---
title: "Parental, medical and caregiver leave, and coming back"
canonical: "https://www.joinandwise.com/crossings/time-off-and-fmla"
checked: "2026-10-21"
claim: "andwise:crossing/time-off-and-fmla@2026-10-21"
license: "CC BY 4.0"
---

# Parental, medical and caregiver leave, and coming back

Which leave rules apply depends on the stage: accreditation rules for residents and fellows, federal and state law and the contract for attendings. This page lists those rules, what leave does to loans, bonuses and coverage, and what applies on the way back.

**The decision:** Taking medical, parental, caregiving or mental-health leave, and returning to work.

## What changes

- ACGME Institutional Requirements §4.8: residents and fellows have at least six weeks of approved medical, parental and caregiver leave at least once during an accredited program, from the day they are required to report. The first six weeks of the first approved leave are paid at 100% of salary, at least one more week of paid time off is reserved for use outside them, and health and disability insurance continue during approved leave. Programs must explain how a longer leave affects completion and board eligibility. ([ACGME Institutional Requirements, including FAQs (2026), §4.8](https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/800_institutionalrequirements_2026.pdf); checked 2026-10-27)
- The ABMS requires member boards whose training lasts two years or more to allow at least six weeks away for parental, caregiver and medical leave once during training, without using up other allowed time away and without requiring the training to be extended. ([ABMS, policy on parental, caregiver and medical leave during training](https://www.abms.org/policies/parental-leave/); checked 2026-10-27)
- The Family and Medical Leave Act protects a job for up to 12 workweeks of leave, which is unpaid unless paid leave is substituted. Eligibility needs 12 months with the employer, 1,250 hours actually worked in the 12 months before leave starts (paid and unpaid leave do not count), and 50 employees within 75 miles. A physician in the first 12 months at a new employer does not meet the 12-month test. ([29 CFR 825.110, FMLA eligibility](https://www.ecfr.gov/current/title-29/subtitle-B/chapter-V/subchapter-C/part-825/subpart-B/section-825.110); [U.S. Department of Labor, Fact Sheet #28: the FMLA](https://www.dol.gov/agencies/whd/fact-sheets/28-fmla); [U.S. Department of Labor, FMLA frequently asked questions](https://www.dol.gov/agencies/whd/fmla/faq); checked 2026-10-27)
- Thirteen states and the District of Columbia have paid family and medical leave laws. Maryland's program begins paying benefits on January 1, 2028. State programs base eligibility on earnings or hours in the state, not time with one employer. ([U.S. Department of Labor Women's Bureau, paid leave](https://www.dol.gov/agencies/wb/featured-paid-leave); [NCSL, state family and medical leave laws](https://www.ncsl.org/labor-and-employment/state-family-and-medical-leave-laws); [Maryland FAMLI, about the program](https://paidleave.maryland.gov/about-the-program/); checked 2026-10-27)
- The Pregnant Workers Fairness Act, in effect since June 27, 2023, requires employers with 15 or more employees to reasonably accommodate known limitations related to pregnancy and childbirth unless that would cause undue hardship. The PUMP Act gives most employees, including salaried employees exempt from overtime, break time and a private space other than a bathroom to express milk for a year after birth. ([EEOC, what you should know about the Pregnant Workers Fairness Act](https://www.eeoc.gov/wysk/what-you-should-know-about-pregnant-workers-fairness-act); [U.S. Department of Labor, Fact Sheet #73: break time for nursing employees](https://www.dol.gov/agencies/whd/fact-sheets/73-flsa-break-time-nursing-mothers); checked 2026-10-27)
- Through June 30, 2026, the PSLF regulation said paid leave and leave under the Family and Medical Leave Act would be considered in deciding whether a borrower worked full-time. The text in force from July 1, 2026 keeps the 30-hours-a-week test and no longer contains that sentence. ([34 CFR 685.219, Public Service Loan Forgiveness](https://www.ecfr.gov/current/title-34/section-685.219); [34 CFR 685.219 as of May 1, 2026 (prior text)](https://www.ecfr.gov/on/2026-05-01/title-34/subtitle-B/chapter-VI/part-685/subpart-B/section-685.219); [RISE final rule, 91 FR 23768 (May 1, 2026)](https://www.federalregister.gov/documents/2026/05/01/2026-08556); checked 2026-10-27)
- For medical students borrowing under the July 2026 interim exception, an approved leave of absence does not count as leaving the program, so the earlier loan limits continue. ([Federal Student Aid: loan limits and definitions from July 1, 2026](https://studentaid.gov/announcements-events/big-updates/definitions); checked 2026-10-21)
- Individual disability policies can limit benefits for mental disorders, including substance use disorders. One carrier's specimen policy caps them at 24 months over the life of the policy, except during hospital confinement. ([Unum Income Series individual disability policy specimen (2003), SEC Ex. 10.30](https://www.sec.gov/Archives/edgar/data/740112/000095013103001693/dex1030.htm); checked 2026-10-27)
- The FSMB's 2018 policy asks licensing boards to ask only about current impairment, not past diagnosis or treatment. As of September 25, 2026, the Dr. Lorna Breen Heroes' Foundation lists 46 medical licensing boards as verified free of intrusive mental-health questions. State physician health programs offer confidential assessment, referral and monitoring as an alternative to discipline. ([FSMB, Physician Wellness and Burnout policy (2018)](https://www.fsmb.org/siteassets/advocacy/policies/policy-on-wellness-and-burnout.pdf); [Dr. Lorna Breen Heroes' Foundation, licensure and credentialing applications](https://drlornabreen.org/removebarriers/); [Federation of State Physician Health Programs, about](https://www.fsphp.org/about); checked 2026-10-27)
- As of November 2025, 23 states required private insurance to cover infertility services. In a 2012–13 survey of 327 women physicians, 24.1% of those who had tried to conceive reported an infertility diagnosis, at a mean age of 33.7. ([KFF, state infertility coverage mandates](https://www.kff.org/womens-health-policy/state-indicator/infertility-coverage/); [Stentz et al., Journal of Women's Health 2016;25(10):1059–65](https://doi.org/10.1089/jwh.2015.5638); checked 2026-10-27)
- On return, the FSMB distinguishes a return to work after a shorter medical leave from reentry, for which more than two years away from practice is the commonly accepted threshold. Hospital bylaws set the clinical-activity criteria for keeping privileges; federal rules require periodic appraisal but set no number. ([FSMB, Reentry to Practice policy (April 2025)](https://www.fsmb.org/siteassets/advocacy/policies/reentry-to-practice.pdf); [42 CFR 482.22, medical staff (hospital conditions of participation)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482); checked 2026-10-27)
- Not measured: Andwise has not confirmed how the Department of Education's PSLF employment certification treats months of leave after July 1, 2026.
- Not measured: No source measures how often attending contracts include paid parental or medical leave.

