Background: Among Society of Hospital Medicine (SHM) members, 40% are women, and most of them are assistant professors, which suggests that a significant proportion of hospitalists are women of childbearing age. The United States lags behind most other countries regarding support for working mothers and parental leave, but there is limited data to describe the experience of female hospital medicine physicians. We sought to learn more about the experiences of women going through pregnancy, parental leave, and their return to work in academic hospital medicine.

Methods: We conducted a qualitative descriptive study that is ongoing. To date we have completed interviews with five female academic hospitalists chosen from institutions across the country that are represented in SHM Committees. Interview guides were based on the following domains: experience in pregnancy, parental leave, and return to work. Interviews were recorded, transcribed verbatim, and analyzed using a general inductive approach to theme analysis using ATLAS.ti software. Three team members coded transcripts and resolved discrepancies through group discussion.

Results: Women in academic hospital medicine experience challenges during the time period from pregnancy through new motherhood. Themes with illustrative quotes included: 1) Haggling for maternity leave, “It was an exhausting process to have to count your hours and go back and forth with HR.” 2) Financial burden, “I got penalized for going on maternity leave… I have gone an entire academic year without bonusing, which is money that we usually rely on.” 3) Feelings of guilt, “Right now you just always suck at something.” 4) Physical Challenges, “Taking care of patients with a sleep deprived brain…feels like it’s plowing through molasses.” 5) Missed career opportunities, “Her plate is full, we are not gonna ask her to do anything extra,” and “All of these great projects that I had started.. dwindled and died on the vine,” and 6) Breastfeeding challenges, “There was no time to pump and I would get home and be in pain, and worrying about if I was gonna have enough milk.”
Some physicians reported symptoms of burnout and patient safety concerns, “I was just trying to keep my life from spinning off into complete chaos,” as well as a more empathetic perspective regarding patient care: “I’m a lot more patient when children and parents struggle with making decisions for their loved ones.”

Conclusions: Large-scale deployment of evidence-based approaches to support women during these pivotal times in their career are needed to promote equity in the workplace. Such approaches may include: 1) Creation of a flexible clinical schedule both before and after birth to account for the mental and physical challenges of new motherhood, 2) Paid parental leave with a transparent process for acquiring it, and 3) Accessible locations for pumping and milk storage. A robust and supportive program has the potential to alleviate burnout and improve resiliency among early career female faculty, and to alleviate gender pay and leadership gaps.