Family and Medical Leave Act

The Family and Medical Leave Act (FMLA) allows up to 12 weeks off each year for family or medical reasons to eligible employees of companies with 50 or more employees.⁵ Personal serious health problems that preclude performance of the job are permitted leave. In addition, care of family members defined as spouse, child, and parent with serious medical illnesses is also protected under the law. Leave may permissibly be taken after childbirth, adoption, or foster placement.⁶ To be eligible, employees must have worked a minimum of 1,250 hours in the previous year. Employers are required to maintain employee health insurance benefits during the time taken for FMLA leave. This period includes pregnancy loss.

Additionally, depending on the state, women who give birth may be able to apply for paid sick leave or partial wage reimbursement covered by state temporary disability insurance. Women at high risk of miscarriage may be eligible for workplace accommodations under the Americans with Disabilities Act. The following website is a resource regarding legal protections and miscarriage.

Know Your State Family Leave Protections

Several states have additional family protection leave laws. For example, California offers paid family leave that is funded through state disability insurance via state tax withholding.⁷ The plan allows for 60 to 70 percent of income (calculated from the previous 12 months of work), with a maximum weekly benefit of $1,252.⁸ For most emergency physicians, this is equivalent to a single shift at best, but over the course of six weeks, it does provide some support. This website provides a comparison of family leave laws and regulations by state.

Future Directions

Many of the current laws are not optimized for emergency physicians. For example, many emergency physicians work for groups with fewer than 50 employees, meaning that the protections under both the FMLA and the Affordable Care Act do not apply. For those who are employed in groups with 50 or more employees, the minimum of 1,250 hours of work required in the previous year can cause physicians to delay starting a family or preclude taking time off even for personal or family illness. Many physicians have already postponed starting a family as a result of the burdens around medical school and residency. Lastly, FMLA is unpaid leave. Lack of paid parental leave has been associated with poor parental and infant outcomes, including spontaneous abortion, preterm labor, infants who are small for gestational age, depression, and breastfeeding noncompliance.^9-11 So while current laws provide some options for emergency physicians, there is much room for improvement.

There are some emergency medicine organizations with progressive family leave policies, including Acute Care Solutions and Vituity.^12,13 However, only 50 percent of emergency physicians report having a formal parental leave policy in their workplace, and as many as 36 percent are dissatisfied with policies they do have.¹⁴ With the American Academy of Pediatricians recommending 12 weeks of parental leave as the minimum necessary for healthy children, it must be asked, when will all of emergency medicine support our physician parents?¹⁵ When Walmart has a more progressive parental leave policy than the majority of EM workplaces, we really need to ask ourselves, beyond the laws, if we are doing enough for our fellow physicians.¹⁶