Friday, September 21, 2007

How much accommodation is enough?

That was the question I asked myself when I read the story of Sophie Currier, an MD/PhD graduate of Harvard University who is asking for additional break time during testing for her medical license because she is breastfeeding.

The test that Currier is taking is the USMLE Step 2, a nine hour test that is the second of three tests that are necessary to become a fully licensed physician. A physician must pass at least the first two steps prior to starting their residency training. This test is usually taken one year prior to completing one's medical school education. That way, if you are not successful the first time, you have another chance to take the exam the following year, prior to starting residency. Evidently Dr. Currier took the test when she was 8.5 months pregnant the first time, and failed by a few points. If she doesn't pass the test this time, she'll have to delay starting residency for at least another year, until she passes the test.

I have a lot of sympathy for physician/mothers. Both jobs are very time consuming and tough, and juggling two full time jobs is next to impossible. One of my heroes during my internship year was a fellow intern who was a single mom to a 2 year old (her husband couldn't handle having a wife that was "smarter" than he was, so left her when she was in med school). We all tried to pitch in and help her out, but there was no doubt that that doctor mom fully pulled her share. She asked normal favors of us (as all friends would), but never asked for any special considerations because of her situation.

So my first inclination when reading the story was to think "Why couldn't the board give her some extra time to pump during the test? It's a 9 hour test, with only 45 minutes allocated to break time. Surely they could make some accommodation. I mean, this can't be a unique situation." But then I continued reading the article:

...Currier has already received special accommodations under the Americans with Disabilities Act for dyslexia and attention deficit hyperactivity disorder, including being granted permission to take the test over two days instead of one.

In the lawsuit, she was seeking an additional 60-minute break on each day. The board cited the need to be consistent in the amount of time given to doctoral candidates and said other nursing mothers who have taken the exam have found the 45 minutes of permitted break time sufficient. ...

I'm all in favor of her getting accommodations for her dyslexia and ADHD. But it appears that since she'll be taking the test over two days instead of one, then she'll have 4 hours of testing on one day, and 5 hours on another. She still has 45 minutes of break time that she can allocate over that time, to take when she wants. This may not be the extra hour of break time each day that she wants, but it appears on the surface to not interfere too badly with her breast feeding requirement of having to pump or feed every 3 hours. Also:

...The judge said the board offered Currier several special accommodations, including a separate testing room where she could express milk during the test or during break time, and the option to leave the test center to breast-feed during break times. ...

For its part, the USMLE (United States Medical Licensing Examination board) responded publicly on its website to the "Currier question" regarding breastfeeding during exams.

...How have you responded to Sophie Currier’s request for extra time to express milk?
As the papers filed in court show, NBME offered Ms. Currier a variety of comfort measures and personal item exceptions, such as permission to bring multiple, assembled pumps to eliminate the time involved in cleaning, assembling, and disassembling them; permission to pump milk while taking the test and on break time, with privacy within the constraints of exam security, in the individual testing room that she receives on account of her ADA disability. We also provided her with a sample schedule demonstrating how an examinee can flexibly manage the time to take a 20- to 30-minute break every three hours. ...

And I gotta tell ya, that's starting to sound pretty fair to me. But to give myself a little reality check before I ran my mouth off (since I am male, and therefore have never faced such a situation) I bounced this question off of a colleague of mine, herself an MD/PhD, who has small children and has breast fed. After thinking a bit, and without me even telling her the part about her getting to take the test over two days, she felt that the medical board had gone far enough. Indeed, she didn't even think they had to go that far. "Whisper Pump.", she said. To my blank look, she explained that the Whisper Pump is a wearable bra/pump contraption that you can wear while you work. It takes about 5 minutes to rig up, and pumps while you work. So it appears that Dr. Currier might not need any extra time at all in order to take the test and also pump.

I gotta tell ya, it feels a little uncomfortable arguing against someone getting an accommodation they say they need, especially when I have not walked in that person's shoes. But this one doesn't seem to pass the sniff test, and it would appear to me that Dr. Currier would spend her limited time better studying for her exam, rather than talking to her lawyer.


