IN 2015 when Sarah Hoper, MD, had her first child, she had some decisions to make. Dr. Hoper, who was working in Nashville as an ED physician for Vanderbilt University, wanted to take family leave, but as her family’s primary breadwinner, she needed to keep an eye on her income.
While state law allowed her to take off up to 16 weeks, Dr. Hoper ended up taking only eight, six of which were paid for by her practice. Because the group would pay for only six weeks, she worked one extra shift a month during the nine months she was pregnant, banking that time and using it to cover most of the additional two weeks she took off. The group’s scheduler even allowed her to avoid working nights during the last three months of her pregnancy, which made life considerably easier.
Dr. Hoper—who now works as an ED physician at East Central Iowa Acute Care in Cedar Rapids, Iowa— says that taking maternity leave was fairly straightforward at her next job because she made sure to negotiate six weeks paid leave before she signed on for the position. She points out, however, that her current group had never paid a physician maternity leave before her.
“Purchase life and disability insurance before getting pregnant.”
~ Bonnie Koo, MD
Dr. Hoper’s experience, however, may be far from the norm. In smaller, privately owned groups, for example, physicians don’t often receive paid time off, and they may not be encouraged to take even unpaid leave. After all, if one physician takes leave in a four-person practice, the workload dramatically spikes for the remaining partners.
And even when physicians working for larger groups receive time off for the birth of a child, the process is anything but well-defined. At groups both big and small, there’s plenty of confusion about parental leave policies, forcing physicians to figure out how much time they can take off and how to pay for it.
Taking a financial hit
The first thing that many doctors who take parental leave realize is that they may feel a real financial impact. Employees of large organizations can take leave without fear of losing their job under the Family and Medical Leave Act, but that legislation doesn’t require employers to pay people while on leave. As a result, even in groups that offer leave, physicians may get little or no paid time off.
Bonnie Koo, MD, a dermatologist in the Philadelphia area, was working in private practice when she had her first child in 2017. Dr. Koo took off 16 weeks—and while six of those weeks were paid, they were covered by a short-term disability policy. (Because pregnant women are considered “disabled” once they give birth, short-term disability insurance is often used to cover leave.) In Dr. Koo’s case, she received her full base salary.
But as part of her compensation plan, Dr. Koo was paid a salary and a bonus based on how much the practice collected from her patients; the more services she provided during the year, the bigger her bonus. Because Dr. Koo wasn’t seeing patients while on leave, she generated less income for her practice.
As a result, she would have received a smaller bonus when she returned. (She ended up not returning to that practice because she and her fiance relocated for his career.)
Dr. Koo doesn’t regret taking extra time off, but she urges other physicians to learn from her experience and ask detailed questions. Discovering that your bonus has been slashed after you come back from leave would be what she calls “a second whammy. You just came back from leave and you probably weren’t paid at your normal salary. You think your pay will be back to normal, but it may not.”
“Sometimes, I hear there is no such thing as paternity leave and that I was very lucky to get that.”
~ Moises Auron, MD Cleveland Clinic
(Dr. Koo, who blogs under the name Miss Bonnie, MD, has a two-part blog post online on issues to consider when taking maternity leave.)
Retirement savings may be another financial consideration. Because Dr. Koo was due in mid-October and knew she wouldn’t be coming back that calendar year, she made sure she maxed out her 401(k) plan before going on leave.
She also has this strong suggestion for young physicians: “Purchase life and disability insurance before getting pregnant.” Those policies become only more expensive as you get older, she points out, and sometimes directly as a result of pregnancy. “I developed gestational diabetes while I was pregnant,” Dr. Koo says. “An insurance agent told me my insurance premiums would have quadrupled if I’d waited to buy those policies until after I was pregnant.”
Find out what’s available
In larger practices with paid leave, some physicians we spoke to had a hard time figuring out just what was available to them. Eric Adkins, MD, was able to take off three weeks for the birth of his first child in 2010, all fully paid. But Dr. Adkins, who works in the ED and ICU at Ohio State University Wexner Medical Center, found that the rules for how much time he could take off were a little unclear.
“The advice I received as one of the men in the group was, ‘Try to reshape your schedule around when you have the baby so you can spend some time at home,’ ” he says.
Now vice chair for clinical operations in the ED and associate chief of the clinical information office at Ohio State’s Wexner Medical Center, Dr. Adkins says that as a new faculty member, he didn’t want to rock the boat. He identified the three weeks he thought would work best for him and cleared his schedule for that time. No one discouraged him from taking leave, Dr. Adkins explains, but he still found the process a little puzzling.
Moises Auron, MD, a med/peds hospitalist and associate professor of medicine and pediatrics at the Cleveland Clinic, considers himself fortunate that he was able to take off four weeks when his son was born in 2014. Two of those weeks were considered paid paternity leave; the other two were covered by vacation time that he had accrued.
