An overview of family leave in IR
By John T. Moon, Ilana Breen, Ashmit Mittal, and Meridith J. Englander, MD, FSIR Summer 2019
The expectations and requirements placed on physicians and physicians-in-training can make integrating family and career a challenging prospect. As stated in the SIR position statement on parental leave, becoming a parent should not be a barrier to career progression, nor should it indicate a physician’s dedication to their field and aspirations therein. Yet, residents and attending IRs encounter a wide range of responses when they announce that they are expecting a child, and not all practices and training programs are supportive. The authors believe that taking time off when a family has a new child should become both expected and normal.
The roots of today’s leave practices can be traced back to 1993, when the U.S. Department of Labor’s Family and Medical Leave Act (FMLA) mandated that employers provide up to 12 weeks of unpaid leave to eligible employees.
Eligibility for FMLA leave include but are not limited to:
- Birth of a child and care for the newborn child within 1 year of birth
- Placement of a child for adoption or foster care with the employee and care for the child within 1 year of placement
According to the most recent American College of Radiology Commission on Human Resources Workforce Survey, the most commonly cited reason for FMLA leave in radiology was for care of a newborn or adopted child (57%), with women taking an average of 10.7 weeks and men taking an average of 4.7 weeks. The average number of paid weeks was 8.8 weeks for women and 4.0 weeks for men.
Paid maternity leave policies in the field of medicine (and in radiology) lag far behind those of other industries within the United States, such as the technology industry, in which paid maternity leave can range from 16 to 26 weeks. At baseline, however, the United States offers no statutory entitlement to paid maternity leave.
The resident and residency dilemma
According to the American Academy of Pediatrics, scientific evidence extols the benefits of 12 weeks of paid family leave for both parent and infant. With the profession’s current emphasis on evidence-based medicine, why are institutions not translating findings and recommendations on paid family leave into evidence-based practices?
One answer may be institutional variability. In other professions, paid parental leave is more ubiquitous, but medicine poses a unique challenge in that vast institutional diversity complicates the creation of a universal policy. Institutions vary by department size, residency program size, budget, workloads, patient volume, call schedules and work culture, among other factors. These actors result in a dilemma for both residents and residency programs.
For residents, the factors combine into significant attitude-based, practical and wellness-related problems. Child-rearing residents are not only expected to advocate for and negotiate for paid leave without established policy but, in addition, are likely to encounter both overt and covert discrimination. Pregnant residents report resentment from colleagues, including co-residents and faculty, perhaps due to corresponding scheduling conflicts. Moreover, the absence of formal leave policies has contributed to delayed childbearing, the use of assisted reproductive technology and difficulty maintaining breastfeeding. Because women more commonly take parental leave, female residents are disproportionately impacted by the dearth of support, perpetuating the gender gap in radiology. These residents may also suffer from increased burnout and unfulfilling work–life balance.
Residency programs face a dilemma around supporting their residents’ individual needs while balancing institutional goals. They have an obligation to maintain adequate training programs that comply with board requirements. At first blush, limiting parental leave and enforcing maximal leave (for any reason) appears to support resident training, secure a new workforce of safe and competent physicians, and stabilize the health care delivery system (i.e., by reducing resident flux and scheduling workarounds).
However, Cornell radiologist and American Association of Women in Radiology (AAWR) President Elizabeth Kagan Arleo, MD, quoted the Harvard Business Review in saying that “forward-thinking companies recognize that generous paid parental leave and other family-friendly policies provide reputational benefits, confer a competitive edge in recruitment, and increase employee productivity and retention.” That is, improving the work environment and supporting workers’ needs, including parental benefits, confer long-term advantages not captured in the myopic view of individual resident and even attending physician leave.
In her article, Dr. Arleo further cites financial studies conducted at Google wherein the cost of 12 weeks of parental leave and retaining an employee was equivalent to the cost of searching for, hiring and training a new one. Extended parental leave policies may also lead to decreased burnout (which is currently placing an enormous burden on the health care system), thus potentially serving as a conduit to counteract the physician depression and suicide crisis.
The current landscape
In 2017, the Society of Interventional Radiology endorsed a position statement encouraging 100% paid parental leave for at least 6 weeks. The AAWR supports 12 weeks of paid parental leave. The AAWR position is also shared by the Society of Chairs of Academic Radiology Departments (SCARD), which endorsed this policy last year. In this policy, department chairs committed to providing their employed radiologists a full 12 weeks of paid parental leave.
At present, 22 of 24 specialty medical boards have leave policies; however, only 11 mention parental leave as a potential reason for a resident physician to take leave. The current lack of standardization regarding parental leave policies, and the surrounding cultural attitudes, leave much to be desired. Last year, the American Board of Radiology (ABR) amended its policy about leave during residency, indicating that it does not have specific requirements about leave during training, which is left to the discretion of the program director. In addition, the policy changed this year to allow residents to take the Core examination after only 32 months of training, instead of the usual 36 months. This change will allow for up to a 4-month leave from training without affecting board eligibility.
This past spring, the Association of Program Directors in Radiology (APDR) endorsed a policy that encourages radiology trainees to take up to 12 weeks of parental leave, as allowed under FMLA. This policy does not offer paid leave, but it does offer support to residents and provides a message that parental leave is important and should be taken by new parents. The APDIR is currently reviewing this policy. Hopefully, this can be implemented in the new IR/DR residency.
With the support of professional societies and increasing awareness of the problems surrounding current parental leave policies, the specialty is well positioned to transform policy recommendations to departmental and institutional change. Further action is necessary, and leaders and policy makers should explore options to mitigate the burdens of parental leave on individuals, practices and training programs. Some options to explore may include incorporating part-time training opportunities and extensions of federal reimbursement for graduate medical education loans for parental leave. The published policies and position statements reflect both past and current developments in parental leave policies. Emerging recommendations seek to advance the well-being of radiologists and elevate the specialty as a whole. As a community, we should endeavor to further discuss, refine and enact these recommendations to sufficiently meet existing needs.