A former Michigan medical resident was awarded more than $10 million by a federal jury this week after alleging she was terminated from her obstetrics and gynecology residency for failing a licensing exam she was required to take during job-protected maternity leave. 

The lawsuit focuses on Nicole Walker, DO, a second-year resident at Ascension Genesys Hospital in Grand Blanc, Michigan, at the time of her dismissal in April 2021. According to the complaint, her firing “clearly had nothing to do with her performance and everything to do with her upcoming maternity leave...and the birth of her son.” 

It further alleges that requiring Walker to take the exam during leave — and tying her continued employment to that outcome — interfered with her rights under the Family and Medical Leave Act (FMLA). 

The dispute reflects longstanding concerns  about how residency programs handle pregnancy leave and accommodations and how those policies affect women entering or remaining in training environments with rigid schedules and high-stakes evaluation requirements. 

Research suggests that many training programs lack clear or consistent accommodation guidelines for pregnant residents. In a 2024 review of 285 emergency medicine residency programs, only 10% of program websites included parental leave information , and just two programs described specific accommodations for pregnant residents. 

Medscape Medical News contacted Ascension and Walker’s attorney for comment, but they did not respond by publication time. Ascension Genesys Hospital merged with Henry Ford Health in 2024 and has since been renamed Henry Ford Genesys Hospital. 

A Failed Exam During Leave 

Walker’s FMLA leave started on December 7, 2020, and she gave birth to her son the following day. She then took the COMLEX Level 3 exam in late January 2021 while on leave. She initially planned to complete the exam in 2020, but pandemic-related disruptions delayed her, the complaint said. 

She learned in late March 2021, while still on FMLA leave, that she had not passed the exam. Walker was terminated by Ascension the following month. According to court records, she later passed the exam in June 2021. 

The lawsuit describes Walker as a high-performing resident with strong evaluations from supervising physicians. One associate program director wrote that she was “incredibly talented” and skilled at managing high-risk patients. 

No Accommodations: Lawsuit 

According to the filing, the program refused to provide Walker with probation, remediation, or other assistance, even though those options were offered to other non-pregnant residents who failed the exam. The complaint further claims that program leadership knew she would be on leave when setting exam completion deadlines, with one physician stating that Walker should consider other career avenues since “being a mother made it difficult for her to devote time to the program.”

Walker’s case follows a similar legal challenge by another resident. In December, a jury awarded $4.4 million to Andrea Avellan, DO, a Texas third-year internal medicine resident who alleged she was placed on a performance improvement plan after announcing her pregnancy . 

Court records claimed that senior physicians treated Avellan differently from her peers because she was “a woman, mother, and pregnant.” Due to experiencing a pattern of harassment, discrimination, and retaliation during the program, Avellan was unable to sit for medical boards and was eventually fired, the complaint said. 

The jury found that her employer, Methodist Hospitals of Dallas, failed to comply with its resident physician agreement. 

Evolving Legal Protections 

In 2022, the Accreditation Council for Graduate Medical Education implemented minimum requirements for paid parental leave , requiring programs to provide residents and fellows with at least 6 weeks of paid leave for medical, parental, or caregiver duties. Still, decisions about exam timing and remediation are typically made at the program level. 

“Medical residents are in a unique position,” Margaret Zhang, assistant professor at Widener University Delaware Law School, Wilmington, told Medscape Medical News. “They’re covered by employment laws but also by education laws like Title IX, which can apply to training programs.”

Besides FMLA, Zhang said that pregnancy-related claims may also fall under Title VII of the Civil Rights Act and, more recently, the Pregnant Workers Fairness Act, which requires employers to provide reasonable accommodations for pregnancy and childbirth-related conditions. 

“If the accommodation is reasonable, the employer should provide it unless it poses an undue hardship,” she said. Based on the details of Walker’s complaint, Zhang said a reasonable accommodation may have been as simple as allowing additional time to complete the exam. 

She said that some pregnancies may also qualify as a disability, offering another layer of legal protection, particularly when conditions such as gestational diabetes or preeclampsia  occur. “Courts generally do not consider a normal, healthy pregnancy to be a disability, but after childbirth, there is often a short period where someone may be considered disabled because they can’t function in the same way they did before childbirth,” said Zhang. 

Walker’s substantial verdict may not be the final word. Zhang said a judge must still enter judgment, and post-trial motions or an appeal could affect the final award. 

“But it shows that juries care about these issues,” she said. 

Steph Weber is an award-winning freelance journalist specializing in health care and law. 

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