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ARROgram #32
ARRO Letter to ABR June 2005
Date: June 28, 2005
To: Radiation Oncology Trustees of the American Board of Radiology (ABR)
Re: New ABR policy on resident absence from training
CC: Association of Program Directors in Radiation Oncology (ADROP)
Society of Chairman of Academic Radiation Oncology Programs (SCAROP)
Resident physicians in radiation oncology training programs in the United States
American Society for Therapeutic Radiology & Oncology (ASTRO) Board of Directors
American Association for Women Radiologists (AAWR)
American College of Radiology – Resident & Fellow Section (ACR-RFS)
Attached is a letter of inquiry from ARRO in regards to the new ABR policy on resident absence time from training. ARRO is hopeful that the ABR Radiation Oncology Trustees will carefully review and consider each of the concerns raised in the letter. On behalf of our constituents and colleagues, we thank you in advance for your attention.
Sincerely,
The ARRO Executive Board
Attachment _________________________________________________________
Questions or Comments? Contact your representatives: Shilpen Patel, Chair, spatel@umm.edu ; Eric Hansen,Vice Chair, hansen@radonc17.ucsf.edu ; John Wilson, Treasurer, wilsonj@xrt.upenn.edu ; Joshua Petit, Education Officer, jpetit@partners.org ; Kenneth Chao, Events Coordinator, kchao@beaumont.edu ; Eugene Huang, Election Officer, ehhuang@mdanderson.org
Date: June 28, 2005
To: Radiation Oncology Trustees of the American Board of Radiology (ABR)
Re: New ABR policy on resident absence from training
cc: Association of Program Directors in Radiation Oncology (ADROP)
Society of Chairman of Academic Radiation Oncology Programs (SCAROP)
Resident physicians in radiation oncology training programs in the United States
American Society for Therapeutic Radiology & Oncology (ASTRO) Board of Directors
American Association for Women Radiologists (AAWR)
American College of Radiology – Resident & Fellow Section (ACR-RFS)
On June 22, 2005 , the ABR Radiation Oncology Trustees announced a new policy regarding resident time away from training programs in a letter to Radiation Oncology Program Directors and Chairs. The Association of Residents in Radiation Oncology (ARRO) was subsequently notified by our constituent Program Directors of this policy change. As the elected representative organization for residents in Radiation Oncology and at the request of our constituents, ARRO writes this letter of inquiry in response to the new policy.
To briefly summarize from the ABR letter, effective July 1, 2005 , the ABR will only permit absences of 20 days per year from training in radiation oncology. The absent time includes vacation, sick days, personal, family, and medical leave. Residents in training before July 1, 2005 are permitted 30 days per year for those prior training years. The cumulative absences allowed during the four training years are 80 days plus an additional 10 for each training year prior to July 1, 2005. Residents who exceed the number of absent days must extend their training to compensate for the additional absence time. As far as ARRO is aware, the letter to Program Directors and Chairs was the first notice of this decision by the ABR. ARRO is also unaware of any resident input into this change in policy.
After the ABR’s announcement, ARRO has received a vast amount of correspondence from both residents and attending physicians in Radiation Oncology training programs expressing concern and raising important questions about the new policy. ARRO will attempt to summarize these points in the following paragraphs.
The rationale for the new policy, as written in the ABR letter, was that “a total of 120 [absent] days … in 4 years of training was an excessive amount of time [that could interfere] with adequate training of a resident.” Many physicians, however, noted that in the ABR’s Holman Research Pathway, residents are required to only complete 27 months of full-time clinical radiation oncology compared to a minimum of 36 months for non-Holman pathway residents.
This nine-month difference amounts to no less than 180 working days of clinical experience. If it is possible to receive adequate clinical training in 27 months in order to be Board Eligible in Radiation Oncology, then explanation for the new absent-days policy is warranted and we ask the ABR to consider whether this new policy should be withdrawn. There is no a priori reason to assume that only the people who apply for the Holman Pathway are qualified to complete training in a shorter period of time. Many of the brightest clinicians in our field will not apply for the Holman Pathway simply because they are not lab-oriented, even though they are just as bright as their Holman colleagues, probably more clinically-oriented, and therefore more likely to be adequately prepared for clinical practice in a shorter amount of time. In addition, the superb academic qualifications of residents entering Radiation Oncology training programs continues to increase. The competition to enter our field has increased to such an extent over the last few years that many physicians remarked that even recent graduates or current senior residents in training would possibly have difficulty gaining a residency position currently. Without clear and compelling evidence that the previous absent-days policy is inadequate to ensure effective resident training, it is inappropriate to enact this new inflexible policy.
