As the health care debate in our country continues to press on, a few points have emerged as key considerations. First is the reality of dealing with economic uncertainties of funding for health care. Excellence in clinical leadership requires managing this unknown, which critically includes the forecasted dearth of future physicians, as well as the financial burden placed on training hospitals to fill this workforce gap. Second, and perhaps more importantly, the debate has crystallized the importance of acting in ways that demonstrate a commitment to a fundamental value system. Now, more than ever, it is essential to speak honestly and lead by positive example. One such example is parental leave policies for resident physicians, and what such policies signify to those who train under our leadership.
The United States has no federally sponsored parental leave program. The closest we have is the Family and Medical Leave Act (FMLA) of 1993, which guarantees 12 weeks of unpaid leave — a job security measure. Consequently, it falls to employers to provide comprehensive paid leave. Many do, as the value of such subsidized leave policies is well-documented — they benefit the health of parent and child, and improve retention of parents in the workforce.
Physicians, including both male and female residents, are eligible for these employee benefits. However, it is often difficult for residents to use the leave they are offered. In most Accreditation Council for Graduate Medical Education–accredited training programs, residents are not allowed to take more than 4 weeks of leave per year for any reason, including parental leave. To do so risks delaying training by a full year, or risks losing one’s place in the program altogether. The inflexibility of these requirements often unequally affects women physicians, as residency training is the most common time for a woman resident to have her first child. But, as recent surveys show, providing family-friendly job accommodations leads to increased career satisfaction for male and female physicians alike. Many physicians can recall instances of our peers taking leave to deliver their child, only to return to work within a few days, even after, perhaps, undergoing a caesarian section surgery. As stewards of the future of our physician workforce, what does this say to the next generation of physicians, and parents?
The U.S. is now training a generation of physicians who are 50% women, from many different religious, ethnic, sexual preference/gender identity cultures, with differing socioeconomic backgrounds, and, importantly, with predominantly working partners. We must not only value these trainees, but we must also consider how sustaining these trainees through their work-family balance will enrich the staff as a whole.
At NewYork-Presbyterian, we recently implemented a program of paid parental leave. In addition to any medically necessary time off for a mother giving birth, our residents can now take 6 weeks of paid parental leave for the primary parent, and 2 weeks of paid parental leave for the secondary parent. This is available to both women and men, for birth, adoption, and surrogacy. Throughout the process, we have engaged various stakeholders in graduate medical education leadership to ensure these benefits do not come at the expense of quality or length of training.
As an evidence-based organization, we plan to evaluate the impact of this policy change by assessing the number and duration of awarded leaves by gender, by medical specialty, and by year. We will obtain feedback from residents on the implementation of this change, and alter it as appropriate. Most importantly, we will track retention and promotion of both our male and female physicians into our attending and leadership physician roles, and we will determine if our policy change has shifted that balance to create leadership that is fully representative of the diverse patient population that we serve.
Through this initiative, we’re addressing the financial concerns posed by a shortage of physicians by making it easier and more fulfilling for all of our training physicians to enter, and stay, in medicine. More importantly, we’re backing up our words with actions — we believe in respecting and caring for all our employees, and our shared values demand nothing less than substantive investment in their well-being. At NewYork-Presbyterian, we made a decision to engage in difficult conversations and self-examination to make progress in the ways we train the next generation of physicians. This means examining the culture of training we endured by considering which components are needed to forge the caring, excellent physicians we seek to train, and which parts no longer fit within our culture of respect for our employees, ourselves, and our future leaders. Creative and honest leadership solutions will be needed as next steps to achieve this ideal. This is a pivotal moment for health care institutions in our country. Through strong, values-based leadership, we can chart the way forward.