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Table.  
Childbearing and Family Leave for Academic Faculty Members at Top-Tier US Medical Schools
Childbearing and Family Leave for Academic Faculty Members at Top-Tier US Medical Schools
1.
Jena  AB, Khullar  D, Ho  O, Olenski  AR, Blumenthal  DM.  Sex differences in academic rank in US medical schools in 2014.  JAMA. 2015;314(11):1149-1158.PubMedGoogle ScholarCrossref
2.
American Academy of Pediatrics.  Major pediatric associations call for congressional action on paid leave. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/FAMILYLeaveAct.aspx. Accessed December 12, 2017.
3.
Bohnet  I.  What Works: Gender Equality by Design. Cambridge, MA: Harvard University Press; 2016.Crossref
4.
Aitken  Z, Garrett  CC, Hewitt  B, Keogh  L, Hocking  JS, Kavanagh  AM.  The maternal health outcomes of paid maternity leave.  Soc Sci Med. 2015;130:32-41.PubMedGoogle ScholarCrossref
5.
Nandi  A, Hajizadeh  M, Harper  S, Koski  A, Strumpf  EC, Heymann  J.  Increased duration of paid maternity leave lowers infant mortality in low-and middle-income countries.  PLoS Med. 2016;13(3):e1001985.PubMedGoogle ScholarCrossref
6.
Schuster  MA, Chung  PJ.  Time off to care for a sick child—why family-leave policies matter.  N Engl J Med. 2014;371(6):493-495.PubMedGoogle ScholarCrossref
Research Letter
February 13, 2018

Paid Family and Childbearing Leave Policies at Top US Medical Schools

Author Affiliations
  • 1Department of Psychiatry, University of California, San Francisco
  • 2Department of Dermatology, University of California, San Francisco
  • 3University of California, Berkeley
  • 4Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
JAMA. 2018;319(6):611-614. doi:10.1001/jama.2017.19519

Retaining women in academic medicine is challenging, despite gender parity in medical training. Child-rearing and differential preferences on work-life balance may contribute to sex differences in retention in medicine.1 Retaining women during childbearing years is central to gender parity, as even short workforce interruptions can have long-term consequences—and may partially explain the gender wage gap. Our goal was to examine variations in childbearing and family leave policies at top US medical schools.

Methods

We reviewed US medical schools on top-10 lists for both funding by the National Institutes of Health and academic ranking by the US News & World Report academic ranking, which yielded 12 unique institutions. Leave policies were collected between September 2016 and August 2017, located via web searches for childbearing, maternity, family, parental, and childrearing leave/absence at each school. Childbearing leave was defined as a leave of absence taken by birth mothers; family leave was defined as a leave of absence taken by birth mothers after childbearing leave, or by fathers or non–birth parents to raise their child. Data on leave duration, salary support, policy wording and clarity (including explicit reference to fathers, adoptees, or same-sex couples), and constraints imposed were examined; discrepancies between reviewing authors were reconciled. Faculty Affairs departments were contacted in August 2017 to ensure accurate interpretation of leave duration and salary support. The institutional review board at the University of California, San Francisco, declined to review this study.

Results

Childbearing and family leave policies were available online for all schools. The mean length of full salary support during childbearing leave was 8.6 weeks (range, 6-16), though policies varied widely between institutions (Table). Three of the 12 schools provided more than 8 weeks of full salary support for childbearing leave, the median leave duration reported. Eight schools allowed extensions, usually for medical reasons.

The mean length of family leave was 17.9 weeks (range, 2-52). Four provided more than 8 weeks of salary support (1 only for tenure track), but salary coverage varied widely (Table). Most family leave policies had several constraints, such as being at the discretion of the department (3 schools) or only available to “primary caregivers” who care for a child more than 50% of the time (5 schools). Three policies included ambiguous language regarding the duration of leave. To whom the leave could apply was often unclear; fathers were mentioned in 10 policies. Interpretation accuracy was confirmed by administration at all but 1 university undergoing active policy revision.

