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Table.  Paid Childbearing and Family Leave for Nonrepresented Administrative Staff With New Children at Top US Medical Schools
Paid Childbearing and Family Leave for Nonrepresented Administrative Staff With New Children at Top US Medical Schools
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    1 Comment for this article
    EXPAND ALL
    This is a start
    Louise Andrew, MD JD | none
    This  report is actually minimally encouraging. When I carried the first pregnancy on the Osler residency at Hopkins, after passage of the Pregnancy Discrimination Act of 1978, I endured a grueling schedule and was hospitalized for first, second, and third trimester complications. There was no such thing as maternity leave, and I made up for those absences with even more 36 hour stints of duty with no food, minimal hydration, and even less rest. It is encouraging that another study has found that at least 47% of schools are now providing such for residents (though why not 100%? ALL physicians in training are considered to have high risk pregnancies).
    What is NOT encouraging is that only 16% of schools surveyed now have paid childbearing leave for administrative  staff, now 40 years after the PDA and 18 years after the FMLA (which took 9 years for passage due to obstruction by GWBush and those with economic interests).
    How is it that medical schools can get away with ignoring or flouting federal laws? Is it presumed by regulators that, in health matters at least, these institutions will "do the right thing" for their trainees and employees?
    Or are those who dedicate their careers to these institutions simply so accustomed to having their rights and needs denied that they don't call attention to the injustice?
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    Physician Work Environment and Well-Being
    January 21, 2020

    Assessment of Paid Childbearing and Family Leave Policies for Administrative Staff at Top US Medical Schools

    Author Affiliations
    • 1Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
    • 2UCSF Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco
    • 3Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
    • 4Department of Radiation Oncology, University of Michigan, Ann Arbor
    • 5Private Consultant, San Francisco, California
    • 6Department of Dermatology, Stanford University, Stanford, California
    • 7Department of Epidemiology, Stanford University, Stanford, California
    JAMA Intern Med. 2020;180(4):589-592. doi:10.1001/jamainternmed.2019.6653

    Integrating work and family commitments can be difficult, especially after the birth, adoption, or placement of a child. Institutional family leave policies have been reviewed at top US medical schools for faculty and resident physicians,1,2 but to our knowledge, policies for administrative staff have not been studied.

    Methods

    We reviewed childbearing and family leave policies for benefits-eligible, nonrepresented administrative staff at 12 leading US medical schools, as externally ranked.1,2 We defined childbearing leave as an absence for physical recovery by birth mothers; family leave as leave provided to birth mothers after or instead of childbearing leave or to non–birth parents with a new child; and administrative staff as nonrepresented employees who function in professional/managerial (eg, department manager, deputy director) or clerical/support (eg, executive assistant, program coordinator) roles. We defined fully paid leave as 100% base salary support without a waiting period or spend-down requirement, not including sick leave, short-term disability leave, or medical leave that could be used but was not specifically designated for childbearing; a minimum leave length was not required. We identified leave policies via searches on each school’s website using the terms childbearing, maternity, family, parental, and/or childrearing leave/absence. We reviewed policies for leave duration, salary support, constraints/provisions, and references to non–birth parents as described in previous studies.1,2 Two authors reviewed each policy; discrepancies were resolved by a third author. For institutions at which policies differed depending on staff title or tenure, we used the lowest leave duration and salary coverage in our calculations. The human resources department at each institution was contacted to confirm policies. The institutional review board at the University of California, San Francisco, determined that this study was exempt from review because it did not involve human subjects research.

    Results

    Paid childbearing and family leave policies were found online for all 12 institutions (Table) and confirmed by each between June and August 2019. All policies contained references to non–birth parents (eg, fathers, adoptive or foster parents).

    Two institutions (17%) had childbearing leave policies with full salary support for 6 weeks. Eight institutions (67%) offered partial salary support. Six institutions (50%) had family leave policies with full salary support, with a mean (range) length of 3.8 (1-6) weeks. Three institutions (25%) offered partial salary support.

    Of the 11 institutions that offered any salary support for childbearing or family leave, most imposed constraints, such as a minimum prior amount of time worked (n = 9; 82%) or a waiting period or spend-down requirement (n = 6; 55%) before paid leave could be taken. Three institutions (25%) had policies that differed between professional/managerial and clerical/support staff.

