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

Abstract

This study describes childbearing and family leave at 15 graduate medical education (GME)–sponsoring institutions affiliated with 12 US medical schools on top 10 lists for funding or ranking.

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).

Table. Paid Childbearing and Family Leave for Trainees With New Children at 15 GME-Sponsoring Institutions Associated With 12 Top US Medical Schools.

Medical Schoola	Affiliated GME-Sponsoring Institution	Institution-Level Policies for Paid Childbirth Leave (Birth Mothers)		Institution-Level Policies for Paid Family Leave (Non–Birth Mothers, Fathers, and Adoptive Parents)
		Childbirth Leaveb	Constraints, Clarifications, and Related Provisionsc	Family Leave	Constraints, Clarifications, and Related Provisionsc
Columbia University	New York Presbyterian Hospitald	6 Weeks	Additive to any disability entitlements or leaves under New York State Paid Family Leave law, which can extend leave up to 26 weeks, a portion of which is paid	6 Weeks for primary parent or 2 weeks for secondary parent	Primary vs secondary parent status is self determined; New York State Paid Family Leave law can extend leave up to 26 weeks, a portion of which is paid
Duke University	Duke University Hospital	No institutional policy	Paid leave determined by departmental policy	No institutional policy	Paid leave determined by departmental policy
Harvard University
	Brigham and Women’s and Massachusetts General Hospitals (Partners HealthCare)e,f	Up to 8 weeks	If childbearing causes significant illness beyond the 8 weeks, sick leave may be used (12 days per year, which may accrue to a maximum of 60 days); vacation time may be used to extend paid leave to 12 weeks	No institutional policy	Paid leave determined by departmental policy; vacation time may be used to extend leave to 12 weeks
	Boston Children’s Hospital	No institutional policy	Paid leave determined by departmental policy	No institutional policy	Paid leave determined by departmental policy
	Beth Israel Deaconess Medical Center	No institutional policy beyond sick leave	Birth mothers permitted to use up to 8 weeks sick leave paid at 100% by short-term disability followed by 4 weeks sick leave paid at 60%, which can be extended by 14 weeks paid at 60% if medically necessary; vacation time may be used to extend leave	No institutional policy beyond sick leave	Unpaid unless trainee elects to use vacation time
Johns Hopkins University	Johns Hopkins University School of Medicine	8 Weeks paid leave (not specifically for childbearing parent)	May combine with paid sick leave (5 additional weeks) and unused vacation (for up to a total of 17 weeks)	8 Weeks (total granted for any new parent, not additive to the 8 weeks provided to childbearing mothers)	May combine with vacation
University of Michigan	Michigan Medicine/University of Michigan Health System	6 Weeks	2 Additional weeks for cesarean delivery; up to an additional 6 months paid sick leave available if medically necessary	2 Weeks if father, same-sex domestic partner of a birthing mother, or secondary caregiver of an adoptive child; 6 weeks at time of adoption if the house officer is the primary caregiver	May combine with 2 weeks of vacation
University of Pennsylvania
	Hospital of the University of Pennsylvania	Up to 6 weeks paid leave (not specifically for childbearing parent)	May be extended by short-term disability and vacation	6 Weeks for any new parent (not additive to childbearing leave)	May be extended by vacation
	Children’s Hospital of Philadelphia	No institutional policy	Paid leave determined by departmental policy	No institutional policy	Paid leave determined by departmental policy
University of Pittsburgh	UPMC Medical Education	No institutional policy beyond sick leave	Birth mothers permitted to use sick leave paid at 100% by short-term disability (typically 6-8 weeks)	No institutional policy beyond vacation
University of California, San Francisco	University of California, San Francisco, School of Medicine	Minimum of 2 weeks (for any new parent; not specific to childbearing mothers)	May combine with 12 days’ paid sick leave and vacation	Minimum of 2 weeks (for all new parents; not additive to that listed for childbearing mothers)	May be extended by vacation
Stanford University	Stanford Health Care	No institutional policy beyond sick leave and/or state disability benefits	May use available sick leave (up to 20 days) and personal time off (up to 3 weeks) to supplement applicable state disability benefits	1 Week specified for paternity
University of Washington	University of Washington School of Medicine	No institutional policy beyond sick leave	May use available sick leave (17 days per year), vacation, and personal holiday time	No institutional policy	Up to 4 months of parental leave may be granted; the resident may use a combination of vacation, up to 10 days of sick leave, personal holiday, and leave without pay
Washington University St Louis	Washington University/BJH/SLCH Consortiumg	No institutional policy beyond sick leave	May use available sick leave (up to 10 days) and vacation (20 days)	No institutional policy
Yale University	Yale–New Haven Hospital	4 Weeks	2 Additional weeks for cesarean delivery; can be extended with written documentation of continued medical need by treating physician; additive to 6 weeks parenting leave	6 Weeks (additive beyond the maternity leave for childbearing mothers for total of 10 weeks for birth mothers)	Applies to adopting and fostering mothers and fathers of children from birth, adoption, or fostering

Abbreviations: BJH, Barnes-Jewish Hospital; GME, graduate medical education; NIH, National Institutes of Health; SLCH, St Louis Children’s Hospital; UPMC, University of Pittsburgh Medical Center.

^aMedical schools selected as in Riano et al.³ Selected schools were among the top 10 in 1 of the following rankings: (1) US News and 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 schools were on both lists, the search resulted in 12 unique schools.

^bPolicies apply to vaginal delivery, with specification for cesarean delivery in constraints, clarifications, and related provisions. Only 100% paid leave is included. Leave does not include vacation time, sick leave, or short-term disability for those with disability extending beyond sick leave.

^cVacation time is listed when institutional policies specifically state that vacation may be used in this setting; unused vacation time may be available for this purpose at other institutions, but vacation time is not listed when policies on childbearing or family leave do not state this (as it is unclear how much time off may be taken in one stretch or whether the resident can expect unused vacation time to be scheduled at the time of birth).

^dAffiliated with both Columbia and Cornell medical schools; included in this study because of its Columbia affiliation.

^eBrigham and Women’s Hospital and Massachusetts Hospital are separate Accreditation Council for Graduate Medical Education “sponsoring institutions” but have many integrated GME programs and share GME policies determined by a common governing body.

^fAt the time of submission, this policy was under revision. The policy was changed in September 2018 to include 8 weeks of paid parental leave for nonchildbearing (as well as childbearing) parents. To ensure consistency in the July 2018 end of the evaluation across institutions, that change has not been included.

^gThis policy is under revision.

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.