When and how to start your family are very personal choices, but many residents choose to start their families during their residency.
Yes! If you managed to budget your way through your undergraduate degree(s) and medical school, you can budget for a child. There are many ways to prepare for parenting. You can buy every baby item new and from top end boutiques but you don’t have to go this route. 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 baby stuff before the arrival of your child, stock up on some simple essentials and then see what you and your child need as they grow. You will not be trapped in your home once the baby arrives. You can make it out to the shops to pick up items as you need them. The advantage to buying as you go is also that you will not have to store loads of bulky stuff, waiting to use them. I also believe you do not need as many things as you think. The items you can forgo may be different than mine but keep in mind that lots of things are not essential. One wonderful (free!) resource is “Baby’s Best Chance,” a book published by the province of BC.
Friends and family are great resources for preparing for your baby. It is inevitable that you will receive gifts for your newborn. Many parents find they hardly need to purchase any clothes for the first six months! People cannot resist buying adorable outfits in those tiny sizes; you will likely receive more than you need. If people ask what you need, it is often helpful to suggest clothing in sizes over six months to avoid the upfront oversupply. Friends and family are also a good resource for gently used hand-me-downs. People are 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. If you or your child does not like the item in the trial you may have saved yourself a large amount of money.
Thrift stores and child consignment shops are a good place to get clothing and accessories at affordable prices. Craigslist is a 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 out date within 5 to 8 years. If you want to check on whether used items have any safety concerns or have been recalled, go to the Health Canada website; it lists recalled items and is a good information source. Health Canada also has a section on child safety.
Leave (with the exception of maternity leave) is unpaid. However, residents may qualify for EI during this time. What you can expect to earn while on leave 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 $50,800 and all full time residents will pass this cut off). In other words, you can receive a maximum payment of $537 per week from EI. This amount is “topped up” to 85% of your salary for biological mothers for weeks 1 – 17.
Maternity Leave is weeks 1 – 17 of leave, birth mothers may take up to 52 weeks of consecutive leave; weeks 18 – 52 are considered parental leave.
If you qualify, there is a two-week waiting period for EI; during this two-week period, you will receive 85% of your salary from the employer as part of the Supplement Employment Benefits Plan (SEB Plan).
You are required to have worked for 600 hours in the last 52 weeks or since your last claim, to be eligible for EI benefits. If you are not eligible for EI benefits, for the 15 weeks of your maternity leave, the employer will provide 85% of your salary as part of the SEB Plan.
Maternity EI benefits are a maximum of 15 weeks (exclusive of the 2 week waiting period). A combination of maternity and parental leave can make up to a maximum of 50 weeks of EI benefits.
The basic benefit rate is 55% of your average insured earnings up to a yearly maximum insurable amount, which for 2016 is $50,800. This means you can receive a maximum payment of $537 per week.
If you work while on maternity leave, your earnings will be deducted dollar for dollar from your benefits.
Your EI payment is a taxable income, meaning federal and provincial or territorial taxes will be deducted if applicable.
R1 who qualifies for EI
Weeks 1-2 SEB: $832.25 (85% of base salary)
Weeks 3-17 EI: $537 + SEB: 295.25 = 832.25/week
Parental EI Benefits are a maximum of 35 weeks, shared with your spouse (i.e. one takes 12 weeks the other 23; or any other configuration adding to 35 weeks)
If you or your spouse completes the two-week waiting period for maternity benefits it does not need to be repeated for parental leave (not applicable for adoption leave)
You are required to have worked for 600 hours in the last 52 weeks or since your last claim.
The basic benefit rate is 55% of your average insured earnings up to a yearly maximum insurable amount of $49,500. This means you can receive a maximum payment of $524 per week (as of January 2015)
If you work while receiving parental leave benefits, you can earn up to $50/week or 25% of your weekly benefit (131) whichever is greater. Under the Working While on Claim (WWC) pilot project, available until August 2015, once you have served the waiting period, if your earnings are equal to or less than 90% of your weekly earnings that were used to calculate your benefit rate, your benefits will be reduced at a rate of 50% of your earnings each week. Any earnings that exceed this 90% threshold, will be deducted dollar for dollar from your benefits.
EI payment is a taxable income, meaning federal and provincial or territorial taxes will be deducted if applicable.
A PGY-3 resident on paternity leave who has met the criteria for EI and plans to work while receiving benefits.
