The Family and Medical Leave Act of 1993(www.dol.gov) entitles nonmilitary, eligible employees to take a total of 12 workweeks of leave each year for specified family or health-related reasons, including for the birth or adoption of a child. Whether any of that leave is paid, however, remains at the discretion of the employer.
The U.S. Supreme Court in 2011 ruled that residents are, indeed, considered employees,(www.nejm.org) so they are in most instances covered by FMLA. The caveat is that FMLA eligibility is determined, in part, by whether an employee has been employed for 12 months and worked at least 1,250 hours during the 12 months before FMLA leave is taken. Thus, first-year residents may not be eligible for FMLA leave.
AAFP policy adopted in 2000 and reaffirmed in 2017 outlines the tenets of a comprehensive parental leave plan for FM residency programs. Among other things, the policy recommends that programs encourage residents to "take the longest leave that is feasible" to facilitate parent-infant bonding; specify whether leave is paid or unpaid; and clearly communicate to residents the impact parental leave will have on their graduation and ability to sit for the ABFM exam.
But now a study in the October issue of Family Medicine(journals.stfm.org) that examined parental leave policies and practices in FM residency programs has found wide variation among programs, as well as strong ties between the amount and type of leave offered and taken by residents and faculty in the same programs, suggesting that institutional factors affect how parental leave is used.
- New research shows considerable differences in parental leave policies and practices at family medicine residency programs throughout the United States.
- On average, programs allowed residents to take 11.5 weeks of combined paid and unpaid maternity leave.
- Almost 30% of residency programs offered no paid maternity leave to residents or faculty members, and almost 40% offered no paid paternity leave.
Study Details and Methods
The researchers invited 478 FM residency program directors across the United States to complete an online survey seeking information about parental leave policies. Specifically, they were asked to describe the maternity and/or paternity leave most recently taken by residents and core faculty members. Other questions focused on whether programs had a rural focus or rural training track, the relative percentages of female residents and faculty members, and whether new parents were offered elective rotations with fewer work demands.
Program directors who didn't respond initially received multiple follow-up email reminders. Overall, 261 program directors completed the survey.
The researchers uncovered a wide range of paid maternity and paternity leave policies. Perhaps most notably, almost 30% of residency programs offered no paid maternity leave to residents or faculty members, and almost 40% offered no paid paternity leave.
Of programs that did offer paid maternity leave, most offered six weeks or less. Only two programs offered more than 12 weeks of paid maternity leave to either residents or faculty.
Adding unpaid leave to the equation boosted residents' average allowed leave totals to 11.5 weeks of combined paid and unpaid maternity leave and nine weeks of paternity leave. Faculty were allowed an average total of 12.8 weeks maternity leave and 10 weeks paternity leave.
Four residency programs offered no resident maternity leave at all, and 10 programs offered no resident paternity leave. In addition, four programs offered no maternity leave for faculty, and 12 programs offered no faculty paternity leave.
On the upside, more than 73% of residency directors surveyed stated that their program offered an at-home elective option for new parents.
Andrea Wendling, M.D., the study's corresponding author and a professor in the Department of Family Medicine at Michigan State University College of Human Medicine in East Lansing, told AAFP News that the survey did not gather explanatory information from residency programs on their leave policies.
The amount of paid family leave residents and faculty actually used was significantly less than the amount of paid leave offered by an average of 0.5 weeks to 1.6 weeks. Overall, faculty and residents at smaller residency programs and residents at rurally focused programs took less total maternity leave than those at large and nonrural programs.
Regarding whether institutional factors play a role in the use of parental leave, the researchers found strong associations between the amount of paid leave offered residents and the amount offered faculty at the same program, and between the amount of paid and total parental leave that was available but not used by faculty and the amount available but not used by residents at the same program. "This supports the concept that organizational culture, including modeling by faculty and the hidden curriculum, may at least partially impact these decisions," the authors wrote.
Authors Call for Action
Expressing surprise at some of their findings, the authors called for systemic changes.
"Although many programs supplement parental leave with at-home elective options for residents, our research demonstrates a surprising lack of universal support for parental leave among academic FM programs," they wrote. "This finding runs counter to the family orientation of our specialty and the fact that many residency and academic medicine programs and organizations have called for family-friendly parental leave policies for faculty and residents."
The authors noted that the Accreditation Council for Graduate Medical Education has no specific policy on resident parental leave; rather, leave policies are determined by the medical specialty boards. Because time missed due to the birth of a child can extend residency training and therefore interfere with the start date of a job or fellowship or run afoul of board-certification timelines, some residents may take less leave than offered. They suggested the ACGME consider more strictly regulating parental leave policies to provide better support for residents and faculty.
The authors also observed that the AAFP does not recommend a specific duration for parental leave. Such a recommendation "could support the development of more uniform and family-friendly policies," they wrote.
"Despite AAFP support for policies that encourage time away from work duties for new parents, there remains large variability in parental leave policies among FM programs and variable benefit from the policies that do exist," the authors concluded. "FM residency programs should be aware of the many factors that influence resident and faculty comfort with taking time away from the workplace after the addition of a child and should encourage an environment that supports new parents."
Corresponding Author Comments
Wendling provided additional insight in this brief Q&A.
Q: What's the take-home message of this study for family physicians?
A: Parental leave tends to be a temporally acute issue for residents and for early career physicians. Developing and communicating supportive parental leave policies provides an opportunity to highlight our own professional values and support new physicians entering our discipline. Negotiating parental leave may be especially difficult for physicians in small practices or those working in rural/underserved areas. By having clear professional policies in place and working to build a culture that can support those policies, we may be able to address one of the barriers that currently exist for caring for vulnerable populations.
Q: The findings suggest that institutional culture may be responsible for the way parental leave is used. What can be done to change that culture?
A: Culture is difficult to change, but we are hoping that through our work faculty might be empowered to use their own leave more deliberatively, inadvertently creating structures along the way to address this predictable workforce issue. Hopefully, then programs could use these structures to provide a more supportive framework for their residents, as well. We believe that academic programs and residencies have good intentions, but might often respond reactively to singular leaves, rather than stepping back to think creatively about how to build the framework needed to do this well. We are hoping our evidence could be used to start these types of conversations.
Q: What role could the AAFP play in standardizing parental leave policies?
A: The AAFP parental leave policy is supportive and encouraging but stops short of providing any specific recommendations. With the absence of specifics, the leave policy may be interpreted in a less supportive way than it was intended. This is an opportunity for our discipline to highlight our professional values. Clearly, the AAFP cannot mandate employers to provide benefits, but professional policies may be used as a starting point for negotiations.
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Delegates Act on Family Medicine Education Issues