Feasibility and Financial Implications

Covering shifts with little notice, especially night shifts, can create a financial strain for emergency departments. Sites in which the trust level is high between providers and leadership will foster earlier notification of issues that impact the schedule, including pregnancy, and allow for creative solutions. Sites may choose to distribute the shifts among existing providers. For small groups, this may cause some shared sacrifice of increased shifts, yet individuals may realize that their temporary increased shift load may be offset by a reduction in the future due to unexpected illness or family emergency. Sites may consider hiring moonlighters who can be utilized during periods of staff shortages, which can include situations beyond pregnancy to include unexpected resignations, sabbaticals, and medical illnesses. At sites with a large academic or administrative load, these duties may be able to be shifted to gravid physicians requesting or requiring a reduced clinical load, and providers who typically do this type of work can be temporarily diverted toward more clinical work. This model can also be considered for other employees requiring limitations due to medical restrictions.

Thoughtful scheduling and planning during physician pregnancy stands to benefit all members of a department. While no single practice of emergency medicine is the same, it is imperative that departments and groups make evidenced-based policies to support emergency physicians during these transitional times. In reviewing the aforementioned recommendations, we hope that future scheduling policies for emergency physicians will use these data to promote healthy pregnancies, well-balanced physicians, and successful careers for our colleagues.

“The Equity Equation” is curated by Dara Kass, MD, and Uché Blackstock, MD.

Dr. Coldebella is clinical assistant professor of emergency medicine at the University of South Carolina School of Medicine in Greenville and an emergency physician at Prisma Health–Updstate.

Dr. Pilarski is associate professor of emergency medicine at Medical College of Wisconsin/Froedtert Hospital in Milwaukee.

References

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