In a previous post, I recognized lactation support for women physicians as an equity issue. Many of the women physicians I’ve interviewed have identified returning to work while breastfeeding as a major challenge and a major source of stress. Providing accommodations to ensure that these professionals have access to the resources they need to do their work is essential to creating an equitable workplace.

Soon after I published this post, I was introduced to a physician leader who has created a program that provides just this type of support. Isn’t serendipity amazing?

Michelle Mourad, MD, vice-chair for clinical affairs and value for the department of medicine at the University of California San Francisco, knows personally the challenge of lactation while working. “When I returned to work, it was really difficult to carve out the time to pump while doing clinical work and between meetings. I pumped in the bathroom the first two days back at work because I couldn’t find the lactation room in the scarce minutes I had available. Fortunately, I was far enough along in my career to advocate for myself and to ask for the flexibility I needed.” But she wondered about other women who weren’t so fortunately situated.

In her role as clinical affairs vice-chair, Dr. Mourad was determined to partner with others in the organization to better understand and address the gender gap in physician satisfaction (based on the net promoter score) that had been documented in the annual surveys at her institution. At an organization-wide retreat on equity issues last year, led by chief physician experience officer Diane Sliwka, MD, the need for more support for lactation and returning to work after childbirth were identified as equity issues.

Dr. Mourad voiced the need for change and was invited to create a proposal for a lactation support program for the faculty. After interviewing faculty members who were or had recently been lactating, she presented a program that provides 30 minutes of paid time to pump for every four-hour clinic session (essentially paying 1/8th of their compensation for ambulatory clinic work), along with better facilities for pumping, and additional communication about the supplies and resources available.

The program was launched in November 2020. It has been extremely well-received. “We have had only positive feedback. What we’ve heard is gratitude and the wish from women who had completed lactation that the program had existed earlier.” The feedback included these comments:

• “I’m so grateful for this program and can’t even imagine surviving clinic without it.”
• “It’s hard for me to believe, but only a few years ago, the message was that sure, we could set aside time for pumping, but that we were still responsible for making our wRVU targets even if that meant additional clinic sessions, etc. Amazing how things are changing – you have a very grateful employee here.”
• “This is amazing! My only regret is that this [program] wasn’t started earlier as I’m nearing the end of my lactation time. Oh, well. I will use it for the next baby.”

Setting up the lactation support program for faculty physicians who work in clinics (and expanding it to include advanced practice providers) was relatively straightforward. The greater challenge has been bringing the program to physicians who have work schedules that don’t easily allow for timed breaks, such as emergency physicians, anesthesiologists, surgeons, and hospitalists.

Through focus groups with these physicians, Drs. Mourad and Sliwka learned more about their specific needs. These needs include a functional lactation room (i.e., with a phone and a computer) that is nearby and can be reserved and a system for covering their time while they pump (e.g., someone to hold their pagers or cover for codes). They are now working to make these accommodations available and to continue to expand the program.

According to Dr. Mourad, UCSF leadership support was essential. “Top leaders recognized the value of the program to lactating physicians. Their executive sponsorship made it possible.”

Are you interested in establishing a similar program at your organization? Dr. Mourad shared these tips for getting started:

• Frame lactation support as an equity issue. Find the champions of equity within your organization and partner with them.
• Connect with groups within your organization that support and communicate the status of women. Ask them to share what they know about the landscape and the decision-making process for policy change within your organization.
• Be aware that it may take time and several rounds of communication for a physician lactation support program to gain traction. “Even the best ideas may need time.”

Why should organizations invest in programs such as this one? Dr. Mourad put it this way, “Leaders who put scarce dollars towards lactation support for physicians, especially in the tight times of the pandemic, send an important message: that they see these physicians and they value them. A little goes a long way, and the effort is so worth the investment.”

Diane W. Shannon is an internal medicine physician and physician coach and can be reached at her self-titled site, Diane W. Shannon. 

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