Lindsey and Rob are fourth-year medical students who plan to get married before starting residency. They want to attend programs in the same location, but don't know if this is possible. They are both 26 years old and are also thinking about having children. They’ve been to information sessions with residents who have children and heard their classmates talking about the challenges of parenting during residency. Lindsey and Rob both have some questions.
- Are there any strategies for a couple to match to residency programs offered at the same location?
Lindsey and Rob are excited to read about the Couples Match on CaRMS. This match is not restricted to people who are married, but anyone who wants to be with someone else — a friend, relative or serious relationship partner — during residency. Upon completing the rank order list, applicants can designates themselves as part of a couple by emailing CaRMS and noting their status in the Applicant Webstation. This distinction is not permanent; applicants can later remove themselves from the Couples Match. A complete set of instructions on participating in the Couples Match, as well as match statistics, can be found on the CaRMS website.
- How will Lindsey manage to do call in her first and third trimesters?
During the first trimester, pregnant residents may struggle with morning sickness, making call responsibilities tougher. Residents who had children in residency suggested trying to arrange for rotations with light call duties during both the first and third trimesters, avoiding such rotations as ICU and Team Medicine.
In some provinces, a pregnant resident is exempt from call during the third trimester after 31 weeks. This may be earlier in some residency programs, such as obstetrics. However, this exemption can occur earlier in the pregnancy if the resident’s physician deems it necessary. Even though duties may be lighter, residents who had babies cited that a lack of sleep even without call affected their abilities to function at work.
- How much time can Lindsey take off work if she has a baby? Can Rob take paternity time when their child is born?
Parental leave time for residents varies from province to province. The time allowed for maternity leave is as follows:
| Province |
Required length of pregnancy leave
|
Maximum length of pregnancy leave
|
| Newfoundland and Labrador |
N/A |
Up to one year |
| Maritime provinces |
17 weeks |
1 year |
| Quebec |
15 to 18 weeks |
1 year |
| Ontario |
17 weeks |
1 year |
| Manitoba |
N/A |
26 weeks |
| Saskatchewan |
18 weeks |
1 year |
| British columbia |
17 weeks |
1 year |
The decision to take more time than required is up to the individuals, although they may feel pressure from their staff, because they want to prepare the resident for board examinations, and their fellow residents, because they want the resident back on the call schedule.
Paternity leave ranges from five days in Saskatchewan to three to five weeks in Quebec. Rob could talk with the program director and arrange vacation around the expected due date so that he can spend some time at home once the baby is born.
- Will having a baby during residency mean that it will take Lindsey longer to finish her residency program?
In general, residents are forgiven the required pregnancy leave length but are expected to make up any extra time taken. However, residents may feel pressure from the Royal College and their program directors to make up all time in order to be best prepared for board examinations.
- What are some advantages to having a child while in residency rather than while practising?
There are a number of advantages:
• Financial. Residents are paid 75% of their pay through Post-graduate Medical Education and Employment Insurance (EI) during the first six months of leave. After six months, they receive only EI. In practice, there are programs like the OMA Pregnancy and Parental Leave Program, where a physician can be paid up to 50% of average fee for service billings or $1,000 per week, whichever is higher, for a maximum of 17 weeks.
• Finding a replacement. Residents do not have to worry about finding coverage for their practice, whereas practising physicians will need to find someone to care for their patients.
• Maternal age. Residency is now longer. Postponing pregnancy until you finish may mean the pregnancy is not as safe for mom and baby.
• Guaranteed time off in residency. In residency, provincial contracts dictate how residents are paid and how much time off they can take. In practice, these decisions may need to be negotiated with colleagues, and you will be at the mercy of their decision.
• Career planning. When residency is completed, new physicians may want to establish their practice. This would be difficult if they wanted to take time off at the beginning of their career.
- What are some options to make return to work easier?
Some suggestions include:
• Part-time training: work one month, take one month off.
• Start with lighter rotations.
• Hire a nanny.
• Build a strong support system at home.
- Should Lindsey factor pregnancy into the decision of what residency program she chooses?
Some residents feel that non-surgical specialties are more accommodating of having children in residency. However, other residents feel that any residency program is manageable with pregnancy, and this should not be factored into career planning decisions.
In particular, provincial agreements differ, so it may be helpful to review which provinces are more supportive of pregnant residents in choosing the location of the residency program.
- How can Rob and Lindsey prepare financially so that they can take as much leave as possible?
As parents, Rob and Lindsey may qualify for a number of benefits and tax deductions available from the federal government. These include:
- Universal Child Care Benefit. This federal payment of $100 per month is paid to every Canadian family for each child under the age of six. Payment is not automatic; they will need to apply for it.
- Canada Child Tax Benefit. This monthly non-taxable benefit is available for families with low and moderate incomes (less than $40,970 in 2011). The maximum benefit is $112.33 per month for each child under the age of 18 in all provinces except Alberta, where it is $103.00 for children under seven. If a couple’s income is less than $23,855, they’ll also qualify for the National Child Benefit Supplement, which is a maximum $174.00 per month.
- Child care expenses. In addition, their childcare expenses will be deductible, to a maximum of $7,000.
So the tax breaks will provide some relief and, as mentioned above, Lindsey will be able to receive Medical Education and Employment Insurance payments, to make up for some of her lost income.
If they have personal resources, they could tap into those as well. For example, if Lindsey has been saving in an RSP, she could take money from there. While withdrawals are taxable, if she has little other income her marginal tax rate should be quite low. Withdrawals from her spousal RSP are another option, but only if Rob has not made any spousal contributions in the year of the withdrawal or the two preceding calendar years. Otherwise, the withdrawals would be attributed to him for tax purposes.
If Lindsey and Rob have an investment portfolio or own real estate, they could consider selling assets to generate cash flow. However, any capital gains resulting from the sales would be taxable.