In the fall of 2007, a Harvard medical student in Boston, Massachusetts named Sophie Currier sued the USMLE for discrimination. The National Board of Medical Examiners initially refused to afford Ms. Currier additional breaks during her nine-hour medical license exam to express her breast milk by saying that lactating doesn’t qualify as a disability under the Americans with Disabilities Act. Therefore they didn’t need to give her extra time. The judge said Currier had the option of waiting until she had finished with breastfeeding before she took the exam again, even if it meant delaying her residency training. Later that week, a Massachusetts Appeals Court judge overturned the earlier ruling, finding that Currier needed the extra break time to put her on ‘equal footing’ with the men and non-lactating women who take the exam.

You will have many opportunities during your medical career to take long, standardized exams including United Stated Medical Licensing Examination (USMLE) Step 1, Step 2, and Step 3 as well as your specialty boards. Each of these exams is at least one full day in length. All board exams have strict rules and regulations for administration including time limits. In addition to the logistical challenges of getting through a regular work day while lactating, taking board exams is another professional obligation that poses significant challenges if you are a breastfeeding medical student or physician.

If you have to take one of these exams while you are pregnant, you may survive with a few extra bathroom breaks and some Tums stashed into your bra. But if any of these exams occur when you are breastfeeding a new baby, you are limited to pumping regularly during your examination time which is very challenging with no appropriate space and maybe not even an outlet in the bathroom. The National Board of Medical Examiners provides information on Expressing Breast Milk during the USMLE at http://www.nbme.org/about/BF-USMLE.html. Ironically, if you type “breastfeeding” directly into the search engine on the USMLE website at http://www.usmle.org, you get only “Test content and practice materials.” An alternative to the currently suboptimal testing environments offered to breastfeeding women is for you to defer your examination and possibly your medical training for a year.