Residency training in urology often coincides with prime childbearing years for both men and women. This is evidenced by 2019 AUA Census data showing that nearly 1 in 4 urology residents had children under the age of 18 years, and almost 80% of those had a child during residency.¹ This creates a necessity for clear, easily accessible and fair parental leave policies for trainees in urology.

The American Board of Medical Specialties (ABMS) recently adopted a progressive parental leave policy to be implemented by member boards.² The new ABMS policy requires that a minimum of 6 weeks of parental leave be available to trainees, separate from allotted vacation time. The American Board of Urology (ABU) should be commended for updating their “leaves of absence” policies to align with this requirement.³

The ABU previously required 46 weeks of training each year during the 48 months of urology training. Any leave longer than this would require ABU approval and possibly an extension of training. The new ABU policy allows the 46-week requirement to be averaged over several years. Specifically, the “46 weeks may be averaged over the first 3 years of residency, for a total of 138 weeks required in the first 3 years, and over the last 2 years, for a total of 92 weeks required.”³ This would allow parental leave of 8–10 weeks without exhausting vacation time.

Recently, 2 surveys of urology residency program directors (PDs) have been published on the topics of parental leave and perception of pregnancy during residency.^4,5 Overall, they suggest that program directors are supportive of pregnancy during residency. However, parental leave policies are widely variable, and while available to current residents, they are often less available to applicants.⁴ Lack of paid parental leave has been cited as a reason not to consider surgical professions among female medical students.⁶ It is therefore important that urology residency programs make their policies available to prospective residents and continue to support parenthood among trainees.

Within urology, a third of programs reported that covering residents received no additional compensation, vacation or reduction of hours/call when a co-resident took parental leave.⁵ Only about 20% of PDs felt that parental leave “burdens other residents unfairly.”⁴ In contrast, a study of surgery residents found that “strain on residency program” was among the most commonly cited obstacles to taking parental leave.⁷ This disconnect is worth further consideration and discussion.

The ABU policy clarifies time away from program; however, questions remain regarding compensation, safety precautions during pregnancy and burden placed on co-residents.⁸ While 60% of PDs felt prepared to advise pregnant residents during training, over 90% reported it would be helpful to have formal policies in place regarding parental leave, with many suggesting this come from the ACGME (Accreditation Council for Graduate Medical Education).⁴ The demographics of urology residents are changing, with nearly 30% of current residents identifying as women. The ABU has taken steps to meet the progressive standard set by ABMS. While some policies will need to be program specific, a standardized approach to parental leave with consideration of paid leave status, support for covering residents and consideration of the needs of pregnant residents both prenatally and postnatally is warranted. We have taken positive steps and should continue along this path to support the needs of urology trainees.