While the American Academy of Pediatrics has publicly called for Congress to enact laws that ensure that parents of new babies have access to at least 12 weeks of paid leave to help bond with and care for their children, many physicians in the U.S. don’t themselves have access to the amount of leave their own colleagues recommend. And even if they have it, they don’t take it, according to a new paper in the Journal of the American Medical Association.
Not only are these policies variable, but often the policies themselves are unclear or left up to a supervisor to decide how much leave a person will actually receive. As Dr. Christina Mangurian, one of the study’s authors, noted, “One of our main findings is that these are policies that are extraordinary difficult to interpret and understand. And then they have all these funny things, which disadvantage women, like your leave is up to your chair or your supervisor. ‘Talk to your supervisor to see if you can do this.’ Or you have ‘up to’ this many weeks of leave.” All of this flexibility in interpretation of leave policies can make new parents feel like “good” doctors don’t take the full amount of leave they’re entitled to, assuming they can even determine how much that might be according to their institution’s policies.
A team of physicians and researchers led by Nicholas Riano tracked down the family leave policies at 12 of the top U.S. medical schools and discovered that birth parents are offered 8.6 weeks of leave on average and that nonbirth parents—sometimes just including fathers, sometimes nonbirth parents in same-sex couples, or families that gain children through adoption or surrogacy—were offered extremely variable amounts of leave, from two weeks to a year.
All the evidence points to better outcomes when parents are able to take leave to recover from birth and bond with their newborns, including greater retention of female employees, leading to a more diverse workforce and better health outcomes for babies. “We’re doctors—we know data. We like data,” said Mangurian. “Let’s try to work together and use this data to help ourselves.”
Dr. Stacy Wang Baird was one of the lucky ones. A cardiologist at Columbia University Medical Center, she had her first son, who is now 5, while finishing up her training. She had her second son, now 1½ years old, as an attending physician. She was able to take 14 weeks with her first and 12 weeks with her second. And she felt that her program and colleagues were “incredibly supportive.” But still, taking leave wasn’t without its challenges.
“Navigating the experience as a fellow was challenging in that there were so many policies that governed my training and I had to make sure that I was fulfilling all the requirements,” said Baird. “I also had to be aware that my training needed to be completed by a certain date in order to be eligible to take my subspecialty boards that year I finished training,” otherwise she risked extending her training time by an additional year.
All these inflexible requirements meant that with her first child, Baird ended up front-loading all her overnight call time into the first half of her year, while she was pregnant, because, she said, “As a first time mom with little prior experience taking care of babies, I had no idea what to expect.” And she believed it would be easier to work these punishing shifts while pregnant than with an infant at home. But it took a toll on her health. “Related or not, I do wonder if I may have overdone that and whether being so heavily front-loaded might have been a factor leading to my developing shingles on one of my overnight calls during this period,” Baird said.
The culture for physician fathers, even those who work in pediatrics, can be even less forgiving. Dr. Josh Bonkowsky, a father of four, had children with his physician-wife during all stages of their training. While his wife had 12 weeks fully paid at the University of Utah for each birth, Bonkowsky didn’t take a single day of leave with his kids. Bonkowsky admitted he wasn’t sure exactly what the policy even was for new fathers. (The University of Utah School of Medicine has not yet responded to a request to confirm this policy.) “I can think of one male colleague who took leave for the birth of a child. It’s not commonly done among male physicians here,” he said. While he might have liked to take paternity leave, “It’s not encouraged—the entire cultural setup has to change to make it happen,” said Bonkowsky.
But for some physician dads outside of academia, the culture may already be changing. Dr. Hans Pohl, a pediatric surgeon specializing in urology at Children’s National Medical Center in the District of Columbia, has a 4-year-old son with his husband, born by surrogate. “Everybody was absolutely thrilled that I had a son on the way,” he said. He found that figuring out what leave he was entitled to was simple—he applied for it and was granted a month of leave. Pohl believes that the culture within medicine is changing. It did not occur to him to check the leave policy when he first started at the hospital more than 15 years ago, but now he believes it is becoming more common and it’s what many fathers and mothers want. Still, Pohl echoed many of his colleagues in that he felt he could not have taken a longer leave because of his duty to and the concern he felt for his patients, and insufficient redundancy among providers to avoid burdening other physicians.
And things are starting to change at the institutional level too. Even since the JAMA study went to press, some institutions have updated their policies, including the University of California, San Francisco,* which announced it will double childbearing leave to 12 weeks, fully paid for faculty at the medical school, beginning July 2019.
Mangurian says that the paper “shines a light” on areas that need improvement and that she fundamentally believes institutions want to improve. All health providers can step up by expanding access to the AAP-recommended 12 weeks paid leave for all parents—mothers, fathers, birth, or adoptive—and by changing the structures within their institutions to allow for more redundancy to accommodate the caregiving responsibilities that affect them just as much as they affect their patients and their families. Medical training programs can help change the culture by building in more flexibility to accommodate childbirth, parental, and family leaves so that these policies are actually used and medical students and residents aren’t forced to extend their training by a full year or engage in scheduling heroics to meet training and licensing requirements.
Ultimately, doctors should be entitled to the same happy, healthy family lives they want for all of us.
Correction, Feb. 20, 2018: This article originally mistakenly referred to University of California, San Francisco as “University of San Francisco.”