Pregnancy-Related Staffing FAQs in the Dental Office

The easy answer is that you’re required to follow all federal, state and local laws that apply to your practice. Yet the easy answer may not be the complete answer.

Consider what all of your employees, not just the pregnant ones or those who are new parents, would like you to do and compare that to the practice’s resources. If you think you might have the capacity to increase or add new benefits, talk to your business advisors, such as your attorney and financial consultant, to make sure you can expand your benefits package. If they agree that it’s possible, talk to your staff to confirm that they’ll value the changes you’re considering before proceeding.

If you need general suggestions regarding valued employee benefits, some human resources professionals suggest starting with a review of the medical/health insurance offered by the practice and determining whether it can be enhanced. Practices that cannot offer medical/health insurance may consider looking into alternatives.

Most human resources consultants would likely advise you to treat all employees in similar circumstances/health conditions equally. Since the applicable federal, state and local laws typically apply equally to everyone, your practice policies should as well. Of course, there may be some differences regarding whether employees are exempt vs. non-exempt; be sure to know if they apply in your office. If you’re not certain, consider contacting either a qualified attorney who’s knowledgeable about employment law or a human resources professional.

It shouldn’t be a surprise that some new dentists may inquire about and even try to negotiate parental leave benefits into their employment agreements. Many of them have excessive student debt and are trying to figure how they’ll balance paying their loans while starting a family. Your established human resources policies apply equally to all employees so there’s no need to negotiate this into the associate agreement.

Respond to these requests with empathy and understanding while simultaneously stressing that the practice has worked hard to ensure that its benefits plans and human resource policies are fair and applied equally to everyone.

If your maternity leave policy is more than a few years old, it might be time to evaluate whether it should be updated. Refer to the "Considerations for a Maternity Leave of Absence Policy" [PDF] article from the ADA’s Guidelines for Practice Success™ (GPS™) module on Managing the Dental Team for suggestions for assessing your current policy.

While information in this resource regarding maternity leave or benefits does not apply to employees who meet the criteria established by the Internal Revenue Service and the Department of Labor for independent contractors, the reality is that few dental healthcare workers meet those criteria. It’s a good rule of thumb to contact a qualified attorney who’s knowledgeable about employment law or a human resources professional before determining that any employee is an independent contractor. Also be aware that having independent contractors on your staff does not exempt you from following the applicable rules and can actually be a disadvantage to the employer in that the practice is protected by having certain policies and rules that employees must agree to follow. The same conditions cannot always be imposed on independent contractors.

Employers should refrain from asking employees about their plans to start or add to families and should not have a policy requiring them to do so.

The employee’s physician should provide you with a statement outlining what accommodations, if any, are appropriate. Be aware that both pregnant women and nursing mothers may need more frequent bio-breaks. Refer to the articles on "For Employers: Highlights of the U.S. Equal Employment Opportunity Commission’s Pregnancy Discrimination Act (PDA)" and "For Employers: Highlights of the U.S. Department of Labor’s Family and Medical Leave Act (FMLA)" for specific information and resources.

While you may consider suggesting, or even implementing, accommodations that you believe may be helpful to the pregnant employee, making any decision regarding an accommodation without direction by the employee is actually pregnancy discrimination.

It’s always a good idea to provide the physician with a copy of the job description since having that information will allow him/her to assess any potential risks or concerns and determine what, if any, accommodations should be implemented in the workplace.

It can also help you plan for any cross-training of staff that might be needed. Since physicians sometimes recommend that pregnant employees not take patient radiographs, knowing in advance that you need a back-up person to help take X-rays might help you identify that person early enough to conduct any necessary training.

Human resources professionals report that new graduates in most fields, and individuals looking to change employers, are savvy enough to look beyond the annual or hourly salary and to consider the value of the complete benefits package. This perspective makes offering a good insurance plan especially important. Having a competitive benefits package can help you attract – and retain – employees that bring value to your patients, team, and practice.

Not every pregnancy is planned. Regardless of whether or not an employee planned to add to his/her family, having access to health insurance provides both peace of mind and some relief from the financial costs associated with pregnancy and raising a child. In some cases, it could even mean the difference between remaining on staff vs. leaving the position and getting health coverage through state-supported programs like Medicaid.

Some solo, start-up, or small group dental practices may not have the financial capacity to offer employees top tier benefits like medical insurance. In those cases, some type of compensation in lieu of medical benefits can be both a highly valued benefit for the staff and a definitive competitive advantage for the employer.

Compensation in lieu of medical benefits is typically a fixed amount paid either monthly or annually to employees regardless of whether or not they received medical services. Participants in the plan are not required to limit the use of the allowance for medical expenses and are not required to submit bills or other documentation substantiating payment for medical treatment received.

Practices opting for this type of benefit should consider ensuring that it’s implemented equally across the board for all employees to avoid any appearance of favoritism.

Given the sense of family that develops in many dental practices, it’s understandable that you’d be sensitive to an employee’s hardship situation and want to help. Yet, as the employer, it’s important for you to be consistent in following established policies. While the final decision is yours, be aware that allowing exceptions can cause resentment among staff and create the expectation that similar arrangements will be made for other employees experiencing hardships in the future.

Any information about the medical plan and other benefits available to staff should be detailed in the employee handbook and clearly communicated to all employees.

The FMLA requires employers to return employees who have been on leave to his/her position. Your human resources manager can keep the name and contact information of the temporary employee on file to be contacted if a suitable opening develops in the future. Practices that do not qualify under the FMLA should still conduct their due diligence in these types of situations. Many states have lower employee thresholds than the FMLA regarding leaves that apply to maternity leave and the protections afforded to employees. Thus, just because FMLA doesn’t apply, there could still be significant risk in replacing the original employee with a temporary employee depending upon the state in which the dentist practices.

Be aware that while a pregnant employee, like any other, can be let go at any time, the potential risks can be significant and that the burden-of-proof is on the dentist who must be able to demonstrate that the termination, regardless of when it incurred, was in no way related to or because of the pregnancy. For this reason, it’s important that any corrective action should be taken any time any employee performs below expectations. Be sure to document all discussions regarding performance coaching in the employee’s personnel file to ensure that you have a complete and accurate record of the problems and the steps taken to correct them. Consistent performance feedback should be given to every employee throughout his/her tenure with the practice.

Performance issues cannot be attributed to pregnancy or any other medical condition. Any employee who is not adequately fulfilling the duties for which they were hired should be coached and all discussions should be documented in the personnel file without regard for his/her medical status.