Background: The benefits of breastfeeding for infants and women are well established with the recommendation from the American Academy of Pediatrics to breastfeed for at least 1 year. However, balancing clinical responsibilities with the mental, physical, and time load for breastfeeding physician mothers returning from parental leave proves extremely difficult and contributes to gender disparities in career satisfaction. A national survey of physician mothers shows that support such as protected pumping time would likely help them thrive in their careers as well as maintain breastfeeding. There are currently no established service models nationally for hospital medicine leaders to accommodate pumping needs for lactating hospitalists.

Purpose: To establish a lactation accommodation policy for hospitalists in our division with the aim to account for the significant time required to pump while on clinical services, empower this subset of faculty to achieve both clinical and lactation related work, and promote gender equity within our division of hospital medicine.

Description: In January 2021, under the guidance of our hospital medicine division’s Women’s Council Taskforce for Breastfeeding Faculty, our division implemented an accommodation for lactating faculty on direct care services to reduce their team census by one to facilitate balancing patient care demands with the time needed for pumping. Our direct care services distribute new patients in a census-equalization model; thus reduction in team census by one allowed for a meaningful reduction in clinical demand (approximately 1 hour) to allow for pumping time. To do this, we worked with our electronic medical record (Epic) liaison to create a ‘test’ patient that lactating faculty could add to their team list. This allowed all faculty on clinical service (including those admitting and distributing new patients) to maintain proper census numbers and avoided the need for a manual re-adjustment of team numbers, while also providing a layer of anonymity for lactating faculty. After 3 months of the initial pilot, feedback was obtained from lactating and non-lactating faculty showing significantly increased benefit to lactating faculty without appreciable increased clinical burden on non-lactating on-service faculty. In March 2021, the policy was extended to include lactating faculty and residents on the inpatient teaching services who admit patients on a Q4 call cycle and receive overnight holdover admissions based on team census. The team census was reduced by one and total daily admission cap was lowered by one, again utilizing the ‘test’ patient in Epic, for any team that had a lactating faculty member or resident. Five women have utilized this policy thus far, with 100% of them reporting that the policy is helpful for their lactation efforts.

Conclusions: Implementing a lactation accommodation policy enabled lactating faculty to better balance clinical responsibilities with demands of pumping, without placing undue clinical burden on non-lactating faculty. Further innovations in this area are necessary to better support physician mothers.