As we searched for jobs out of residency, we found collaborative frustration in that we could not easily find transparent information from the large community emergency physician (EP) groups (TeamHealth, Schumacher, Envision, Vituity, USACS) regarding parental leave policies and benefits.
Glassdoor and Fairygodboss offer anonymous reviews online of companies, but many of the reviews of EP groups are filled out by employees in administrative roles, rather than physicians.
It seems many EP groups keep information about benefits secret until you have a job offer in hand. This is unfortunately common outside of medicine as well. In a 2016 report done by the nonprofit PL+US, 31 out of 60 big US companies researched would not share their parental leave policies (1).
This year the American College of Physicians released a position paper on gender equity and recommendations for how to achieve gender equity for physicians in compensation and career advancement. Specifically, “ACP supports transparency and routine assessment of the equity of physician compensation arrangements by all organizations that employ physicians” (2).
It took some creative research efforts to gather specifics on the parental leave policies of a few of the biggest EP groups. We emailed recruiters directly, scoured company websites, and requested personal stories from physicians through social media platforms. Many of these groups employed physicians in other specialties, but we only focused on the experiences of emergency physicians. This is what we learned.
TeamHealth is a private company where some physicians work as independent contractors (1099 tax status) and others as employees (W-2 tax status). When TeamHealth was contacted directly, they declined to comment about their parental leave policy as they considered it “proprietary information”. Furthermore, no parental leave policy or benefits were listed on their website. We did, however, receive many anecdotes from current physicians.
Physicians cited taking anywhere from 3-6 months off and sometimes getting paid for the first 6 weeks by having purchased short-term disability (STD). STD is available through many large groups. One doctor cited getting “$2000/week” but the amount varies depending upon how much is purchased. Of note, most STD plans will not pay for a pre-existing condition, so it cannot be utilized if you are already pregnant when the plan is purchased.
Most physicians seemed quite happy with the flexibility they received as independent contractors at TeamHealth. Many reported being able to take longer vacations with their families; specifically citing “[TeamHealth was] easy to work with.” Another person wrote, “[I] didn’t have to increase my hours” and “[I] did not have to work extra shifts the other months of those years.” One physician cited, “My 2 year contract [was] extended by the amount of time I took off (about 12 weeks).”
Schumacher, also a privately held company, merged with ECI Healthcare Partners in 2016. Most physicians work with Schumacher as independent contractors. They pay for their own health insurance and other benefits. There is no parental leave policy listed on the Schumacher website. Schumacher was contacted directly but did not email back when asked about their parental leave policy. One physician reported no official minimum or maximum hours he was required to work with the group. All who took parental leave reported being independent contractors and going on unpaid leave, ranging from 6 weeks to 16 weeks. Most were able to get the time off they wanted. A few described parental leave as being “no trouble at all” with an “accommodating and supportive group.” One was able to come back part time after parental leave and retain her medical director position. A few physicians stacked shifts before parental leave to prepare for the financial hit of taking time off but others “didn’t work extra before or after.”
Envision was formed through the merger of EmCare and Sheridan in 2016. There is no parental leave policy listed on their website. When we reached out to their general company number, the recruiter shared that physicians can work in a variety ways, mostly as independent contractors or employees. There isn’t a uniform parental leave policy because Envision has acquired many smaller groups. Some of these groups negotiated to keep their previous parental leave benefits. Envision does offer STD. One mother wrote, “[I] paid for additional STD benefits that apparently pay 40-60% average salary after a 15-30 day period to either 6-12 weeks.”
One group acquired by Envision already had 6 weeks of paid leave at 50% salary, and this group kept this parental leave policy after the acquisition. Many other physicians had to take unpaid leave. One wrote, “I am not aware of any parental leave policy;” whereas another stated, “[My] director just told me to come back as soon as possible.” Another physician wrote, “One of the physicians does the schedule and he was very accommodating.” Another cited, “Got scheduler to squeeze my shifts into first half of my last month so got a bit more time off.”
Vituity, formerly known as California Emergency Physicians (CEP), is a nationwide physician-owned partnership where physicians are not 1099 independent contractors or W-2 employees but rather partners. Vituity has “a white paper” for partners offering a $10,000 parental leave stipend for a parent of a newborn or adopted child who takes 60 days off of clinical practice. There’s also a $25,000 interest-free parental loan available starting at the beginning of employment available to all partners working at least 50 hours a month. This loan is, as one physician writes, “to bridge the gap for female partners that want to take maternity leave but didn’t save the money to take time off.” One Vituity physician wrote that having the white paper was nice “to have everyone on the same page when you’re having that initial discussion you’re pregnant.”
