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Table.  Paid Childbearing and Family Leave for Trainees With New Children at 15 GME-Sponsoring Institutions Associated With 12 Top US Medical Schools
Paid Childbearing and Family Leave for Trainees With New Children at 15 GME-Sponsoring Institutions Associated With 12 Top US Medical Schools
1.
Stentz  NC, Griffith  KA, Perkins  E, Jones  RD, Jagsi  R.  Fertility and childbearing among American female physicians.  J Womens Health (Larchmt). 2016;25(10):1059-1065. doi:10.1089/jwh.2015.5638PubMedGoogle ScholarCrossref
2.
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(7):972-978. doi:10.1097/ACM.0000000000001006PubMedGoogle ScholarCrossref
3.
Riano  NS, Linos  E, Accurso  EC,  et al.  Paid family and childbearing leave policies at top US medical schools.  JAMA. 2018;319(6):611-614. doi:10.1001/jama.2017.19519PubMedGoogle ScholarCrossref
4.
American Academy of Pediatrics. Major pediatric associations call for congressional action on paid leave. March 20, 2015. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/FAMILYLeaveAct.aspx. Accessed December 12, 2017.
5.
Jagsi  R, Tarbell  NJ, Weinstein  DF.  Becoming a doctor, starting a family—leaves of absence from graduate medical education.  N Engl J Med. 2007;357(19):1889-1891. doi:10.1056/NEJMp078163PubMedGoogle ScholarCrossref
Research Letter
December 11, 2018

Childbearing and Family Leave Policies for Resident Physicians at Top Training Institutions

Author Affiliations
  • 1Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Medicine, Massachusetts General Hospital, Boston
  • 3The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
  • 4Office of Graduate Medical Education, Partners Healthcare, Boston, Massachusetts
  • 5Weill Institute for Neurosciences, University of California, San Francisco
  • 6Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
JAMA. 2018;320(22):2372-2374. doi:10.1001/jama.2018.14414

Integrating career and family is challenging for physicians at all stages of professional development but especially during residency, which occurs during prime childbearing years and involves long, inflexible work hours.1,2 Parental leave policies can influence physician well-being and gender equity. A recent report found that the mean paid childbearing leave for faculty physicians at 12 top US medical schools was 8.6 weeks in 2016-2017,3 but corresponding institution-level policies for residents have not been reported.

Methods

In February through July 2018, we reviewed institution-level childbearing and family leave policies for 15 graduate medical education (GME)–sponsoring institutions affiliated with the 12 medical schools studied previously, which were on top 10 lists for funding or academic ranking.3 We evaluated duration, constraints, and other provisions related to institution-provided paid childbearing leave (defined as a leave of absence taken by birth mothers) and family leave (defined as additional leave provided to birth mothers after childbearing leave or to fathers or non–birth parents with a new child). Institution-level policies were obtained from publicly accessible websites for 10 institutions or requested from GME offices. All GME offices were contacted for verification.

Results

Policies were verified by GME offices at all 15 institutions. Seven of 15 institutions had an institutional GME policy providing paid designated childbearing leave (Table), with a mean duration of 5.7 weeks (range, 2-8 weeks). The mean duration of maternity leave (encompassing both childbirth leave and designated family leave available to childbearing mothers) was 6.6 weeks (range, 2-10 weeks). Six of these—and 1 other institution (that lacked provisions beyond sick or state-funded disability leave for birth mothers)—had policies on paid family leave for non–birth parents, with 6 of 7 using inclusive language for same-sex couples and adoptive parents and 1 specifying that this was “paternity” leave specifically. In these 7, the mean paid leave (to a parent not designated as primary) was 3.9 weeks (range, 1-8 weeks).

Discussion

Only 8 of 15 GME-sponsoring institutions studied had policies providing either paid childbearing or family leave for residents, though all 12 of the affiliated medical schools for the institutions studied have policies for faculty physicians. The mean duration of 6.6 weeks of paid total maternity leave (encompassing both childbirth leave and designated family leave available to childbearing mothers) for residents in programs that do provide leave is less than the 8.6 weeks provided to faculty and less than the 12 paid weeks that would be provided in a proposed federal law that was supported by the American Academy of Pediatrics.4 The federal Family and Medical Leave Act requires large employers to provide 12 weeks of unpaid leave but only after 12 months of employment. Laws in certain states are even more generous.

The study was limited to 15 GME-sponsoring institutions affiliated with 12 top medical schools. It focused on institutional policies for paid leave; unpaid leave, state-provided leave, and individual departmental policies were not included. Paid leave duration, in practice, may exceed the written policy at some institutions. This study also did not include requirements for making up training time, as mandated by many individual boards of the American Boards of Medical Specialties.5 The complexity of navigating these overlapping protections and constraints are challenging for residents and program directors alike.

Policies for paid parental leave for residents require balancing of multiple interests, including the need to support residents who are facing the physical and emotional needs of parturition and parent-child bonding, the duty to ensure clinical competence of all residents, and consideration of potential effects on care delivery in institutions that continue to rely heavily on residents to provide patient care. Further research should investigate which policies optimize the shared goals of resident well-being, education, and patient care.

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

Accepted for Publication: September 5, 2018.

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

Author Contributions: Drs Magudia and Bick 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. Drs Mangurian and Jagsi contributed equally as senior authors.

Concept and design: Magudia, Bick, Cohen, Ng, Mangurian, Jagsi.

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

Drafting of the manuscript: Magudia, Bick, Ng, Weinstein, Mangurian, Jagsi.

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

Statistical analysis: Magudia, Bick, Jagsi.

Administrative, technical, or material support: Magudia, Ng.

Supervision: Mangurian, Jagsi.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Mangurian reported receiving salary support from the National Institutes of Health (NIH) and the Doris Duke Charitable Foundation during the study period for unrelated work. Dr Jagsi reported receiving grants from the NIH, the Doris Duke Charitable Foundation, the Susan G. Komen Foundation, and the Greenwall Foundation for unrelated work; consulting fees from Amgen and Vizient; and stock options in Equity Quotient. No other disclosures were reported.

References
1.
Stentz  NC, Griffith  KA, Perkins  E, Jones  RD, Jagsi  R.  Fertility and childbearing among American female physicians.  J Womens Health (Larchmt). 2016;25(10):1059-1065. doi:10.1089/jwh.2015.5638PubMedGoogle ScholarCrossref
2.
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(7):972-978. doi:10.1097/ACM.0000000000001006PubMedGoogle ScholarCrossref
3.
Riano  NS, Linos  E, Accurso  EC,  et al.  Paid family and childbearing leave policies at top US medical schools.  JAMA. 2018;319(6):611-614. doi:10.1001/jama.2017.19519PubMedGoogle ScholarCrossref
4.
American Academy of Pediatrics. Major pediatric associations call for congressional action on paid leave. March 20, 2015. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/FAMILYLeaveAct.aspx. Accessed December 12, 2017.
5.
Jagsi  R, Tarbell  NJ, Weinstein  DF.  Becoming a doctor, starting a family—leaves of absence from graduate medical education.  N Engl J Med. 2007;357(19):1889-1891. doi:10.1056/NEJMp078163PubMedGoogle ScholarCrossref
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