Rethinking Parental Leave in Medicine

In a group text of female physician-CEOs, a colleague recently asked how to handle a parental leave request. Her small staff was already stretched thin, and a clinician who had just returned to work after having a child was now requesting more time off. My colleague wanted to say “yes” — she could still feel the sting of not getting parental leave herself years ago — but she knew the clinician's absence would mean more work for the team.

Personal stories poured into the text thread. One physician had received only four weeks of leave during residency and was told that if she took more time off, she would have to repeat the year. Another doctor had worked full time while on bed rest for preterm labor, answering phones, refilling prescriptions, and charting from a laptop propped on pillows. Another said she offered her staff generous leave, but recalled doing double the work for three years when her associate had three babies back-to-back-to-back.

The spillover of emotions quickly made it clear: Women who are in the decision-making seats of many practices now want to create a dramatically different culture for physicians having babies today.

I received zero paid leave with my four children. But I was allowed some flexibility that taught me what is possible, even inside a rigid system.

When my first child was born during residency, the idea of leaving her after just a few weeks to return to an 80-hour-a-week job felt unbearable. I pleaded with my residency director to work part-time. Instead, he suggested two months of flexible time that counted toward residency. For one of those months, I did a breastfeeding research rotation. I stayed home longer, studied something I was living through, and graduated on time. I never forgot his willingness to find a creative solution.

Years later, when I bought my practice, the first change we made was to create a parental leave policy. The business had existed for 35 years without one. Since then, we've celebrated a small parade of babies.

As a practice owner, here are six things I've learned about how to make parental leave work:

1. Mindset comes first. Believe that we can give what we did not get.
2. Get creative with scheduling. If you can't give a block of leave, offer flexibility with phased returns, remote research, administrative projects, or job-sharing.
3. Plan financially. Covering a physician for three months or more isn't cheap. Add parental leave coverage as a line item in your annual budget — a policy is only sustainable if the dollars are there to back it. Cross-train staff in advance so one absence doesn't overwhelm the team.
4. Change the culture, not just the policy. Normalize taking leave by discussing it in staff meetings, celebrating new babies, and taking leave yourself. If people feel they'll be judged for taking leave, many won't, even if it's available.
5. Support colleagues who provide backup. Covering for someone on leave is hard. Build backup systems: temporary hires, locums, adjusted patient loads, etc. Check in with staff to see how they're doing and make sure they're not burning out. Expressing gratitude is part of it, but it's not enough. Create systems to handle the overload fairly.
6. Ask the expecting parent what they need. Compare parent experiences before and after your policies change. The benefits should compound. When doctors and the team feel cared for, they stay longer, they work better together, and patients feel the difference.