Implementation of Federal Dependent Care Policies for Physician-Scientists at Leading US Medical Schools

Abstract

This survey study explores whether leading US medical schools have policies about dependent care travel costs.

Travel support for dependents of physician-scientists at medical schools (children or other dependent family members), including care for dependents left at home while the researcher travels and care for dependents who accompany the researcher for travel, has been recommended as an important step to achieve gender equity in academic science.¹ In December 2014, the US government issued regulation in 45 CFR §75.474, allowing temporary dependent care travel costs to be expensed to federal grants.² We surveyed leading US medical schools to investigate whether institutional policies allow for implementation of this clause.

Methods

As in previous work,³ medical school rankings by National Institutes of Health funding and the US News & World Report were combined to identify the leading 51 unique institutions. Institutional travel policies were located via online searches from March to May 2019 and searched for the terms dependent care, childcare, and babysitting. Administrators at each school were contacted to confirm the interpretation of policies and assure accuracy. This study was not considered human subjects research by the University of California, San Francisco institutional review board and was therefore exempt from review.

The 2014 US Department of Health and Human Services regulation states: “Temporary dependent care costs (as dependent is defined in 26 U.S.C. 152) above and beyond regular dependent care that directly results from travel to conferences is allowable provided that: (i) The costs are a direct result of the individual’s travel for the Federal award; (ii) The costs are consistent with the non-Federal entity’s documented travel policy for all entity travel; and (iii) Are only temporary during the travel period.”² We ascertained whether travel policies at each medical school allowed for reimbursement of dependent care costs as permitted in this regulation. Two of us (C.H.O. and R.Y.H.) reviewed travel policies from each medical school to determine concordance with the regulation.

Results

Of 51 schools contacted, 50 confirmed institutional policies and 1 declined to participate. One university system comprising 5 campuses (David Geffen School of Medicine at University of California, Los Angeles; University of California, Davis; University of California, Irvine; University of California, San Diego; and University of California, San Francisco) had a policy explicitly providing reimbursement of the full range of dependent care costs permitted by the regulation.² Travel policies at 32 schools (64%) either did not reference dependent care (17 [34%]) or explicitly classified it as a nonreimbursable expense (15 [30%]). At the other 13 schools, policies varied widely (Table 1). Table 2 shows the specific policies for individual schools.

Table 1. Types of Dependent Care Provisions in Travel Policies at 50 US Medical Schools^a.

Dependent Care Provisions in Institutional Policy	Implementation of 45 CFR §75.474 Written in Travel Policy?	No. of Schools
Temporary dependent care costs can be charged to federal funds if they are above and beyond regular dependent care that directly results from travel to a conference for the federal award.	Yes	5
Dependent care expenses are reimbursable if 2 spouses employed by the university are required to attend a professional function/conference, if the spouse of a university employee is required to attend a professional function/conference with the employee, or a single parent employed by the university is required to attend a professional function/conference.	No	1
Dependent travel expenses are reimbursable if the dependent’s travel is required for a meeting or related to rest and recuperation travel allowable under the terms of a sponsored project.	No	1
Dependent travel–related expenses are reimbursable if the dependent serves a business purpose.	No	5
Dependent travel–related expenses are reimbursable during the interview process prior to an employment offer or if the dependent serves a business purpose.	No	1
Dependent travel expenses are reimbursable during the interview process prior to the acceptance of an employment offer.	No	1
Dependent travel expenses are reimbursable for relocation airfare on a final trip.	No	1
Dependent care is a nonreimbursable expense.	No	15
Policy does not reference dependent care.	No	17

^a Two schools were unable to provide details on policies and 1 school had a policy under review.

Table 2. Dependent Care Provisions in Travel Policies at 50 US Medical Schools^a.

