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Figure.  Paid Parental Leave at U.S. News & World Report 2020-2021 Best Hospitals and Best Hospitals for Cancer
Paid Parental Leave at U.S. News & World Report 2020-2021 Best Hospitals and Best Hospitals for Cancer

Graph shows total maternity (childbirth plus parental) leave duration based on uncomplicated vaginal delivery. Estimates shown represent maximal benefits estimates where benefits differ. Hospital rankings are designated by groups of 5 or if more than 20. For the full list of included institutions, see eMethods in the Supplement.

aDenotes no paid maternity or parental leave.

bThe parental leave policy was confirmed to be 0 but the pay level during short-term disability was not disclosed.

Table.  Paid Parental Leave at U.S. News & World Report 2020-2021 Best Hospitals and Best Hospitals for Cancer
Paid Parental Leave at U.S. News & World Report 2020-2021 Best Hospitals and Best Hospitals for Cancer
1.
Van Niel  MS, Bhatia  R, Riano  NS,  et al.  The impact of paid maternity leave on the mental and physical health of mothers and children: a review of the literature and policy implications.   Harv Rev Psychiatry. 2020;28(2):113-126. doi:10.1097/HRP.0000000000000246PubMedGoogle ScholarCrossref
2.
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. doi:10.1001/jama.2015.10680PubMedGoogle 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.
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
5.
Scully  RE, Davids  JS, Melnitchouk  N.  Impact of procedural specialty on maternity leave and career satisfaction among female physicians.   Ann Surg. 2017;266(2):210-217. doi:10.1097/SLA.0000000000002196PubMedGoogle ScholarCrossref
6.
Organisation for Economic Co-operation and Development. OECD family database: parental leave systems. Published 2019. Accessed February 28, 2021. https://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf
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    Research Letter
    Health Policy
    May 11, 2021

    Paid Parental Leave Policies Among U.S. News & World Report 2020-2021 Best Hospitals and Best Hospitals for Cancer

    Author Affiliations
    • 1Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
    • 2Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston
    JAMA Netw Open. 2021;4(5):e218518. doi:10.1001/jamanetworkopen.2021.8518
    Introduction

    The American Academy of Pediatrics endorses 12 weeks of paid parental leave on the basis of studies showing health benefits to parents and children.1 Parental leave policies can impact the distribution of child-rearing responsibilities, which may be associated with gender equity and retention of women in medicine.2 Although prior studies have examined leave policies at select top-tier US medical schools3 and graduate medical education–sponsoring institutions,4 there is a paucity of data describing paid parental leave for faculty and staff physicians at leading US hospitals and cancer centers, which was studied here.

    Methods

    This cross-sectional study qualified as nonregulated, non–human participant research exempt from approval and the need for informed consent according to the Cedars-Sinai Medical Center institutional review board. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    In October 2020, we reviewed publicly accessible websites to retrieve child-bearing and parental leave policies for the 2020 to 2021 U.S. News & World Report Top 20 Best Hospitals and Best Hospitals for Cancer. A total of 27 unique institutions were included in our analysis. Human resources and/or benefits representatives were contacted at each institution to verify policies and/or retrieve unavailable or incomplete policies. Duration of paid childbearing (maternity) and parental leave and extent of salary support was obtained. Parental leave included leave available after childbirth or disability (for birthing mothers) and for nonbirthing mothers, partners, and adoptive parents, as applicable. Paid leave was defined as receiving 50% or more of base salary pay and excluded regular accrued paid time off (eg, vacation); duration of paid leave less than 50% of salary or without pay was considered to be 0. For additional details, see eMethods in the Supplement. Mean durations of leave were calculated using Stata statistical software version 16.1 (StataCorp).

    Results

    Of 27 unique institutions, 2 (7.4%) would not provide pay details during short-term disability and 1 (3.7%) would not confirm online information for accuracy. Six institutions (22%) offer longer leave and/or greater pay according to the extent of caregiving responsibility (eg, primary vs secondary; 2 institutions) or employment position (eg, academic faculty vs nonfaculty staff physician; 4 institutions) (Table).

