Op-Ed: Gender Inequity Persists for Physicians in Training

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California Academy of Family Physicians

Jun 25, 2021, 16:29 ET

SAN FRANCISCO, June 25, 2021 /PRNewswire/ -- California has a shortage of primary care doctors, and this is projected to worsen over the next decade. As a state, it is critical that we train and retain as many physicians as we can if we are to meet the health care needs of our population. However, the California Academy of Family Physicians warns that new licensing requirements for resident physicians threaten to drive many early-career doctors—particularly women, out of the state.

Last year, licensing requirements for physicians changed significantly now requiring that in order to become eligible for a California medical license, medical school graduates must successfully complete three years of post medical school graduate training in an accredited program, two of these three years must be uninterrupted training in the same program.

To understand why this is a problem, let's consider that residents are generally in their late 20's to early 30's and often starting families of their own while completing their training. While California labor law is quite clear that pregnancy-based employment discrimination is illegal, a female resident who has a baby during training could lose the ability to get a medical license if she takes maternity leave because training must be continuous for 24 months and she must complete 36 months of training, there are no exceptions for parental leave. It does not matter if the resident is in good academic standing or if they complete all requirements and pass their board examinations. If they take time off, they are ineligible for licensing in California unless they extend their training program, which is not possible due to lack of funding. While the same rule would apply to a male resident who wanted to take parental leave, this rule disproportionately affects women.

This has real impact for physicians and California communities. For example, recently, a family medicine residency program accepted a physician into their global health fellowship program. The program is located in one of the more underserved communities in the state, and graduates of this particular program almost universally remain in the area after training, providing primary care to immigrant farmworkers. However, due to California's revised licensing requirements, the residency program's incoming fellow was denied a California license, and was therefore unable to practice there.

The fellow was denied eligibility for a California license for a technical reason that has nothing to do with her ability to practice medicine. She was in excellent standing throughout her training, but had to transfer from her first residency program to another one due to her partner's serious health condition. She therefore completed 15 months at one residency program and 21 months at a second program, which does not meet California's licensure requirement of 24 continuous months at the same program. This meant that this family physician, who is fluent in Spanish and dedicated to practicing in an underserved community, had to take a position in another state which does not have the 24-month continuous training requirement.

The California Academy of Family Physicians, which represents almost 11,000 family physicians, medical residents, and medical students in California, along with coalition partners, the California Medical Association, the California Primary Care Association, SEIU California State Council, and the California Chapter of the American College of Emergency Physicians, strongly opposes the revised licensing requirements. Regardless of intent, a policy that effectively bars parental and other types of family leave during training is discrimatory. Furthermore, requiring 24 months of continuous training at the same program creates many unforeseen barriers for people like the global health fellow, who have legitimate reasons for needing to relocate during training that have no bearing on the physician's ability to practice medicine. Given California's physician workforce shortage, we should not create barriers to practice. Rather, we must support an equitable system that bolsters the primary care physician workforce. One step we can take to achieve this is to immediately fix the licensing requirements in California that drive many early-career doctors—particularly women, out of the state. Assembly Bill 1156, authored by Assembly Member Weber, provides a solution and should be passed by the Legislature immediately.

About the Author: Shannon Connolly, MD, FAAFP, is the President of the California Academy of Family Physicians (CAFP). Dr. Connolly is Associate Medical Director at Melody Health in Orange County where she also sees patients. Dr. Connolly received a B.A. in Biomedical Ethics from Brown University and an M.D. from University of Southern California. She did her medical residency in Family Medicine at the University of California Los Angeles and completed a fellowship in Primary Care Psychiatry at the University of California Irvine.

About the California Academy of Family Physicians: With more than 10,000 members, including active practicing family physicians, residents in family medicine, and medical students interested in the specialty, CAFP is the largest primary care medical society in California. Family physicians are trained to treat an entire family's medical needs, addressing the whole spectrum of life's medical challenges. FPs serve a broad base of patients in urban, suburban and rural areas, often in California's most underserved areas.

SOURCE California Academy of Family Physicians