Physician Maternity Leave and Short-Term Disability (2026): The Real Math Behind “60% of Salary”

What FMLA Actually Provides — and Does Not

The single most important thing to understand about the Family and Medical Leave Act is that it is job protection, not income. FMLA guarantees up to 12 workweeks of leave in a 12-month period with your job and health benefits intact — it does not require your employer to pay you a single dollar during that time. The Department of Labor's FMLA fact sheet says it plainly: FMLA leave is job-protected, unpaid leave. This distinction is the source of more confusion among physicians than any other part of the leave conversation.

FMLA eligibility requirements: you must have worked for your employer for at least 12 months, logged at least 1,250 hours in the 12 months before the leave, and work at a location where your employer has at least 50 employees within 75 miles. Most attending physicians at hospitals and large group practices clear this threshold easily — except in their first year at a new job, when the 12-month requirement is not yet met, so a leave that starts in your first attending year may not be FMLA-protected at all. Physicians in small private practices — a 3- or 4-physician group, for instance — may not qualify either, since the 50-employee count includes all staff, not just physicians, and many small practices fall well under that number. If both parents work for the same employer, federal rules let the employer limit the couple to a combined 12 weeks for birth and bonding, so the available leave is not automatically doubled — worth confirming directly with HR rather than assuming.

What FMLA actually solves: it prevents your employer from terminating you or eliminating your position while you are out, and it requires your group health insurance to continue under the same terms as if you were actively working (you remain responsible for your normal share of the premium). Your employer can also require you to use your paid leave at the same time as FMLA leave, so the 12-week clock and your PTO run together. What FMLA does not solve: your paycheck. Every dollar of income replacement during a physician's leave comes from somewhere else entirely — short-term disability insurance, employer-provided paid parental leave, state paid family and medical leave programs, or your own accumulated PTO — and understanding which of these actually applies to you, and how each one calculates your benefit, is the entire financial exercise this guide walks through.

The Physician Society Landscape: What "Should" Happen vs. What Actually Does

Before getting into the mechanics of your specific benefit, it is worth understanding where organized medicine currently stands, because the gap between policy recommendation and physician reality is itself instructive.

A 2023 cross-sectional analysis of the parental leave that national physician societies give their own employees found real inconsistency even among the organizations setting policy for the rest of the field: the AMA provides 8.6 weeks of paid leave for birth mothers, and the AAP provides 12 weeks of paid leave for all parents — but the AOA, AAFP, and ACOFP provide no paid leave at all, offering only the unpaid leave the law requires. ACOG's statement of policy calls for at least 8 weeks of parental leave at 100 percent of pay with full benefits, separate from vacation and sick time, and says medical schools, training programs, specialty boards, the ACGME, and medical practices should build it into physicians' standard benefits. It cites lower infant mortality, less postpartum depression, better breastfeeding rates, and better worker morale and retention — yet ACOG told the study's authors that it does not disclose its own internal leave policy.

ACOG's specific policy guidance for training programs goes further than most institutions currently implement in practice: physicians in training should not be required to use vacation days for parental leave, should not be required to make up missed call shifts as a consequence of taking leave, and programs should proactively plan for how parental leave affects timely completion of training and board examination eligibility — ideally identified and resolved well before the leave begins, not scrambled together afterward.

The practical reality for many physicians sits well below these recommendations. Outside of residency, there is no national standard for attending physicians: leave is set employer by employer and group by group, and reporting from otolaryngology practices describes policies ranging from fully paid leave to half pay to whatever vacation a physician has banked. This is precisely why the specifics of your own contract and your own group's policy matter more than any society recommendation: the recommendation is not enforceable, and your paycheck depends on what your specific employer or partnership agreement actually says.

Short-Term Disability: The Mechanics, and the "Salary" Trap

Short-term disability (STD) insurance — either employer-provided group coverage or, in a handful of states, a state-mandated program — is the primary income-replacement vehicle during the physical recovery period after childbirth, and it operates under mechanics that are worth understanding precisely.

