Planning for Parental Leave
Published on: Jul 23, 2018
The length of parental leave time taken by new parents has been shown to significantly impact the parent-child bonding process. During this time, the bonding process is critically involved in the infant’s brain development, while mitigating post-natal depression for the mother. Research has also shown that enhanced paternal leave can significantly impact the father’s subsequent long-term engagement with the child.
Enabling mothers to stay at home with their newborns not only increases the likelihood of breastfeeding, associated with health and emotional benefits for child and mother, but also increases the likelihood of early childhood checkups and immunizations.
With all these benefits, it is hard to imagine that society does not make it easy for new parents to spend this important time with their newborns, and that the United States is one of only six nations that does not give working mothers universally paid maternity leave.
A Call for 12 Weeks Paid Leave
The American Academy of Pediatrics (AAP) has called on Congress to enact laws to grant new parents 12 weeks of paid leave to help them bond with and care for their new infant. At present, American workers are entitled to take up to 12 weeks unpaid leave under the Family Medical Leave Act (FMLA) of 1993. However, there is no guarantee that new parents will be allowed to take the full 12 weeks by their employers.
It would seem logical that physicians would have the most informed family and parental leave policies, yet the profession calling for this improvement is among the worst served by parental leave policy. According to a new study in the Journal of the American Medical Association, physicians feel that they are letting partners, colleagues and patients down if they take their full entitlement, so even where physicians are permitted to take the full 12 weeks, they do not.
Dr. Christina Mangurian, one of the study’s authors, says the flexibility around the interpretation of parental leave entitlement can make new parents feel like ‘Good doctors don’t take time off from work’, assuming they even know how much time that might be.
Policies & Planning
With the lack of standardization in policy across the profession, upon learning that one is expecting, the priority must be to investigate the policies of the institution or group for which you work. Assess your family finances to understand how many weeks of unpaid leave you can possibly afford to take and compare this against the amount you are entitled to take. Many physicians will use a combination of paid sick leave and vacation days to cover the first few weeks after birth, then return part-time, if they are able.
If it is possible to do so, working additional shifts in the second trimester, when it poses less risk to the mother or baby, may be one way to bank additional paid time off work, or reduce the number of shifts, after the birth. It is also vital to allow for contingency within these plans, in case of extended post-partum recovery times or the inevitable occasional time off to look after your child that will be required in the early months. Speaking with hospital management early is key to planning effectively.
The Problems of Partnership
While large health systems or groups might offer more generous family leave packages, taking parental leave in a small practice can be problematic.
Writing for KevinMD.com, one physician complained, “We are the ones recommending that women exclusively breastfeed for a year – yet practice administrators dictate whether or not physicians can build 15-minute pumping breaks into their schedules. We recommend that women do not return to work for eight weeks after a cesarean section, yet we don’t pay them.”
In most situations, partners will be expected to cover overhead costs while not drawing a salary. For small practices, the problem of covering for a physician that is absent for weeks at a time is particularly disruptive; and many physicians feel they cannot ask their partners to cover for them for the extended period of time they would like. Without effective coverage, the pressure to return to work is that much greater.
For the duration of the parental leave, other doctors must work harder and see the absent doctor’s patients, which may lead to a fall in revenue as a result. How this affects the partners and physician taking leave will vary from practice to practice, making it very difficult to plan financially.
A Mixed Bag for Residents
While many teaching hospitals now provide allowances for parental leave with pay, this does not answer the practical problems of completing residency programs and the necessary hours within a specified year. As a result, says a New England Journal of Medicine study, “the personal and educational needs of trainees with children often collide with colleagues’ expectations, their hospital’s workforce needs and the requirements of the American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME)”.
While the American Medical Women’s Association (AMWA) reports that 50% of female physicians have their first baby during residency training, many find themselves having to extend training by a year if the timing doesn’t work out.
Managing the Economics of Parental Leave
An experiment in California points to one possible solution for improving access to paid maternity leave for all working parents. It began in 2002, offering six weeks of wage replacement for workers who go on leave to bond with a new biological, adopted or fostered child. The scheme is paid out of an employee-paid, inflation-indexed payroll with no direct costs to employers, which would help small practices mitigate the impact of parental leave.
The scheme has been shown to be beneficial in terms of employee retention and, as a result, led to a reduction in the business costs associated with recruiting and training new workers, according to analysis by the Center for Economic and Policy Research. This is not insignificant when one considers that Stanford University recently reported that the cost of recruiting a new physician is in the range of $250,000 to $1m.
The kind of creative solution employed in California will need to be adopted throughout the medical profession in the years to come to coincide with the changing outlook of gen-Xers and millennials who place a greater emphasis on work-life balance, including issues around parental leave.
As Gray Tuttle Jr. points out in Medical Economics, “With women forming an ever larger percentage of the physician population, practices should think twice about letting maternity leave be an economic hardship for female doctors. If you want to recruit and retain women, you need competitive benefits.”
A Pediatrician’s View of Paid Parental Leave, NPR; October 10, 2016 - http://www.npr.org
The Neuroscience of Paid Parental Leave, Daniel Barron, Scientific American Blog Network; November 29, 2017 - blogs.scientificamerican.com
The Economics of Paid Parental Leave, Daniel Barron, Scientific American Blog Network; November 29, 2017 - blogs.scientificamerican.com
Doctors Aren’t Taking the Leave They Recommend for New Parents, Amanda Lenhart, Slate.com; February 19, 2018 - slate.com
Family Leave: Making It Work Phyllis Maguire, Today’s Hospitalist; August 2011 - www.todayshospitalist.com
Maternity Leave For Physicians Is A Disgrace. It’s Time to Fix That, Kevin MD; October 2015 - www.kevinmd.com
Maternity Leave Policies That Really Deliver, Robert Lowes; Medical Economics Modern Medicine Network; July 9, 2001 - medicaleconomics.modernmedicine.com
Becoming a Doctor, Starting A Family – Leaves of Absence from Graduate Medical Education, Reshma Jagsi, M.D., Nancy Tarbell, M.D., and Debra Weinstein, M.D. ; November 8, 2007 - www.nejm.org
The Problems of Parental Leave, Sean Price; October 2017 - www.texmed.org
How Physicians Can Plan For Maternity Leave, Linda Kossoff; March 6, 2017 - www.enttoday.org
Congratulations You’re Pregnant! Now, About Those Shifts…, Casey Z MacVane, M.D. M.PH, Megan L Fix, M.D., Tania D Strout, PhD, RN, MS, Kate D Zimmerman, D.O., Rebecca B Bloch, M.D., and Christine L. Hein, M.D.; July 17, 2017 - www.ncbi.nlm.nih.gov
Parental Leave During Residency Training AAFP www.aafp.org
Why Having A Baby Pushes Women Out of Medicine, Rebecca Greenfield and John Tozzi; October 10, 2017 - www.bloomberg.com The length of parental leave time taken by new parents has been shown to significantly impact the parent-child bonding process.