Paid Family and Childbearing Leave Policies at Top US Medical Schools

Abstract

This study characterizes variations in duration, salary support, policy clarity, and constraints or prerequisites for childbearing and family leave policies at 12 top-tier US medical schools.

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. 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.

Table. Childbearing and Family Leave for Academic Faculty Members at Top-Tier US Medical Schools.

Top-Tier Medical Schoola	Childbirth Leave (Birth Mothers)c		Family Leave (Non–Birth Mothers, Fathers, and Adoptive Parents)
	Childbirth Leave	Constraints	Family Leave	Percentage of Salary Covered	Constraints	Explicit References to Non–Birth Motherd
Columbia Universityb	6-8 wk	More if medically necessary	Up to 52 wk	1 academic term reduced workload at 100% or 1 y of reduced workload at 50%	Primary caregiver only	He (father), adopted
Duke University	12 wk	Must meet requirements of family medical leave policy	12 wk (tenure track faculty), 6 wk (non–tenure-track faculty)	100%	Primary caregiver only; non–birth parents only	Adoption, domestic partner
Harvard University	8 wk	More if medically necessary	4 wk	100%		Adoptive parents, partners of birth mothers
Johns Hopkins University	6 wk	Must have been at university for at least 1 y; may include vacation or sick leave in accordance with departmental policies; may be extended for medical necessity	4 wk	100%	Must have been at university for at least 1 y	Biological, adoptive, or surrogate parent or the domestic or marital partner of biological or adoptive parent; birth and non–birth parent of any gender (fathers and same-sex couples)
Stanford University	Up to 16 wk	Leave length determined by physician; faculty member must apply for disability insurance, the university pays the difference between disability benefit and full salary	12 wk	100%	Faculty member must apply for disability insurance, the university pays the difference between disability benefit and full salary	Adoption, paternity bonding (father)
University of California, San Francisco	6 wk	Additional 6 wk at full or partial salary may be offered by individual departments	2 wk	100%	Additional weeks at full or partial salary may be offered by individual departments	Fathers and adoptive parents
University of Michigan	6 wk	8 wk for cesarean delivery; must take sick leave, medical leave, or short-term disability; modified duties available for 1 additional mo of leave	Up to 52 wk	Unpaid or modified duty (100% salary for 4 wk additional leave over 2-3 mo)	Modified duties and incentive determined by department	He (father), adopted child, partner (domestic partner)
University of Pennsylvania	8 wk	Must take sick leave, medical leave, or short-term disability; more leave if necessary, determined by physician	1 academic y	100% while working 0.5 FTE	Primary caregiver only	His (father)
University of Pittsburgh	6 wk	8 wk for cesarean delivery, up to 26 weeks if complications arise; leave must be certified by physician	4 wk	100%	Birth mother can add 4 wk on to childbirth leave or take within 1 y of birth or adoption; additional 12 mo unpaid leave available after paid leave expires; more at the approval of the vice provost	Men (fathers), adoption
University of Washington	Up to 12 weeks (90 d) in 1 academic y	Applications must be accompanied by physician documentation; requires approval by department, school, and provost’s office	Up to 12 wk	Unpaid	Extension with provost’s approval	His (fathers), adopted
Washington University in St Louis	8 wk	Must be approved by department chair or dean; leave must be certified by physician, additional leave determined by physician	Up to 12 wk	100%	Additional leave granted by department chair or dean; primary caregiver only	His (father), adoption, domestic partner
Yale University	8 wk	Must be taken via sick leave, medical leave, or short-term disability; 1-y extension granted automatically if requested by a full-time faculty member; can be repeated for subsequent birth	8 wk leave plus 8 wk partial duty	100% for first 8 wk, second 8 wk partial duty paid at % of effort	Primary caregiver only; if 2 members of the faculty are primary caregivers, the leave will be split between them; 1-y extension granted automatically if requested by a full-time member of the faculty and can be repeated for subsequent adoption	His (father), adopts, spouse/same sex domestic partner

Abbreviation: FTE, full-time equivalent.

^aSchools were selected by being among the top 10 in 1 of the following rankings: (1) US News & World Report (Best medical schools: research. 2016; https://tinyurl.com/dzn9s8) or (2) Blue Ridge Institute for Medical Research (Ranking tables of NIH funding to US medical schools in 2016. 2016; https://tinyurl.com/y74oomth). Because many of the schools were on both lists, the search resulted in 12 unique schools.

^bColumbia University’s policy is under revision. The policy available on its website as of August 2017 is reported here. Columbia is the only school for which childbearing leave is subtracted from family leave duration.

^cChildbirth leave for birth mothers was covered at 100% for all schools above.

^dExplicit references to father, adoptive parents, domestic partners, and same-sex couples. These policies are vague, and do not explicitly reference any or all of the potential parental populations. However, it is possible that missing populations could be implied.

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. 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. 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 parent and infant, no federal law requires US employers to provide paid childbearing leave. 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.