In Europe, legislatively mandated policies for parental leave after the birth of a child start at 14 guaranteed weeks off for every working mother and can run as long as a year in some countries, often including salary. Parental leave is considered an essential right.
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August 2024In the U.S., this level of benefit is rarer. More common approaches max out at three months, which may or may not include pay or require spending any accumulated vacation and sick leave. The picture is slowly changing in this country, with growing recognition that supportive parental leave practices are essential to worker satisfaction and healthy families. Otolaryngology employers are also evolving.
Depending on who is in charge of setting the practice’s policies—otolaryngology group practice, larger multispecialty medical group, hospital or health system, or medical school—they seek a balance between the needs of the parents who work for them and the demands on the practice for staffing, call coverage, and financial viability while a new parent is out on leave.
“I think solutions will be variable, depending on where people practice and what the practice model is,” said Regan Bergmark, MD, MPH, a rhinologist and endoscopic skull base surgeon at Brigham and Women’s Hospital and Dana Farber Cancer Center in Boston. She is also on the faculty at the Center for Surgery and Public Health. “The bottom line is it’s really good to have something in place in terms of clear policies and practices.” It’s also helpful to consider it as part of an attractive benefit package.
“You basically want your surgeons to stay in the workforce, and you want their patients taken care of when surgeons are out for a period of time. Parental bonding time is critical to the health and well-being of children, and of their parents as well,” she said. “You want people to have the ability to come into this field and also to achieve their family goals, because if you don’t, a lot of people aren’t going to choose this field.”
Dr. Bergmark herself had three children, now aged 12, 9, and 6, during her medical training, the first two during residency and the third at the end of a fellowship. In the past, many women have used three or four weeks of vacation as their maternity leave and, when possible, tried to use research or other time that was more flexible. Alternatively, people may delay having children, potentially not having the family they envisioned or going through fertility treatments, she said. “Since then, I think we’ve all gotten better at offering longer leave times and more flexibility.”
And then there’s the challenge of breastfeeding and private rooms where the mother can pump after returning to work. “That’s another place where a hospital can make a big difference,” Dr. Bergmark said. “When we interviewed women who had children during otolaryngology residency, this was one of the areas that was most challenging about returning to work—simply not having a private, clean space near the operating rooms, and refrigeration.”
Acknowledging Their Other Lives
Designing parental leave is part of a broader issue of acknowledging that physicians have other things going on in their lives—personal and family. Providers can have serious personal medical issues of their own or other family health needs. Historically, otolaryngology groups haven’t always had good ways of dealing with that, Dr. Bergmark said.
You want people to have the ability to come into this field and also to achieve their family goals, because if you don’t, a lot of people aren’t going to choose this field. —Regan Bergmark, MD, MPH
At the foundation of many of these considerations is the Family and Medical Leave Act (FMLA) passed by Congress in 1993. The act declared that for companies with 50 or more employees, qualified workers were entitled to family and medical leave for up to 12 weeks following the birth of a child. There are also certain conditions to the law, such as a requirement to work 1,250 hours (three-quarters time) in the previous 12 months. The leave is unpaid, but existing job and group health insurance benefits are protected.
FMLA also covers serious personal illness and disability leave, leave for both parents to stay with newborns, including adoptions and fosters, leave to care for other family members, and leave for certain family responsibilities created by military service. Family and medical leave practices also vary significantly by state and by industry. Paid leave is voluntary to the company. These are considered minimum recommendations to help ensure healthy pregnancies.
Childbirth and maternity leave are just part of the natural life of many physicians, and they offer a way to talk about people having their whole-person-care taken care of, Dr. Bergmark said. One thing to do is allocate resources for this extra coverage. “I think if you provide some extra resources for this, it goes a long way. It makes other staff feel they aren’t getting work unfairly pushed on them that they weren’t expecting.” Smaller practices might need to hire locum tenens physicians and/or physician extenders. For bigger practices, people often just cover for one another.
For otolaryngological groups, it is possible that more time—and/or salary coverage—might be added to the unpaid 12 weeks for FMLA coverage—for example, if the employee spends available vacation or sick leave to have their salary extended. Other groups might opt to segregate the 12 weeks of parental leave, keeping other accumulated leaves untouched by the childbirth experience.
For physicians in the practice, base salaries or regular bonuses might or might not be covered while they’re on leave, and if they are owners of the practice, then other financial considerations need to be addressed. For a medical or otolaryngologic group that uses RVUs (relative value units) and productivity totals to determine incentive payments, determining how to handle productivity payments during parental leave can be one of the thorniest issues. Preserving surgeon block time is also critical to maintaining a surgeon’s practice on return after leave.
Brigham and Women’s has developed an innovative new policy for parental or medical care for physicians, said Rachel E. Roditi, MD, section chief for the division of otolaryngology at Brigham and Women’s Faulkner Hospital in Jamaica Plain, Mass. Now, to retain their full earning potential while out on leave, they can get the same RVU credit they earned 12 months previously—which is considered to be what they would have earned based on productivity if they were not on parental leave—plus a “little extra.” “That extra is a 15% additional payment to compensate for the few months before and after the true leave period, when productivity is lower due to ramp down, ramp up, breastfeeding, etc.,” Dr. Roditi said.
