In a recently published article in Pediatrics, the American Academy of Pediatrics (AAP) provides an updated policy statement regarding parental leave for residents and fellows (10.1542/peds.2021-055988). This article builds significantly on a prior policy statement by broadening its scope and providing actionable items that may help training programs better navigate potential barriers that make time away for parental leave more difficult to implement in a training program.
The benefits of paid parental leave are plentiful and are well documented in the literature. Paid leave is associated with reduced infant mortality and maternal depression, a propensity for on-time well child checks and vaccine administration, as well as a higher likelihood of continued breastfeeding at 6 months postpartum.1,2,3 Yet, many programs fail to guarantee residents and fellows the AAP’s recommended 6 to 8 weeks of paid leave. This is especially true for non-birth parents such as fathers, same sex couples, and parents who adopt or choose surrogacy. A recent survey of surgical residents showed that nonchildbearing parents received only 1 or 2 weeks of paid leave.4
The barriers to paid or unpaid parental leave within training programs are both structural and cultural. For instance, the Accreditation Council for Graduate Medical Education (ACGME) requirements do not often allow enough time for trainees to adequately take parental leave without delaying graduation. Board examination dates offered only once a year limit flexibility for parents, possibly leading to a delay in certification and a later entrance into the workforce. Additionally, a lack of protected time and space to pump at work, a paucity of affordable childcare options, and a culture that allows for verbal criticism from colleagues about parental leave, adds further challenges.
A key recommendation in this policy statement is that the ACGME guarantee 12 weeks of leave (at a minimum) and expand its terminology from “maternity” or “paternity leave” to include gender-neutral and non-birth parents. It strongly recommends that programs continue to advocate for paid leave given the significant financial impact that parental leave without pay can have on trainees and their infants. They suggest reevaluating the academic calendar and board certification dates to allow for increased flexibility. Additionally, the authors emphasize the importance of promoting a culture that supports all trainees who become parents by developing less strenuous rotations and making schedule adjustments to facilitate pregnant and returning trainees, as well as providing all staff with dedicated lactation time, space, and equipment.
Perhaps coincidentally, this policy statement comes on the heels of President Biden’s failed attempt to pass a national paid leave program, which I wrote about this past summer. As leaders in health care, we should be helping to shape a future which includes national paid parental leave for all patients and their families. This starts within our own healthcare systems. We can stand up for the physical and mental well-being of all medical staff and their children including nurses, respiratory therapists, medical assistants, and others by providing a uniform, substantive and encompassing policy on paid parental leave. If we fail to lead in this way, how can we expect the rest of our country’s policy makers to do so?
References:
- Snyder, Brandy. “United States Paid Parental Leave and Infant Mortality.” International Journal of Sociology and Social Policy, vol. 40, no. 1/2, 2020, pp. 145–153., https://doi.org/10.1108/ijssp-10-2019-0197.
- Choudhury, Agnitra Roy, and Solomon Polachek. “Diuin Pap I - Iza Institute of Labor Economics.” The Impact of Paid Family Leave on the Timing of Infant Vaccinations, July 2019, https://ftp.iza.org/dp12483.pdf.
- Hamad, Rita, et al. “Paid Family Leave Effects on Breastfeeding: A Quasi-Experimental Study of US Policies.” American Journal of Public Health, vol. 109, no. 1, 2019, pp. 164–166., https://doi.org/10.2105/ajph.2018.304693.
- Sandler, Britt J., et al. “Pregnancy and Parenthood among Surgery Residents: Results of the First Nationwide Survey of General Surgery Residency Program Directors.” Journal of the American College of Surgeons, vol. 222, no. 6, 2016, pp. 1090–1096., https://doi.org/10.1016/j.jamcollsurg.2015.12.004.
