Handling Parenting Pressures

Sindhu J. Malapati, MD

Early-career oncologists and oncology trainees reported a multitude of issues around inadequate parental leave and support for lactating mothers, according to findings from a survey published in JCO Oncology Practice.¹

Findings from the survey demonstrated that among early-career or trainee clinicians with experience regarding parental leave and return to work after parental leave (n = 114), 79% felt overwhelmed with demands of work and home upon their return to work. Sixty percent of this group also reported feeling guilty when asking colleagues for help upon their return from parental leave and 50% felt pressured to work during their parental leave. Additionally, 40% responded that the duration of their parental leave was 4 weeks or less.

Program directors or associate program directors of training programs (n = 23) reported that their current parental leave duration is either adequate (61%) or too short (39%). Over half of the directors (52%) reported that their institution had a differing parental leave policy for trainees compared with faculty.

“I had my child during my fellowship and the more I spoke to others in training and early in their careers, I found that the experience of having inadequate parental leave, insufficient time, and lack of facilities for pumping breaks is almost universal,” Sindhu J. Malapati, MD, assistant professor of medicine, Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, in Little Rock, and the study's lead author, said in an interview with Oncology Fellows. “I felt that the first step to fixing a problem is quantifying it, which is what I set about doing on this study.”

Investigators performed a cross-sectional study of clinicians in their early career and training, defined as the first 5 years after terminal training, regarding their knowledge of current work practices and guidelines and return-to-work experiences following parental leave. The survey was conducted online from May 5, 2021, to June 6, 2021, and was comprised of 43 questions about patient demographics, practice settings, parental leave, available resources to support parents returning to work, lactation policies and facilities, and experiences on returning to work.

At baseline, respondents in early career and training (n = 255) consisted of trainees (71%) and early-career faculty (29%). Most respondents were female (54%), between 31 and 35 years old (58%), had children during training (51%), practiced in a university or academic setting (83%), and graduated from a US medical school (74%).

Sixty percent of respondents were not aware of the parental leave policy of their certifying board and 40% had assigned parental leave during training. Nearly half (47%) said that they were not sure if parental leave or lactation policy documents were accessible by trainees or faculty at their current institution. Respondents were split regarding whether parental leave policies did or will play a role in the selection of their first or current job, with 37% responding yes, 45% responding no, and 18% saying that they were not sure.

Additional findings from the survey revealed that among respondents who had breastfed for any length of time (n = 65), 69% reported having access to the designated lactation room. However, only 40% felt comfortable asking for pumping breaks, 44% had an adequate duration of allotted pumping breaks to access and use the lactation room, and 66% said that pumping breaks were not mandated in their contract.

Among clinicians who took parental leave and returned to work after parental leave, only 19% reported having the option to work part time or choose lighter rotations during their transition back to work. Moreover, 32% of this group said they had additional responsibilities upon their return and only 27% said they felt they had the resources to address the transition back to work.

Notably, policy changes have been adopted by multiple governing bodies since the survey was conducted in 2021 aimed at addressing parental leave issues. In July 2022, the Accreditation Council for Graduate Medical Education applied new institutional requirements mandating that sponsoring institutions must have leave policies that include a minimum of 6 paid weeks off for medical, parental, and/or caregiver leave. In April 2023, the federal PUMP (Providing Urgent Maternal Protections) Act took effect, mandating employers to provide “a private, functional space that isn't a bathroom, and reasonable break time to pump each time you need to express milk while working.”^2,3

“There is increasing recognition of the attrition of female faculty, who are disproportionately affected by poor parental leave and lactation policies, in the early-career stage,” Malapati said. “Making the workplace more supportive for young parents with improved parental leave and lactation policies can be part of a multipronged approach to address the larger issue.”

References

1. Malapati SJ, Idossa D, Singh SRK, et al. Parent penalty: parental leave experiences of trainees and early-career faculty in oncology subspecialties. JCO Oncol Pract. 2023;19(10):899-906. doi:10.1200/OP.23.00242
2. ACGME answers: resident leave policies. Accreditation Council for Graduate Medical Education. September 28, 2022. Accessed February 5, 2024. https://www.acgme.org/newsroom/blog/2022/acgme-answers-resident-leave-policies/
3. Your breastfeeding rights. WIC Breastfeeding Support US Department of Agriculture. Accessed February 5, 2024. https://wicbreastfeeding.fns.usda.gov/your-breastfeeding-rights