## Who is paid for what

- **The residency program.** Pays 100% of salary for the first six weeks of the first approved leave and continues health and disability coverage, under ACGME rules. ([ACGME Institutional Requirements, including FAQs (2026), §4.8](https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/800_institutionalrequirements_2026.pdf)) Not part of its role: Deciding board eligibility; each certifying board sets its own rules on time away.
- **The employer of an attending.** Pays leave as the contract, its policies and state law require. FMLA leave itself is unpaid unless paid leave is substituted. ([U.S. Department of Labor, Fact Sheet #28: the FMLA](https://www.dol.gov/agencies/whd/fact-sheets/28-fmla)) Not part of its role: Explaining how leave affects bonus thresholds, repayment commitments or the non-compete.
- **Disability insurer.** Pays a monthly benefit under the policy's definitions and limits, which can cap mental-disorder claims. ([Unum Income Series individual disability policy specimen (2003), SEC Ex. 10.30](https://www.sec.gov/Archives/edgar/data/740112/000095013103001693/dex1030.htm); [The Standard, individual disability outline of coverage, form 9145(2/10)CA](https://www.standard.com/eforms/9145ca.pdf)) Not part of its role: Holding the job open; employment law and the contract do that.

## Costs that come later

- Whether paid leave is written into the contract (at signing) → Any leave in the first 12 months, before FMLA eligibility — https://www.joinandwise.com/contracts/clauses/benefits
- How leave counts against the wRVU threshold → The bonus year that includes the leave — https://www.joinandwise.com/contracts/pto-threshold
- Repayment commitments measured in calendar time or time worked → Leaving within the commitment after a leave — https://www.joinandwise.com/contracts/clawback
- The disability policy's definitions and its mental-disorder limit → A claim during or after the leave — https://www.joinandwise.com/decide/disability
- Months of leave while on a PSLF track → The count of qualifying payments — https://www.joinandwise.com/decide/loans
- Resident leave beyond the board's time-away allowance → The training end date and board eligibility — https://www.joinandwise.com/residency/union-contracts

## What is fixed and what moves

- Resident and fellow leave: Set by program or union contract. ACGME sets a floor of six weeks once in a program; programs and union contracts can provide more. ([ACGME Institutional Requirements, including FAQs (2026), §4.8](https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/800_institutionalrequirements_2026.pdf); [Andwise: resident union contract benchmarks](https://www.joinandwise.com/residency/union-contracts))
- FMLA eligibility: Set by law. 12 months, 1,250 hours worked, 50 employees within 75 miles. ([29 CFR 825.110, FMLA eligibility](https://www.ecfr.gov/current/title-29/subtitle-B/chapter-V/subchapter-C/part-825/subpart-B/section-825.110))

## Deadlines

- FMLA eligibility: 12 months with the employer, judged on the date leave starts — Set by law
- July 1, 2027: the ACGME's revised requirements renumber the leave rules and start eligibility on the day of employment — Set by the program or a licensing body
- Reentry: more than two years away from practice is the commonly accepted threshold — Set by the program or a licensing body

## Tools

- [Check a disability quote](https://www.joinandwise.com/decide/disability): Own-occupation definition, mental and nervous limit, benefit period.
- [Time off and the wRVU bonus](https://www.joinandwise.com/contracts/pto-threshold): What leave does to a threshold bonus.
- [Benefits clause](https://www.joinandwise.com/contracts/clauses/benefits): Two versions of the clause, and the questions it raises.
- [Union contract benchmarks](https://www.joinandwise.com/residency/union-contracts): Leave terms in ratified resident contracts.
- [Compare repayment plans](https://www.joinandwise.com/decide/loans): Plan, payment and PSLF progress.

