As leaders of the Family Support Initiative group at the University of North Carolina (UNC) School of Medicine in Chapel Hill, Lindsey “Lou” Gaghan, MD, and Bao-Tran “BT” Parker, MPH, heard from their fellow students who were parents about their confusion surrounding the school’s approach to parental leave.
Without an official policy to turn to, pregnant and parenting students had to rely on their individual supervisors to allow or deny their plans for taking time away.
Parker and Gaghan, who were not yet parents at the time — though they’d later give birth during medical school — felt that the lack of a concrete policy was an ethical issue, disadvantaging students with new children.
“We just thought to ourselves, ‘There has to be a better way to get this information instead of having to [reinvent] the wheel every time,’” Parker says.
The duo spent the next nine months creating what would become UNC School of Medicine’s New Child Adjustment Policy, which lays out a student’s options for taking up to six months of leave while retaining student benefits, such as health insurance and financial aid. The policy also discusses options such as taking remote classes while transitioning back from parental leave.
Today, UNC is part of a minority of medical schools in the United States that have a publicly available parental leave policy. While federal law and accreditation requirements mandate a minimum amount of time away for medical residents, the same protections don’t apply to students. According to a comparative study published in Academic Medicine in 2021, out of 199 schools reviewed, 65, or 33%, had a parental leave policy available online or in the student handbook. Just 25% of the 155 MD-granting schools reviewed had a public policy, while nearly 60% of the 44 DO-granting schools reviewed published their policies.
Another review, conducted by researchers at the University of California, San Francisco, looked at 56 U.S. medical schools and found that only 14% had “substantive, stand-alone parental leave policies.” While most schools offered general leave of absence policies that were not specific to parenting, the researchers also found that policies crafted specifically for pregnant and parenting people were substantially different from general leave policies.
“The structures for medical training are not really designed for individuals who are pregnant or who are taking on significant parenting roles,” says Amy S. Gottlieb, MD, associate dean for faculty affairs and professor of medicine and of obstetrics and gynecology at the University of Massachusetts Chan Medical School–Baystate, and the chair of the AAMC’s Group on Women in Medicine and Science Steering Committee.
“This is a workforce issue,” she adds. “With half of the workforce of physicians identifying as women, and the convergence of medical training with the biological reality of timing for pregnancy, this is something, as a medical community, we will have to revisit … so it becomes the norm and not the exception [to provide parental leave.]”
Changing a career-first culture
Medicine has long been a career known for its grueling training demands, from the extensive studying required in medical school to the long call shifts with little down time during residency, and beyond. But in recent decades, cultural shifts and demographic changes have led many to question this approach, particularly as women have grown to represent 47% of residents and 54% of medical students in 2022.
“Women should not have to feel like they’re asking for a special favor” when asking for time off or flexibility to give birth and care for a new child, says Deborah Kwolek, MD, an assistant professor at Harvard Medical School, director of the Women’s Health Resident Rotation at Massachusetts General Hospital, and chair of the Women and Medicine Commission of the Society of General Internal Medicine.
On average, people who go into medicine spend their late 20s and early 30s in medical school and residency, coinciding with their prime reproductive years, according to the American College of Obstetricians and Gynecologists.
In a 2019 commentary published in Academic Medicine, several physician authors, including Gottlieb, decried the lack of standardized and adequate parental leave policies at medical schools and residency programs, citing barriers such as rigid training timelines, workforce and duty hours challenges, and stigma.
“The historic lack of parental leave policies reflects a bygone era when single men who lived at the hospital were the predominant group among medical trainees,” the authors wrote. “That is no longer the case, and our educational system has failed to keep up with the changing demographics.”
Kwolek added that the benefits of parental leave are well established, including time for the birthing parent to heal physically and for parent-baby bonding.
"[Postpartum] women are still bleeding, in pain, and sleepless at night,” she says. “It’s really serious for their health.”
While there has been some movement on parental leave for residents since the Accreditation Council for Graduate Medical Education (ACGME) began requiring residency programs to provide six weeks of paid parental leave for both birthing and nonbirthing parents in 2022, medical students often lack such guarantees.
This leaves policies up to individual medical schools.
Standardizing the approach to parental leave
Parental leave policies can vary significantly from one medical school to another.
Harvard Medical School, for example, has a stand-alone parental leave policy that encourages students to make an individual plan in consultation with their advisor, supervisors, and financial aid counselor. The policy also lays out more details, including a possible 12-month leave of absence or scholarly project when having a child in the pre-clerkship phase, or allowing for up to 12 weeks of absence or scholarly work in the clerkship and post-clerkship phases.
University of Chicago Pritzker School of Medicine uses the same policy as the undergraduate school, which allows a student who becomes a parent to take a one-quarter (10-week) leave of absence while retaining benefits, but does not go into further detail apart from medically necessary leave. Washington University School of Medicine in St. Louis does not have a stand-alone parental leave policy, but a university representative said the school’s medical/personal leave policy “accommodates for parental leave and offers flexibility in the schedule.”
Similarly, Ohio State University School of Medicine has a general leave of absence policy that a student must request from a dean and allows up to a year of leave, although the policy says any leave of absence could affect graduation time.
