To the Editor:
We applaud Dr. Stack and colleagues’ recent Research Report illustrating the variability and limitations of maternity leave during residency.1 We echo the authors’ sentiments regarding how we might better support maternity leave for our trainees. However, we are also concerned about challenges for faculty.
Although faculty family leave policies exist at many institutions, both policies and salary coverage vary widely.2 Despite women comprising an increasing proportion of the physician work force, little has been done to address concerns regarding maternity leave policies, fertility management, child care, and breastfeeding at work.3 One particular challenge is ambiguous policy wording which may inadvertently disadvantage women by restricting leave to the primary caregiver or may imply that benefits are granted at the discretion of departmental leadership. Perceived lack of support for taking leave may be why the average length of maternity leave for women physicians is less than the recommended minimum leave duration of 12 weeks.4 Finally, many workplaces do not clarify whether clinical effort will be prorated for maternity leave time or missed call will need to be paid back. This uncertainty, piled atop the challenges of navigating new motherhood and breastfeeding at work, is unnecessary and harmful.
Absent of any national mandates surrounding family leave policy, there are several things institutions can do to better support women who are simultaneously trying to grow their careers and families. First, parental leave policies should be normalized, flexible, and transparent, maximizing the amount of time that both parents can spend with their newborns. Departments should not “penalize” employees for taking leave by requiring payback of call or heavier clinical loads over shorter time periods. Departmental policies for coverage should exist so women do not need to negotiate for coverage of clinical responsibilities while on leave. Every effort should be made at the institutional level to offer paid leave time, as this is paramount to recruitment and retention of faculty. Finally, breastfeeding upon return to work should be fully supported with adequate space, time, and flexibility provided for milk expression for a minimum of 12 months, as recommended by the American Academy of Pediatrics.5 Only by acknowledging that women faculty face similar challenges as trainees regarding parental leave can we hope to make progress toward truly inclusive workplaces.
Kathryn M. Pendleton, MD
Assistant professor, Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; email@example.com; Twitter: @Pendlkm; ORCID: https://orcid.org/0000-0003-3248-5738.
Arghavan Salles, MD, PhD
Scholar in residence, Stanford University School of Medicine, Palo Alto, California; Twitter: @arghavan_salles.
1. Stack SW, Jagsi R, Biermann JS, et al. Maternity leave in residency: A multicenter study of determinants and wellness outcomes. Acad Med. 2019;794:1738–1745.
2. Riano NS, Linos E, Accurso EC, et al. Paid family and childbearing leave policies at top US medical schools. JAMA. 2018;319:611–614.
3. Snyder RA, Bills JL, Phillips SE, Tarpley MJ, Tarpley JL. Specific interventions to increase women’s interest in surgery. J Am Coll Surg. 2008;207:942–947.
4. Blair JE, Mayer AP, Caubet SL, Norby SM, O’Connor MI, Hayes SN. Pregnancy and parental leave during graduate medical education. Acad Med. 2016;91:972–978.
5. Section on breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–841.