Issue 7 / 27 February 2012

CHILDBEARING continues to have a significant impact on female doctors’ choice of speciality, but the situation is improving, according to female specialists.

Dr Kate Drummond, who chairs the women in surgery section of the Royal Australasian College of Surgeons (RACS), said the major difficulty still facing women who want to have children was how to undertake all the requirements to complete training while pregnant and raising young children.

Dr Kathryn Austin, a representative of the AMA Council of Doctors-in-Training, said although childbearing still had a significant impact on choosing a speciality, attitudes to pregnant trainees were changing and colleges were more flexible in training arrangements.

The doctors were commenting on a US study which showed there was still a “magnitude” of negative attitudes towards women surgical residents becoming pregnant compared with positive influences. (1)

The analysis of surveys completed by 1937 women surgeons found that the perception of stigma during training remained large but did decrease between those who graduated more than 30 years ago to those who graduated less than 10 years ago.

The researchers also found that although negative attitudes were more prevalent among male surgeons compared with female peers, “even women residents hold negative views of pregnancy among their colleagues during training”.

“Surgical training takes place during a woman’s fertile years. Both the demands of training in surgical specialties and subspecialties and negative attitudes toward pregnancy may deter students from choosing surgery as a career”, the researchers wrote.

Dr Drummond said training in Australia was generally very different to that in the US, but the difficulties of childbearing during training were still an issue here.

She said more women were choosing surgery, with the percentage of female Fellows of the RACS increasing from around 4% in the mid 1990s to about 10% now, but the numbers were still small. The number of female surgical trainees has increased to 25%. These compare with Australian Institute of Health and Welfare figures, which show that 35.7% of employed medical practitioners in Australia in 2009 were women (up from 32.9% in 2005). (2)

The RACS had made training much more flexible, with trainees able to take a year off for approved purposes, which included childbearing and parenting, Dr Drummond said.

“But it is still difficult to provide opportunities for part-time training. How do we create part-time training jobs for surgical trainees that allow them to do enough hours to gain the appropriate level of experience, with the right mix of types of work in the job to complete their training and which are acceptable to the hospital that employs them?”

“Change is happening and I am cautiously optimistic, but it is difficult.”

Dr Austin, an obstetrics and gynaecology trainee in NSW, said more needed to be done to support both male and female trainees who wanted to have children.

“Help for young professional couples [with] flexible training arrangements, access to part-time roles for short periods and allowing trainees to work smarter, not just longer, are areas for improvement, particularly for surgical specialties”, Dr Austin said.

“With generational change there will be increasing need to support professionals who are committed to their specialties who may need to have periods of time to balance work and life.

“Trainees — male and female — will always expect to work hard to obtain specialty qualifications but there must be flexibility to allow for maternity and paternity leave if we are to keep up with societal changes”, she said.

– Kath Ryan

1. Arch Surg 2012; online 20 February
2. Australian Institute of Health and Welfare 2011; Medical labour force 2009

Posted 27 February 2012

11 thoughts on “Pregnancy still dictates specialty choice

  1. Older generation says:

    Funny, we were told that the colleges were becoming more accepting of women and pregnancy when I was pregnant in my last year as a registrar 20 years ago. In the “new era of acceptance” we were meant to be able to extend our registrar years or work 5/8 and many other concessions were to be made.
    In practice, no one was interested or even remotely helpful.
    I remember my thoughtful registrar colleagues suggesting that if I had any trouble working full time I might want to work permanent “on call” instead. Very considerate.

  2. Paeds Trainee says:

    Coming from the paediatric training world, it is quite common for paeds registrars to get pregnant before completing training. Our superiors do not have a problem with this – perhaps because we are surrounded by children and families all day!
    My hospital does allow parents (including fathers) to job-share. However, you are expected to find your own job-share companion at a similar stage of training and are still expected to do a hefty amount of shift work and night shifts. This makes life very difficult in arranging care for your own children while you work. Every day I still consider changing to GP training… life would be so much easier, but what a waste of all the years of training that I have already done.

  3. G.P trainee says:

    I did O&G training for many years, but was faced with an unsupportive, judgemental workplace after having my first child and returning to work from maternity leave. Sometimes I think the older generation of female consultants are not as supportive as I think they should be. There is an attitude of “I had to suffer so you can to” I left for G.P training and havent looked back, no nights, no weekends, 9am starts, bliss… Pity though, they lost a dedicated trainee.

