The research, conducted in collaboration with the Society of Chairs of Academic Radiology Departments and the Society of Chairs of Academic Radiation Oncology Programs, took the form of an anonymous survey distributed to department chairs at academic radiology and radiation oncology programs across the United States between June and July 2025. By targeting the leaders who administer and interpret leave policies, the investigators aimed to capture a department-level picture of how paid family and medical leave, commonly abbreviated as PFML, is structured in the academic settings where radiologists and radiation oncologists are trained and employed.

The headline finding is one of broad availability but uneven execution. PFML policies were reported to exist in academic radiology and radiation oncology departments of every specialty, geographic region and department size, suggesting that the era in which physician parents or caregivers had no formal paid leave option at all has largely receded. Yet availability is only the first step. According to the study authors, a significant number of programs surveyed require faculty members to draw down vacation or sick time as part of their leave, a design choice that effectively reduces the total time off a physician can accumulate. The survey also documented wide variability in two structural features that can determine whether leave is genuinely usable: whether leave can be taken in noncontiguous blocks rather than one continuous stretch, and whether the promotion clock can be extended to compensate for time away.

These details matter because the structure of a leave policy shapes how it functions in practice. Requiring physicians to exhaust vacation and sick banks before accessing paid family leave can leave them with little discretionary time off in the years that follow a birth, adoption or serious illness. Restrictions on noncontiguous leave can force a recovering parent or a physician managing a chronic condition to take all protected time in a single block, even when a phased return or intermittent schedule would better serve their health and their family. And when promotion clock extension is inconsistent or unclear, faculty may face a hidden career penalty for taking leave that is nominally available to them, a concern that weighs heavily in specialties where the pathway to tenure and academic advancement is tightly calibrated to years of service.

Kirti Magudia, MD, PhD, assistant professor of radiology at Duke University and an author of the study, framed the results as evidence of a persistent gap between what policies promise and what physicians experience. Paid family and medical leave, she noted, is an important workplace benefit that all radiologists and radiation oncologists can be expected to use at some point during their careers. While the survey results are promising in showing how widespread formal policies have become, she expressed the hope that these policies will continue to improve to support the wellness of the workforce. That framing captures the study’s central tension: the infrastructure for leave exists almost everywhere, but its design and delivery have not converged on a standard that physicians can rely on as they move between institutions.

Perhaps the most striking utilization finding is that most survey respondents reported that fewer than 10 percent of faculty in their departments used leave during the previous year. On its face, such a low figure seems at odds with the demographic realities of a workforce that includes physicians in their childbearing and child-rearing years, as well as clinicians who inevitably face medical events and family caregiving responsibilities. The authors interpret this as another signal of the gap between policy and implementation. Low reported utilization may reflect genuine underuse, whether because physicians hesitate to take leave, because coverage constraints make it impractical, or because the administrative pathway is burdensome. It may also reflect how utilization is counted at the departmental level. Either way, a benefit that fewer than one in ten faculty members access in a given year is not functioning as the routine, expected support that its advocates envision.

Underlying much of the survey’s findings is the problem of clinical coverage. Substantial concerns about who will read the studies, deliver the treatments and staff the services when a physician steps away emerged as a recurring theme among respondents. In radiology, where coverage models are built around continuous interpretation of imaging studies, and in radiation oncology, where treatment courses cannot be paused without clinical consequences, the absence of a single faculty member creates a tangible workload that must be absorbed by colleagues or covered through temporary hiring. The survey suggests that in many departments, no robust system exists for absorbing this workload, which means the practical feasibility of leave often depends on informal goodwill rather than institutional design. That reliance on informal coverage is precisely the kind of structural weakness that makes leave policies feel precarious to the physicians considering them.

The study’s methodology, a chair-level survey rather than a review of written policies or an analysis of personnel records, carries both strengths and limitations worth noting. Chairs are uniquely positioned to describe how leave is administered in their departments, including the informal norms that never appear in an employee handbook. At the same time, self-reported perceptions of policy clarity and utilization may diverge from what faculty themselves experience, and the anonymous design, while encouraging candor, prevents follow-up with individual respondents. The survey period of June to July 2025 also captures a snapshot of a landscape that continues to evolve, as states expand their own paid family and medical leave programs and institutions adjust to a patchwork of federal, state and local requirements.

That patchwork is an important part of the context. In the United States, there is no comprehensive federal mandate for paid family leave, so the benefits available to a physician depend on a combination of institutional policy, state programs where they exist, and the federal Family and Medical Leave Act, which provides unpaid job-protected leave for eligible employees. Academic medical centers therefore occupy a policy space where generous departmental practices can coexist with minimal legal floors, and where a physician relocating from one state or one institution to another may encounter dramatically different entitlements. The variability documented in this survey is a window into that fragmented system, seen from the vantage point of the department leaders who must translate institutional rules into workable schedules.

The implications extend beyond radiology and radiation oncology. Academic medicine has often served as a bellwether for physician workplace policy, and the patterns identified here, including mandatory depletion of vacation banks, unclear promotion protections, coverage anxieties and low utilization, are likely to resonate in other specialties grappling with the same structural questions. For a profession facing well-documented pressures on wellness, burnout and retention, the design of leave policy is not a peripheral administrative detail but a core element of workforce sustainability. The study’s authors, by documenting the extent of inconsistency with survey data rather than anecdote, have given departments and professional societies a concrete baseline against which future reform can be measured. Whether the next survey of academic chairs reports convergence on clear, usable, genuinely supportive leave policies will be one measure of how seriously academic medicine takes the wellness of the physicians it trains and employs.

Subject of Research: Paid family and medical leave policies in U.S. academic radiology and radiation oncology departments

Article Title: JACR study explores discrepancies among paid family and medical leave policies across U.S. academic and radiation oncology departments

Article References: JACR study explores discrepancies among paid family and medical leave policies across U.S. academic and radiation oncology departments. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: paid family leave, medical leave, radiology, radiation oncology, academic medicine, department chairs, survey research, physician wellness, workforce policy, Journal of the American College of Radiology, Duke University, clinical coverage