Institution	Implementation of 45 CFR §75.474 Written in Travel Policy?	Dependent Care Provisions in Institutional Policy
Albert Einstein College of Medicine	No	Childcare is nonreimbursable.
Baylor College of Medicine	No	Policy does not reference dependent care.
University of Iowa Carver College of Medicine	No	Policy does not reference dependent care.
Case Western Reserve University School of Medicine	No	Travel-related expenses for dependents are reimbursable if the dependent’s presence on the trip contributes substantially to the conduct of official University business.
David Geffen School of Medicine at University of California, Los Angeles	Yes	Reimbursement of travel expenses, including dependent care expenses for a spouse, domestic partner, dependent-care provider, and dependents who accompany an employee or candidate for employment on bona fide University business travel may be allowed in limited circumstances with preapproval by a senior official. Reimbursement of expenses related to dependent care provided outside of normal working hours while an employee or candidate for employment is traveling on bona fide University business may be allowed in limited circumstances with preapproval by a senior official. Reimbursable expenses that do not have a clear University business purpose are taxable. Reimbursements under this policy for dependent(s) travel expenses and/or dependent(s) care are taxable. Dependent care costs can only be charged to federal funds if they are above and beyond regular dependent care that directly results from travel to a conference for the federal award and are temporary during the travel period. This is subject to the circumstances where such expenses can be reimbursed as determined by the Campus Chancellor. The travel expenses of the dependent cannot be charged to a federal fund.
Duke University School of Medicine	No	Dependent care expenses are reimbursable if 2 spouses employed by Duke are required to attend a professional function/conference, if the spouse of a Duke employee is required to attend a professional function with the employee, or if a single parent employed by Duke is required to attend a professional function/conference.
Emory University School of Medicine	No	Policy does not reference dependent care.
Northwestern University Feinberg School of Medicine	No	Childcare is nonreimbursable.
Geisel School of Medicine at Dartmouth	No	Childcare is nonreimbursable.
Harvard Medical School	No	Expenses related to an employee’s family member are reimbursable if there is a bona fide business purpose for the dependent’s presence on the trip.
Icahn School of Medicine at Mount Sinai	No	Policy does not reference dependent care.
Indiana University School of Medicine	No	Policy does not reference dependent care.
Johns Hopkins School of Medicine	No	Policy does not reference dependent care.
Keck School of Medicine of University of Southern California	No	Dependent care is nonreimbursable.
Mayo Clinic Alix School of Medicine	No	Policy is unavailable.
Medical University of South Carolina	No	Dependent expenses are nonreimbursable.
University of Miami Miller School of Medicine	No	Policy does not reference dependent care.
New York University School of Medicine	No	Dependent care is nonreimbursable.
Ohio State University School of Medicine	No	Travel expenses for dependents are reimbursable if the dependent has a documented university business purpose.
Oregon Health & Science University	No	Policy does not reference dependent care.
Perelman School of Medicine at the University of Pennsylvania	No	Travel expenses for a dependent are reimbursable for bona fide business purposes or during the interview process.
Stanford Medical School	No	Travel expenses for a family member are reimbursable if the accompanying person has a position with the University and is traveling to make a significant contribution in furtherance of University business.
University of Alabama School of Medicine	No	Policy does not reference dependent care.
University of California, Davis School of Medicine	Yes	Reimbursement of travel expenses, including dependent care expenses for a spouse, domestic partner, dependent-care provider, and dependents who accompany an employee or candidate for employment on bona fide University business travel may be allowed in limited circumstances with preapproval by a senior official. Reimbursement of expenses related to dependent care provided outside of normal working hours while an employee or candidate for employment is traveling on bona fide University business may be allowed in limited circumstances with preapproval by a senior official. Reimbursable expenses that do not have a clear University business purpose are taxable. Reimbursements under this policy for dependent(s) travel expenses and/or dependent(s) care are taxable. Dependent care costs can only be charged to federal funds if they are above and beyond regular dependent care that directly results from travel to a conference for the federal award and are temporary during the travel period. This is subject to the circumstances where such expenses can be reimbursed as determined by the Campus Chancellor. The travel expenses of the dependent cannot be charged to a federal fund.
University of California, Irvine School of Medicine	Yes	Reimbursement of travel expenses, including dependent care expenses for a spouse, domestic partner, dependent-care provider, and dependents who accompany an employee or candidate for employment on bona fide University business travel may be allowed in limited circumstances with preapproval by a senior official. Reimbursement of expenses related to dependent care provided outside of normal working hours while an employee or candidate for employment is traveling on bona fide University business may be allowed in limited circumstances with preapproval by a senior official. Reimbursable expenses that do not have a clear University business purpose are taxable. Reimbursements under this policy for dependent(s) travel expenses and/or dependent(s) care are taxable. Dependent care costs can only be charged to federal funds if they are above and beyond regular dependent care that directly results from travel to a conference for the federal award and are temporary during the travel period. This is subject to the circumstances where such expenses can be reimbursed as determined by the Campus Chancellor. The travel expenses of the dependent cannot be charged to a federal fund.
