Discussions around paid family leave have been buzzing since last year, when the Senate passed legislation—on a vote of 86 to 8—that provides federal workers with 12 weeks of guaranteed paid time off for parents following the birth, adoption, or fostering of a child.1 This has been the first update to federal family leave policy since the U.S. Family and Medical Leave Act (FMLA) was enacted in 1993.2 The United States is one of the few countries left in the world where parental leave is not an entitlement.3 Attitudes about parenthood and family leave, however, and particularly how they fit with a career in medicine, are rapidly changing. Women currently constitute more than half of all medical student matriculants, and 38 percent of all emergency medicine applicants are female.4,5 Nationally, in 1980, only 13 percent of female graduate medical education trainees became pregnant during their training, but that number has nearly tripled to 35 percent, and, in some instances, that number is higher still.6 Seventy-seven percent of baby-boomer fathers believed that paternity leave is important, and now more than 93 percent of millennial-generation new fathers believe that it is.7 These changes all beg the question: What is emergency medicine’s ethical obligation to provide parental leave benefits?
The Ethics of Paid Versus Unpaid Leave
In the best of circumstances, emergency medicine, much like pregnancy, is physically demanding. Without paid leave, late-gestational female physicians must work through the strain of night shifts, lack of physical or nutritional breaks, and physically threatening patients, while striving to “bank shifts” and save any days off for after delivery. The United States is the only industrialized nation without legally protected paid maternity coverage resulting in a mere 11 percent of American women with access to paid maternity leave.8 Paid parental leave is demonstrated to lead to longer parental lifespans and improved parental mental health.9
Economically, it is expensive to develop a physician with years of education, training, and experience. Parental leave improves the likelihood of returning to full time work after delivery.10 Physicians are often the primary breadwinners for their family, making unpaid leave unviable. All the physical stressors of emergency medicine continue to be present after the arrival of a new child, compounded with sleep deprivation and the demands of providing care to an infant.