Physicians Know That Giving Parental Leave Is Important, But Finding the Time and Money to Make It Happen Is Another Matter
Public Health Feature — October 2017
Tex Med. 2017;113(10):47-51.
By Sean Price
When Melinda Lopez, MD, found out she was pregnant in late 2015, she knew by heart the advice about spending time with her newborn she ought to follow.
"If I was talking to any patient [as an OB-Gyn], I would be saying, 'You need to take time for yourself, you need to be enjoying this to the full extent you can.'"
But as a medical professional, she also knew that following that advice would be difficult. Her colleagues at the People's Community Clinic in Austin, a federally qualified health center, were very supportive of her pregnancy. But the fact remained that Dr. Lopez couldn't afford to lose several weeks of pay.
Aside from the one week of vacation and sick leave she had saved, Dr. Lopez would have to cover the expense of any extended leave herself. So she came up with a plan.
"As soon as I found out we were pregnant, I analyzed our budget and cut corners and doubled up on hospital shifts in my second trimester, when I knew I could still handle 24-hour shifts, and tried to make up for lost income there," she said.
Working that hard through a pregnancy was difficult, but all the saving and extra shifts paid off. She was able to take off 10 weeks to be with her daughter, who was born in August 2016. But the experience with taking that time off drove home an important lesson.
"I'm around women who have babies all the time and hear about their struggles in getting off of work," she said. "And then I got to go through it myself, and we just don't do a great job in this country. We don't show enough support for pregnancy and parenting at a policy level."
Technically speaking, American workers are entitled to a lot of time off at the birth of a child or in a family emergency. Thanks to the 1993 U.S. Family and Medical Leave Act (FMLA), about 88 percent of all U.S. workers are able to take up to 12 weeks off in those situations, according to Drew DeSilver, a senior writer at Pew Research Center.
However, most workers face the same problem as Dr. Lopez: The time guaranteed by FMLA is not required to be paid, and they can't go that long without a paycheck. According to the U.S. Department of Labor, the percentage of Americans with access to paid family and medical leave is small but growing steadily.
"Not many workers had access to paid family leave," Mr. DeSilver said. "But the trend is upward. If you look at all civilian workers in 2010, about 11 percent had access to paid family [and medical] leave. And by 2016, that had [risen] to 14 percent."
Scientifically speaking, the benefits of granting parental leave are straightforward, says Rakhi C. Dimino, MD, a Houston OB-Gyn who serves on the Texas Medical Association's Council on Science and Public Health. Numerous studies have shown that allowing parents time with a newborn makes the child and the parents healthier, both physically and mentally.
But she says there are still huge obstacles to making parental leave more common. Many physicians, especially the nearly four in 10 U.S. physicians who work in practices with five or fewer doctors, worry about how to pay for that leave for themselves and their staff.
"The practical part of the problem is probably the most important part," she said. "I don't think there are a ton of bad bosses who don't want to give their employees this opportunity to be new moms and dads. I think it really comes down to, can a company afford to give this opportunity to moms and dads? And especially in small businesses, it becomes very challenging."
The United States is the only major industrialized country in the world to not require paid parental leave. Almost all of the world's 193 countries offer it. The United States is joined by only a few other smaller countries, including New Guinea and Suriname. The countries that do offer it provide paid leave ranging from eight to 87 weeks.
A Pew Research Center poll released in March shows that 82 percent of Americans believed mothers should get paid time off for the birth or adoption of a child; 69 percent believed fathers should as well. However, partisan gridlock makes any new federal laws on parental leave unlikely right now, says Pronita Gupta, director of the job quality policy team at the Center for Law and Social Policy, or CLASP, in Washington, DC.
However, there has been substantial movement at the state level, Ms. Gupta says. Three states ― California, New Jersey, and Rhode Island ― already have state-financed programs that give access to parental leave. By 2020, those three states will be joined by New York, Washington state, and the District of Columbia.
For all five states and the District of Columbia, parental leave is part of a program that also gives access to family and medical leave. (See "What Type of Leave?") The states finance these programs either through a tax on workers or a joint tax on both workers and employers. In California, for instance, workers pay 0.9 percent of annual wages. When workers go on leave, they're usually paid about half to two-thirds of their normal wages.
Ms. Gupta, who is a former deputy director of the Women's Bureau at the U.S. Department of Labor, says that several other states ― though not Texas ― are also seriously considering paid family and medical leave proposals. They include Colorado, Connecticut, Massachusetts, and Minnesota.
"There is tremendous momentum on the state level for paid family [and medical] leave," said Ms. Gupta. "And I think all that's an indication that the population is really tired of seeing nothing moving on the national level."