How STD treats pregnancy and childbirth: in most employer group STD plans, an uncomplicated pregnancy, delivery, and postpartum recovery qualifies as a covered disability with physician certification — not because pregnancy is an illness, but because the plan defines the physical incapacity of delivery and recovery as a covered event. Federal law backs this up: EEOC guidance says an employer may not set a shorter maximum period for pregnancy-related leave than for other medical or short-term disability leave. Group STD pays a set percentage of pay — the Bureau of Labor Statistics found a median replacement rate of 60 percent in private-industry plans — and for childbirth usually follows the same clock the state programs publish: up to 6 weeks after an uncomplicated vaginal delivery, or up to 8 weeks after a cesarean, plus up to 4 weeks before the due date, in California's and New York's rules. Your own plan document sets the actual terms. Pregnancy complications extend this window further: a treating clinician can certify a longer disability when there are complications, rather than the fixed 6-to-8-week standard.

The elimination period is the first gap physicians miss. Most STD plans pay nothing for an initial waiting period that the plan sets (California's state program, for comparison, has a seven-day unpaid waiting period), during which the physician typically must use accrued PTO or sick leave, or go unpaid. A physician who assumes STD coverage begins on day one of leave is frequently surprised to find the first week or two depend entirely on whatever PTO balance they had banked in advance.

Here is the trap that specifically affects physicians more than almost any other profession: STD benefit calculations are based on your base salary as defined in the policy — and for a very large share of practicing physicians, base salary is only one component of total compensation. A physician on a blended compensation model — base salary plus wRVU-based productivity bonus, base plus quarterly incentive, or a partnership distribution structure — will typically find that the STD policy's 60 percent replacement rate applies only to the base salary line, not to the bonus or distribution income that may represent the majority of what that physician actually earns in a normal working year.

Worked example — why "60% of salary" is not what it sounds like:

On top of the reduced replacement rate, the productivity bonus itself is likely to shrink for the quarter(s) surrounding the leave, since a physician generating little or no clinical volume for 8 to 12 weeks generates correspondingly little or no wRVU-based bonus for that period — a second, compounding hit that has nothing to do with the disability benefit calculation at all and everything to do with how the bonus formula works. This is precisely the dynamic Dr. Rachel Roditi, section chief of otolaryngology at Brigham and Women's Faulkner Hospital, described to ENTtoday from personal experience: "When I was on maternity leave, I had a substantial decrease in pay since much of our yearly earnings were RVU bonus-based rather than true 'salary.'"

How One Sophisticated Employer Actually Solved This: The Brigham RVU-Credit Model

Because the base-salary-only calculation problem is so structural, a small number of forward-looking institutions have built compensation policies that specifically address it — and the mechanics are worth understanding as a benchmark for what to ask for, even if your own employer has not yet adopted anything similar.

As Rachel Roditi, MD, section chief of otolaryngology at Brigham and Women's Faulkner Hospital, described it to ENTtoday in August 2024, Brigham and Women's adjusted its compensation plan so that a physician on parental leave receives the same RVU credit they earned 12 months earlier — treated as what they would have produced had they not been on leave — plus an additional 15 percent payment to cover the few months before and after the leave, when productivity is lower because of ramp-down, ramp-up, and breastfeeding. She said the change applies to other medical leaves as well.

This is a genuinely elegant solution to the exact problem illustrated in the worked example above: rather than a physician's bonus compensation collapsing toward zero during leave, it is calculated as though normal productivity continued, with an explicit buffer for the transition periods on either side. This is the specific model to reference when asking your own institution or practice whether a similar policy exists, or could be adopted — it gives HR and practice leadership a concrete, already-implemented example to evaluate rather than an abstract request.

The Private Practice and Partnership Problem: When You Are the Revenue

Everything discussed above assumes an employed physician on a salary-plus-bonus structure. The math changes entirely — and the risk increases substantially — for a physician who is a practice owner or partner, because a partner's income is not a salary subject to an employer-provided disability policy at all; it is a share of practice profit, typically distributed according to production, collections, or ownership percentage.

The structural problem: a partner who takes 8 to 12 weeks of leave generates little or no billable production during that period. Under most standard production-based or collections-based partner compensation formulas, that means the partner's income for the leave period approaches zero — unless the partnership agreement contains an explicit provision addressing parental or medical leave, most partnership agreements are silent on this exact scenario, because they were drafted around the assumption of continuous, full-time physician production.

