BC||Alberta||Saskatchewan||Manitoba||Ontario||Quebec||Maritimes||Newfoundland and Labrador|
|# of gestational weeks:||24||27||28||28||27||20||28||32|
|Link to policy:||Policy||Policy||Policy||Policy||Policy||Policy||Policy||Policy|
Most Canadian residents pay into Canada’s Employment Insurance program (EI). EI provides maternity benefits to persons who are away from work because they’re pregnant or have recently given birth as well as parental benefits for parents of a newborn or newly adopted child. You must accumulate at least 420 insurable employment hours (excluding on-call and after-hours coverage) to qualify. Please note that 420 hours is valid until September 2022, after which time the government will reevaluate the number of insurable hours required: https://www.canada.ca/en/services/benefits/ei/ei-maternity-parental.html
As of 2022, EI provides a maximum benefit of $638 per week before taxes.
Maternity benefits are only available to the person who is away from work because they’re pregnant or have recently given birth. They can’t be shared between parents. The person receiving maternity benefits may also be entitled to parental benefits. A person can start receiving maternity benefits as early as 12 weeks before their due date or the date they give birth. A maximum of 15 weeks of benefits is available.
A person can start receiving parental benefits the week their child is born or placed with them for the purpose of adoption.
When applying for parental benefits, a person needs to choose between 2 options:
- standard parental (up to 35 weeks, up to $638 a week)
- extended parental (up to 61 weeks, up to $383 a week)
If a person applied for parental benefits at the same time as maternity benefits, they don’t need to apply again. Once you start receiving parental benefits, you can’t change options.
Sharing parental benefits
If sharing benefits, each parent must choose the same option, standard or extended. Each parent must submit their own application. If parents don’t choose the same option, the choice on the first application received is used to determine the parental benefit option for all parents.
When sharing, the maximum number of weeks available increases to:
- 40 weeks for standard parental
- 69 weeks for extended parental
One parent can’t receive more than 35 weeks of standard or 61 weeks of extended parental benefits. The remaining 5 weeks of standard or 8 weeks of extended parental benefits are available on a use-it-or-lose-it basis: if taken, they can only be taken by the other parent(s).
Parents can receive their weeks of benefits at the same time or one after another.
Many provincial residency contracts provide additional financial support for residents on pregnancy and/or parental leave, called a “top-up”. Others may substitute a resident’s EI benefit for their parental leave. This is often paid in a lump sum at the end of the 17-week maternity portion. To determine what additional benefits you may be eligible for under your provincial residency contract, please contact your PHO directly.
A few weeks prior to your return to work, you should take care of the following:
- Contact your post-graduate medical education office and health authority to confirm your return date. You may also need to contact your human resources department to confirm your return date and ensure that payments are not delayed.
- Access to hospital computer systems may be cut off during your maternity leave. Therefore, contact your local IT department several weeks in advance of your return to get your passwords reset and restore access to clinical tools necessary for patient care.
- Call the Canadian Medical Protective Agency (CMPA) to resume your coverage.
Adjusting to Your Return to Work
When returning to work after maternity and/or parental leave, it’s normal to feel overwhelmed. You may also feel disconnected from your peers and you may feel that other residents do not relate to what you are going through.
Be assured that many residents have succeeded in this transition. Most provinces and universities have wellness offices that can help with the transition or any time issues arise. Returning to residency part-time is sometimes a possibility and may be worth exploring. Ask for help when you need it.
“The first month back will most likely be a HUGE adjustment period both at home and at work. It’s normal to feel totally overwhelmed, feeling like a terrible mom/wife/doctor on a regular basis, but this gets better with time! Be kind to yourself, spend lots of time with your kid(s) when you get home after work, and save the studying for after bedtime. And don’t forget self care! I have been very upfront with my current preceptor about my needs to pump, and to occasionally even go home to breast feed, and they have been more than accommodating.” – Samantha Reaume, Family Medicine
It is possible to continue nursing as you make the transition back to work. Having a double electric breast pump is helpful for pumping milk during the day in the shortest amount of time possible. Most pumps also come with freezer containers to store the milk if access to refrigeration is limited.
