Background: In 2019, for the first time, greater than 50% of medical school graduates in the United States are female. With changing demographics of physicians, establishing and advertising appropriate support for providers throughout pregnancy and lactation is critical. Pregnancy and lactation support has been directly linked to recruiting women early in their careers as well as to lifelong retention and full workforce engagement long after individuals are finished lactating. Additionally, women physicians have higher rates of suicide than male physicians, including high rates during the postpartum time period. Addressing physician wellness and burnout during the postpartum is a critical and understudied area for investment in hospital medicine.
Purpose: We aimed to create a multi-disciplinary intervention addressing three primary categories: time accommodations, physical needs accommodations (space and equipment), and emotional support/sense of social belonging supplemented by Departmental, Division, and Medical School policies, guidelines and procedures to improve postpartum support for providers working in hospital settings focused on lactation.
Description: We created lactation specific recommendations and pregnancy/peripartum recommendations. In June 2020 the Department of Medicine officially adopted a lactation policy providing 30 minutes for lactation purposes for each four-hour period, without change in pay, including counting a RVU credit towards incentive pay. The Division of Hospital Medicine has implemented the lactation specific procedures and guidelines and informed the department’s official Lactation Policy. Specifically, postpartum providers are excluded from night shifts for 6 months and shifts where they are the sole provider for one year, and are preferentially scheduled on services with a lower patient census and where another provider can cover communication to allow time for pumping. We have created shared “Tips and Tricks” documents and other resources, including references to Dr. MILK’s Facebook page and workflow strategies to integrate pumping time. Administrative support comes from establishing pre- and post-parental leave meetings to familiarize providers with the resources available, from lactation rooms and supplies to connections to peers and mentors who have breast/chest-fed as hospitalists and recently utilized these supports.
Conclusions: Since 2020 these guidelines and policies have been disseminated to and adopted by regional health systems of a large midwestern city resulting in implementation of portions of guidelines and procedures. The department had a total of 9 individuals in FY21 & FY22 that took advantage of this program, resulting in an average of $2,538 increase in incentive by using the accommodation vs. not having the accommodation. We are currently evaluating the impact of these changes in provider wellness, and to identify ongoing issues to further improve the support provided during this critical time period.