You Can’t Have It All: The Experience of Academic Hospitalists During Pregnancy, Parental Leave, and Return to Work
BACKGROUND: The United States lags behind most other countries regarding the support for working mothers and parental leave. Data are limited to describe the experience of female hospital medicine physicians during pregnancy, parental leave, and their return to work in academic hospital medicine.
METHODS: We conducted a qualitative descriptive study including interviews with 10 female academic hospitalists chosen from institutions across the country that are represented in Society of Hospital Medicine (SHM) Committees. Interview guides were based on the following domains: experience in pregnancy, parental leave, and return to work. Interviews were recorded, transcribed verbatim, and analyzed using a general inductive approach to theme analysis using the ATLAS.ti software (Scientific Software Development GmbH, Berlin, Germany).
PRIMARY OUTCOME: Women in hospital medicine experience the following six common challenges in their experience as new parents, each of which has the potential to impact their career trajectory, wellness, and are associated with areas for institutional improvement: (1) access to paid parental leave, (2) physical challenges, (3) breastfeeding, (4) career opportunities, (5) colleague responses, and (6) empathy in patient care.
© 2018 Society of Hospital Medicine
RESULTS
The demographics and the characteristics of the hospital medicine group are shown in Table 1. Although we asked questions about both the positive and challenging aspects of the experience of parenthood, the interviews tended to focus more on the challenges faced and on areas for optimization.
Paid Parental leave
Most of the participants described inadequate paid parental leave, with minimal transparency in the processes for ensuring time off following the birth of their child, resulting in “haggling” with bosses, human resources, and the administrative staff. Rarely was a formal parental leave policy in place. Once a parental leave plan was established, several women reported the financial burden associated with a leave that was partially, or fully, unpaid.
“All of my leave was unpaid. .. managed to finagle short-term disability into paying for it… the system was otherwise set up to screw me financially.”
For the three women who did experience sufficient paid parental leave, they recognized the financial and emotional benefit and suggested that further optimization would include a prebirth schedule to account for the physical challenges and potential complications.
Physical Challenges
All of the women described significant physical challenges when working during pregnancy, resulting in limited bandwidth for additional academic activities outside of direct clinical care responsibilities.
“Exhaustion that hits you in your pregnancy and then you have to round. I used to lie on the floor of my office, take a little nap, wake up, write some notes, go home, take another nap, wake up, write some more notes.”
Upon return to work, women reported additional physical challenges related to sleep deprivation, impacting their productivity with academic work and emotional well-being.
“I came back from maternity leave and I was sleep-deprived and exhausted, I didn’t have the energy. All of these great projects that I had started or dreamed of … dwindled and died on the vine.”
Solutions suggested by the participants included creation of a flexible schedule with a ramp-up and ramp-down period around the birth.
Breastfeeding
The majority of participants in this study encountered several challenges associated with a shared goal of breastfeeding according to evidence-based guidelines.11 Designated pumping areas were often inconveniently located and not conducive to multitasking.
“It’s two chairs that are behind a curtain in a women’s locker room in the basement of the hospital, that are tiny and gross. No computers, so I felt like I was wasting time.”
One hospitalist described carving out time for pumping in her office while multitasking with clinical work.
“I would get to work, set up, and pump while chart reviewing. Then I would go and see people… and come back to my office and pump and write a few notes. And go out and see more patients, and then pump and write a few more notes. And then pump, and then go home. I was like a cow.”
Women highlighted the barriers that could be optimized such as creating time in the clinical schedule for pumping, a physical space to breastfeed or pump, and accessible milk storage facilities.