Worse, a small or mid-sized practice frequently needs to hire a locum tenens physician or increase colleagues' call burden to maintain patient coverage during the absent partner's leave — and depending on how the partnership agreement allocates that cost, the departing partner may be indirectly funding their own coverage out of their own reduced distribution, compounding the income loss with an added expense.

A real-world example of a practice that built an explicit policy to solve this: Dr. Nariman Dash, chair of a private otolaryngology practice with 10 providers in Fredericksburg, Virginia, described the group's specific solution to ENTtoday: 6 weeks of paid time off per year, plus up to 3 months of parental leave paid at half-time — with the explicit acknowledgment that taking additional time beyond that comes at "significant financial cost," and that for a solo practice or a group of only 2 or 3 physicians, this kind of leave is "very difficult" to absorb without a larger group to share coverage. Dr. Dash's specific framing is instructive for any physician evaluating a private practice offer: at roughly 6 to 7 physicians, a group typically needs to develop a formal, written parental leave policy — below that size, coverage during any partner's extended absence becomes a genuine operational and financial strain that the remaining partners feel directly.

What this means practically for a physician evaluating a partnership-track position: the size of the group is not a minor detail — it is a direct proxy for how survivable a parental leave will be, both clinically (who covers your patients) and financially (how your absence is compensated or not compensated under the partnership formula). A solo or two-physician practice with no written parental leave policy is a structurally different financial risk than a 15-physician group with an established, written policy — even if both describe themselves as offering "the standard 12 weeks."

Individual Disability Insurance and Pregnancy: A Different Set of Rules

This is a distinction that frequently confuses physicians who already carry the individual, own-occupation disability insurance policies covered in our Complete Physician Insurance Guide — because individually underwritten physician disability policies (Guardian, Principal, Ameritas, MassMutual, The Standard — compared in our disability insurance review) do not necessarily follow the same rules as employer-provided group STD.

State-mandated disability programs (California SDI, New York DBL, New Jersey TDI, Hawaii TDI) treat pregnancy and recovery from delivery as a covered disability — each state agency says so on its own pages — and group STD plans work the same way, consistent with the mechanics described above. Rhode Island is the exception: its TDI program says it is not for maternity leave and pays only when a clinician certifies you unable to work, and it points new parents recovering from delivery to its caregiver program (TCI) for up to 8 weeks of bonding benefits. The state benefits are capped low for a physician's income: New York's disability benefit is 50 percent of the average weekly wage up to $170 a week, and Hawaii's statutory benefit is 58 percent of the average weekly wage up to a state maximum.

Individual, physician-owned own-occupation disability policies purchased privately are a different underwriting question, and the treatment of normal pregnancy specifically varies meaningfully by carrier and by the specific policy language — some individual policies exclude normal, uncomplicated pregnancy and childbirth from coverage entirely, treating it as a normal biological process rather than a covered sickness, while covering pregnancy-related complications as they would any other covered illness. Other individual policies and riders provide some level of maternity-specific benefit. This is not a detail to assume — it is a detail to read directly in your specific policy's definitions section, or confirm directly with your carrier or broker, particularly for a physician who purchased an individual DI policy during residency through the GSI (Guaranteed Standard Issue) program covered in our Disability Insurance for Residents guide and has not revisited the specific pregnancy-related provisions since.

GME-Specific Considerations: Leave During Residency and Fellowship

A significant share of physicians have their first child during residency or fellowship — a period with its own distinct set of financial and structural considerations beyond the attending-physician mechanics above.

Board eligibility and training extension: specialty boards require a minimum amount of training time for board eligibility, and an extended parental leave can push a resident's total training time beyond what the standard timeline anticipates, sometimes requiring an extension of the training period itself. There is now a floor: since July 2021, ABMS policy requires member boards with training programs of two or more years to allow at least six weeks away once during training for parental, caregiver, or medical leave without using up vacation or sick time and without extending training, and to state clearly when a longer leave will require an extension. ACOG's policy guidance specifically recommends that the trainee and program director meet early — well before the leave begins — to review exactly how the planned leave interacts with training completion requirements and board examination eligibility timing, since the alternative (discovering after the fact that a leave has pushed board eligibility back by months) is a substantially worse outcome than planning around it proactively.

