Paid Family Leave and FMLA

Personal Leave 

Health care employers are gaining a deeper understanding that physicians are at high risk for burnout due to workload, long work hours, and cognitive and emotional demands. Physician burnout is a recognized workplace hazard and can also take a toll on quality of patient care and productivity. 

As explored in much greater depth in the AAP resources, it is in the interest of the specialty that employers promote wellness and foster a culture that supports physician well-being. This includes health care employers providing leave for personal and mental health reasons for physicians they employ. The specific terms of personal leave policies should be clearly delineated by the employer in the employment contract, including whether it is paid or unpaid status and allowable time periods. 

Family Leave 

Pediatricians know better than others how essential family relationships are to a physician’s personal well-being and the health of their families.   

The Family Medical Leave Act (FMLA) is a federal law that guarantees unpaid leave for qualifying employees. The law mandates that employers with more than 50 workers allow an employee leave for 12 weeks without fear of being fired and/or replaced, provided they have held that job for 12 months and logged at least 1,250 hours. Employees may be absent for 12 work weeks over a 12-month period.  

The FMLA applies to: 

• The birth of a child or placement of a child with the employee for adoption or foster care; 
• Caring for a spouse, child, or parent who has a serious health condition; 
• For a serious health condition that makes the employee unable to perform the essential functions of their position; 
• For any qualifying exigency arising out of the fact that a spouse, child, or parent is a military member on covered active duty or called to covered active duty status; 
• Caring for a covered servicemember with a serious injury or illness, when the employee is the spouse, child, parent, or next of kin of the servicemember (eligible for 26 work weeks leave unpaid). 

Typically, employees need to make such requests 30 days in advance (assuming the need is foreseeable). Any employee who returns from FMLA leave must be restored to their position that they were performing  at time of taking leave or given an equivalent position) with equivalent pay, benefits, and other terms and conditions of employment. 

Parental Leave 

The commitment to rational, equitable, and effective parental leave policies that are sensitive to the needs of pediatricians, their families, and developing infants is a core value of the specialty. Parental leave is essential to enabling parents to spend adequate and good-quality time with their young children. Coparenting, adopting, or fostering of a child should entitle the employee, regardless of gender, to the same amount of paid leave (6–8 weeks) as a person who takes maternity/paternity leave.  

It is important for each employer to have a policy for parental leave that is written, that is accessible to employees and clearly delineates the health care facility’s practices regarding parental leave. At a minimum, a parental leave policy must conform legally with the Family Medical Leave Act as well as with respective state laws. However, many independent practices with fewer than 50 employees are not bound by the FMLA.   

Flexibility, creativity, and advanced planning are necessary to arrange schedules that optimize staffing needs, cultivate equity in sharing workloads, and protect pregnant physicians from overly strenuous work experiences at critical times of their pregnancies. 

Paid or Unpaid Leave 

Paid leave is most commonly found in employment contracts with academic, hospital, and large health care organizations; but it can be negotiated. 

The reason that paid leave is less common in independent practices is simple. When physician salaries are based on relative value unit (RVU) productivity, the practice may argue that paid leave unfairly burdens working physicians by requiring them to finance another employee’s leave with the RVUs they earn during the physician on leave’s absence. 

Alternatives to traditional paid parental leave may be found. Some  physician groups offer low-interest loans to help physicians finance parental leave or allow them to “bank” paid sick leave prior to taking  parental leave. 

Paid leave can be negotiated depending on many factors including how valuable your skills are and the supply/demand of qualified applicants.  

Should Job Applicants Disclose Their Pregnancy? 

You do not have to disclose or discuss your pregnancy in a job interview. The Pregnancy Discrimination Act (PDA) prohibits an employer from refusing to hire a woman based on current, past or potential pregnancy, as well as discriminating against an employee due to a pregnancy-related medical condition.  

Another relevant federal law is the Americans with Disabilities Act, which protects disclosed pregnancy-related impairments and requires reasonable accommodations.   

Due to the PDA and ADA require a minimum of 15 employees, the laws may or may not apply to a small independent pediatric practice. Even with less than 15 employees, a practice must treat employees similarly to avoid claims of discrimination, and state laws may provide additional protection. 

While you don’t have to legally disclose your pregnancy, it may be best to do so. Small offices require planning to ensure patient care is not affected, and your new colleagues may feel a lack of trust and honesty with nondisclosure. While acknowledging the decision of disclosure is up to you, the Department of Labor recommends that you “be truthful, self-determined and proactive” with respect to disclosing any disability.