Parental Leave Policies Fall Short for Med School Residents

Nancy A. Melville

December 11, 2018

Parental leave policies for resident physicians are lacking at many medical schools and even at the specialty medical boards that guide medical school policies. Those that do have such policies generally allow only about 6 weeks for maternity leave, which is well short of the 8.6 weeks typically provided to faculty, according to new research.

The work appears as two research letters in this week's issue of JAMA.

"It's remarkable that nearly half of these institutions lacked a common institution-level policy for resident parental leave, even though they all had at least some policy to support faculty leave," said Reshma Jagsi, MD, DPhil, director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan, Ann Arbor, and co-senior author of the letter detailing policies at medical schools.

"In some cases, even where policies did exist, it was difficult to find out what they were. And the policies that did exist typically didn't cover common concerns, like whether on-call duties have to be paid back," Jagsi said in a press statement from her institution.

A prior review of policies at the top 12 medical schools in the United States in 2016-2017, published in February (JAMA. 2018;319:611-614), showed that faculty physicians at the schools were provided a mean paid childbearing leave of 8.6 weeks, but similar data have not been available on resident physicians, who are subjected to rigorous, inflexible work hours — typically during their prime childbearing years.

Average Maternity Leave of 6.6 Weeks Falls Short of AAP Guidance

In the new research letter regarding medical schools, first author Kirti Magudia, MD, PhD, of the Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, and colleagues reviewed the childbearing and family leave policies at 15 graduate medical education (GME) sponsoring institutions affiliated with the 12 medical schools in the previous review, which were among the nation's top 10 schools for funding or academic ranking.

Childbearing leave was defined as a leave of absence taken by birth mothers. Family leave was defined as additional leave after childbearing leave provided to birth mothers or fathers, or nonbirth parents with a new child.

The researchers found that of the 15 schools, only seven had institutional GME policies that provided paid designated childbearing leave, with a mean of just 5.7 weeks (range, 2-8 weeks).

Six of the seven institutions, and one other that only had sick or state-funded disability leave for birth mothers, allowed paid family leave for nonbirth parents, with a mean paid leave of 3.9 weeks (range, 1-8 weeks).

Among those seven institutions, six had language that included same-sex couples and adoptive parents, whereas one specified that family leave was specifically "paternity" leave.

Combined, the policies allowed for a mean duration of 6.6 weeks of total paid maternity leave, encompassing a combination of childbirth and designated family leave, for childbearing mothers.

"Only eight of 15 GME-sponsoring institutions studied had policies providing either paid childbearing or family leave for residents, though all 12 of the affiliated medical schools for the institutions studied have policies for faculty physicians," the authors conclude.

The discrepancies in family leave policies are particularly troubling in a profession that should have a higher awareness of parental needs in all ranks of the workplace, Jagsi noted.

"Failing to recognize and accommodate the physical and emotional needs of childbirth and parent-child bonding is inappropriate within a profession that, at its core, seeks to promote human health," she added.

“Simply put, no one should have to choose a medical career at the cost of being able to have a family.”

The authors note that, in addition to being less than the 8.6 weeks typically provided to faculty, the 6.6 weeks is significantly less than the 12 weeks of paid leave proposed in the Family and Medical Leave Insurance (FAMILY) Act, which has been supported by the American Academy of Pediatrics.

The federal FAMILY Act requires large employers to provide 12 weeks of leave, but does not require paid leave and is only required after 12 months of employment; however, the authors note that in some states, the laws are more generous.

Medical Boards Do Not Specifically Address Parental Leave

In the ssecond research letter, published in the same issue of JAMA, Briony K. Varda, MD, MPH, Department of Urology, Boston Children's Hospital, Massachusetts, and colleagues further investigated the issue by looking into the parental leave policies of 24 specialty board organizations that are members of the American Board of Medical Specialties and therefore have important influence over institutions' leave policies.

They found that 22 of the 24 boards had leave policies but only 11 specifically mentioned parental leave as a possible reason for resident physicians taking leave, and none of the boards had a separate policy for parental leave.

Time-based training requirements for board eligibility were in place for 20 of the specialty boards, and those allowed for a median of 6 weeks of leave (range 4 to 12 weeks) for any reason during a year.

Eight of the boards included clear language allowing directors to provide exemptions from resident physicians from the time-based requirements without extending training duration.

Although the boards' median provision of 6 weeks leave without requiring a subsequent extension of training is similar to the 6 to 8 weeks of paid parental leave that the AAP currently recommends, the board policies fall short by failing to specifically address parental leave, the authors say.

"Most board policies lacked specific reference to parental leave and were ambiguous about whether training would need to be extended, which may create barriers to resident physicians taking parental leave," they explain.

Consequences of Inadequate Parental Leave Are Significant

The potential consequences of inadequate parental leave can be significant, say Varda and colleagues.

"Inadequate parental leave during residency has been associated with delayed childbearing, use of assisted reproduction technology, and difficulty maintaining breastfeeding," they note.

And this absence of support "for adequate parental leave during residency training may contribute to persistent sex disparities in certain specialties, dissatisfaction with work-life balance, and increased risk of physician burnout."

The lack of more specific guidance from specialty boards has the undesired effect of placing the burden on residency program directors.

"[Program directors] must weigh potentially conflicting factors such as adhering to board and institutional policies, maintaining adequate clinical service coverage, considering precedent within the program, and ensuring that resident physicians are well trained."

US doctors have previously protested inadequate parental and maternity leave. For example, in 2017 a group of female anesthesiologists urged the American Society of Anesthesiologists to adopt a parental leave statement, as reported by Medscape Medical News.

The authors have reported no relevant financial relationships.

JAMA. Published December 11, 2018. Reasearch letter 1, Research letter 2

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