University of California, San Diego School of Medicine	Yes	Reimbursement of travel expenses, including dependent care expenses for a spouse, domestic partner, dependent-care provider, and dependents who accompany an employee or candidate for employment on bona fide University business travel may be allowed in limited circumstances with preapproval by a senior official. Reimbursement of expenses related to dependent care provided outside of normal working hours while an employee or candidate for employment is traveling on bona fide University business may be allowed in limited circumstances with preapproval by a senior official. Reimbursable expenses that do not have a clear University business purpose are taxable. Reimbursements under this policy for dependent(s) travel expenses and/or dependent(s) care are taxable. Dependent care costs can only be charged to federal funds if they are above and beyond regular dependent care that directly results from travel to a conference for the federal award and are temporary during the travel period. This is subject to the circumstances where such expenses can be reimbursed as determined by the Campus Chancellor. The travel expenses of the dependent cannot be charged to a federal fund.
University of California, San Francisco School of Medicine	Yes	Reimbursement of travel expenses, including dependent care expenses for a spouse, domestic partner, dependent-care provider, and dependents who accompany an employee or candidate for employment on bona fide University business travel may be allowed in limited circumstances with preapproval by a senior official. Reimbursement of expenses related to dependent care provided outside of normal working hours while an employee or candidate for employment is traveling on bona fide University business may be allowed in limited circumstances with preapproval by a senior official. Reimbursable expenses that do not have a clear University business purpose are taxable. Reimbursements under this policy for dependent(s) travel expenses and/or dependent(s) care are taxable. Dependent care costs can only be charged to federal funds if they are above and beyond regular dependent care that directly results from travel to a conference for the federal award and are temporary during the travel period. This is subject to the circumstances where such expenses can be reimbursed as determined by the Campus Chancellor. The travel expenses of the dependent cannot be charged to a federal fund.
University of Chicago Pritzker School of Medicine	NA	Policy is unavailable.
University of Cincinnati College of Medicine	No	Policy does not reference dependent care.
University of Colorado School of Medicine	No	Policy does not reference dependent care.
University of Florida College of Medicine	No	Policy does not reference dependent care.
University of Maryland School of Medicine	No	Policy does not reference dependent care.
University of Massachusetts Medical School	No	Travel expenses for an employee’s family are nonreimbursable.
University of Michigan Medical School	No	Transportation, lodging, or meal expenses for a dependent are reimbursable with a clear university business purpose.
University of Minnesota Medical School	No	Policy does not reference dependent care.
University of North Carolina School of Medicine	No	Policy is under review.
University of Pittsburgh School of Medicine	No	Childcare is nonreimbursable.
University of Rochester School of Medicine	No	Childcare is nonreimbursable.
University of Texas Southwestern Medical School	No	Policy does not reference dependent care.
University of Utah School of Medicine	No	Policy does not reference dependent care.
University of Virginia School of Medicine	No	Travel expenses for dependents are reimbursable during the interview process prior to the acceptance of an employment offer.
University of Washington School of Medicine	No	Travel expenses for dependents are reimbursable for relocation airfare on final trip.
University of Wisconsin–Madison School of Medicine	No	Dependent care is nonreimbursable.
Columbia University Vagelos College of Physicians and Surgeons	No	Transportation, lodging, and meal expenses for a dependent are reimbursable if the dependent’s travel is required for a specific business event or meeting or related to rest and recuperation travel allowable under the terms of a sponsored project.
Vanderbilt University School of Medicine	No	Childcare is nonreimbursable.
Wake Forest School of Medicine	No	Policy does not reference dependent care.
Warren Alpert School of Medicine at Brown University	No	Childcare is nonreimbursable.
Washington University School of Medicine	No	Babysitting is nonreimbursable.
Weill Cornell Medical College	No	Babysitting is nonreimbursable.
Yale School of Medicine	No	Childcare is nonreimbursable.

Abbreviation: NA, not applicable.

^a Boston University School of Medicine declined to participate.

Although few written policies allowed for reimbursement of dependent care, 6 schools (12%) reported allowing for reimbursement if an investigator provided justification for the departure from institutional policy. One school referred investigators to federal regulations for reimbursement of expenses, although its policy listed childcare as a nonreimbursable expense. At 15 schools (30%), faculty could apply for grants and awards for dependent care travel expenses.

Discussion

Of the 50 medical schools surveyed in 2019, 5 (10%) had travel policies that implemented the 2014 federal dependent care policies for physician-scientists. We did not ask the other schools why they had not adopted similar travel policies.

This study has limitations. One school declined to participate, 2 were unable to provide details on their policies, and 1 had a policy under review. We contacted the leadership at each medical school to inquire about institutional policies but did not determine whether specific departments had different policies in effect.

The disproportionate burden of dependent care contributes to gender disparities in academic medicine.⁴ At the same time, the number of dual-physician⁵ families in the United States is increasing, and both women and men may be limited in their ability to travel for work. Explicit incorporation of 45 CFR §75.474 into medical school travel policies would offer important support to researchers with dependents.