Base salary = $61,893.80
Weeks 1-35 (This EI benefit can be split with a partner in any configuration totaling 35 weeks) EI: $537/week + up to $134.25/week in income, any earnings above this amount will be deducted dollar for dollar from the EI amount.
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 Collective Agreement includes a Memorandum of Understanding on Workload during pregnancy, that ensures if the resident’s physician notes a reduction in work is warranted then the workload shall be reduced to the extent prescribed, including the elimination of call if necessary.
UBC also has a policy regarding Pregnancy in Residency. This policy specifically denotes that after 24 weeks gestation residents will not be required to work more than 12 continuous hours, and may opt out of duties to comply with infectious disease prophylactic measures.
You should meet with your Program Director as soon as you are comfortable doing so to discuss your training adjustments and expected Maternity Leave date. When you sit down with your Program 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. 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. You may have to stop work earlier than planned or have lighter duties if there are complications during your pregnancy.
Hopefully, your pregnancy will be problem free and you will transition gracefully into maternity leave; however complications do arise during pregnancy. Should you have to stop work early due to complications of your pregnancy you should be aware that, under the current Collective Agreement, this time should be considered sick leave, not maternity leave:
9.01 (E) Sick Leave Provisions – Maternity leave medical complications of pregnancy shall be covered by sick leave provisions. Pregnancy shall not constitute cause for termination.
As per the Collective Agreement sick leave is six (6) months, or until your Long Term Disability coverage starts, whichever comes first. 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 make a claim. Consider arranging a research elective if you need to go on bed rest or reduced activities to minimize time missed from your residency.
EI Sickness Benefits
If your income is reduced by more than 40% while on disability you may qualify for EI Sickness Benefits.
According to Service Canada, Sickness benefits may be paid up to 15 weeks to a person who is unable to work because of sickness, injury or quarantine. As with maternity leave you are required to have worked 600 hours in the last 52 weeks or since your last claim to be eligible. You will also need a medical certificate from your physician to confirm the duration of your inability to work. The fees for the certificate are your responsibility. A person who makes a claim for sickness benefits is not only required to prove to be unable to work but also that he or she would be otherwise available for work.
If you work while on sick leave your earnings are deducted dollar for dollar from your benefit amount. For more information on Sickness Benefits visit: http://www.servicecanada.gc.ca/eng/sc/ei/benefits/sickness.shtml
When a pregnancy terminates within the first 19 weeks of pregnancy, it is considered an illness under EI. If that is the case, sickness benefits may be paid as long as the qualifying conditions for sickness benefits are met.
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. You may also be eligible for sick leave or long-term disability under the Collective Agreement.
If your spouse’s pregnancy terminates, residents are eligible for compassionate leave of three (3) days, plus an additional two (2) days travel if needed. You may also be eligible for sick leave or long-term disability under the Collective Agreement.
The Employee and Family Assistance Program (EFAP) and the Physicians Health Program (PHP) both offer services to support residents dealing with grief and loss. Both offer confidential 24- hour help lines and referrals.
If you’re a resident without your own personal family physician, you’re not alone. However, starting a family should give you the push to put this at the top of your list. The Physician Health Program of BC, through Doctors For Doctors will seek family physicians in your area will to accept a new physician-patient. Contact the Physician Health Program at 604-742-0747 or firstname.lastname@example.org for more information.
In the lower mainland, the BC Women’s Hospital has a list of doctors accepting new full practice and maternity patients: http://www.bcwomens.ca/Services/PregnancyBirthNewborns/MaternityAndFamilyCare/FindaDoctor.htm
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).
On the more day-to-day side of being an expectant resident, it is important to follow the same advice you would give a pregnant patient. Biologically, you are the same as regular mortals despite your superhuman schedule. Remember to eat frequently and 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 to $20 you can pick up a pair from a medical supply drugstore to try them out.
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 workday are the least inconvenient.
The Physician Health Program in 2010 wrote a consensus statement on Medicine and Motherhood. This paper provides a summary of the current evidence regarding the impact of work on maternal and fetal health, including the implications for women who delay pregnancy until later in life. It also highlights workplace conditions that may need to be modified for the pregnant physician. It is intended to serve as a guide to assist the pregnant physician and her colleagues with conversations about workplace accommodation as set out in the Human Rights Code of Canada.