“When I was on maternity leave, I had a substantial decrease in pay since much of our yearly earnings were RVU bonus-based rather than true ‘salary.’ This was challenging to manage along with increased costs of childcare when returning to work,” she said. “I therefore helped Brigham and Women’s Hospital adjust its compensation plan to help close this gap. We were able to have this process apply not only to parental leave but also to other medical leaves.”
Different Stakes
Stephen Park, MD, chair of the department of otolaryngology–head and neck surgery at the University of Virginia in Charlottesville, says it helps to remember that every actor in this process has a somewhat different stake in the game and different needs. “A 30-year-old physician with a newborn sees it from one angle,” he said, which may be different from their partner, male or female, from other family members, or from co-workers.
“Our otolaryngology faculty are allowed roughly 12 weeks off with pay, which typically is based on combining eight weeks of paid parental leave and four weeks of short-term disability, with a little wiggle room for more time for complications,” he said. Male physicians are allowed the same leave, but it is less common for them to take that full amount. In his department, most new fathers take off for roughly a month.
During that time off, any budgeted collections obviously would not be realized while compensation continues. This deficit is spread out among the group and absorbed over the course of the year. Therefore, Dr. Park said, the culture of the group or department is very important; a supportive climate allows co-workers to welcome and celebrate the occasions that engender these absences.
Doing the Right Thing
Katie Phillips, MD, assistant professor of otolaryngology–head and neck surgery at the University of Cincinnati, has had three different parental leave opportunities and was able to observe how they differed. She had her first child as a resident “when there wasn’t a defined national parental leave policy for residents.” She got very interested because she was surprised; how could there not be a policy that could just be referenced?
When I look back a year out from my last baby, reflecting on these experiences, I have had many conversations with my chair about how to continue making things better going forward. What I feel strongly about, and I think my generation feels strongly about this, is focusing the leave discussion on both parents. —Katie Phillips, MD
She had her first baby long before the recent American Board of Medical Specialties recommendation for a minimum of six weeks away during residency training for caregiver, medical, and parental leave, without having to extend training. “I was able to take six weeks off,” Dr. Phillips said. Her program director helped her work through the transitions.
“I mean it’s absolutely the right thing to take the time off, but it’s tough on your co-residents, especially in a small group like otolaryngology. There definitely was guilt associated with leaving your co-residents hanging because you were on leave,” she said. “Then it was tough going back because I immediately had to start taking call, and my husband was alone with our new baby several days a week. It’s tough just being a first-time mother, anyway.”
Her second birth was during fellowship, but also during the COVID-19 pandemic, when it wasn’t clear how dangerous COVID-19 would be to pregnant women or their babies. “I negotiated my new job to start in October, and they were totally fine with that, but definitely no salary or benefits because the job hadn’t started yet. I had my last baby as an attending.”
Dr. Phillips is at an academic institution and in a multi-specialty physician group, clinically employed by both the physician group and the college of medicine. “As an attending, for the first time, I had paid 12-week maternity leave, yet this was still under my typical salary as I was only receiving my base pay. Nonetheless, it was much better than not being paid,” she said. “It was a great leave, as I was truly able to check out of emails and patient responsibilities thanks to partners who covered for me.”
“When I look back a year out from my last baby, reflecting on these experiences, I have had many conversations with my chair about how to continue making things better going forward. What I feel strongly about, and I think my generation feels strongly about this, is focusing the leave discussion on both parents.” If you just have the woman taking all the time off for parental leave and then, following leave, being the parent who is more likely to leave work for childcare issues such as picking up sick children, that can significantly impede career advancement for women relative to men, she said.
Is 12 Weeks Enough?
Nariman Dash, MD, is the chair of a private otolaryngology practice and chief of surgery at Mary Washington Healthcare in Fredericksburg, Va., which employs 10 providers and 52 other employees, and associate clinical professor in the department of otolaryngology at the University of Virginia in Charlottesville. “Our policy is we provide six weeks of paid time off per year, and up to three months for maternal or paternal time off, paid at half-time. If you take more time than that, we can’t guarantee your position will still be there,” he said. The doctors can take other time off, but at a significant financial cost.
For a solo practice or a small group of two or three, this time off would be very difficult. When you start to get up to six or seven doctors, it’s time to develop a policy, he said. “It’s a difficult journey going through pregnancy and childbirth. We want to be fair to our employees and their children. We try to treat our staff like family.” Other offered benefits are also competitive.
“I hear other countries give up to a year off for parental leave. That would be wonderful but economically unfeasible in the absence of a government policy,” Dr. Dash said. He has two children now in medical school, and he hopes their future careers will provide them with a fair and healthy work-life balance.
Is 12 weeks off for parental leave, as practiced at the University of Virginia and other sites profiled in this article, enough? Dr. Park said that he personally feels that the amount of time probably is sufficient. But he recognizes large variability among people, especially in the realm of support and finances.
“It is important that people are not afraid to come into my office to announce that they are expecting and will be taking a few months off. It is my job to congratulate them and ensure that the department continues to function smoothly and without holes,” Dr. Park said.
Dr. Bergmark added, “I think it requires some creativity, but it’s a solvable issue. The first thing I would say is that just being supportive is a step in the right direction—and then have in place the resources needed for people to be successful, so they can come back, work hard, take great care of their patients, and also take care of their own needs and their baby’s. Put it in the budget.”
Larry Beresford is an Oakland, Calif.-based freelance medical journalist.