Residency, Board Exams and Babies? How to Support the Physician Breastfeeding Mother

sup·​port | \sə-ˈpȯrt\
: to promote the interests or cause of
: to uphold or defend as valid or right 
: to assist, help

The majority of women entering medical school are now women, leading to more women residents. Women physicians are in all specialties, all fields, medical and surgical. As an academic pediatrician, I train medical students and residents on a daily basis. Not surprisingly, the field of Pediatrics has a higher percentage of women physicians, with many of these women getting pregnant and/or having children during this stressful period of training. After completion of the 3 years of residency, Pediatric boards occur a few months later that Fall. Graduation, starting a new job or fellowship, studying for the Boards—it is all very stressful. Now for many, add a new baby into the mix and multiply the number of things to juggle. Over the past few years, I would see a common issue/question both amongst my residents and on social media as it related to women physicians. During a board exam, what about those female physicians who were currently breastfeeding? Understandably, there was a concern due to the lack of accommodations; in fact, physicians who had to leave the test space to express/pump breastmilk were penalized, as they lost exam time to do so. These concerns were across the board: Pediatrics, OB-Gyn, Family Medicine & Internal Medicine.

Last year, I had the privilege to work with the American Board of Pediatrics and American Academy of Pediatrics former-CEO, Dr. Karen Remley to get support for those doctors who are nursing mothers without penalty during the board exam.  Breastfeeding is good for infants and mothers. Countless studies in the U.S. and throughout the world support this. According to breastfeeding data from the Centers for Disease Control and Prevention 75 percent of mothers in the U.S. initiate breastfeeding.

Advocating for children through the protection, promotion, and support of breastfeeding is a high priority for the AAP. Educating pediatricians to understand their role in encouraging and supporting breastfeeding is also essential.

It stands to reason, therefore, that pediatric organizations should support pediatricians who are, themselves, breastfeeding. The American Board of Pediatrics (ABP) reports in its annual workforce data book that nearly 71% of first-time takers of the initial certifying exam are women. In fact, more females than males are entering most pediatric subspecialties.

The ABP allows courtesy accommodations for breastfeeding mothers during examinations at secure testing centers. The key is for the exam candidate to let the ABP know her needs when she applies to take an exam – long before the actual day of the exam.

The exam for general pediatric certification takes seven hours, and other exams, for subspecialties and maintenance of certification, take at least four hours to complete. We want these nursing mothers to be comfortable during the exam, so we allow them to take additional break time (30 extra minutes) to express milk.

They also offer a “personal item exception” to allow nursing mothers to bring aids (such as a breast pump), medication or other items into an examination room. Breast pumps may be stored in a personal locker, or stored at the testing center administrative desk.
We require that requests be made in writing at least 8 weeks prior to the testing day so we can work out details with the testing center.

The sooner the ABP staff knows a mother needs special accommodations, the better able they are to communicate this need to the secure testing center. Some testing centers have no dedicated space for breastfeeding mothers, while some centers are better suited for breastfeeding mothers than others. Occasionally, testing center staff have been able to repurpose space to accommodate breastfeeding mothers, or a candidate may be directed to a different testing center that can better serve her needs. Most major cities have multiple testing centers. When the ABP is informed of these needs in advance, the ABP staff will work directly with the testing center staff to find the best arrangement for the testing candidate.

The ABP is aware how important these accommodations are to mothers and infants and is very supportive of our pediatrician mothers to help make arrangements for their breastfeeding needs.
How amazing would it be if we could expand this for women physicians in all specialties (OB-Gyn, FP, IM, Surgery, ER) and other careers where mothers are required to take long certifying exams (dental/nursing/law/business, etc)? Let’s support ALL of our professional mothers. As women, we can make the change that is needed to help support our fellow physicians who are breastfeeding.


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