    The mean duration of paid leave for birthing mothers (childbirth plus parental leave) was 7.8 weeks (range, 0-14 weeks), and that for parental leave was 3.6 weeks (range, 0-12 weeks), using benefits from primary caregiver and academic faculty status where institutional benefits differ (Figure). Conversely, using benefits from secondary caregiver or nonfaculty status where benefits differ, the mean paid leave for birthing mothers was 6.8 weeks (range, 0-12 weeks), and that for parental leave was 2.3 weeks (range, 0-8 weeks). Although most institutions (23 institutions [85.2%]) offered short-term disability for childbirth, pay varied markedly (range, 0% to 100%). Four institutions (14.8%) did not provide paid leave for childbirth, and more than one-half (15 institutions [55.6%]) did not provide paid parental leave beyond childbirth (according to secondary caregiver or nonfaculty status where benefits differ).

    Discussion

    Despite longer paid leave being associated with improved health of mothers and infants, career satisfaction among female physicians, favorable societal economic impact, and sustained lactation and breastfeeding,1,5 the mean duration of paid maternity and parental leave at leading US hospitals and cancer centers is only 7.8 weeks and 3.6 weeks, respectively, at maximal benefits estimates. In contrast, the mean duration of paid maternity leave among other Organisation for Economic Co-operation and Development countries is 18.6 weeks (13.6 weeks at 100% pay).6

    Several limitations should be considered. Because only U.S. News & World Report top-ranked institutions were analyzed, the results may not be generalizable to other institutions. We did not evaluate unpaid leave duration or department-specific policy variations, nor did we assess the association of family leave with outcomes. These results highlight a striking variation in paid parental policies among leading US hospitals and cancer centers, generally well below American Academy of Pediatrics recommendations and Organisation for Economic Co-operation and Development benchmarks, suggesting that evidence-based updates that inclusively support the health and well-being of families and gender equity in the workplace should be considered.

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    Article Information

    Accepted for Publication: March 11, 2021.

    Published: May 11, 2021. doi:10.1001/jamanetworkopen.2021.8518

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Lu DJ et al. JAMA Network Open.

    Corresponding Author: Katelyn Atkins, MD, PhD, Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, AC1019, Los Angeles, CA 90048 (katelyn.atkins@cshs.org).

    Author Contributions: Drs Lu and Atkins 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: Lu, Tarbell, Atkins.

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

    Drafting of the manuscript: Lu, Tarbell, Atkins.

    Critical revision of the manuscript for important intellectual content: Lu, King, Sandler, Kamrava, Atkins.

    Statistical analysis: Lu, Atkins.

    Administrative, technical, or material support: Lu, King.

    Supervision: Tarbell, Kamrava, Atkins.

    Conflict of Interest Disclosures: Dr Sandler reported receiving personal fees from Janssen for serving on a clinical trial steering committee, receiving stock from Radiogel Stock for serving on a medical advisory board, and being a member of the ASTRO board of directors outside the submitted work. No other disclosures were reported.

    References
    1.
    Van Niel  MS, Bhatia  R, Riano  NS,  et al.  The impact of paid maternity leave on the mental and physical health of mothers and children: a review of the literature and policy implications.   Harv Rev Psychiatry. 2020;28(2):113-126. doi:10.1097/HRP.0000000000000246PubMedGoogle ScholarCrossref
    2.
    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. doi:10.1001/jama.2015.10680PubMedGoogle 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.
    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
    5.
    Scully  RE, Davids  JS, Melnitchouk  N.  Impact of procedural specialty on maternity leave and career satisfaction among female physicians.   Ann Surg. 2017;266(2):210-217. doi:10.1097/SLA.0000000000002196PubMedGoogle ScholarCrossref
    6.
    Organisation for Economic Co-operation and Development. OECD family database: parental leave systems. Published 2019. Accessed February 28, 2021. https://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf
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