Looking at parental leave through the medical student “lens helped me identify this had practical implications toward wealth and equity,” says Christina Mangurian, MD, a professor of clinical psychiatry at University of California, San Francisco (UCSF) School of Medicine and the UCSF Department of Psychiatry vice chair for diversity and health equity, who led the UCSF review of parental leave policies. “The highest-paid people had the best leave and it went down from there. It’s all about privilege.”
The UCSF researchers noted that most medical school leaves of absence allowed for a reasonable leave length, but one unnamed outlier granted only 2 weeks during the first two years of medical school, and 5 days during the second two years.
The researchers called for a more standardized approach to parental leave that incorporates best practices including:
- having a formal, stand-alone policy;
- specifying that the student is entitled to parental leave rather than requiring approval;
- making the leave available to all parents, not just birthing parents;
- preserving access to benefits such as insurance and financial aid; and
- giving a minimum of 12 weeks of leave, which meets the American Academy of Pediatrics minimum recommendations.
“Generations of women didn’t get pregnant during medical school or residency because of the discrimination,” Mangurian says. “The culture is slowly growing to be more understanding and recognizing that people are getting pregnant … [but] medicine is not yet at a place where a pregnant person is fully accommodated.”
Parker and Gaghan found it more challenging than they expected to rally supporters for creating a policy among faculty members and fellow students.
“Some faculty we spoke to said they had never considered that medical students might want to have children during medical school. Others felt like it was not their issue to advocate for because they themselves were not parents, and some did not see the merit in having a parental leave policy that would only benefit a few students,” Gaghan says.
But Gaghan and Parker found faculty allies in Sue Estroff, PhD, a professor of social medicine and Beat Steiner, MD, MPH, senior associate dean for clinical curriculum and medical student education at UNC School of Medicine. With their help, they ultimately won over the administration with a combination of student testimonials about their struggles parenting during medical school and education about Title IX, which offers certain legal protections to pregnant and birthing parents.
The New Child Adjustment Policy was implemented at UNC in 2019, and since then has helped several students, Parker says. Parker and Gaghan wrote about their advocacy work in Academic Medicine, outlining strategies for creating an inclusive, student-centered parental leave policy.
Gaghan’s first child was born at the beginning of the COVID-19 pandemic. Although she’d originally hoped to graduate in four years, Gaghan decided to take a full year away from clinical rotations for maternity leave and dermatology research. Because of her husband’s job, she was able to maintain insurance and had financial support for her family. Then, less than a month after giving birth to her second child, Gaghan started her transitional intern year at Spartanburg Regional Healthcare System in South Carolina in 2022. Because she was not yet a resident during the birth of her second child, resident parental leave policies didn’t apply to her.
“It was exhausting,” Gaghan recalls. “I was definitely stretched thin and not getting much sleep. I was [working] in the emergency room; that was really challenging. I was also pumping, that was another strain on my body.”
Her husband worked part-time from home, which allowed Gaghan to manage both the challenges of internship and parenthood.
“It would have been so hard without that [support at home],” she says.
Gaghan and Parker, who now has a one-year-old and is completing an MD-MPH at UNC this year, are part of the roughly 9% of medical students who become parents during medical school. They consider the creation of the parental leave policy at UNC as just the beginning of many reforms required to make medical school more supportive for parents.
Currently, most parental advocacy efforts are piecemeal and done at the institutional level, but there are some national efforts underway.
Louisa “Dru” Brenner, who is completing her medical degree at the University of Chicago Pritzker School of Medicine this spring, took a year off from medical school to launch the PRIME (Parent Resources in Medical Education) Initiative in 2021.
She surveyed physicians and medical trainees, both parents and non-parents, about experiences of parenting (including hesitations about having children during training), and conducted another survey focused on what supports parents in medicine felt they needed. The findings showed that more than 80% of respondents did not have or were not aware of parental leave policies at their school, most wanted clear policies that did not require a delayed graduation, and most indicated a need for childcare support and flexible return to work strategies for new parents, including part-time and remote options.
The PRIME Initiative has created toolkits for medical students who want to start chapters at their institutions, whether to create a community for support and resource-sharing among other parents, or to advocate for policies to medical school administration. So far, it has chapters at 30 medical schools, Brenner says.
Brenner says that rallying both parents and nonparents around advocacy has been key to the initiative’s success so far, since parents bring their experiences, but nonparents often have more time and energy for advocacy work.
But although medical students can play an important role in changing policies, Parker worries that this approach can place too much pressure on students who are already stretched thin and will spend a limited amount of time at the institution.
“The onus should not be on students to bring this forward and have to fight so hard when our first priority should be being medical students, getting that knowledge, and becoming fantastic clinicians,” Parker says. “Until the people who really have decision-making power are spreading this from the top down … this is not going to be a very sustainable grassroots effort.”
Kwolek agrees that it is up to institutions, with encouragement from national associations, to create an environment that is more humane and welcoming to young families. She’s hopeful that, as more women take on leadership positions at medical schools and teaching hospitals, there will be more traction for policies that support new parents.
“A lot [of women leaders] have first-person experience with childbirth and can remember the needs,” she says. “[But] there’s still a lot of work to be done.”