Many physicians also raised the point that requiring a specific number of days in the Radiation Oncology Department is not necessarily an accurate measure of the educational exposure that a resident receives. For example, patient loads, clinic schedules, and educational conferences in residency programs are highly variable. In addition, residents at some institutions take up to 12 months out-of-clinic for elective time (e.g., research) during residency, while at other institutions residents are limited to only a few months of elective, instead spending their time taking care of patients in clinic. A better surrogate for training experience is the ABR’s own existing policies regarding the minimum number and types of cases to be seen annually (and over four years), as well as the other core competencies as outlined in the ACGME Radiation Oncology Program Requirements (available online at: http://www.acgme.org/acWebsite/downloads/RRC_progReq/430pr703_u704.pdf). On behalf of our constituents, ARRO respectfully requests further clarification of the rationale for the ABR’s new policy. ARRO also would like to review the data upon which the ABR based their conclusion that 120 days absent time was too much time away from the Radiation Oncology Department.
While Radiation Oncology continues to evolve with the incorporation of new technologies and new trial results, until 1996 only three years of training was considered sufficient for Board Eligibiligy and Certification in Radiation Oncology. Even then, as far as ARRO is aware, three months were allowed for leave. Further explanation is therefore needed to explain why the ABR feels that four years minus 120 days for personal/family/medical leave is insufficient only nine years later. Our colleagues in Hematology and Medical Oncology have not changed their requirement of three years of fellowship training despite the arguably more rapid advances in their field of expertise.
While the new ABR policy changes the leave time allowed for residents in Radiation Oncology, for Diagnostic Radiology residents, the ABR rules have not changed, at least according to the ABR website as of June 28, 2005 (http://www.theabr.org/DRAppAndFeesinFrame.htm). Diagnostic Radiology residents still may take 30 working days per year or 120 working days over 4 years for leaves of absence and vacation according to local rules. Numerous physicians asked for clarification on why the ABR has judged that Radiation Oncology residents are less in need of leave time compared to Diagnostic Radiology residents.
Multiple physicians also emphasized that the discretion of individual Program Directors should be utilized when evaluating whether there is a need to extend residency in specific cases of residents who have required a great deal of additional medical or personal leave. After all, Program Directors are in the best position to know the skills and knowledge of their residents. The ability of the resident to pass the Written and Oral Board Examinations should be used to evaluate the resident’s understanding of essential knowledge and patient care skills on a national level.
In its letter, the ABR stated that they are “sensitive to physician’s desire[s] to address family balance in their lives.” Perhaps the most common concern that has been expressed to ARRO is that the new policy may adversely affect women in training who wish to have children during residency. Multiple physicians pointed out that the new policy could economically penalize women who have children during residency by requiring that they extend training if they utilize extended maternity leave that places them over their 80 day limit. Extending their training would translate into deferred attending-level salaries in an era when the educational indebtedness of residents often exceeds $100,000. Furthermore, the new policy could penalize women during the job application cycle because it could make them less desirable as a result of their delayed start date for a practice/Department compared to individuals who did not have to delay their training completion. Importantly, male residents who take extended leave for personal, medical, or family reasons would also be adversely affected by the new policy for the same reasons.
One woman in training wrote to ARRO explaining how she could be specifically penalized by the new decision by the ABR. She had her child in August of last year when she was told that she was allowed 120 days of absences from training. She took extended maternity leave. Since she is starting her final year of training in July (PGY-5), she is left in a situation where she cannot make up the time by taking fewer vacation days. Another resident wrote to ARRO that she is pregnant now entering her PGY-5 year and that she was planning to take extended maternity leave. At this point, she cannot delay her childbearing, and if she takes 8 weeks maternity leave, she will be required to extend her training, and delay her opportunity to start a new job.
The new policy states that for residents in training before July 1, 2005 , thirty (30) days of leave per year are permitted for those training years. Many physicians expressed concern that this policy is regressive and punitive by not allowing a “grandfathering” period. One resident in her PGY-2 training year informed ARRO that she could potentially be penalized by this new policy. She took 35 working days of maternity leave last year when she understood that she had a total of 120 days over the 4 years available. As written in the ABR letter, this resident could potentially be required to extend her training by one week even if over four years she takes ‹90 days absent time (80 days plus 10 additional days for the year prior to July 1, 2005 ). ARRO seeks clarification whether the new policy of 30 working days per year applies retroactively or whether residents in training before July 1, 2005 would merely be required to meet the cumulative 80 day limit (plus an additional 10 days for each training year prior to July 1, 2005 ).
