Abstract
This quality improvement study reviews the human resources policies for childbearing and family leave for administrative staff at 12 leading US medical schools.
Integrating work and family commitments can be difficult, especially after the birth, adoption, or placement of a child. Institutional family leave policies have been reviewed at top US medical schools for faculty and resident physicians,1,2 but to our knowledge, policies for administrative staff have not been studied.
Methods
We reviewed childbearing and family leave policies for benefits-eligible, nonrepresented administrative staff at 12 leading US medical schools, as externally ranked.1,2 We defined childbearing leave as an absence for physical recovery by birth mothers; family leave as leave provided to birth mothers after or instead of childbearing leave or to non–birth parents with a new child; and administrative staff as nonrepresented employees who function in professional/managerial (eg, department manager, deputy director) or clerical/support (eg, executive assistant, program coordinator) roles. We defined fully paid leave as 100% base salary support without a waiting period or spend-down requirement, not including sick leave, short-term disability leave, or medical leave that could be used but was not specifically designated for childbearing; a minimum leave length was not required. We identified leave policies via searches on each school’s website using the terms childbearing, maternity, family, parental, and/or childrearing leave/absence. We reviewed policies for leave duration, salary support, constraints/provisions, and references to non–birth parents as described in previous studies.1,2 Two authors reviewed each policy; discrepancies were resolved by a third author. For institutions at which policies differed depending on staff title or tenure, we used the lowest leave duration and salary coverage in our calculations. The human resources department at each institution was contacted to confirm policies. The institutional review board at the University of California, San Francisco, determined that this study was exempt from review because it did not involve human subjects research.
Results
Paid childbearing and family leave policies were found online for all 12 institutions (Table) and confirmed by each between June and August 2019. All policies contained references to non–birth parents (eg, fathers, adoptive or foster parents).
Table. Paid Childbearing and Family Leave for Nonrepresented Administrative Staff With New Children at Top US Medical Schools.
Medical Schoola | Childbearing Leaveb | Family Leaveb | |||
---|---|---|---|---|---|
Leave Offeredc | Constraints, Clarifications, and Related Provisions | Leave Offeredc | Constraints, Clarifications, and Related Provisions | Explicit References to Non–Birth Mothers | |
Columbia University, New York, New York | None | Managerial staff: up to 6 mo may be taken as 100% paid medical leave, with actual leave length based on medical necessity as determined by physician; runs concurrently with state disability leave, which provides up to $170/wk for up to 26 wk as a short-term disability benefit; clerical staff: partial salary coverage may be available through state disability leave; may use accrued sick leave | None | May take 10 wk at 55% of average weekly salary coverage, with a cap per state law; must have worked ≥20 h/wk for at least 26 consecutive wk or worked <20 h/wk and have worked at least 175 d | Adoption, foster |
Duke University, Durham, North Carolina | None | Must use accrued leave (sick, vacation, discretionary/designated holidays, or PTO) before leave without pay can be taken | None | Up to 3 consecutive wk of 100% paid parental leave for employee who is the primary caregiver only and has worked for 1 y and 1250 h as of the last day worked; follows a mandatory 3-consecutive-wk waiting period after the last day worked, during which employee must use accrued leave (sick, vacation, discretionary/designated holidays, or PTO) before leave without pay can be taken | Both men and women, adoption, same-sex spousal equivalent, father |
Harvard University, Cambridge, Massachusetts | None | May take 8 wk as short-term disability leave without a waiting period, with salary coverage of 75% if employee has had <7 y of service and 100% if >7 y; must have completed a probationary/orientation and review period under the applicable policy | 1 wk | 2 Options: (1) 1 wk at 100% salary coverage or (2) 4 wk at 100% salary coverage for employees with >7 y of service and 75% for employees with <7 y; does not apply to foster parents, who may use accrued time to pay for leave; must have completed a probationary/orientation and review period under the applicable policy | Adoptive parent |
Johns Hopkins University, Baltimore, Maryland | 6 wk | May be extended if medically necessary; must have worked for 1 y | 4 wk | Must have worked for 1 y | Fathers, same-sex spouses/partners, adoptive parents, parents of children born via surrogate |
Stanford University, Stanford, California | None | May use short-term disability leave for partial salary coverage, with typical leave length of 1-4 wk prepartum and 6-8 wk postpartum (at physician’s discretion); may augment salary coverage with accrued time | None | May take 6 wk as short-term disability leave with partial salary coverage; may augment salary coverage with accrued time | Fathers, same-sex spouses and registered domestic partners, adopted, foster |
University of California, San Francisco | None | Typically 2 wk prepartum plus 6 wk postpartum for vaginal delivery (8 wk postpartum for cesarean delivery) may be taken as short-term disability leave, with total time off defined by medically determined disability period; may be eligible for 55% salary coverage through state disability leave if employed <18 mo or 60% salary coverage if voluntary short-term disability plan was elected (otherwise eligible for basic disability leave up to $800/mo); requires a 14-calendar-d waiting period, during which up to 22 d of sick leave must be used if the employee has them; may also use accrued time for salary coverage in lieu of short-term disability leave | None | May take 2 wk to 30 d as unpaid leave; may use accrued vacation days and up to 30 d of accrued sick leave per calendar y for salary coverage | Fathers, his, adoption, foster |
University of Michigan, Ann Arbor | 6 wk | May be extended if medically necessary with accrued time and then with parental leave (but birth mothers are not required to use parental leave as physical recovery time); eligible immediately on hire | 6 wk | Must have completed 6 mo of service | Legal guardians, foster, non–birth parent |
