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
Career Opportunities
When asked about the impact of parental leave on career opportunities, a few of the women described a phenomenon of no longer being asked to participate or being left out of prior projects.
“People didn’t want to offer you things or give you things because they realize you’re having this transition in your life. Not out of animosity, but out of courtesy that they don’t want to fill up your place even more. Her plate is full; we are not going to ask her to do anything extra.”
However, two women specifically reported a supportive environment without a loss of opportunities, often referenced as a boss who “saved” projects for their return.
Colleague Responses
One participant used the term “microaggressions,” to describe passive aggressions encountered by their colleagues or leadership.
“(A colleague) was diagnosed with pre-eclampsia, and very urgently had to deliver and couldn’t cover a week of shifts…She was asked initially to find her own coverage…Not treating (pregnancy) similar to other serious illnesses is what I would term a microaggression.”
Yet, women in our study also reported positive responses from colleagues and the importance of support networks of physician mothers (Table 2).
Empathy in Patient Care
Finally, the experience of motherhood impacted all of the women as physicians, described as increased empathy, patience, and understanding of difficult family situations.
“I’m just more sensitive to people’s lives outside the hospital, so, you know, when it’s difficult for a family member to get there because they have three other kids they are taking care of or, somebody that says they are leaving AMA, but it’s because they have a sick kid at home. I just have a better context for that.”
DISCUSSION
Gender disparities persist in both internal medicine and hospital medicine.1 Providers in this descriptive qualitative study suggested that the following factors contribute: lack of paid parental leave and the associated financial penalties, loss of career opportunities, the physical challenges associated with pregnancy, decreasing productivity, and the amount of time and effort involved in breastfeeding. However, the participants also shared valuable ideas for future solutions to relieve the challenges imposed on working physician mothers (Table 2).
Breaking the Glass Ceiling
Participants noted the importance of a paid leave policy that encompasses not only maternity leave but also a flexible scheduling period before and after the leave to account for the challenges of pregnancy and new motherhood. Paid parental leave is rare in academic settings, but studies from other industries show that when women take paid leave, they are more likely to remain in the workforce 9-12 months afterward, work more weekly hours, and feel more loyal to their organization.12,13 In the rare instance when negotiations around leave violate local policy or the law, women should be encouraged to seek guidance from their human resources department.
Me Too: Building Solidarity
Women in our study reported the value of a supportive workplace in easing their transition into motherhood. Specifically, they noted that a supportive boss who protected their career opportunities prevented momentum loss in their career trajectory. Access to mutual supports such as the Physicians Mom Group, a well-established Facebook group comprising more than 70,000 women, was referenced as a meaningful way to share joys and tribulations related to balancing a career as a physician and motherhood. Growth of similar support systems within institutions will further support this experience.
