New Zealand International Rotation Maternity Leave During Medical Training Jill Grothusen, MS4

Aotearoa—Land of the Long White Cloud

Auckland Healthcare Auckland is a city of 1.3 million people in a country with the total population of 4 million—there are more sheep than people in NZ! New Zealand has a public health system that provides free health services for all citizens. People can have coverage by private insurance or pay out of pocket for private services Auckland District Health Board consists of: Auckland Hospital (inpatient dermatology unit) Greenlane Clinical Centre (outpatient dermatology clinic) Buchanan Rehabilitation Centre Greenlane consists of most outpatient/ambulatory services, including dermatology, rheumatology, pediatrics, laboratory services Inpatient services at Auckland Hospital—one of the few inpatient dermatology units in country 1. http://www.adhb.health.nz/

My Commute to work through a cow paddock

Dermatology Services Adult dermatology service: registrars (residents) normally see 3-5 patients per half day; consultants (attendings) see 7-8 patients per half day—not all patients seen by a registrar also have to be seen by a consultant Pediatric dermatology service: ~30 patients scheduled per half day clinic, 4 registrars and 2 consultants No shows common; adult 1-2/half day, peds 5-8/half day Limited number of Mohs surgeons in public service— usually 3-6 month wait for Mohs

Family life/Maternity Leave in Medical Trainees in NZ vs. USA Topic chosen because options in NZ appear much more family friendly than in the US Both my registrars were new moms or moms-to-be Having had two children during medical training makes this topic especially interesting

Maternity Leave NZ vs. USA According to the AAMC, 47% of medical students are female, 46% of medical residents are female, and 38% of full-time faculty are female1 Considering many women will have children either during their training years or early faculty years, maternity leave in medical training is an important factor affecting not just the women having babies, but all the physicians training and covering service Majority of women will be aged 25-35 during their training years, which are prime years for having children https://www.aamc.org/members/gwims/statistics/

Maternity Leave NZ vs. USA (cont) Paid maternity leave is not a guaranteed benefit in the United States, while most jobs provide at least six weeks as a courtesy, it is not a mandatory benefit Notably, the Department of Defense now gives 12 weeks paid maternity leave Most US residency training programs will give a limited amount of time off for maternity leave Varies by specialty; ~3-12 weeks with most of the time as unpaid Time off benefits the parent but can create a strain on the program that must cover necessary services with one fewer resident

Maternity Leave NZ vs. USA (cont) Trainees in NZ guaranteed 6 weeks paid maternity leave—can take up to 12 months unpaid1,2 Trainees can also find a fellow registrar to split time off with and go part-time Despite more friendly policies, studies show that women who take leave experience pushback from administration and fellow trainees3 42.1% of OB/GYN trainees in Australia/New Zealand in one study reported experiencing negative comments about their leave 26.2% female OB/GYN candidates were asked about future pregnancy intentions in interviews http://www.asms.org.nz/employment-advice/agreement-info/nz-dhb-senior-medical-and-dental-officers-collective-agreement/part-three/clause-28/ http://www.asms.org.nz/employment-advice/agreement-info/parental-leave/ Costa C, et al. Integrating parental leave into specialist training: experience of trainees and recently graduated RANZCOG Fellows. Med J Aust 2013; 199 (5): 359-362.

Conclusions While on the surface New Zealand better addresses the issue of lack of maternity leave compared to the US, attitudes about maternity leave in medical trainees appears to be similar in both countries With the rise of women in medicine, increasing numbers of women in fellowship positions, and thus extending training further into reproductive years, this issue will continue to challenge administrators in graduate medical education More conversations about strategies to improve options for working mothers must continue

Most profound clinical experience University of Auckland has an in-patient service This is uncommon in the US and becoming less common abroad Patients admitted with severe skin conditions such as eczema or psoriasis, as well as more severe conditions such as toxic epidermal necrolysis or bullous diseases. Dermatology also consulted on cellulitis cases by internists—rare occurrence in the US Attending physician only rounds on inpatient service twice a week Attending physician was SHOCKED at the use of Vancomycin in an MRSA patient

Most profound cultural experience Raising kids in NZ is much less helicopter parent than the US Kids are encouraged to play outside, get dirty, experience the world and take some risks—Ms. Frizzle would be proud! Less judgment from other parents for allowing this “free range” parenting style

Amazing sunrises

Fun play structures!

Farm visit—notice no helmets…

Lots of “tramping”

No age restriction on fun!

My NZ Family

The sunset is pretty great too!

…Land of the long white cloud