Parental Leave and Pediatric Residents—Reply

The article by Weiss et al¹ in the July 1998 issue of the ARCHIVES articulates an important area of discussion for pediatric residency training programs. Pediatrics as a discipline includes, within its professional organization's stated mission, advocacy for children, pediatricians, and families. The authors contend that children's hospitals provide no better parental leave benefits (defined both as maternity/paternity leave and adoption leave) than those offered at Fortune 500 companies, although they point out that hospitals provide more child care and support systems for breast-feeding mothers. They had hypothesized that a children's hospital would be more likely to be cognizant of such issues, given its pediatric thrust.

Indeed, there are several nuances to this issue that are worth noting. First, as a residency program director, I would like to note that these results come as no surprise. Following the initial signing of the Family Medical Leave Act (FMLA) by President Bill Clinton, I surveyed pediatric programs and discovered that most were not in compliance with the provisions of FMLA and failed to even notify pediatric trainees of their rights to unpaid leave under FMLA.² More recently, at 2 successive annual meetings of directors of smaller pediatric residency training programs (1997 and 1998), I surveyed directors on this issue: while 86% of programs offer a defined maternity leave policy, only 49% offer a defined paternity leave policy. Also, recent unpublished data from a survey of American Board of Pediatrics examinees suggests that pediatric training programs provide an unsupportive environment regarding family issues. All of this suggests that pediatric residency programs and their institutions barely provide even the basic level of family support and leave for their trainees—a significant difference from Fortune 500 companies.

Second, an additional key issue revolves around the mistaken understanding that physicians in general and residents in particular are even covered by a hospital's benefit programs. Many residency programs do not view residents as employees and, as such (without entering this complex legal quagmire), define their benefits differently from those of their own employees. Additionally, faculty at the same institutions are not often clearly covered by any prevailing family-related leave benefit, and as such shorten their time off for family-related issues.

Finally, sick time and short-term disability, as discussed by the authors, are confused from a human resource perspective. Few employers permit sick time to be used even for a senior employee (defined by years of service) when an illness or medically justified absence (such as maternity) are not present. In essence, an employee with 9 months' accrued sick time cannot take 9 months of paid sick time with the birth of a child without specific medical authorization. Additionally, it is fairly common practice to use up such sick time before a short-term benefit is invoked. Thus, the apparent distinction between children's hospitals and Fortune 500 companies needs further clarification and legalistic definition.

Nevertheless, the author's point is crucial. We in pediatrics do not practice what we preach—despite our protestation to the contrary, in public advocacy we often fail to provide basic family-related benefits to our trainees, faculty, and nonphysician employees in our hospitals. That must change. The discipline of pediatrics should set the standard for employment policies that support and promote family health and optimal family functioning.