Call coverage should not become a personal debt to repay. ACOG's policy explicitly states that residents should not be required to make up missed call shifts as a direct consequence of taking parental leave, and that any additional call coverage needed as a result of a resident's absence should be covered through appropriately compensated coverage — by advanced practice providers, other non-GME physicians, or explicitly compensated colleague coverage — rather than informally absorbed by the departing resident upon return. This is worth knowing explicitly, because in practice, many residents are not aware this is even a stated position of a major specialty organization, and default to assuming they personally owe the missed shifts back.

PGY-level income during leave is governed by GME policy rather than any of the mechanics described above for attending physicians — residents are W-2 employees on a fixed PGY-level salary, not production-based compensation, so there is no bonus-versus-base distinction to navigate. And unlike attendings, residents have a national minimum: since July 1, 2022, the ACGME Institutional Requirements have required sponsoring institutions to provide at least six weeks of approved medical, parental, or caregiver leave once during training, paid at the equivalent of at least 100 percent of salary for the first six weeks of the first such leave, plus at least one week of paid time off reserved for use outside those six weeks. Anything beyond that depends on the institution's own policy.

State Paid Family and Medical Leave Programs: What Actually Fills the Gap

For physicians practicing in a growing number of states, a state-run paid family and medical leave program exists independently of — and often more generous than — an employer's own STD or paid leave policy, and can be layered with or used sequentially alongside short-term disability benefits.

States with paid family and medical leave programs paying benefits in 2026 include California, Colorado, Connecticut, Delaware (in full effect since January 1, 2026), Massachusetts, Minnesota (launched January 1, 2026), New Jersey, New York, Oregon, Rhode Island, Washington, Maine (benefits for leave on or after May 1, 2026), and the District of Columbia. Maryland's program has been delayed; the state now says benefits start in January 2028. Virginia enacted a program in April 2026, with contributions starting April 1, 2028 and benefits December 1, 2028.

Replacement rates vary by state, and every program caps the weekly benefit well below physician pay: Washington pays up to 90 percent of weekly pay but no more than $1,647 a week in 2026, and allows up to 16 weeks of combined medical and family leave in a claim year (18 with a pregnancy complication such as a C-section). New Jersey pays 85 percent of the average weekly wage up to $1,119 a week in 2026, with pregnancy disability typically lasting 10 to 12 weeks and up to 12 more weeks of bonding. Delaware pays up to 80 percent of wages, capped at $900 a week, for up to 12 weeks with a new child, and requires a year and 1,250 hours with one employer. Maine's weekly benefit is capped at the state average weekly wage, about $1,250 in 2026, which its benefit chart shows a worker reaching at about $90,000 a year in earnings. Washington, D.C. provides up to 12 weeks of parental leave plus 2 weeks of prenatal leave, funded entirely by employers, with a weekly maximum of $1,190 that drops to $1,100 on October 1, 2026. Minnesota allows up to 20 weeks a year when medical and family leave are combined.

Critically, state paid family leave and disability benefits generally run in sequence, not at the same time — New York says an employee cannot collect disability and Paid Family Leave benefits at the same time and caps the combined total at 26 weeks in any 52, and California sends a new mother her Paid Family Leave claim after her last pregnancy disability payment. The usual pattern is disability first, covering the physical recovery, then paid family leave for bonding. A physician practicing in a state with an active PFML program should specifically map out the sequencing — which benefit covers which weeks, and where any gap exists between the two — well before the leave begins, since HR benefits staff are not always proactive about walking a physician through this sequencing without being asked directly.

Most states, however, still have no state paid leave program at all — including Texas, Florida, Georgia, Ohio, Tennessee, and Pennsylvania (statewide) — meaning physicians in these states depend entirely on FMLA's unpaid job protection combined with whatever their specific employer or partnership voluntarily provides.

