We all know that completely different medical conditions can create the same effects on our patients’ work lives. That is, from the employer’s purely administrative standpoint, an absence is an absence regardless of its cause. Even medical care professionals react differently to similar effects rendered by completely different circumstances.
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Explore This IssueAugust 2015
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A Personnel Crisis
Let me give you a hypothetical example. You own or operate a busy, successful subspecialty practice. You employ six care providers and rely on them to treat many patients, do some teaching and administrative work and cover on-call obligations. Now picture this: Within a couple months, four of them reveal that they have health issues and will need to take two–three months off. Two or three of them will take time off simultaneously, and this will begin about six months later.
As a caring employer or manager you would be very understanding and supportive, but let there be no mistake, this situation presents an impending personnel crisis. You will need to confer with all staff about covering patients, following test results, sharing teaching assignments and reorganizing the on-call schedule so the after-hours burden is fairly redistributed. You would have to be either naive or a saint not to raise an eyebrow and consider the situation difficult and, perhaps, overwhelming.
The rational part of your cerebrum would question why in the world you passed on that tidy pharmaceutical research position that was offered to you years ago. Despite the obstacles, you roll up your sleeves, try not to violate your employees’ right to keep health issues private and take care of the business.
Now I ask that you take a deep breath and imagine that you have the same personnel scenario, but rather than operating a private practice you run a fellowship program where the same number of your trainees tell you that, about six months from now, they simultaneously will be missing in action due to maternity leave. Now, would you as readily label that situation a crisis? Would you be equally eager to schedule meetings with all of your staff and divide up the work? Would doing so interfere with the expectant mothers’ right to privacy? Would any such right to privacy have any practical application once the expectant mother is five or six months into her pregnancy and, to anyone but the blind, obviously “in a family way?”
Before preceding any further, and in an effort to lessen or defuse any undue controversy and speculation, please allow me to clarify. I am a mom. I have a mom. I adore babies. Many of my dearest friends and relatives are, have been or will be moms. I support birth and the continuation of our species upon this planet. I harbor absolutely no ill will toward those who are, may be, will be or have been pregnant. My comments in this article are addressed solely and objectively to the means by which we may effectively deal with, plan for and accommodate the impact that pregnancy-related absences have upon the mothers’ workplace.
Let me describe an experience of my own. Immediately after residency I worked in a busy primary care clinic with an extremely high patient volume. The clinic was pro family and, rightly so, took pride in that attribute. Within the first few months, I found out that two of my colleagues were expecting to give birth. I congratulated them and went about my business, but foolishly never thought to ask administration about how it planned to provide care for the expectant moms’ patients when they simultaneously took their three-month leaves of absence. Perhaps being green, I simply expected that my employer, the majority of whose staff was women, certainly must have dealt with similar issues in the past. I reasonably expected that it would hire some temporary additional help to cover this completely foreseeable lack of personnel rolling directly toward us like a freight train. Silly me.
Instead, when the babies arrived, I found that the clinic’s “plan” was that, in addition to treating my usual roster of patients, I would somehow miraculously find extra time to take on the new moms’ phone calls, medication refills and scheduled patient visits. There was no conversation with management about how my schedule would be magically adjusted to accommodate these additional duties. I was not a happy camper.
The resulting chaos and stress were, of course, pointless and totally preventable. But I had learned a valuable lesson. Over a year later, when the same scenario was presented by more oncoming babies, I did not hesitate to request that management adjust my schedule in order to allow me to cover my colleagues’ workload, and I respectfully suggested that locum tenens (i.e., temporary physician staffing) might be needed to provide essential extra help. I was pleased to see my employer took the necessary steps to address the impending absences. My schedule was better, I could more effectively cover my colleagues’ workload, and we brought on a locum tenens to help out during those months when the new moms understandably were at home with their babies. All in all, it was a remarkably better, less stressful and more egalitarian situation than before.
