Q&A: ‘Women shouldn’t have to advocate’ for equitable parental leave policies in GI
Click Here to Manage Email Alerts
A few years after publishing survey results that showed just 35% of gastroenterology fellows reported their training program had a parental leave policy for all genders, Lauren Feld, MD, remains steadfast in her calls for systematic change.
“The vast majority of parental leave policies were for women only, which discounts the experience of a number of families and also places the burden on women alone to take on primary responsibility for the child and childcare,” Feld, assistant professor of gastroenterology and hepatology and physician executive of diversity, equity, inclusion and belonging at UMass Chan Medical School, told Healio.
In recognition of her efforts to promote gender equity and improve work environments through structural solutions, the advocate for parental leave for all genders received the 2024 Scrubs & Heels Break the Glass Ceiling Award.
“The lack of fair parental leave policies and flexible work schedules in medicine, and in particular in interventional specialties like GI, contributes to gender inequities in the field,” Aline Charabaty, MD, clinical director of the Inflammatory Bowel Disease Center at Johns Hopkins Sibley Memorial Hospital and co-founder of Scrubs & Heels, told Healio. “It deters women from choosing a career in GI, prevents women from maintaining an integrated career in GI and pursuing leadership roles, and contributes to women leaving the field all together.”
She added, “Dr. Feld has been a strong and effective advocate for structural changes in the medical work environment to improve workforce equity.”
In addition to guiding research focused on gender equity and medical ethics, Feld also led the charge on a manuscript recently published in Gastroenterology, which highlighted the benefits of improved parental leave and return-to-work policies, as well as a blueprint for implementation.
These accomplishments elevated Feld among those who are “dismantling barriers and driving progress in gender equity,” Anita Afzali, MD, MPH, MHCM, FACG, professor and executive vice chair for clinical operations at the University of Cincinnati College of Medicine and co-founder of Scrubs & Heels, said, making her an ideal candidate for the Break the Glass Ceiling Award.
In this Healio interview exclusive, Feld expands on the role parental leave policies play in advancing equity in GI, as well as how they should be implemented to benefit women, men and families alike.
Healio: Why is gender equity so important in gastroenterology and how does it affect women entering the field?
Feld: There is an established difference between equity and equality. Equality means everyone is treated the same vs. equity, which makes sure everyone is able to achieve equal outcomes. Gender equity in gastroenterology means everyone has the tools in the environment to succeed.
What real gender equity would mean is making sure that all GIs can thrive and do the best work that interests them — clinical care, research or advocacy — with whatever tools they need to thrive in their career and gain a sense of fulfillment, happiness and satisfaction outside of their work as well.
Without gender equity in our field, we will lose talented, compassionate physicians if they sense this is not a field in which they can thrive. We are not optimizing the future of GI if we are systematically dissuading large groups of people from applying to our field. However, my fear is also that if we make progress in the percentage of women who are entering GI, but don’t make progress in the day-to-day realities for women GIs, we are doing a disservice to those trainees who are entering the field.
Healio: How do parental leave policies affect women in GI?
Feld: A predominant barrier for female medical residents applying to GI are concerns about the incompatibility of GI training and being able to have a family.
Unfortunately, these fears are not a misconception. The amount of leave offered by fellowship programs and taken by attendings is far below what our own medical societies and research recommend is adequate. In addition to leave, we can create more family friendly environments to support physician parents. We are disincentivizing people from entering GI because they correctly look at the field and determine that if they want to become pregnant or grow their family, they very likely will face barriers. We are dissuading a lot of medicine residents, both men and women, for very fixable reasons.
Lack of parental leave impacts retention as well as recruitment. We are seeing the effects of what happens when people are forced to choose between their career or family. We have high turnover rates, limited continuity for patients, and burden on the clinicians who remain.
While this disproportionately impacts women, it is important to note that it is not just women who face barriers regarding parental leave and childrearing, but also fathers and diverse families. I am a big advocate that all genders should have access to leave, which is one thing that will be necessary to achieve gender equity in the workforce and in childcare responsibilities. If only women can take leave, research suggests they are more likely to default being responsible for more childcare responsibilities throughout early childhood.
Bias may also be introduced during the hiring process. Say you have two applicants, a 29-year-old woman and a 29-year-old man. Even if they both want to have children, it may be perceived that only the woman may take time off, which puts her at a disadvantage.
Healio: How can women advocate for equitable parental leave policies in their practices and institutions?
Feld: My goal is that women shouldn’t have to advocate for themselves on an individual basis. We will have to in the short term, but I think parental leave and family-friendly policies should be standardized and systemic.
There are laws that govern paid leave requirements now in 12 states and Washington D.C., and the number of states with these laws is increasing. It is certainly possible that soon the U.S. will have federal protections for paid leave. We also have recently implemented federal protections for pregnant workers, although these protections are frequently violated in health care settings.
There should be hospital policies — consistent with those laws — that are implemented automatically so that when someone wants to take leave, they don’t have to be put in a position where they have to negotiate individually with their administrators for their 12 weeks of leave or lactation time. We often act as if it is a surprise every time someone is going to have a baby and create band-aid solutions to cover their leave time. A really good way of breeding resentment and stigma from colleagues is by health care administration and leadership not planning ahead for leave and then putting undue burden on that person’s colleagues to cover for them. We are forcing women to be the ones who have to advocate for themselves, which puts them in an uncomfortable position with their colleagues and their patients.
It would be much better if we instead had automatic systems that went into place that mitigate the physical impact of a pregnant person’s job during their pregnancy and implement a coverage plan for the parental leave period and beyond, without overburdening colleagues. These coverage systems benefit everyone, since it plans ahead to create a system that doesn’t rely on overworking colleagues. It also facilitates opportunities for more robust leave options, including medical leave and caregiving leave for aging parents.
Healio: How does Scrubs & Heels help advance the field for women?
Feld: Having created a community where women can be celebrated, feel joy and come together to discuss the practical, tangible things they can do to improve both their work experience and their ability to care for patients is unique and incredible. Drs. Afzali and Charabaty deserve a lot of credit for creating a special environment that is both supportive and driving forward advocacy.
I was incredibly honored and humbled to have received [the Breaking the Glass Ceiling Award] and was shocked that they would consider me. I think that it is really a testament to how important issues around parental leave and family friendly work environments are to women. I’m grateful to my incredible mentors and collaborators who advocate for women in medicine.
Based on the incredible work being done in workforce gender equity and the Scrubs & Heels community, I have no doubt we are making things better for future generations of gastroenterologists and patients.
References:
- Feld L, et al. Am J Gastroenterol. 2021;doi:10.14309/01.ajg.0000778828.42456.65.
- Feld L, et al. Gastroenterology. 2023;doi:10.1053/j.gastro.2023.08.014.
Collapse
Healio Interviews
Read more about
Click Here to Manage Email Alerts