Discussion

The American Academy of Pediatrics has publicly endorsed 12 weeks of paid family leave based upon the scientific evidence of benefits to the child.2 Yet the mean length at 12 of the top medical schools was 8.6 weeks. Some childbirth and most family leave policies included constraints implying benefits were at the discretion of departmental leadership. Other human resources policies that are negotiable have been shown to disadvantage women.3 Allowing for supervisory discretion in leave policies may also affect how women who take leave are perceived, inadvertently encouraging women to forgo or take shorter leaves. Restricting family leave availability to the primary caregiver prevents partners from taking any leave, potentially contributing to the attrition of women by not facilitating cooperative parenting.

This study had several limitations. Only 12 top-tier medical schools were included and their policies may not be generalizable. In addition, the analyses were strictly descriptive and did not examine the association between leave policies and retention.

Despite the benefits of paid childbearing leave for parent4 and infant,5 no federal law requires US employers to provide paid childbearing leave.6 Future longitudinal studies are needed to assess policies at other institutions and examine the association between leave policies and retention of women in academic medicine, adjusting for characteristics affecting retention, such as child care availability and costs, household characteristics, job satisfaction, and burnout.

Section Editor: Jody W. Zylke, MD, Deputy Editor.
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Article Information

Accepted for Publication: November 21, 2017.

Corresponding Author: Christina Mangurian, MD, MAS, University of California, San Francisco, Zuckerberg San Francisco General Hospital, Department of Psychiatry, Weill Institute for Neurosciences, 1001 Potrero Ave, Ste 7M, San Francisco, CA 94110 (christina.mangurian@ucsf.edu).

Author Contributions: Mr Riano and Dr Mangurian had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Riano, Accurso, Mangurian.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Riano, Eleni Linos, Elizabeth Linos, Simard, Mangurian.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Riano, Simard.

Obtained funding: Mangurian.

Administrative, technical, or material support: Riano, Accurso, Sung, Mangurian.

Supervision: Mangurian.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Mangurian reported being the chair of the Council of Minority Mental Health and Health Disparities for the American Psychiatric Association (APA) and working with several other APA members on a position paper about the importance of fully paid childbearing leave for the mental and physical well-being of the mother and child. No other disclosures were reported.

Funding/Support: This study was unfunded, although salary support was received from grants K23MH093689, R01MH112420, and R03DK101857 (Dr Mangurian); NIH NIAMS K01-AR066878 (Dr Simard); K76AG054631, R21CA212201, and DP2OD024079 (Dr Linos) from the National Institutes of Health.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Jena  AB, Khullar  D, Ho  O, Olenski  AR, Blumenthal  DM.  Sex differences in academic rank in US medical schools in 2014.  JAMA. 2015;314(11):1149-1158.PubMedGoogle ScholarCrossref
2.
American Academy of Pediatrics.  Major pediatric associations call for congressional action on paid leave. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/FAMILYLeaveAct.aspx. Accessed December 12, 2017.
3.
Bohnet  I.  What Works: Gender Equality by Design. Cambridge, MA: Harvard University Press; 2016.Crossref
4.
Aitken  Z, Garrett  CC, Hewitt  B, Keogh  L, Hocking  JS, Kavanagh  AM.  The maternal health outcomes of paid maternity leave.  Soc Sci Med. 2015;130:32-41.PubMedGoogle ScholarCrossref
5.
Nandi  A, Hajizadeh  M, Harper  S, Koski  A, Strumpf  EC, Heymann  J.  Increased duration of paid maternity leave lowers infant mortality in low-and middle-income countries.  PLoS Med. 2016;13(3):e1001985.PubMedGoogle ScholarCrossref
6.
Schuster  MA, Chung  PJ.  Time off to care for a sick child—why family-leave policies matter.  N Engl J Med. 2014;371(6):493-495.PubMedGoogle ScholarCrossref
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