Open a Dialogue
What I encountered then and since is that we too often overlook the need to conduct an open conversation about how to handle pregnancy-related needs and absences. I advocate common sense planning for the natural and well-anticipated event of employees having children. It is not a sudden, unforeseen acute illness that needs to be addressed. There is plenty of time (normally about six months) to talk, plan, rehearse and behave normally to humanely and professionally manage the collateral effects that this physiological event will bring upon the mother’s workplace. Just as she should not feel guilty about taking time off after giving birth, nor should her colleagues feel overwhelmed due to her absence.
Advance planning is necessary, and it is foolish to hope that the unavoidable, but wholly predictable, fallout will somehow take care of itself. The issue should be squarely addressed, particularly in residence and fellowship programs when so many doctors in training are, thanks to biology, predisposed to starting families at this already busy juncture of life. Although both the issue and the solution seem obvious, my experience has been that they too often are inadequately addressed.
The responsibility to work out solutions falls as much upon expectant mothers as upon their employers.
The responsibility to work out solutions falls as much upon expectant mothers as upon their employers. Too many times, our impressions of pregnancy and its effects seem like leftover baggage from a different, bygone era. My female resident recently told me that during the specialty interview process, the female interviewees asked the questions about maternity policies so a visibly pregnant applicant would not fear that she was being singled out as an expectant mom and be perceived as a less competitive job candidate. Theoretically, this was a bright and brave idea, but I find it only a partial, and somewhat unsatisfying, solution.
My impressions are, in some part, drawn upon having experienced the better and worse parts of the situation while being a pregnant chief resident. Apprehensive that my colleagues’ impression of my work ethic might change, I did not let anyone know that I was pregnant until well into the fifth month, because there appears to be some subtle, yet lingering, stigma about pregnancy-related work abilities. Too many times, I have heard pregnant women themselves volunteer after making a workplace error that they were operating with a “pregnancy brain.” Say what you like, but I find many expectant moms to be creative, productive and motivated. They may be exhausted, but their IQs are intact.
Lose the Guilt
I have had expectant colleagues express that they sometimes feel guilty and take on additional work in an attempt to compensate before they leave to give birth. Without an honest and respectful dialogue, both sides feel unjustly treated: Expecting moms feel that they will be leaving substantial work for others, and colleagues are afraid that they will have to do both their and someone else’s job for some time. There is ample room for improvement in this area.
With women comprising more than 50% of rheumatologists, I promote the preparation of a plan for action well before anyone announces her pregnancy. There remains the biological need and dependency of the newborn upon its mother. They both need—and we must make all reasonable effort to ensure they have—the time to bond and develop maternal intimacy. I suggest that the American College of Rheumatology and its educational branches study the issue and provide whatever assistance may be granted. Both mothers and their colleagues, who are after all teammates, need to be heard.
Women have entered the workplace and will not be exiting. At this point no one—doctors nor society—can afford to ignore issues that too often are treated as too sensitive for polite discourse.
Katarzyna Gilek-Seibert, MD, is a staff rheumatologist at Roger Williams Medical Center, Providence, R.I., and affiliated with the Boston University School of Medicine. Contact her via e-mail at firstname.lastname@example.org.
The federal Family & Medical Leave Act (FMLA) entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to:
- 2 workweeks of leave in a 12-month period:
- for the birth of a child and to care for the newborn child within one year of birth;
- for the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
- to care for the employee’s 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 his or her job;
- for any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty”; or
- 26 workweeks of leave during a single 12-month period to care for a covered servicemember with a serious injury or illness if the eligible employee is the servicemember’s spouse, son, daughter, parent or next of kin (military caregiver leave).
For more information about the FMLA, visit the Wage and Hour Division Website, and/or call the toll-free helpline, 1-866-4-USWAGE (866-487-9243).
Your practice should consider how it intends to cover the individual’s work while the expectant mom is away. Can her duties be covered internally? Is extra assistance required? Ideally, there should be a handover period with the employee to ensure an easy continuation of her duties.