Baby en route: What to expect when your practice partner is expecting

Childbirth leave is becoming a necessity in even the smallest physician offices. Experts say the best way to handle it is to figure out the rules of leave before anyone needs it.

By Dave Hansen — Posted Sept. 24, 2007

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When you're going to call yourself Family to Family Medical Center, it follows that you're going to let doctors and staff take time off when they're starting -- or expanding -- a family.

Ventura, Calif., pediatrician Rola Magid, MD, is expecting her second child in November and is secure knowing that she has eight weeks of leave coming, as well as reduced hours in the last few weeks of her pregnancy. The practice's three pediatricians as well as the staff are eligible for maternity leave.

The center falls under the minimum employee cutoff in most federal and state laws that give employees the right to a family or medical leave. But like more and more practices, Family to Family views maternity leave as not only a nice gesture, but also an enticement to attract patients, staff and physicians -- especially as the number of female doctors continues to grow.

Dr. Magid left a larger practice to join Family to Family in part because of its flexible, family-friendly schedule that included maternity leave. "It sealed the deal," Dr. Magid said.

Patients of Family to Family know that the practice's employees care deeply for their families and appreciate it, said Kristen Pena, MD, one of Dr. Magid's partners. "Good staff are hard to find," she explained. "If it means sacrificing and not having them here [during leave], it is worth it."

The number of female physicians in the United States grew from 25,401 (7.6% of the physician work force) in 1970 to 235,627 (26.6% of the physician work force) in 2004, according to the American Medical Association. There were 8,446 women who were enrolled in U.S. medical schools during 2006 compared with 8,924 men, according to the Assn. of American Medical Colleges.

Consultants say those numbers don't necessarily mean that practices have to come up with maternity leave policies. But they do mean that practices should expect more questions about it -- and if they offer leave, they need to codify how they handle it.

"Maternity leave wasn't an issue when medicine was predominately men," said Dan Stech, director of products and innovation with The Pinnacle Group, a Denver-based health care management firm.

"But now, with more females in medicine and primary care, it is becoming a serious business issue that groups must devise solutions to," Stech said.

No leave required

The Family and Medical Leave Act of 1993 gives employees up to a total of 12 weeks of unpaid leave in a 12-month period for a number of personal health circumstances, including maternity leave, paternity leave and adoption leave.

But many practices are too small to qualify for FMLA. The federal law applies only for businesses with at least 50 employees. Eleven states and the District of Columbia have requirements that go beyond FMLA, but some practices still fall outside their realm.

Vermont, for example, mandates maternal leave for firms with 10 or more employees, while Minnesota requires it for businesses with at least 21 employees at one work site.

In many cases, leave is an issue between physician partners, if a doctor is the one requesting it, or between physicians and staff members, if the practice is allowing employees to take leave.

Physicians and human resource experts strongly recommend implementing a written maternity leave policy so that work gets done and relationships stay healthy between physicians, partners and staff members.

"It makes it clear for everyone how the practice feels, so it helps eliminate questions and keeps it from being subjective," said Cindy Dunn, who serves as a consultant with the Medical Group Management Assn. "You want to treat everyone equally. And if people have questions you can firm up your policy."

A maternal or paternal leave policy should cover how much time a physician or employee can take, and how much pay would be drawn during that time -- if any. For example, leave at Family to Family is uncompensated for both physicians and staff. Yet in some states, including California where Family to Family is located, mothers-to-be can apply for payments through the state's disability fund.

How employees request leave also should be addressed. Dunn cited Henry Ford Medical Group's policy as an example.

To request maternity leave, Henry Ford physicians and employees must follow the same procedures as they would for a medical leave of absence. They must submit to their department chair or medical director a statement from their physician that includes:

  • Appropriate medical facts regarding the health condition.
  • The date the health condition started.
  • The expected duration of the condition.

The notice must be given at least 30 days in advance.

The leave must be taken within the first year of birth or placement of a child. In addition, employees must document the qualifying event (submit a birth certificate or adoption papers).

A small practice would not have a department chair or medical director, necessarily, but experts recommend noting in the policy who in the practice should receive these documents, and who gets to approve leave.

If a policy is not in place when a physician or staff member requests a leave, that gives practices an opportunity to create one. It also gives physicians and staff an opportunity to negotiate how to maximize their leaves.

Prospective parents can start negotiating supplemental leave long before a due date by building a reserve of good will with co-workers to draw down later, such as taking more call than required, said Pat Katepoo. the founder of Kaneohe, Hawaii-based employment consulting firm Work Options.

The issue of time -- not only the expected dates of the leave, but also the unexpected dates -- also should be addressed in policy, experts said. What happens if a mother requires preterm bed rest, or has post-term complications, or has some other unexpected condition?

Making up the absence

But a bigger issue for doctors than time off is who will cover call, and whether the physician must make it up when they return, Dunn said. "As long as doctors discuss it ahead of time, I haven't seen any problems," she said. "Ignore it, and get hard feelings."

Covering the everyday patient workload is another concern, she said. "You don't want someone to do surgery three days before they leave because your partners must cover the post-op," she said.

According to a July 2006 survey by the Medical Group Management Assn., the vast majority of physician practices -- 88.7% -- divided the patients of a doctor on leave among remaining physicians. Locum tenens were used by only 4.3%.

Practices who choose to go the locum tenens route during a parental leave should spend several months lining one up, because a last-minute replacement can be very expensive, said Lucas Hutchinson, a consultant with The Pinnacle Group.

Another cost consideration: Whether the physician must continue paying for overhead while absent.

An MGMA survey in July 2006 found that about two-thirds of all practices continued deducting expenses and benefits from a physician's revenue while on leave.

And practices also should plan what to do if the physician changes her mind and decides she wants to return work part time, Dunn said. Human resource experts recommend solving that issue before a physician takes leave, if that is at all possible.

Discussing maternity leave is a good time to talk about expectations for when a physician returns to work, Dunn said, such as a flexible or part-time schedule. Anticipate problems before they arise, she added.

Family to Family chooses a case-by-case approach to maternity leave instead of using a written policy covering physicians and staff.

Family to Family's three doctors cover each other's call or use two locum tenens in town, Dr. Pena said. The longest leave an employee has taken is two months, while three months is the longest for a physician.

"We are very family-friendly and promote that atmosphere," Dr. Pena said. "We are moms, so we understand."

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Leave checklist

Experts say any paternal or maternal leave policy should state how it will handle the following scenarios, beyond postpartum recovery:

  • Bed rest before birth
  • Bed rest after birth
  • Day care issues
  • Sick-newborn issues
  • Adoption travel and leave

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Setting up a leave policy

Human resources experts say that if you're offering a doctor or staff member parental leave, you need to have a plan in writing before any time is taken. Here's a step-by-step guide based on expert opinion:

  • Meet with all partners and divide call schedules, patient loads, overhead and revenue.
  • Establish a mutually acceptable length of leave.
  • Determine the documentation you will need to verify birth/adoption/placement.
  • Decide if physicians must make up missed call time.
  • Decide if hiring a locum tenens benefits the practice during a physician's leave.
  • Set up how you would handle a request by the physician or staff member to return to work part time.

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States with parental leave laws

Some states extend parental leave to all employees. Others proscribe longer or shorter leaves than the 12 weeks available under federal law. Experts advise physicians to check with an attorney about laws in their states.

Required leave

  • California
  • Connecticut
  • District of Columbia
  • Hawaii
  • Maine
  • Minnesota
  • New Jersey
  • Oregon
  • Rhode Island
  • Vermont
  • Washington
  • Wisconsin

Source: U.S. Dept. of Labor, Employment Standards Administration

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