AAP Voices Blog

“Cynicism. Irritability. Difficulty concentrating. Feelings of inefficacy….”

The characteristics of burnout in physicians rolled onto the screen in my office. I noticed a sinking feeling inside as I saw myself reflected in those webinar slides. While I had already recognized that my life--professionally and personally--had become overwhelming, it was only in this moment that I realized I was burned out.

Female physicians have 20-60% higher rates of burnout compared to male physicians, according to a recent National Academy of Medicine report. While we are just beginning to understand the nature of burnout related to gender, a complex set of factors are thought to contribute to these differences: challenges in work-life integration, societal norms in performing household duties, workplace gender bias and discrimination, maternal discrimination, sexual harassment, and imposter experiences.

While many factors likely contributed to my experience, my identity as both mother and physician played a major role in my burnout. Ten months before that webinar, I had given birth to a healthy baby girl, my second child. I was fortunate in that I could afford to take 12 weeks of leave, using a combination of vacation, sick leave, and unpaid leave. The resultant lack of vacation following that year, paired with a sleepless infant, was exhausting. But more than that, the internal struggle to be present for my children and my job was tearing me apart. I, for the first time, seriously doubted whether I could be a mother and a doctor.

One study found that the top 12 ranking medical schools, as ranked by the National Institutes of Health and U.S. News & World Report, had a mean length of salary support during childbearing leave of 8.6 weeks. However, salary coverage varied widely and many policies provided only partial salary coverage. Most policies included constraints, like approval by department chair, or were available only to “primary caregivers.”

Constraints on using parental leave policies risks discrimination, and unfairly excludes parents who are not the child bearer and those who adopt. In some institutions, parents use sick leave or vacation, however, this can be problematic if that leave is needed for a medical complication or sick child or in cases where banked sick leave or vacation can be used as retirement benefits.

More than money

While I didn’t know it at the time, the presence of paid parental leave policies can have major implications for the mother and infant. Paid maternity leave is linked to improved maternal mental health, which is critical in promoting the well-being of infants. A Swedish study found that paid leave for partners decreased the use of anti-anxiety prescriptions by mothers by 26%.

Numerous studies also illustrate the benefits of paid parental leave for infants; for example an increase in paid leave from 6 to 12 weeks improved the duration of breastfeeding active duty mothers. In addition the health benefits, paid parental leave is essential in achieving gender equity; it may help lessen the gender pay gap, and increase the likelihood that women remain in the workforce.

Parental leave is not the only opportunity to support working parents. Organizations should consider allowing a graduated transition back to work, or time-limited part-time employment, particularly during the first year of life when most babies are still waking throughout the night. Other strategies, like flexible scheduling and extension of promotion tracks, may help improve work-life satisfaction and the well-being of physician mothers.

“Paid parental leave should not be a luxury, yet it is still lacking in many healthcare institutions, despite the mission of these organizations to promote the health and well-being of communities.”

In her book Unfinished Business, Anne-Marie Slaughter makes the case that businesses and society must transition to valuing caregivers through policy and culture. We can support parents in the workplace by facilitating conversations with men and women who are expecting children about how they plan to fit career and family together, including the division of home responsibilities and the potential for adjustments in work schedule.

It is also important to recognize that parents who decrease to a part-time or flexible schedule because for caregiving responsibilities are not less committed than those working full time and may have ambitions for career progression or leadership. Organizations ought to recognize the skills and experiences that caregivers acquire and welcome a period of “ramping back up” if or when he or she is ready.

Looking forward

Despite the evidence that paid parental leave benefits parents and infants, the United States is one of the few well-resourced countries with no national paid family leave policy. As pediatricians, we understand the value of parental presence in the early days of childhood, the impact of maternal mental health and breastfeeding on infant well-being. This expertise and our status compel us to be leaders on the journey to creating a better system of supporting caregivers.

I recognize that my challenges as a mother and physician exist in a space of privilege; as a white woman and a professional with a supportive partner, I benefit from resources to which other women do not have access. Paid parental leave should not be a luxury, yet it is still lacking in many healthcare institutions, despite the mission of these organizations to promote the health and well-being of communities. Equitable leave policies and flexible re-integration into work are important in creating a workplace culture where parents can thrive personally and professionally. Together, we can advocate at our local institutions and for a national paid parental leave policy for parents, that includes both genders and adoptive parents. In doing so, we will be promoting the health and well-being of physicians, women, babies, and families.