    Discussion

    Only 2 of 12 leading US medical schools provide fully paid childbearing leave for all staff, in contrast with leave provided for faculty (100%)1 and residents (47%)2 in studies conducted with similar methods. The mean duration of leave for staff (6.0 weeks) was less than that for faculty (8.6 weeks) and similar to that for residents (5.7 weeks).1,2 At 3 institutions, leave policies differed by staff titles, highlighting further institutional disparities among employees. Because administrative staff are among the lowest-paid individuals at medical schools, they are at increased risk of attrition when family leave is unpaid.3

    The study’s generalizability may be limited because we surveyed only 12 schools. We focused on institutional policies for paid leave, but actual salary coverage may differ from written policies. State-sponsored leave and individual departmental leave policies were not assessed. Policy changes made after confirmation in summer 2019 may not be reflected. We used medical school faculty and residents as the relevant comparators for administrative staff; however, these are not equivalent positions at other employers in the community. That said, from the perspective of promoting equity in the workforce, it can be argued that family leave policies should be adequate and uniform across organizations, regardless of the type or tenure of employment.

    Despite the benefits of paid childbearing leave for both mother4 and child,5 as well as support by the American Academy of Pediatrics of proposed legislation requiring 12 weeks of paid leave,6 there is no federal mandate for employers to provide paid childbearing leave. Given that administrative staff are critical to the functioning of medical schools, instituting more generous childbearing and family leave policies would be an opportunity for the medical profession to lead by example in promoting equity and well-being in the workforce.

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    Article Information

    Accepted for Publication: November 14, 2019.

    Corresponding Author: Mary C. Vance, MD, MSc, Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (mary.vance.ctr@usuhs.edu).

    Published Online: January 21, 2020. doi:10.1001/jamainternmed.2019.6653

    Author Contributions: Dr Vance had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Study concept and design: Vance, Riano, Jagsi, Linos, Mangurian.

    Acquisition, analysis, or interpretation of data: Vance, Riano, Jagsi, Guzman, Beeler, Mangurian.

    Drafting of the manuscript: Vance, Riano, Beeler, Mangurian.

    Critical revision of the manuscript for important intellectual content: Vance, Riano, Jagsi, Guzman, Linos, Mangurian.

    Administrative, technical, or material support: Vance, Riano, Guzman, Linos, Mangurian.

    Study supervision: Vance, Beeler, Linos, Mangurian.

    Conflict of Interest Disclosures: Dr Jagsi reported receiving grants to her institution from the National Cancer Institute, Greenwall Foundation, Doris Duke Charitable Foundation, Susan G. Komen, and Blue Cross Blue Shield of Michigan; receiving stock options from Equity Quotient for her service as an adviser; and receiving personal fees from Amgen, Vizient, and the Greenwall Foundation outside the submitted work, and is a volunteer founding member of TIME’S UP Healthcare. Dr Linos reported receiving grants (DP2CA225433 and K24AR075060) from the National Institutes of Health. Dr Mangurian reported receiving grants from the National Institutes of Health (R01MH112420), Doris Duke Charitable Foundation, California Health Care Foundation, and the California Office of Statewide Health Planning and Development; receiving speaking fees from Uncommon Bold, American Psychiatric Association, and American Academy of Pediatrics; and receiving writing fees from the New England Journal of Medicine outside the submitted work, and is a volunteer founding member of TIME’S UP Healthcare. No other disclosures were reported.

    Disclaimer: The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences or the US Department of Defense.

    References
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    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
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    Magudia  K, Bick  A, Cohen  J,  et al.  Childbearing and family leave policies for resident physicians at top training institutions.  JAMA. 2018;320(22):2372-2374. doi:10.1001/jama.2018.14414PubMedGoogle ScholarCrossref
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    Houser  L, Vartanian  TP.  Pay Matters: The Positive Economic Impacts of Paid Family Leave for Families, Businesses and the Public. New Brunswick, NJ: Center for Women and Work; 2012.
    4.
    Nandi  A, Jahagirdar  D, Dimitris  MC,  et al.  The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature.  Milbank Q. 2018;96(3):434-471. doi:10.1111/1468-0009.12340PubMedGoogle ScholarCrossref
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    Thakrar  AP, Forrest  AD, Maltenfort  MG, Forrest  CB.  Child mortality in the US and 19 OECD comparator nations: a 50-year time-trend analysis.  Health Aff (Millwood). 2018;37(1):140-149. doi:10.1377/hlthaff.2017.0767PubMedGoogle ScholarCrossref
    6.
    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 May 6, 2019.
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