Association Between Parental Leave And Ophthalmology Resident Physician Performance

Dana D. Huh, Wilmer Eye Institute
Jiangxia Wang, Johns Hopkins Bloomberg School of Public Health
Michael J. Fliotsos, Wilmer Eye Institute
Casey J. Beal, University of Florida
Charline S. Boente, Indiana University School of Medicine
C. Ellis Wisely, Duke Eye Center
Lindsay M. De Andrade, University of Iowa Hospitals & Clinics
Alice C. Lorch, Harvard Medical School
Saras Ramanathan, University of California, San Francisco
Maria A. Reinoso, LSU Health Sciences Center - New Orleans
Ramya N. Swamy, University of Maryland School of Medicine
Evan L. Waxman, University of Pittsburgh School of Medicine
Fasika A. Woreta, Wilmer Eye Institute
Divya Srikumaran, Wilmer Eye Institute


Importance: Although parental leave is essential in enhancing resident wellness and fostering inclusive workplace environments, residents may often feel discouraged from using parental leave owing to perceived stigma and concerns about possible negative effects on their training. Objective: To examine parental leave usage across multiple institutions and compare residency performance metrics between residents who took parental leave vs their peers who did not take leave. Design, Setting, and Participants: This was a retrospective cross-sectional analysis conducted from April 1, 2020, to July 28, 2022, of educational records. Multicenter data were obtained from 10 Accreditation Council for Graduate Medical Education (ACGME)-accredited ophthalmology programs across the US. Included ophthalmology residents graduated between 2015 and 2019. Data were analyzed from August 15, 2021, to July 25, 2022. Exposures: Performance metrics of residents who used parental leave during residency were compared with those of residents who did not take parental leave. Main Outcomes and Measures: Measures of performance included the Ophthalmic Knowledge Assessment Program (OKAP) scores, ACGME milestones scores, board examination pass rates, research activity, and surgical volumes. Results: Of the 283 ophthalmology residents (149 male [52.7%]) included in the study, 44 (15.5%) took a median (IQR) parental leave of 4.5 (2-6) weeks. There were no differences in average OKAP percentiles, research activity, average ACGME milestones scores, or surgical volume between residents who took parental leave and those who did not. Residents who pursued fellowship were less likely to have taken parental leave (odds ratio [OR], 0.43; 95% CI, 0.27-0.68; P <.001), and residents who practiced in private settings after residency were more likely to have taken parental leave (OR, 3.56; 95% CI, 1.79-7.08; P <.001). When stratified by sex, no differences were identified in performance between female residents who took parental leave compared with residents who did not take leave, except a mild surgical number difference in 1 subspecialty category of keratorefractive procedures (difference in median values, -2; 95% CI, -3.7 to -0.3; P =.03). Conclusions and Relevance: In this multicenter cross-sectional study, no differences in performance metrics were identified between residents taking parental leave compared with their peers. These findings may provide reassurance to trainees and program directors regarding the unlikelihood, on average, that taking adequate parental leave will affect performance metrics adversely.