  4. Observer of RACS training says:

    I have observed that amongst physician trainees it is considered acceptable to get pregnant and start to raise a family whilst on advanced training at least. I also observe however that it is unusual for a trainee to start a family before they have had least completed their written exam. Mirroring this perhaps whilst the RACS makes some allowance for female trainees becoming pregnant it is nonetheless relatively unusual. I think this in part mirrors the RACP experience of reluctance to undertake exams with small children. The concept of a job-sharing arrangement to allow parttime completion of training whilst babies are young is whilst in theory an option in practice impossible (no surgical unit which I have discussed this with will tolerate such an arrangement.

  5. Physician-Mother says:

    I have a great deal of sympathy for women wishing to have children while they train. As a mother of 3 young children and a specialist physician, one of the commonest conversations I have with my trainees is about the right time to have a family. My advice has always been the same – if you are otherwise ready, there is no perfect time to have a child. Yes, you will be penalized in the workplace in the short term. You may write fewer papers, attend fewer conferences, not have a private practice – the list is endless. But children bring a form of joy and satisfaction that no career progression does. Make no mistake – you are dispensable in the workplace. So don’t expend all your energies in the workplace, save some love and devotion for a family. Support women who are mothers and learn from their experiences rather than assuming you can’t do it. I work with lots of great doctors who are mothers – they are a delight because they have a whole new perspective on life and medicine.

  6. O says:

    I am a pregnant woman in training who has felt nothing but support and kindness from my colleagues and seniors in recent months. Unfortunately this is not reflected in training flexibility – I must take a minimum 12 month break from training as my due date aligns poorly with the RANZCOG training year. In a 6 year program comprised largely of female trainees, this results in some very prolonged registrar careers at a time when we are often lectured regarding specialist shortages.

  7. Surg Reg says:

    I recently returned to work after the birth of my first child. I took 12months off to make returning to work easier. As I had not operated in a while I was expecting some support and some assistance in returning to where I left off. There was no program of support at all, we are expected to bounce back at the same level we left, which is not fair. I would like to see some sort of return to work policy for those of us returning after extended leave. Even if it is something as simple as a few extra operating sessions with consultants. I do agree we end up extending our training for years trying to have a family and balance training commitments.

  8. Sue Ieraci says:

    Good to hear the perspectives of many current trainees. The GP trainee has found that her training delivers ” no nights, no weekends, 9am starts, bliss…” Who, then should provide the overnight and weekend health care services? If women populate the 9 – 5 weekeday world, and leave men to cover the out-of-hours, doesn’t that make for even less workplace equality? In Emergency Medicine, shift work actually provides some sort of balance, with both mothers and fathers adapting their patterns for childcare. Family life is not just about pregnancy – it is about raising a family with an acceptable work-life balance. Where do fathers figure in the balance?

  9. Alex Harris says:

    As a recently qualified GP I can say that no previous training in any field is wasted, it merely becomes an area of strength.

  10. John says:

    It is unfair to expect your childless colleagues to do all the after hours and oncall. Finish your training and have your children once you are a consultant.

  11. Andrew Watkins says:

    @John

    Trainees are not expecting all of their childless colleagues to do their on-call.

    In many specialities (notably surgery, in which only 10% of consultants are female) those with stay-at-home partners or ones with more flexible jobs are unfairly advantaged by being able to do what they like (I certainly was). These colleagues get to have it both ways – they get the children, albeit sometimes with an impaired relationship with them, and they get the pick of careers.

    More than 50% of medical students have been female for many years. Their academic performance is generally superior to that of males. They remain under-represented in the high power, high prestige specialities nearly 40 years after my medical school intake shifted to being >50% female.

    The rigid, time-based training schemes and training jobs which are designed around the convenience of senior staff (why can’t people in surgical jobs job-share? It requires some organisation and flexibility, but we manage it well enough in neonatology, an intensive discipline).

    Training jobs are supposed to be about training. Why not go further down the path of competency based training? This would allow far more flexibility for the trainees, albeit at the cost of rather more work for we old farts, as we would have to define more comprehensively what we are setting out to achieve. Would this be such a bad thing?

    It should not be beyond the wit of man to devise training which allows trainees of any gender to combine a life with proper clinical training. One wonders, however, whether it is beyond the will of man.

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