The American Academy of Pediatrics and World Health Organization recommend breastfeeding for up to two years, or longer. There are numerous documented benefits of breastfeeding to both parent and infant. For parents who choose to breastfeed, being able to pump at work to maintain breast milk supply is critical. For the lactating physician, the ED schedule compounds the physical stress of maintaining a milk supply and the consequences are measurable. When clinicians lack the ability to attend to biological necessities like milk expression, the toll includes increased risks of mastitis, ductal plugging, and premature milk supply loss [1,2].

Emergency physicians face unique challenges compared to other specialties, given the unpredictable, high-acuity environment that lacks scheduled breaks [3,4] and even when formalized policies exist, cultural barriers often prevent lactating physicians from meeting their goals [5]. A 2022 survey found that only 7.6% of pediatric emergency physicians felt they "always" had sufficient time to pump, and only 32% felt they "always" had appropriate locations [6]. This means that nine out of ten pediatric emergency medicine physicians felt like they did not have the protections needed to pump. The advent of hands free pumps has allowed some physicians to successfully pump while engaged in clinical work, but these pumps are very costly and can sometimes be associated with lower milk output than a traditional pump [7]. For that reason, there should not be an expectation that hands free pumps are a suitable alternative to protected time and space for pumping. One novel solution is a residency program that provided a hands free pump, free of charge, to any interested resident who is pumping.

In addition to the physical constraints of emergency medicine work that threaten successful pumping, there are the financial concerns. For physicians that are RVU based, time away from the clinical setting can result in reduced pay. Several hospital systems across the country have adopted strategies to compensate for this such as a percent-based RVU boost or a fixed number RVU increase per shift for pumping physicians, or decreasing targeted-RVUs for salaried physicians.

Much like the protective scheduling required during pregnancy to reduce the risk of prenatal complications like miscarriage and and preterm birth, lactation accommodations are a matter of occupational safety and workforce retention [8, 9, 10]. As a specialty that prides itself on evidence-based practice, it is incumbent upon leadership to apply these same principles to ensure the longevity of the female workforce and the safety of our clinicians [11, 12]. Not only is providing support for lactation the right thing to do, it is required by law. The PUMP Act requires most employers with over fifty employees to provide time and space for employees to express breast milk at work. Additionally, the ACGME, which accredits Emergency Medicine residencies, has requirements for facilitating lactation.