Editor’s Note: Krista Roncone, MD, is a resident physician in pediatrics at the University of Virginia. She is interested in medical education and health disparities research, and is considering integrating these components into a career in pediatric hospital medicine or critical care.
-Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
It is not hard to remember the feelings of hope and uncertainty I had when I officially decided to pursue medicine. I recall a specific moment sitting up late at night crouched under the light of a microwave and cheap kitchen college table, on top of which was a long pro and con list. On one side: years of training, debt, delaying child bearing years, absence of a predictable parenting schedule. On the other side: my dream. So, I did it anyway.
An article from Drs. Kelsey Miller and Lois Lee, physician advocates at Boston Children’s Hospital, being early released this week in Pediatrics, touches on these exact matters (10.1542/peds.2022-056338). As the authors point out, pediatricians are perhaps the most acutely aware group in medicine of the importance of parent-infant bonding, child development, promotion of breastfeeding, and deep appreciation for the sacred time of a growing family.
While we make our best efforts to directly counsel our patients on the importance of these matters and take time to advocate for the general public, we have at times struggled to incorporate these ideals within our own systems. While we are well-versed in the benefits of paid parental leave, many medical schools, residency programs, and health care systems do not provide this important benefit in a way that is practical, financially realistic, or reliably accessible. While it is true that some institutions may offer paid parental leave, this is often done such that the leave forces the trainee to divert their career in significant ways that create long term and downstream inequities. For example, while a residency program might offer the possibility of paid parental leave, this often requires that residents extend their training time, which in turn also prohibits them from advancing to fellowship on time. In later years of training, this same delay may translate into delayed transition into faculty or leadership positions.
While the challenges of paid maternity and parental leave are issues that we face, not just in medicine but in society at large, the authors lay out a framework of goals for paid parental leave within the medical profession, specifically with regards to those in graduate medication education. They propose several foundational points that include but are not limited to:
- Advocacy for a paid maternity/parental leave period of 12 weeks
- Ensuring that trajectory to fellowship is not detrimentally impacted by maternity/parental leave periods
- Inclusion of adoptive and foster parents in maternity/parental leave policies
Moreover, discussion surrounding maternity leave policies often includes the recognition of how inequities between genders are magnified. The authors uniquely point out how critical it is to recognize that lack of adequate maternity leave policies not only creates gender-based inequities, but also magnifies racial and ethnic inequalities. As the authors note, there are higher rates of educational debt among under-represented groups in medicine, and hence a further financial challenge such as unpaid or under paid leave policies may further exacerbate any pre-existing disparity.
As pediatricians, we strive to have our workforce include a diverse population of physicians with deeply ingrained values of trust, honesty, and respect for the powerful and symbiotic bond between parent and child. The authors point out that a reliable parental leave policy would allow us to attract and retain this exact population.
Years later, as I write this article, my lighting is slightly better, and my kitchen table marginally more sturdy. Each day, I am humbled by the privilege of taking care of the children of others and am reaffirmed in my decision to pursue medicine. Looking back, I now see that the things that made me worried about my decision were the exact underlying values that I believe make me and my peers successful at our work. Looking forward, I see there is still much work to be done. As the authors of this article point out, we are currently witnessing a key moment in our national dialogue about supporting women and parents in society at large. Pediatricians have an opportunity to lead this important undertaking, first by example.