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The Parent Penalty in Medicine

Sindhu Malapati, MD • Duma Lab

Disclosures

September 21, 2021

2020 was a jarring year in which all of us saw our way of life completely changed by a pandemic. The difference was all the more pronounced for me because it was also the year that I had my first baby and my last year of training. To put things in perspective, I am in a very privileged position, in a two-hetero-cis-parent marriage, and have a supportive family and employer. My experience is not the standard.

Despite all the support systems I had in place, returning to work as a new mother was the hardest charge I have undertaken — a proclamation not easily made after having trained in medicine for close to 14 years, taken countless exams, and moved across the world away from my family to pursue residency in the United States.

The statistics in the US show disastrously short maternity leave (1 in 4 women return to work in 2 weeks), overlooked paternity leave, and dismal rates of mothers returning to work. Despite being aware of these issues for years, they came acutely into focus when I was actually in the position of leaving my 3-week-old baby to go to clinic. At that juncture, I couldn’t believe that we are so matter-of-fact about what should be an indefensible situation.

Even though my program was very understanding and able to arrange for me to do more manageable rotations to ease my transition when I returned to work, it was still heartbreaking to be away from my son during what is essentially the “fourth trimester.”

Upon returning, despite having trained for more than a decade to achieve specific career goals, I had a crisis of guilt and aspirations and considered “leaning back.” I vacillated between moving ahead at full steam and decreasing my investment in research and academics so I could spend more time with my newborn son.

All of us learn in medical school that the first few weeks are paramount to establish breastfeeding, bonding, and allowing recovery. Unfortunately, the workplace has evolved to completely ignore this fact and demands that parents bounce back to their pre-child self when they return to work after an unreasonably short parental leave.

We are also very aware of WHO recommendations regarding breastfeeding. Yet work schedules as physicians — no matter which specialty — are very unforgiving to the breastfeeding mother. Many mothers in my acquaintance are penalized for pumping during clinic days, with decreased RVU and pressure to keep up productivity in clinic, not to mention passive-aggressive comments or even overt hostility in the workplace.

From my experience as an oncology fellow in clinic, it was a constant mad rush between seeing patients, lugging around the pump and pump parts while looking for a good place to pump, doing notes and attending online meetings as I pumped discreetly, and cleaning up and storing milk.

The clinic staff worked with me to block time slots to let me pump, but it did not work most times. As anyone who has been in an oncology clinic will attest, we always spend more time with each patient than we say we will. While working with people with cancer is an absolute privilege, it also imposes a heavy emotional toll because of the nature of the disease. This adds to the challenge of returning to work at a mentally tumultuous period.

Every working parent I know gives 100% at work and 100% to their child, but it can get overwhelming and is often at the expense of their own health and mental well-being. The risk of burnout increases significantly due to the added expectations, both from the workplace and at home.

There is also a very real gender bias and discrimination that has been documented with regard to female physicians returning to work. The onus should not be on the new parent who is in a very vulnerable period in their personal and professional lives. The responsibility of supporting new parents through parental leave and transition back to work should be on the institution and board.

There are many ways we can support our colleagues who are returning to work after having a child (biological or adopted):

  1. Longer parental leave mandated by ACGME, individual institutions, and specialty boards

  2. Focused mentorship in the specific setting of having a child: This could be done by the institution or through situational mentoring through larger professional societies like the American Society of Clinical Oncology and American Society for Radiation Oncology.

  3. Support group: Provide new parents with a forum to help each other navigate the first few days back at work.

  4. Lactation support: Working mothers, especially those in medicine, have unique challenges in continuing breastfeeding. Providing access to a lactation consultant who specializes in this and allocating protected time and accessible facilities including a lactation room are essential. Policies should be put into place to stop women from being penalized for breastfeeding.

  5. Normalize breastfeeding and childcare: Be more flexible and supportive when a situation requires new parents to leave early or come in late. Be willing to work with new mothers to come up with solutions that will allow them to remain productive and still continue their pumping schedule.

  6. Do not assume: If there is an opportunity, do not assume lack of interest. Always ask.

Having set policies about parental leave and establishing systems to provide support on return to work is essential because of the unnecessary and unfair parental tax that the younger members of the oncology workforce face. This added stress that is culturally more concentrated on women is a contributor to inequalities in the workforce and, in the long run, is hurting the diversity of our workforce.

This eventually bleeds into the unequal representation of women in leadership. We are losing a very valuable perspective at the table if we do not have systemic changes that prevent the attrition of young parents from the workforce and provide them with the support that they need to fulfill all the roles they carry.

The double standards in academic medicine reveal themselves with this issue trickling over to women of childbearing age without children. For men, this may be perceived as a strength since they can give their undivided attention to their leadership tasks, but women in a similar situation are viewed as “ticking time bombs” who could go on parental leave at any time.

I am fortunate to work with Dr. Narjust Duma, members of the Duma Lab, and other collaborators to design a study that identifies parental leave and lactation policies for trainee and early career oncologists.  All participants were enthusiastic about the opportunity to contribute to a better understanding of the problems with returning to work after a new baby. Based on the information we gather, we will make recommendations about changes that will better support our colleagues through a significant life event.

I believe identifying current practices and quantifying the magnitude of the challenges in returning to work is the first step in designing interventions and bringing a spotlight on this issue.

Let me know what you think in the comments.

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About Dr Sindhu Malapati
Sindhu Malapati, MD, is a breast medical oncologist at University of Arkansas for Medical Sciences, Little Rock. She is deeply passionate about women's health, disparities research, and bridging gaps in access to care. She is a new mother, an avid reader, and, since the lockdown, an amateur outdoor enthusiast.
Connect with her on Twitter: @sindhu_mj

The Duma Lab, formerly known as the Social Justice League, was founded in August 2019 and focuses on social justice issues in medicine, including discrimination and gender bias in academic and clinical medicine, cancer health disparities, and medical education.

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