Hospitals are required to provide you with a space to pump. Still, some residents experience challenges finding a space to pump, and many organizations lack policies around breastfeeding. Some residents have found it helpful to contact one of the lactation consultants at the hospital where they are providing service to assist with getting access to a private space.
Transitioning to cow’s milk can be done at 9 months of age as per the Canadian Association of Pediatrics.
The following organization is a great resource for breastfeeding: http://www.drmilk.org/
For many, obtaining reliable childcare is the most nerve-wracking part of the transition back to work. This is especially true for residents who lack family supports in the community in which they are training. Options for childcare include: daycares, day homes, foreign nannies, au pairs, local nannies, and nanny-on-call companies.
Daycares have long waiting lists and often require you put your name on a list more than one year in advance. Many have extended hours to accommodate university students and working parents. Pay attention to consequences for late fees if you are unable pick up your child on time. Note that some daycares will refuse to let your child attend if they are ill.
Day homes may be somewhat more flexible in terms of the hours to pick up your child. Some residents have had issues with day homes providing little notice for extra vacation time or days they will not be providing care. Note that not all day homes are regulated, although most provinces have regulatory agencies that accredit certain day homes.
Hiring a foreign nanny takes upwards of one year and has many upfront costs, such as $1,000 to obtain a Labour Market Impact Assessment (LMIA) and flights to Canada. Many residents use an agency to assist with the process. These caregivers often assist with meal prep and light household cleaning. Their hours are often more flexible than daycares or day homes and alternate childcare doesn’t usually need to be found if the child is sick. However, nannies also get sick sometimes and you are required to provide vacation. Note that it is no longer legal to require your nanny to live in, after federal changes to the program in 2014.
Hiring an au pair is an option for temporary child care. Au pairs are often students looking for an exchange experience to another country and provide child care in exchange for accommodations. The hours an au pair will work are often more limited, and placements are more temporary.
Hiring a local nanny has the benefit that you can interview locally and in person. Rates for local nannies are often higher than for foreign nannies. Many foreign nannies look for work independently once their contracts end with their current employer. Some may require the LMIA mentioned above to legally work in Canada.
Some cities have nanny-on-call companies which can be useful in situations where your childcare falls through at the last moment: http://www.nanniesoncall.com
Agencies that can help:
Resources for Physician Parents
- The Canadian Medical Association provides resources on their Wellness Hub “to help physicians and their families manage and overcome the challenges that arise throughout a career in medicine and build better relationships”: https://www.cma.ca/physician-wellness-hub/topics/physicians-and-their-families
- Resident Doctors of BC has a comprehensive collection of resources for parenting before, during and after leave: https://residentdoctorsbc.ca/resources/parenting/.
- Medicine and Motherhood: Can We Talk? Written by the Task Force on the Accommodation of the Pregnant Physician, and published by the Physician Health Program of British Columbia: https://www.physicianhealth.com/sites/default/files/images/MedicineAndMotherhood2010.pdf
- Mothers in Medicine, a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding:
Physician parents may also find these podcasts interesting:
- EM-RAP: https://www.emrap.org/
- Peds-RAP: https://www.hippoed.com/peds/rap/
- Primary care RAP: https://www.hippoed.com/pc/rap/
General Parenting Websites
Check out these parenting websites for help and resources:
- Scary Mommy: http://www.scarymommy.com
- Mothers In Medicine: http://www.mothersinmedicine.com
- Fatherly: https://www.fatherly.com/
- Well Family: https://www.nytimes.com/section/well/family
General Parenting Podcasts
Search for these podcasts on parenting-related ideas:
- Good Inside with Dr. Becky: https://www.goodinside.com/podcast/
- Motherhood in Black and White: https://www.buzzsprout.com/1239269
- The Longest Shortest Time: http://longestshortesttime.com/
- Grownups Read Things They Wrote as Kids: https://grownupsreadthingstheywroteaskids.com/podcast/
- Motherhood Sessions: https://open.spotify.com/show/3ltqdX9Em1RtnJNqR3UxrS
- Mom and Dad Are Fighting: http://www.slate.com/articles/podcasts/mom_and_dad_are_fighting.html