Ease burden without blocking opportunities to support colleagues during maternity leave

The AMA reports that in the 2019-2020 academic year, 53.7% of students matriculating into medical school were female. Yet, female physicians are more likely than their male counterparts to leave the profession.

Although the reasons for this situation are complex, the pressure to balance a rigorous professional schedule while maintaining primary responsibility for child care is likely a factor. For this reason, the peri-maternity leave period is an important juncture at which female physicians may feel forced to choose between motherhood and career.

“The level of support for birthing mothers varies significantly across institutions and subspecialties,” Lanna Felde, MD, assistant professor in the division of hospital medicine at UT Southwestern Medical Center and author of a recent paper on maternity leave published in Journal of Hospital Medicine, told Healio. “However, we know that when female physicians across subspecialties are surveyed, the majority feel like the amount of maternity leave is insufficient.”

Although broader policy change at the institutional level will be needed to improve parental leave and the return to the workplace for women in medicine, the paper — which Felde co-authored with Sarah W. Riddle, MD, IBCLC, FAAP, of Cincinnati Children’s —focused on actionable ways in which clinicians can support and help their female colleagues during maternity leave. Importantly, Felde and Riddle also stressed the need to provide this relief to a new mother in a way that does not unintentionally cut her off from opportunities that may arise in her absence.

“Leaders should be intentional about facilitating a transfer of responsibilities in a manner that does not remove the prematernity leave physician from leadership positions long term,” Felde said.

Institutional support

Some of the most valuable help for physicians who take parental leave occurs within the institutions that employ them. Felde said institutions should prioritize and plan for this necessary time away from the stresses of work.

“Institutions should build allowances for parental leave into the budget and operational plans,” she said. “Such planning could also eliminate the need to require women to ‘make up’ time by working extra shifts during their postpartum period, which is already a very vulnerable time.”

She added that institutions should provide clear, accessible information about the duration and terms of their leave policies.

“Employers should focus on transparency, as many physician mothers note confusion surrounding leave policies,” Felde said.

The importance of proxies

For colleagues of a preleave physician, one important way to help is by collaborating with her to identify proxies well in advance of her parental leave, Felde explained. Proxies are the colleagues who temporarily fill in for the physician mother during her absence. Duties of a proxy might include taking over the preleave physician’s administrative, operational or academic duties on a temporary basis.

“It may also include acting in temporary leadership roles, such as overseeing committees in her absence,” Felde said. “The practice of handing off projects can also be used as an opportunity to elevate junior colleagues and create new partnerships. Having leaders involved in this conversation legitimizes the temporary role as an important charge rather than a favor to a coworker.”

Proxies should be identified at least a few months before the parental leave period is expected to start, Felde said. This allows for sufficient transition time and creates a backup plan in case of premature delivery. During this time, the preleave physician can discuss the parameters and boundaries of communication during parental leave.

“The preleave physician and the proxy should work together to formulate a clear plan for project hand-offs before and after the leave, as well as contingency planning and check-ins during the leave,” she said. “The preleave physician should communicate openly with the proxy about boundaries, so that she can achieve the right balance of dialogue and privacy during the postpartum period.”

For example, the proxy and the physician on leave might establish check-in times by phone or email on a set schedule, or the proxy may check in only if a certain situation arises.

“Flexibility is key, as the postpartum physician may be dealing with sleep deprivation, postpartum blues, or even postpartum depression,” Felde said.

The return to work

After the physician mother returns from her leave, Felde said, she and her proxy should meet for a debriefing session in which they discuss the resumption of former responsibilities.

“The handoff is a great opportunity to share fresh perspectives and discuss future directions of the projects or roles that the proxy is handing off,” she said. “Leaders should also schedule a semiformal check-in as the parental leave period comes to an end,” she said. “This allows the leader to assess the postleave physician’s well-being.”

Although the returning physician may not wish to discuss ongoing health complications such as postpartum depression, having a semiformal check-in gives her the opportunity to ask for support if needed, Felde said.

Employers should also be aware of a returning physician’s needs in terms of lactation and should allow sufficient time and space for this necessary activity.

“Lactation needs may add several hours to the workday, as it calls for alternating between pumping for 30 minutes at a time every 3 to 4 hours and tending to clinical, administrative and academic duties,” she said. “Leaders can be supportive by ensuring adequate resources in terms of time and space for lactation needs and being prepared to address any deficiencies.”

Avoiding ‘career deceleration’

Colleagues who want to lighten the load of the physician mother may assume it is helpful to take as much work off her plate as possible. However, Felde explains that in doing so, these colleagues may be unknowingly contributing to “career deceleration.”

“When well-intentioned colleagues try to help the physician mother by taking work off her plate before or after maternity leave, she ends up with less opportunities to grow in her career,” Felde said. “Perhaps she ends up publishing fewer papers, taking on fewer committee roles or leading fewer workshops. Ultimately, this practice leads to women advancing up the academic ladder more slowly compared with their male counterparts.”

It is more helpful for colleagues to act as temporary proxies for the physician mother, with a clear understanding that she will return to her pervious roles and responsibilities once she is back at work, Felde said. Similarly, leaders should not limit career opportunities offered to the physician mother just because they arise during her pregnancy, she said.

“Leaders can also continue to sponsor her during her leave and advocate for allowing her to consider the new opportunity upon returning,” she said.

Felde also encouraged male physicians who are expectant fathers to take parental leave, and not only for the primary reason of bonding with and caring for the baby. She said by also taking parental leave, men can help set a standard that is not gender specific.

“Colleagues who are fathers or adoptive parents can support birthing mothers by asking for and taking more parental leave when they become parents,” she said. “If everyone’s parental leave is comparable in length, it creates an even playing field where women in their reproductive years are not at a disadvantage compared with their male counterparts.”

Felde said it is important to address these challenges faced by female clinicians because they often lead to substantial and meaningful inequality in the workplace.

“Although females represent about half of the new doctors entering medicine, most leadership roles in medicine continue to be held by men,” she said. “It is imperative that male and female leaders advocate for institutional and cultural shifts that make it possible for women to continue their professional advancement during their reproductive years.”

For more information:

Lanna Felde, MD, can be reached at lanna.felde@utsouthwestern.edu.