Paid maternity and parental leave has multiple proven health benefits for both parents and infants, including improved maternal mental health, decreased intimate partner violence, decreased infant mortality, increased infant vaccination compliance, decreased risk of rehospitalization for both mothers and infants, improved parental–infant attachment, and increased initiation and duration of breastfeeding.1,2 Longer paid childbirth and parental leave are also important for job satisfaction and wellness.3,4 Despite this, the United States is the only country among the 43 members of the Organization for Economic Co-operation and Development without a national paid maternity or family leave policy.1,2 Recent attempts to guarantee 12 weeks of paid leave after welcoming a new child by birth, adoption, or foster care failed in Congress, despite lobbying from the American Academy of Pediatrics and other advocates. The current status quo leaves many American working families without guaranteed paid leave. The lack of paid leave increases the challenges of parents and their infants in achieving optimal health outcomes, with disparate impacts on women, communities of color, and individuals of lower socioeconomic status.2 For the American Academy of Pediatrics and other professional health organizations to campaign for increased paid family and medical leave, we must become credible advocates. As pediatric clinicians, dedicated to promoting the health and well-being of families and children, we should be leading the way.
Despite the evidence for the health benefits of paid leave, hospitals, medical schools, and graduate medical education programs often do not provide these benefits to trainees, physician faculty, and administrative staff.5–8 Trainees are often required to extend training and are not guaranteed salary compensation if they wish to take 12 weeks of leave.6,8 Lack of paid leave makes it harder to retain women and individuals from underrepresented racial, ethnic, and socioeconomic groups in the health care workforce at a moment when we are striving for increased diversity. Increased financial concerns, including higher rates and magnitude of educational debt, are recognized barriers to the advancement of individuals underrepresented in medicine.9 To increase and then retain the diversity of physicians in pediatrics and all fields of medicine, there must be intentional efforts to support paid parental leave.
While continuing to advocate for national change, we should not delay implementing optimal maternity and parental leave policies for physicians and physicians-in-training through the following actions:
Encourage physician professional organizations to advocate for 12 weeks of paid maternity leave for physicians and paid parental leave for nonbirth physician parents at the institutional level.
Advocate for policies at the residency and fellowship level to ensure trainees are allowed 12 weeks of paid parental leave during training without a detrimental impact on their training trajectory or finances. Trainees who take parental leave need to demonstrate satisfactory progress to their programs and credentialing bodies, which may require extending training. Supporting 12 weeks of paid leave will entail both increased efforts for competency-based medical education and for ensuring those who need to make up training time are not penalized for delaying subsequent training programs or faculty positions. For example, the American Academy of Pediatrics has proposed solutions including rolling start dates for training programs and flexible board examination to eliminate the need to postpone certifying examinations and employment.8
Increase the length of paid maternity and parental leave available for faculty at academic medical centers, hospitals, and practices to a minimum of 12 weeks of paid maternity leave for birth, adoptive, and foster primary caregivers of new infants, as well as a minimum of 4 weeks of paid parental leave for nonbirth parents. Concurrently, academic institutions should remove waiting periods during which new faculty are ineligible for parental leave; many physicians are beginning their faculty positions at the same time they are starting their families. We advocate for starting with academic centers, recognizing that providing 12 weeks of paid leave to pediatricians and pediatric subspecialists working in smaller practice settings poses greater challenges. These solutions require other innovative approaches such as labor- and wage-sharing pools to support flexible staffing across practices.
Publicly share parental leave policies to ensure policies are transparent, consistent, and equitably applied to all physicians and physicians-in-training at a single institution or practice. In addition, it will allow for disseminating institutional best practices and making this information easily available to physicians-in-training and faculty during recruitment.
Proactively address the academic productivity disparities that can result from faculty taking parental leave. Taking parental leave can have costs outside the financial realm for new parents, including decreased academic productivity and slower promotion.10 Promotion and Tenure committees should have specific published policies on how to address such leaves to ensure equitable treatment of faculty who take parental leave and those who do not. Such policies will also benefit faculty taking other forms of leave, including to care for a sick family member or to manage their own health conditions. In addition, Promotion and Tenure committees should include members representative of diverse parenting experiences.
In advocating for these changes, it is important to consider the economic feasibility of increasing paid leave and acknowledge concerns about economic losses for employers. Paid leave has important and well-documented economic benefits.1,2 Detailed analyses of the Organization for Economic Co-operation and Development and United Nations countries document the economic feasibility of paid parental leave.11,12 Women who have access to paid leave are more likely to achieve job and wage stability. Fathers who receive paid leave experience increased engagement in the home, facilitating mothers being able to return to work sooner, increasing their earnings. Thus, paid leave is important to ensuring participation by and preservation of women in the pediatric workforce.2,11,12 Economic modeling has revealed cost savings by offering paid leave of up to 14 weeks in clinical medicine due to increased retention of female faculty.13 Increased funding for parental leave will have multiple human resource and financial aspects to consider to ensure equitable treatment of all employees and preservation of other benefits without incurring financial losses. As a critical first step, organizations must dedicate resources and staff to assessing and addressing the costs, benefits, and mechanisms of funding parental leave.
As health care institutions, our mission is to improve and optimize the health and wellbeing of our patients, but we must also advocate optimizing the health and well-being of those in our profession, including physician parents and their children. We have the greatest agency over the maternity and parental leave policies within our own hospitals, practices, and training programs. We must be examples of best practices regarding maternity and parental leave. Only then can we truly and honestly advocate for paid maternity and parental leave for all families on the national stage.
Dr Miller drafted the initial manuscript, conceptualized the perspective piece, and reviewed and revised the manuscript; Dr Lee conceptualized the perspective piece and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: No external funding.
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.