Dr. Auron hears, however, that not everyone has such a straightforward experience with paid time off. “Sometimes,” he notes, “I hear there is no such thing as paternity leave and that I was very lucky to get that.”
How much time?
Ohio State’s Dr. Adkin says that as he had additional children, the process of taking paternity leave became more streamlined. By the time his second child was born in 2012, he had moved into a leadership track, and his colleagues were very supportive in helping him take three weeks off. When his third child was born in 2014, taking leave was even easier.
Today, he encourages other expecting physicians to take as much family leave as they can. “I spend a fair amount of time reminding our pregnant faculty, both men and women, about the importance of having children,” Dr. Adkins says. “I highly encourage them to focus on having their child and not worrying about work. Our job as their colleague is to manage the various issues that come up so they can take time off and devote the appropriate amount of attention.”
So how much time is enough? For him, three weeks was enough for each of his three children. That’s due in part, he says, to the fact that his wife, who’s also a physician, was able to take off more time: four to five weeks for their first child, six to eight weeks for their second, and 12 weeks for their third. “We both knew that was going to be our last child,” Dr. Adkins says, “so we did our best to spend as much time with them when they were young.”
He also adds that if his wife had needed a C-section or had a premature birth, three weeks would probably not have been enough time. “If you have a 25-week-old child in the NICU, it could be pretty hard to get back to work in three weeks.”
Contributing factors
For Dr. Auron from the Cleveland Clinic, a month off was plenty of time, and it’s more than many men he works with take off. “The majority of my colleagues don’t even take two weeks. A guy I know had a baby and was working three or four days after the baby was born.”
In his experience, how much time physicians need for parental leave often has to do with how close they live to other family members. In Dr. Auron’s case, for example, his mother-in-law was able to come and stay six months. And once he returned to work, his mother stayed for two months. “That kind of support makes a big difference,” he points out. “That made it very easy for me to go back to work.”
When hospitalist Cecily Gallup, MD, became pregnant, taking off more time seemed prudent. In 2012, Dr. Gallup delivered twins at 36 weeks while working as a hospitalist at the University of California, San Francisco. Knowing that a premature delivery was very possible, Dr. Gallup took off the month before her delivery date and five months after.
Dr. Gallup, who is now assistant clinical professor of medicine and pediatrics at UCLA, says she initially encountered confusion about how much time she was entitled to take off. In the end, she received three months of paid time and three months of unpaid time. To cover the month before her due date, which was not covered by leave, she used banked sick days. She then ended up taking two months unpaid.
She points out that she was able financially to take unpaid leave because her husband is a physician—and that she probably could have covered some of that time with vacation days. “But keeping those vacation days,” Dr. Gallup says, “gave me the ability to take paid time off when I returned to work.”
Edward Doyle is Editor of Today’s Physician.
Time off: How do you use it?
TAKING FAMILY LEAVE isn’t just about the amount of time you take off. Physicians who have taken parental leave point out that how you use that time is important too.
Eric Adkins, MD, who works at Ohio State University Wexner Medical Center, says he definitely got better at taking leave over the course of having three children: “Having multiple children is a great thing. It creates certain stresses on you, and one of the things you get better at is time management and how to disconnect. But a lot of it comes from the people around you who set the expectations and remind you that it’s OK to take off time.”
For him, a key to taking leave is planning. “One thing I tell people is to plan ahead and figure out who will take over your duties while you’re away,” he says. “Planning ahead will help you feel a little more comfortable as you disengage.”
“Planning ahead will help you feel a little more comfortable as you disengage.”
~ Eric Adkins, MD Ohio State University Wexner Medical Center
Dr. Adkins recalls one medical director who was texting him while that director’s wife was in labor. “I told him, ‘Focus on the baby and go be dad. We will take care of everything so you can disengage.’ ”
Further advice: “Turn off e-mail,” Dr. Adkins adds. “That’s a big source of stress for people. In an academic environment, a lot of traffic comes your way, so use out-of-office notifications and let people know you’ll be gone for three weeks because you’ve had a baby. Ask them to message you back later if the issue isn’t critical or reach out to another person who is taking on your responsibilities.”
Hospitalist Cecily Gallup, MD, took another approach during her six-month leave having twins. “In academic hospital medicine, it’s a little stressful to decide to take time off,” she explains. “You think you’re going to fall behind.”
She applied for and was given a leadership position while out on leave, which reduced her clinical time by 10% when she returned to work. At the same time, Dr. Gallup took another 20% cut in her clinical time so she had a little extra time to spend with her twins once she came back.
“Decreased clinical time means more time with my family,” she says, “while leadership time means I’m progressing in my career and not feeling like I lost out because I took off half a year.