University of Pennsylvania, Philadelphia | None | May use short-term disability leave, typically for 8 wk but as long as medically necessary (at physician’s discretion), which provides 100% salary coverage for 6 wk after a 10-d waiting period with spend-down requirement and reduced salary coverage thereafter | 4 wk | Must have had 12 mo of service (even if nonconsecutive) and have worked at least 1250 h during the 12 consecutive mo immediately preceding the date leave would begin; does not apply to the adoption of a stepchild by a stepparent or the placement of a foster child | Adoption |
University of Pittsburgh, Pittsburgh, Pennsylvania | None | May take 6 wk for a vaginal delivery and 8 wk for a cesarean delivery as follows: (1) 4 wk of paid parental leave must substitute for a 30-d unpaid waiting period, then (2) must exhaust sick time before short-term disability leave goes into effect, then (3) short-term disability leave provides 60% salary coverage for the remaining time off; must have had 6 mo of benefits-eligible service | 4 wk | Must have had 6 mo of benefits-eligible service; cannot be used on an intermittent basis | Foster, adoption, legal guardian |
University of Washington, Seattle, Washington | None | May take 6-8 wk or at physician’s discretion as unpaid temporary disability leave; may use accrued time for salary coverage | None | Managerial staff: may take up to 4 mo of unpaid leave, which may be extended with approval; may use accrued time for salary coverage; clerical staff: may take up to 6 mo of unpaid leave, which may be extended with approval; may use accrued time for salary coverage | Fathers, non-birth, foster parents |
Washington University in St Louis, St Louis, Missouri | None | May take 6 wk for a vaginal delivery and 8 wk for a cesarean delivery as short-term medical disability leave; employee must cover the first wk (elimination period) with sick or vacation time, after which salary coverage for remaining time off is 100% paid | 4 wk | Limited to 8 wk within 5 y | Adoption, foster, surrogacy |
Yale University, New Haven, Connecticut | None | Managerial staff: 10 wk (2 wk prior to due date plus 8 wk after birth) may be taken as short-term disability leave, after spending down sick accruals until 5 d remain, then 100% salary coverage for remaining time off up to 8 wk and 60% salary coverage thereafter; may use PTO or remaining sick time to augment other 40% of salary coverage; clerical staff: 8 wk may be taken as unpaid leave for a vaginal delivery (2 wk prior to due date plus 6 wk after birth) and 10 wk for a cesarean delivery (2 wk prior to due date plus 8 weeks after birth); may use short-term disability leave if enrolled for partial salary coverage; may augment salary coverage with accrued time | 4 wk (managerial); none (clerical) | May take up to 26 wk of leave in total, but must use accrued time for salary coverage or take unpaid leave for any time off not covered by paid family leave; does not apply to foster parents; must have passed 90-d probationary period | Fathers, adoptive parents |
Abbreviation: PTO, personal time off.
Medical schools selected as in Riano et al.1 Selected schools were among the top 10 in either the US News & World Report (https://www.usnews.com/best-graduate-schools/top-medical-schools/research-rankings) or the Blue Ridge Institute for Medical Research (http://www.brimr.org/NIH_Awards/2016/NIH_Awards_2016.htm) rankings for 2016. Because many schools were on both lists, the search resulted in 12 unique schools.
The table describes leave policies applicable to benefits-eligible employees, which may include full-time, part-time, temporary, and permanent staff depending on institutional criteria. Childbearing leave applies to birth mothers. Family leave applies to birth mothers, non–birth mothers, fathers, adoptive parents, foster parents, and guardians.
Only 100% base salary support without a waiting period or spend-down requirement is included. Leave does not include vacation time, medical leave, sick leave, short-term disability leave for those with disability extending beyond sick leave, or other paid time off.
Two institutions (17%) had childbearing leave policies with full salary support for 6 weeks. Eight institutions (67%) offered partial salary support. Six institutions (50%) had family leave policies with full salary support, with a mean (range) length of 3.8 (1-6) weeks. Three institutions (25%) offered partial salary support.
Of the 11 institutions that offered any salary support for childbearing or family leave, most imposed constraints, such as a minimum prior amount of time worked (n = 9; 82%) or a waiting period or spend-down requirement (n = 6; 55%) before paid leave could be taken. Three institutions (25%) had policies that differed between professional/managerial and clerical/support staff.
Discussion
Only 2 of 12 leading US medical schools provide fully paid childbearing leave for all staff, in contrast with leave provided for faculty (100%)1 and residents (47%)2 in studies conducted with similar methods. The mean duration of leave for staff (6.0 weeks) was less than that for faculty (8.6 weeks) and similar to that for residents (5.7 weeks).1,2 At 3 institutions, leave policies differed by staff titles, highlighting further institutional disparities among employees. Because administrative staff are among the lowest-paid individuals at medical schools, they are at increased risk of attrition when family leave is unpaid.3
The study’s generalizability may be limited because we surveyed only 12 schools. We focused on institutional policies for paid leave, but actual salary coverage may differ from written policies. State-sponsored leave and individual departmental leave policies were not assessed. Policy changes made after confirmation in summer 2019 may not be reflected. We used medical school faculty and residents as the relevant comparators for administrative staff; however, these are not equivalent positions at other employers in the community. That said, from the perspective of promoting equity in the workforce, it can be argued that family leave policies should be adequate and uniform across organizations, regardless of the type or tenure of employment.
Despite the benefits of paid childbearing leave for both mother4 and child,5 as well as support by the American Academy of Pediatrics of proposed legislation requiring 12 weeks of paid leave,6 there is no federal mandate for employers to provide paid childbearing leave. Given that administrative staff are critical to the functioning of medical schools, instituting more generous childbearing and family leave policies would be an opportunity for the medical profession to lead by example in promoting equity and well-being in the workforce.
References
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