## Questions

### The employer

- Is paid parental or medical leave written into the contract, and does it apply in the first 12 months?
- During leave, are wRVU targets, bonus thresholds or the salary guarantee prorated, paused or unchanged?
- Do repayment commitments and the non-compete run on calendar time or time worked, and does leave pause them?
- Do health, malpractice and disability coverage continue during unpaid leave, and who pays the premiums?
- How are hours reported on PSLF employment certifications for months with leave?
- Is employer leave pay coordinated with the state's paid-leave benefits, where they exist?
- On return, who pays for any focused review or proctoring, and is pay protected while privileges are reviewed?

### The program

- How would a leave longer than six weeks change the completion date and board eligibility?

### The disability insurer

- What is the policy's limit on mental-disorder and substance-use claims, and does a rider change it?

## Sources

- [ACGME Institutional Requirements, including FAQs (2026), §4.8](https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/800_institutionalrequirements_2026.pdf)
- [ABMS, policy on parental, caregiver and medical leave during training](https://www.abms.org/policies/parental-leave/)
- [29 CFR 825.110, FMLA eligibility](https://www.ecfr.gov/current/title-29/subtitle-B/chapter-V/subchapter-C/part-825/subpart-B/section-825.110)
- [U.S. Department of Labor, Fact Sheet #28: the FMLA](https://www.dol.gov/agencies/whd/fact-sheets/28-fmla)
- [U.S. Department of Labor, FMLA frequently asked questions](https://www.dol.gov/agencies/whd/fmla/faq)
- [U.S. Department of Labor Women's Bureau, paid leave](https://www.dol.gov/agencies/wb/featured-paid-leave)
- [NCSL, state family and medical leave laws](https://www.ncsl.org/labor-and-employment/state-family-and-medical-leave-laws)
- [Maryland FAMLI, about the program](https://paidleave.maryland.gov/about-the-program/)
- [EEOC, what you should know about the Pregnant Workers Fairness Act](https://www.eeoc.gov/wysk/what-you-should-know-about-pregnant-workers-fairness-act)
- [U.S. Department of Labor, Fact Sheet #73: break time for nursing employees](https://www.dol.gov/agencies/whd/fact-sheets/73-flsa-break-time-nursing-mothers)
- [34 CFR 685.219, Public Service Loan Forgiveness](https://www.ecfr.gov/current/title-34/section-685.219)
- [34 CFR 685.219 as of May 1, 2026 (prior text)](https://www.ecfr.gov/on/2026-05-01/title-34/subtitle-B/chapter-VI/part-685/subpart-B/section-685.219)
- [RISE final rule, 91 FR 23768 (May 1, 2026)](https://www.federalregister.gov/documents/2026/05/01/2026-08556)
- [Federal Student Aid: loan limits and definitions from July 1, 2026](https://studentaid.gov/announcements-events/big-updates/definitions)
- [Unum Income Series individual disability policy specimen (2003), SEC Ex. 10.30](https://www.sec.gov/Archives/edgar/data/740112/000095013103001693/dex1030.htm)
- [FSMB, Physician Wellness and Burnout policy (2018)](https://www.fsmb.org/siteassets/advocacy/policies/policy-on-wellness-and-burnout.pdf)
- [Dr. Lorna Breen Heroes' Foundation, licensure and credentialing applications](https://drlornabreen.org/removebarriers/)
- [Federation of State Physician Health Programs, about](https://www.fsphp.org/about)
- [KFF, state infertility coverage mandates](https://www.kff.org/womens-health-policy/state-indicator/infertility-coverage/)
- [Stentz et al., Journal of Women's Health 2016;25(10):1059–65](https://doi.org/10.1089/jwh.2015.5638)
- [FSMB, Reentry to Practice policy (April 2025)](https://www.fsmb.org/siteassets/advocacy/policies/reentry-to-practice.pdf)
- [42 CFR 482.22, medical staff (hospital conditions of participation)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482)
- [The Standard, individual disability outline of coverage, form 9145(2/10)CA](https://www.standard.com/eforms/9145ca.pdf)
- [Andwise: resident union contract benchmarks](https://www.joinandwise.com/residency/union-contracts)
- [ACGME Institutional Requirements, effective July 1, 2027](https://www.acgme.org/globalassets/pfassets/programrequirements/2027-prs/800_institutionalrequirements_2027.pdf)

Reviewed 2026-10-27; oldest source check 2026-10-21. General information, not legal, tax or financial advice. The site describes what the law and rules say; it does not say whether a clause is enforceable or what you should do.