Another physician wrote, “I haven’t taken parental leave yet but I’m happy with the flexibility of Vituity work hours. I work 10 shifts a month and still keep my benefits including parental leave benefits. I plan to cut down to 8 when I start a family and am happy that Vituity won’t kick me off these benefits for working part time.” Another wrote with less enthusiasm, “They give you an ‘interest free loan’ of your own money which you have to pay back.”
USACS (US Acute Care Solutions) was started in 2015 and has been expanding rapidly, gaining a lot of the Colorado and East Coast market in the last two years. They list themselves as a physician-owned company where full-time physicians get equity. Their website lists their policy as follows:
The parental leave stipends are based on 12 months of regular pay prior to leave. Birth mothers get 12 weeks of paid parental leave: 8 weeks paid at 100% (2 weeks parental leave and 6 weeks short-term disability) and 4 weeks primary caregiver leave at 50%. A parent who adopts a child gets 6 weeks of paid parental leave. The non primary parent for both adoptions or births (father, partner, spouse) gets 2 weeks of paid parental leave.
USACS physicians commented that the policy was “generous” with a “super responsive HR” department. Many commented that USACS had excellent benefits in general. One person wrote, “They give everyone shares that vest over 5 years.” Most took the maximum time allowed for parental leave. Physicians were happy that they could “make [their] own schedule for 3 months after” and just before delivery. Another wrote, “Very supported by local colleagues. No extra make-up work done or expected.”
But there are also different perspectives. One physician reported that the “108 hours minimum” he is required to work to keep his benefits is much more than he would want to work as a new father. A few physicians complained about a low hourly rate, whereas others thought their hourly was competitive with the local market.
The opportunity to take time off after the birth of a child is an important life event and an experience that is recognized by all of the large EP groups. As you have read, the details of that “benefit” varies. To give generous parental leave, some groups set a minimum number of hours or shifts you must work. Other groups extend your contract by the time you took off, making maternity leave not a benefit but rather a leave of absence. Those employed as independent contractors have a more flexible schedule and work less—with the caveat that all leave is unpaid. A lot of these physicians end up buying STD either from the company or open market to help cover the costs of this unpaid leave.
The Family and Medical Leave Act guarantees employees up to 12 weeks of unpaid leave and continuing paid healthcare benefits during leave for employees who have worked with their company for 12 months. But what about those of us who haven’t worked for a group for 12 months? The job is not protected, even for maternity leave. Currently a lot of groups instead offer “administrative leave” which keeps one employed with the company but offers no healthcare benefits, rendering the employee to have to use COBRA for healthcare or go on a partner’s plan (fortunately this is a life qualifying event).
Furthermore, this article would not be complete without pointing out that the parental leave policies of almost all the groups fall far short of well researched recommendations that women should receive between 12 weeks to 6 months of paid childbearing leave. This leave will “support the child’s medical and developmental needs [and] address the physical effects of pregnancy and parturition” (3). Longer paid maternity leave benefits has been shown to “boost productivity…by encouraging qualified women to stay in the workforce” (4).
One unique challenge for providing parental leave for ER physicians is that we work a variety of clinical hours. Some of us work 40+ hours a week, while others work only 5 shifts a month. EP groups must figure out how to offer fair parental leave benefits that match the compensation we receive while working our regular hours.
Parental leave is an essential part of physician compensation and should be clear and transparent in the job search process. In order to make informed employment decisions, we must share information amongst ourselves. We hope this article inspires others to share more information.
Disclosure: Dr. Bree Jacobs works with a smaller EP group not included in this article. She had twins this year. Dr. Clare Johnson works with Vituity and has not used the parental leave benefit. To minimize bias, Dr. Jacobs wrote the subsection on Vituity.
- “Forging Ahead or Falling Behind? Paid family leave at America’s top companies.” A report by PL+US: Paid Leave for the United States. www.paidleave.us, 2016.
- Butkus, R., Serchen, J., Moyer, D. V., Bornstein, S. S., & Thompson Hingle, S. (2018). Achieving Gender Equity in Physician Compensation and Career Advancement: A Position Paper of the American College of Physicians. Ann Intern Med, 168 (10), 721-723.