A Doctor's Perspective on Paid Parental Leave
Author: Lauren Rissman, MD
I stood on rounds, presented my patient, and felt the tingling sensation as milk began to letdown. Even though I wasn't due to pump yet, my crying patient triggered my body’s natural reflex. It was six weeks to the day after my daughter was born that I returned to work in the cardiac intensive care unit and my own daughter remained admitted a few walls over in the neonatal intensive care unit. Tape marks still ran across my arms and abdomen like train tracks; half of my cesarean incision was still numb. I was expected to care for everyone else's child except for my own.
I share our story, not because mine is the outlier, but because mine is the expectation. On paper, I returned to work of my own volition despite feeling both physically and emotionally unready. Six years into post-medical school training and just a few months away from pediatric critical care graduation, I couldn't stop. With a second fellowship starting across the country a week after the first fellowship ended, I couldn’t extend training. And with unanticipated medical bills, childcare, moving costs, and living expenses in an expensive city, I couldn’t afford to take more time off. When I began feeling sick before our preterm emergency delivery, my attending encouraged me to seek medical care. I distinctly remember sharing that I could not leave the unit because it would cost me time I had built up for parental leave. I was stuck.
In America, new parents are made to feel we are inadequate when, in fact, the support we receive is inadequate. European countries have some of the most supportive, government-mandated parental leave policies in the world. In Croatia, parents receive 28 days of paid leave prior to delivery and 70 days of paid leave after birth or until the child turns 6 months old; adoptive parents receive the same benefits. In the United Kingdom, new parents are entitled to 90% of your income for 39 weeks; adoptive parents receive the same.
In America, the Family Medical Leave Act (FMLA) protects new parents by providing mandatory 12 weeks of unpaid leave from a job—that is, if they've been hired for at least 1 year and worked 1,250 hours. Outside of this federal mandate, a few states provide paid family leave at 67% average weekly wages for 12 weeks; individuals living in these states are eligible for paid leave if they do not work for not-for-profit institutions. Throughout the rest of the country, employers are left to place value on a new parent’s worth in relation to parental leave and compensation. Amazon provides 20 weeks, General Motors provides 158 days, Google provides 24 weeks of paid parental leave.
Shockingly, medical providers in America receive far less support than other workers. The American Medical Association (AMA), the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) provide guidance and statements about the importance of bonding, breastfeeding, Kangaroo Care, parental leave and exercising after delivery. In medicine, we are expected to work more days pre-delivery, take shorter parental leave and receive less pay post-birth. Female surgeons experience higher rates of miscarriages, preterm labor, and pre-eclampsia. Women physicians generally delay childbearing due to training and work conditions. Night shifts and 24-hour workdays contribute to preterm labor. The evidence is there— published by our own colleagues. Why are we actively ignoring it?
It boils down to economics. In Europe, individuals pay higher taxes in exchange for government-provided social services, including paid parental leave. At companies like Amazon, General Motors, and Google, paid parental leave benefits are part of a comprehensive compensation package and are used to incentivize their employees and generate loyalty; though employers retain the right to terminate workers. For physicians, there is job security. Hospitals offer multi-year contracts, higher than average salaries and scheduling flexibility but little paid parental leave.
Providing paid parental leave is costly and options are limited. If leave was funded by institutions, individual pay could decrease. Alternatively, hospitals could cut expenses by reducing services elsewhere. Fewer transport personnel, fewer imaging machines, fewer clinic days could decrease a patient’s ability to receive timely and effective care. Government provided parental leave would call for a collective political will and would need to be funded through a combination of increased taxes or reduced services. I appreciate President Biden’s effort, but if the solution was easy to fix, it would have already been implemented.
Women now make up more than 55% of medical school enrollments. A recent study found that nearly 40% of female physicians work part-time or leave medicine within 6 years of completing residency. If we continue to feel unsupported, we will leave. Ultimately, our withdrawal will reduce both the quality and quantity of patient care. Rather than protecting this valuable asset, many hospitals provide little support for families in the early stages of career development. Now more than ever, providing paid parental leave for physicians should be a priority.
My job includes performing chest compressions to save someone’s life. Yet, I feel more stressed from unstable childcare, difficulties finding colleagues to cover for parental leave, and being able to support my family. Investing in us as productive and effective physicians means investing in us as individuals and parents as we lay the groundwork for future generations while providing care for everyone.
Acknowledgements: Ellen Rissman, Ph.D for sharing an economic perspective; Jacqui Ponczek, MD for helping to provide resources and edits.
About the author: Dr. Lauren Rissman is a pediatric critical care and palliative care physician. She is passionate about communication, ethics, narrative writing and her daughter, Juniper (Twitter: @DrRissman)