In states without mandatory parental leave, it is up to individual businesses to offer that benefit. There are no U.S. or state data specifically on physician access to parental leave. But according to the Bureau of Labor Statistics, between 2010 and 2016, the percentage of health care and social service workers with access to parental leave fluctuated between 15 percent and 18 percent.
Few physicians dispute that paid parental leave helps both parents and children. The American Congress of Obstetricians and Gynecologists (ACOG), which endorses granting fully paid leave for at least six weeks, says the recognized benefits "include decreased infant mortality, improved health of the child and mother, improvements in worker morale and retention, and increased income."
In 2016, TMA's Council on Science and Public Health issued two recommendations about parental leave. In the first, TMA called for greater overall awareness about the importance of parental leave. In the second, it urged physicians to work with Texas state agencies to expand parental leave for the state's entire workforce.
However, many physicians ― especially those in small practices ― worry about the costs involved. Mina Sinacori, MD, is a Houston OB-Gyn who runs a practice that employs eight people. She says paid family leave hits small practices financially in two ways: the practice has to pay an employee while he or she is not working, and it has to pay other employees to cover for the one on leave.
"I am both a mother and an employer, and I understand the issues on both sides," Dr. Sinacori said. "It's a struggle we all have as parents to balance our work and our families and our finances. But also as employers we have to balance our finances. And when you have people requesting a mandatory paid 12-week parental leave, that puts a big onus on employers. "
Dr. Sinacori points out that simply mandating that women get time off can also create subtle discrimination. She says in many countries that require paid leave, women of childbearing age find it difficult to get and keep jobs because it's understood that they will be taking paid absences for long periods.
Many of the concerns of small businesses have been addressed in more recent legislation, Ms. Gupta says. In most cases, leave is paid for out of a state fund that is independent of the employer. Some newer laws, like the one in Washington state, also account for compensating the employer to replace missing workers. Small businesses often see mandatory parental leave as leveling the playing field with larger businesses, she says.
"Many of [the smaller businesses] can't afford to give paid medical leave like a big business can," she said. "But if it's [paid for through] a payroll tax or premium that's levied on the worker, that's a small amount shared by all workers. A lot of [small] businesses think that's fair, and then their workers can take that leave."
Although most physicians agree on the benefits of paid leave, on the job, many resent the extra work that comes when a colleague goes on parental leave. This is not simply a problem of male doctors who are impatient with female colleagues.
"When I was in private practice, there were 10 of us ― obstetricians ― and we were all women," Dr. Dimino said. "And when I had my first child, the idea of taking six weeks off made my partners a little wonky. Many of them who had had children had only taken two weeks off. … There was such a pressure to come back, and come back fast."
The pressure was so intense that she changed jobs and became a hospitalist around the time her second child was born, Dr. Dimino says.
"As obstetricians, we were not supporting each other in building our families," she said. "That really was the kicker for me."
But she says that the issue is not going away. Public support for all types of family leave is increasing, and there is growing bipartisan support among lawmakers. The question is, how and when will it finally be addressed?
"[Parental leave is] an important investment in public health," she said. "I think that's the heart of the issue ― how would we in Texas solve that problem?
Sean Price can be reached by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
What Type of Leave?
The terms "parental leave," "family leave," and "medical leave" often run together in people's minds. But they are defined differently. According to the Pew Research Center, the definitions are:
- Parental leave ― taking time off work after the birth or adoption of a child
- Family leave ― taking at least five days off to care for a family member with a serious health condition
- Medical leave ― taking at least five days off to deal with a serious health condition
Parental Leave and Maternal Mortality
Parental leave is tied to an urgent public health issue in Texas ― the state's unusually high maternal mortality rate.
Texas' rate jumped from 18.6 per 100,000 live births in 2010 to 30.2 in 2011, according to data from the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics. The next year, it spiked to 38.7 and remained above 30 through 2014. Those rates are much higher than national data for this same period. The overall U.S. rate ranged from 19.3 in 2011 to 21.5 in 2014.
The causes are complex and still are being investigated by the state's 15-member Maternal Mortality and Morbidity Task Force, which includes nine physicians. But the task force found most of these deaths occur between 42 and 365 days after birth. Death certificate data show that many causes of death are stress-related, including cardiac events, drug overdoses, and hypertensive disorders like preeclampsia.
Carla Ortique, MD, a Houston obstetrician-gynecologist, is vice chair of the task force. She says creating paid leave would help young women adjust to motherhood. And allowing their partners that same leave would help take pressure off the mother and provide someone to identify issues tied to postpartum depression.
"You could look at the time off as being prevention," Dr. Ortique said. "And if you believe that you're improving a woman's health, a couple's health, a baby's health, then it's going to pay dividends down the road because that baby's going to get sick less, that mom's going to miss work less, and that dad's going to miss work less because they're going to be healthier."
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