Parental/Maternity Leave

This is the second post in a new series from #RADxx members who attended AAWR lectures at ACR 2018. Today, author Dr. Shannon Kim shares her perspective on the session Maternal/Paternal Leave featuring speaker Dr. Susan Ackerman.

During this year’s AAWR Women’s Caucus, the topic was focused on the discussion of parental/maternity leave. Dr. Susan Ackerman started off the caucus with giving congratulations to the newly induced ACR Fellows. Next, the floor was opened for attendees to share their experiences regarding parental leave at their respective institutions.

Multiple institutions rely on the Family and Medical Leave Act (FMLA) of 1993, which consists of 12 weeks of unpaid leave, which can be used for maternity leave, adoption or foster care placement, care for immediate family members, or for the employee’s own serious health conditions. To qualify for FMLA, the employee must be employed with the company for 12 months, have worked at least 1250 hours during the 12 months prior to FMLA leave, and the employer is one who employs at least 50 employees. Several issues stemmed from the clarification of the FMLA requirements:

• The requirement for the employer to have at least 50 employees could pose a problem for small radiology groups.

• Even if you were part time, you still have to meet the minimum threshold for 1250 hours worked within a 12-month period.

• Adoption is already a huge financial burde and then you’re forced to take unpaid leave.

Although the FMLA is a federal act, it is still for unpaid parental/maternity leave. It was brought up that the United States (U.S.) is one of the very few countries in the world with no paid parental/maternity leave. According to The New York Times in 2013, there were only eight countries without paid maternity leave, including: the U.S., Liberia, and Papua New Guinea.

The discussion then shifted to the importance of working with our governing bodies, including the ACR and the AMA, to develop a consensus statement on parental leave for radiologists (or all physicians). Several medical specialty societies have already followed suit, including the Society of Interventional Radiology (SIR):

• SIR Statement on Parental Leave- “If the IR physician is eligible for FMLA, the physician is encouraged to use the allowed leave. SIR encourages institutions exempt from FMLA to voluntarily allow new parents the opportunity to take unpaid leave consistent with that provided by FMLA if requested. SIR supports maternity leave of no less than 6 weeks for vaginal delivery and no less than 8 weeks for cesarean delivery. In addition, SIR supports paternity leave of no less than 6 weeks. Parental leave should be separate from vacation time and sick leave. Planned and unplanned medical events can keep physicians away from work for extended periods of time. In most practices, it is a courtesy to the ill or injured not to require making up call time missed while recovering. Similarly, physicians on parental leave should not be required to make up missed call time. SIR recognizes the importance of and encourages IR employers to provide paid parental leave. Paid parental leave includes maintenance of full benefits and 100% of pay for at least 6 weeks.” Link to SIR Statement

Further discussion stressed that the overall crux is on the federal government which doesn’t mandate paid leave, so ideally this issue needs to rise up to the level of the AMA.

The active discussion then continued with attendees discussing parental/maternity leave policies at their institutions:

• Military: Moving towards 12 weeks of paid maternity leave, which was previously 6 weeks. Also, paternity leave is 2 weeks.

• Small radiology group:Get your call covered during your FMLA time off, but you’re still responsible to make up 100% of your call.

This sparked discussion of the cost to cover the call of a radiologist on parental leave. If the group has to bring in a locums radiologist to cover, where does the cost come from? A valid point was then mentioned—men take more time off later in life due to illness, while women do it early in life due to family/kids, therefore, it should balance out in the end. At UCSD (an example of an academic institution), they write a reserved amount of money in the budget to cover 6 weeks of paid time off.

Everyone agreed that departments/institutions will lose talented women if they do not provide support for parental leave. This may also negatively impact women choosing to pursue a career in radiology. A radiology resident from Vermont, who is currently pregnant, shared that her program provides at least 6 weeks of paid leave (which can be up to 8 wk if needed). She also disclosed that she will choose a job based on how supportive the radiology group/department is.

Someone shared their experience of interviewing for her first job out of fellowship. She did not ask about the parental leave policy because she was focusing on impressing them and was afraid of being looked upon negatively. However, upon reviewing her contract, she did not see anything regarding parental leave. At this point, she asked her potential employers about the policy, and they said that they did not have an official policy regarding parental leave because they did not want to be discriminating.

Multiple people agreed with the fear of the negative stigma of asking about the parental leave policy during interviewing for a job. The floor was asked for input from job interviewers. How often is parental leave asked about? At Emory, they spearhead this issue by informing candidates that they will have the opportunity to speak with HR. The advice was given to future interviewees: Ask your interviewer if there is someone to contact regarding benefits. Then you don’t have to worry about the potential stigma associated with asking directly about parental leave. Also, academic job postings may already have that information included in the online job postings. Next, the head of recruiting at one of the largest radiology groups in the country stressed that radiology practices need to make it a point to talk about the topic straight up. Groups need to already plan for parental leave ahead of time and recruit extra people. Additional experiences were shared:

• Private Practice in Baltimore (100 radiologists)
  • Parental leave is at least 6 weeks paid time off, up to 90 days (using disability)
  • Part-time partnership track is the same number of years for those who work 75% vs. 100%
• Resident
  • States that residents can feel discouraged from having kids during their 1st three years of residency because you need to be there for 36 months to be eligible to take the ABR Core Exam in June, so if you take parental leave during that time, you will have to wait until November to take the Core Exam
  • The response included that when exceptions were made early on, residents did not perform well
  • An additional resident (NYU) said that she had her baby as a 1st-year resident and since she was there less than 1 year that she did not qualify for FMLA. She had to use every drop of her vacation time off
• Private Practice
  • From someone who is the breadwinner of her family, she had the option to get paid up front during maternity leave to care for her family, but then she would have to make up for it later by working without pay.
  • A different private practice radiologist was told she could only use FMLA/disability once. If she wanted to have a 2nd child, she would have to present it to the board to ask what can be done. This policy was stemmed from the fact that 1 of the group’s previous partners had 2 cancers and was felt to have taken advantage of the system.

Someone shared that at her radiology department, there is plenty of parental leave available, but then there is perceived negative stigma of actually using that time. There needs to be a culture change of the view of parental leave. Someone shared the policy from her husband’s job at Citigroup– they mandate that everyone uses their 3 months of parental leave (including both maternity and paternity leave) as an attempt to change the culture. To attract and hold on to talent, groups need to be competitive.

The time to take action is now. What are the next steps/thoughts?

• A literature review of what other societies are doing (surgeons, pediatrics, etc.)
• Work with the women’s caucus in the AMA
• During these initial stages of the development of a consensus statement, need to include the “going back to work part” (including breastfeeding, etc.) and be sure to include trainees
• New word choice-maybe use “family leave” as opposed to “time off”
• Contributing to this innovation of the workforce and assisting with the development of a policy statement will help with wellness and burnout in itself
• Can we work with insurance companies to come up with a product that can cover the employer
  and the employee to help deflect the costs and help to potentially fix the stigma?
• A call for case studies about positive parental policy experiences at their radiology groups/departments.
  • What policies or programs worked?
    • Example= Childcare at meetings. This is normal at some conferences, but not typically at radiology conferences. Thank you to Dr. McGinty who helped to make childcare available for the ACR meeting this year for the first time in history!

Interested in sharing what policies have worked at your institutions to serve as a case study? Please contact Dr. Katarzyna Macura, MD