Concerns were raised not only about maternity leave, but also about limitations on personal or family medical leave. Numerous physicians pointed out that if enforced as written, the new policy could potentially encourage residents to come to work when they are ill so that they are not forced to cancel vacation plans or other personal/family leave. Clearly, such a situation is not in the best interest of patients, residents, or other staff.
Moreover, Radiation Oncology programs typically allow at least 15-20 days of vacation per year. With the new ABR directive, residents would effectively have their locally-determined vacation policies undermined if personal or family medical leave were required in a particular year.
In light of the issues raised regarding personal/family/maternity leave, numerous physicians brought up the Federal Family and Medical Leave Act (FMLA). The FMLA requires that employers must grant eligible employees up to 12 work weeks of leave during any 12 month period for birth and care of a newborn child, care for immediate family members with a serious health condition, or taking medical leave when the employee is unable to work due to a serious health condition. In addition, employers cannot use the taking of FMLA leave as a negative factor in employment actions, such as promotions. Many individuals questioned whether there could potentially be legal grounds against at least one aspect of the new ABR regulations, specifically regarding the 20 day limit per year clause. Although residents are not employed directly by the ABR, the ABR through their policies controls the promotions of residents towards Board Eligibility and Certification. This is a complex legal area, and ARRO seeks the ABR’s opinion about the dichotomy between their policy and the FMLA. Even if the ABR’s new policy were found not to be in violation of the FMLA, the 20 day per year limit on leave clearly undermines the intent and purpose of the law to protect individuals and families during the demanding period surrounding the birth of a new child or the time necessary to endure the hardships associated with caring for oneself or one’s family member with a serious illness.
Finally, ARRO wishes to officially confirm for residents that time to take the ABR Board Examinations, to attend educational and scientific meetings, and to interview for jobs does not count toward the annual and cumulative leave limits in this new policy.
In conclusion, ARRO is hopeful that the ABR Radiation Oncology Trustees will carefully review and consider each of the concerns raised in this letter. The specific issues and questions that would benefit from a response from the ABR are summarized below. On behalf of our constituents and colleagues, we thank you in advance for your attention.
Sincerely,
The ARRO Executive Board
Points in need of clarification
1. Detailed explanation of the rationale for the new policy, including the data upon which the conclusion was made that 120 days of absent time is excessive
2. Reconciliation of the new policy with the requirements for the ABR Holman Pathway
3. Reconciliation of the new policy for Radiation Oncology residents with the ABR’s own requirements for Diagnostic Radiology residents
4. Clarification of how this new policy will impact residents who began training prior to July 1, 2005
5. Official confirmation that time taken for Board Examinations, educational leave, and job interviews will not be counted towards the limitations on absent days
6. Explanation of recourse for residents who are required to deal with serious illness or pregnancy during their training, specifically focusing on the potential negative impact on their careers and personal lives
7. Justification for the apparent dichotomy between this new policy and the spirit of the FMLA
June 23, 2005
Dear Residents,
ARRO discovered yesterday that the ABR has announced a new policy regarding resident time away from training programs. The ABR Radiation Oncology trustees announced in a letter to Radiation Oncology Program Directors and Chairs that effective July 1, 2005 , the ABR will only permit absences of 20 days per year from training in radiation oncology. The absent time includes vacation, sick days, personal, family and medical leave. Residents in training before July 1, 2005 , are permitted 30 days per year for those training years. The absent days accumulated during the four training years is 80 absent days plus an additional 10 for each training year prior to July 1, 2005 . Residents who exceed the number of absent days must extend their training to compensate for the additional absence time. As far as ARRO is aware, the letter to Program Directors and Chairs was the first notice of this decision by the ABR.
ARRO has already expressed concerns on behalf of residents to the ABR. ARRO has asked for clarification whether interviews for jobs and conference time will count toward the 80 day limit. In addition, ARRO has expressed concern that the new policy may adversely affect women in training who wish to have children during residency.
Please let ARRO know about your concerns and we will forward them to the ABR.
Sincerely,
The ARRO Executive Board