The Financial Preparation Checklist

• •Model your actual income gap before you are pregnant, not during leave. Pull your specific STD policy document (not the benefits summary) and confirm exactly how "salary" is defined for benefit calculation purposes — ask HR or your benefits administrator directly whether wRVU bonus, call stipends, or partnership distributions are included in the base used to calculate your benefit, or excluded. This single question resolves the entire ambiguity in the worked example above.
• •Build a dedicated parental leave savings reserve, separate from your general emergency fund. Given the elimination period, the base-salary-only calculation, and the likely reduction in bonus-based compensation surrounding the leave itself, a realistic reserve target is the full projected income gap for the anticipated leave period — not a generic 3-to-6-month emergency fund figure, which is sized for a different kind of financial shock. Calculate this specifically: (normal weekly total compensation − expected weekly benefit during each phase of leave) × number of weeks in each phase, summed across the full leave period.
• •Confirm your individual disability policy's specific pregnancy language if you carry one, particularly if it was purchased years ago during residency and has not been revisited since — do not assume normal delivery is covered the same way a group STD plan covers it.
• •If you are evaluating a new position — employed or partnership-track — ask about parental leave mechanics explicitly during contract negotiation, not after signing. Specific questions worth asking directly: How is the STD or paid-leave base calculated — total compensation, or base salary only? Is there any wRVU-credit or productivity-averaging mechanism during leave, similar to the Brigham model described above? For a partnership-track position, does the partnership agreement address leave explicitly, or is it silent? How is coverage during your absence staffed and funded, and does that cost come out of your own distribution? See our Physician Contract Negotiation guide and Physician Contract Red Flags guide for the complete framework on evaluating a contract before signing — parental leave mechanics belong on that same pre-signature checklist, not as an afterthought raised only once a pregnancy is already underway.
• •Bank PTO deliberately in the months before a planned leave, specifically to cover your STD plan's elimination period — this is a mechanical, plannable gap that a physician who is actively trying to conceive or who already knows a pregnancy is likely can close entirely with advance planning.

Quick Reference: Where Your Income Actually Comes From During Leave

Frequently Asked Questions

Sources

• •Fact Sheet #28: The Family and Medical Leave Act, U.S. Department of Labor, Wage and Hour Division (revised March 2025). Accessed September 27, 2026.
• •29 CFR 825.120, Leave for pregnancy or birth, Electronic Code of Federal Regulations. Accessed September 27, 2026.
• •Enforcement Guidance on Pregnancy Discrimination and Related Issues, U.S. Equal Employment Opportunity Commission. Accessed September 27, 2026.
• •Disability insurance plans: trends in employee access and employer costs, U.S. Bureau of Labor Statistics, Beyond the Numbers (February 2015, March 2014 data). Accessed September 27, 2026.
• •Parental Leave: What Do Physician Societies Provide for Their Employees?, von Fedak S, et al., Women’s Health Reports, 2024. Accessed September 27, 2026.
• •Statement of Policy: Paid Parental Leave, American College of Obstetricians and Gynecologists (amended and reaffirmed July 2019). Accessed September 27, 2026.
• •Otolaryngology Practices Strive to Balance Robust Parental Leave Approaches with Fiscal and Logistical Realities, ENTtoday (August 2024). Accessed September 27, 2026.
• •ACGME Institutional Requirements (effective July 1, 2026), Vacation and Leaves of Absence, Accreditation Council for Graduate Medical Education. Accessed September 27, 2026.
• •ABMS Announces Progressive Leave Policy for Residents and Fellows, American Board of Medical Specialties. Accessed September 27, 2026.
• •State disability programs' own pages: California EDD, Disability Insurance – Pregnancy FAQs and eligibility FAQs; New York Workers’ Compensation Board, Disability Benefits: Employee Eligibility / Benefits; New Jersey Department of Labor, When You’re Pregnant or Just Had a Baby; Rhode Island Department of Labor and Training, TDI/TCI FAQs; Hawaii Disability Compensation Division, About TDI. Accessed September 27, 2026.
• •State paid leave programs' own pages: Washington Paid Family and Medical Leave; DC Paid Family Leave, Program Updates; Maine Department of Labor, PFML benefit chart; Delaware Paid Leave; Minnesota Paid Leave, Common questions; Maryland Paid Family and Medical Leave; Virginia Employment Commission, Paid Family and Medical Leave. Accessed September 27, 2026.