Navigating Parental Leave for Trainee and Early-Career Oncologists

In an interview with Targeted Oncology^TM, Sindhu Malapati, MD, hematologist/oncologist and assistant professor of medical oncology at the University of Arkansas for Medical Sciences, discusses the study, "The parent penalty: Parental leave and return to work in trainees and early-career faculty in oncology." The study, published in the Journal of Clinical Oncology, and which Malapati was principal investigator, identified serious disparities and gaps in parental leave policies for trainee and early-career oncologists.

Notably, the study found that 50% of respondents felt pressure to work while on parental leave, 60% felt guilty for asking co-workers for help, and 79% were overwhelmed with the demands of work and home.¹

In this interview, Malapati discusses the findings more in-depth and presents potential solutions.

Transcription:

0:09 | So what set off the idea was when I had my own child during training in oncology. Super short parental leaves, and not a lot of support when I came back, and then the more people I talked to, it seemed like this was a universal experience. So then I looked into it, and no one had actually quantified the problem. And it seemed like people in leadership and higher positions who actually make the policies were not even aware that this is a thing. So I thought the first step to fixing anything is still identify that it is a problem. And that's how I I went to my mentor, Dr. Flores, and then her team got involved. And together we did this study.

Most of our participants were medical oncologists, about 65%. And a smaller proportion was radiation oncologists. Most of them were trainees, about 70%. And what was crazy was how low the parent leaves were the duration. So on average, it was less than 6 weeks. But 40% had less than 4 weeks, which as a developed country and in medicine, that's crazy.

0:56 | The rest of the world has 6 months to a year at least. And here we are with less than 4 weeks. And then half the people who responded felt pressured to work during their parental leave, like administrative work and research work. And around 60% felt guilty that they had to ask their colleagues for help and support during the time when they came back to work or to cover for them when they were on parenting leave. We know that parenting is very overwhelming. But coming back to work, 79% were overwhelmed by the demands of both work and home. And not many had resources available when they came back to support them. Just something even as simple as having a mentor talk to you or connecting to other parents, something formal, was not available when they came back. So you're pretty much on your own. Another thing we looked at was lactation policies. So 31% had no access to a lactation room. So what I kept hearing over and over were people pumping in bathrooms and patient rooms hoping no one would walk in. So most people had a lactation room that was available, but it was too far away, or they didn't have time to go there. So which is effectively like not having enough resources.

With the trainees, we do have a governing body, the [Accreditation Council for Graduate Medical Education (ACGME)]. And recently, they mandated that there should be 6 weeks of parental leave. So they do have the power to bring about that change. And instead of having rigid timelines, like you have to do this many weeks of clinical rotations, if they could do competency-based graduation from training, which means that even if someone takes a little bit longer, as long as they meet the competencies and are clinically able to care for patients well, they should still be able to graduate. So it's a little bit easier to ask for these things in the trainee level.

2:26| But for the early-career faculty, there's no governing body. So you have all these different practices and hospitals. [The American Society of Clinical Oncology (ASCO)], [the American Society of Hematology (ASH)], the governing bodies on hematologists and oncologists can always raise awareness and ask for all of these things like increased parental leave and availability of lactation resources for these people, but they can't mandate it. I think it has to come more at an individual level where people are negotiating for themselves and looking for mentors who can champion that cause.

There's a lot of judgment surrounding medicine, surrounding putting personal priorities above professional, so even having that conversation with leadership is hard. And then we also saw in our study that a lot of of parents who went back and were pumping couldn't even ask [or] did not feel comfortable asking their supervisors even for some time to go pump. So the hierarchy in medicine and then judgment, and then there's a lot of, "I did this back in the day; why can't you?" You know, that's also another significant barrier to overcome.

3:24 | So there's a lot of research being done. So it's being more and more identified. I think it's time to move on to that next step, like a pilot program, where there's a hospital with committed leadership who are willing to institute these changes and see what what effects it brings on, you know, keeping faculty for longer, decreasing burnout. And what are the financial implications? Unless we know those implications, we can't advocate for a wide scale use of these.

REFERENCE:

1. Malapati S, Singh S, Idossa D, et al. The parental penalty: parental leave and return to work in trainees and early-career faculty in oncology. Journal of Clinical Oncology 40, no. 16_suppl (June 01, 2022) 11005-11005. doi: 10.1200/JCO.2022.40.16_suppl.11005