2/27/08 Dear UCSF Resident Council, We, the undersigned residents, request your advocacy for increased support for UCSF resident parents. UCSF could potentially become a progressive leader in this area, and in doing so, improve recruitment and retention of residents and junior faculty, as well as ease the work-personal life balance issues that often prevent women physicians from remaining in academic medicine. We ask for your help in advocating for change in the following areas: 1. Make residents eligible for the Flexible Spending Account (FSA) (also known as Dependent Care Account): The FSA is a federal tax benefit that allows employees to set aside up to $5,000 tax-free annually from their paycheck to be put towards child care payments. This amounts to roughly a $2000/year savings in taxes. UCSF employees, other than residents, are eligible for this benefit. Because residents go on-and-off the UCSF payroll, (for example we are at times on the SFGH payroll), offering this benefit has been considered too complicated. Resident parents are not the only ones affected by denial of this benefit, as FSA money can be used towards care of a disabled spouse or ill or elderly parent; responsibilities that other residents may have as well. A simple solution could be developed that allows residents to be eligible for this benefit when they are on the UCSF payroll. 2. Improve residents\' access to UCSF childcare: Childcare costs in San Francisco are some of the highest in the nation. Residents work long and unusual hours, and their income is limited, making it more difficult to afford childcare than for faculty or other UCSF staff. (Childcare providers frequently make more per hour than residents; for example, the going rate for a nanny is $14-18/hr, whereas residents make approximately $12/hr.) In addition, as residents tend to be young parents, their children tend to be younger than age two. Currently, the only UCSF childcare sites accepting children under age 2 are at Laurel Heights and Mission Bay, while residents tend to work at Parnassus. However, a new infant center on the Parnassus campus is planned for 2009. Given that residents\' schedules are so difficult, we ask that residents\' children be given first priority for the infant slots at Parnassus so that residents can: -more easily get to work without having to detour to another childcare site, -visit their children during downtime during the day, and -breastfeed. Currently, the waiting list for a UCSF childcare spot for an infant is 12-18 months. Although an expedited waiting list exists, its existence is not well advertised, and its stated purpose is recruitment. A resident who recently asked to be on the list was rejected as she was not "new" to UCSF. Several residents are currently waiting on the regular waiting list. We ask that residents be informed of the expedited list, and encouraged to become listed, whether or not they are new to UCSF. 3. Expand the hours of the daycare center to truly serve resident (and faculty) parent needs: Currently, the Parnassus daycare hours are 7:30 AM to 6:00 PM Mon-Fri. However, on a routine day residents often need to be at work by 6:30 AM, and can not reliably be out by 6:00 PM. Counting on a second parent is often difficult as that parent may also be a resident, be in military service, or have another similarly demanding job. Consider extending hours to at least 6:00 AM to 8:00 PM Mon-Fri, but ideally extend hours to include overnight and weekend hours for residents and faculty on-call. 4. Improve breastmilk pumping facilities at UCSF and our affiliated sites: The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding of infants for the first 6 months of life, and continuing breastfeeding up until at least age one year. A recent AAP abstract suggests that residents who choose to breastfeed their infants find breastfeeding difficult because of inadequate facilities for pumping and milk storage. (1) Currently, the pumping facilities at UCSF are designed to meet the needs of patients, not the needs of breastfeeding staff. (For example, the rooms are only located on pediatric floors where there are breastfed infants). The few pumping rooms that exist often are in use, which makes the already difficult task of finding time to pump as a resident even more challenging. Consider creating more pumping rooms distributed on a number of floors and at the other sites where UCSF Residents work, such as the Ambulatory Care Center, SFGH, and the VA hospital. (Currently the VA has no pumping facilities.) -A telephone installed in the rooms would facilitate answering pagers while pumping rather than interrupting the process to find a phone. Cell phones do not work in some parts of the hospital, and many numbers can only be called back from an in-house line. (1) Mougdal, M, et al, "Breastfeeding among resident physicians: attitudes and practices", abstract presented at AAP, Oct, 2007. Thank you for your consideration and support. Sincerely,

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