Patrick said...

I am probably not qualified as a respondent in this case, but why the rush to get into residency when that will detract from bonding and nurturing time?

Does not a 0-1 year old need perhaps the most amount of attention and care?

Though I doubt Orac is a mother either (forgive my humor) I would welcome his opinion on this too.

Ang said...

It's interesting to see you post about this. I myself got into a discussion yesterday about this same topic, and like you, argued against her receiving more accomodations. And yes, it feels very strange to do that!

Obviously, to receive the diagnoses of ADHD and dyslexia AND to request special accomodations for them, I would assume these disabilities affect her life to a substantial degree.

However, it's amazing that some one affected so much is making their way through medical school AND being a mom to 2 children, both born within a year of each other (if I remember the details of the article correctly). I'd have to say she's learned some pretty good coping skills along the way if she's able to acheive what she has so far....

One of my comments/questions yesterday -- it would be interesting to know how long she has had the ADHD and dyslexia diagnoses. Did she have them all through med school? Or is this a new development that came about after she took the test the first time and failed?

Anyway! Interesting!!

Club 166 said...


I thought I'd get flamed enough for suggesting that someone not get an accommodation (amazingly, that hasn't happened).

I really didn't want to unleash the full force of every feminist on the planet against me by suggesting that, perhaps, it might not be possible to "have it all", at least not at the same time. Because sometimes when you do, bad things might happen.

I also didn't want to go there because I don't know the rest of the details of the story. Perhaps Dr. Currier's husband is taking a year off to stay home, or perhaps she has a close extended family that is able to assist with child care. Or (more commonly) she and her husband are not rich, and can't afford to wait another year to start paying off the enormous debt undertaken in order to attend medical school. So that's why I wanted to stick to the question of whether she had received enough accommodations or not.


Joeymom said...

I've never heard of a whisper pump, I have got to look into that. One more thing to chalk into the "pro" column for having another baby... ;)

Daisy said...

I applaud you for looking into the whole story before posting. Mother or not, you are a parent and a professional.

Casdok said...

Intersting thoughts.

Philip. said...

Some people just ask for too much.

Next she will be asking for someone to take the exam for her.


Anonymous said...

As a former member of the breast feeding club I can attest to the 'on-demand' demand. It certainly wouldn't do to leak all over your exam papers. I remember seeing those hideous contraptions, but it would certainly solve several difficulties at once. I think we give you your 'man card' back.

Anonymous said...

Shame on her for using the system in this way. Hundreds of nursing mothers takes exams every year. They manage to store milk ahead of time so they do not have to actually breast feed that day and then use break time if they need to express. She is a whiner beyond belief. I have breast feed 2 children through school, work, ballgames, trips etc. She is full of it. And it amazes me as the mother of an ADD child the accommodations she has received at school. Her disability is SO amazing and more difficult then anyone else's it astounds me! I hope MY child is accomodated when he heads to college in a year to the extant she has been.

She should be a lawyer not a doctor she is so good at using the system in way no one else has ever thought of. But wait, I married a lawyer and he is not a whiner so that is an insult to him. She has a good deal going and is going to milk it to the end so to speak. But shame shame shame.

And pity the company that hires her because how can she POSSIBLY do research or work if she cannot concentrate, cannot read, cannot organize, needs extra time, cannot remember things, has babies to breast feed etc. She has given out interviews everywhere about her ADHD and other disabilities and I don't know how she even gets through the day! Good luck with that.

Anonymous said...

I thought that it was interesting that, legally, being a lactating mother would qualify you as an American with a disability under the Americans With Disabilites Act. Yet, this medical student is already someone with learning disabilities receiving accomodations in matters relating to her education.

I wonder if malpractice insurance is more expensive for MDs with learning disabilities--or if that information is kept confidential from insurers as it is from the doctor's patients.