Issue 26 / 15 July 2013

SURGICAL trainees wanting children are, in some cases, not revealing their pregnancy until they have secured their smooth return to training, in the latest indication that Australian women in medicine are battling to “have it all”.

An Australian surgical registrar in a major city hospital agreed to speak with MJA InSight about her experience on condition of anonymity.

“I am in my final year of training and have two children, both of whom were born while I was training”, the registrar said. “It’s been a bit of a challenge.

“My first was born in 2009, halfway through my second year. Things were different then. I had 6 weeks off between the two terms, so I missed 3 weeks at the end of the first term and 3 weeks at the start of the second. And I went back to training with a weeks-old baby”, she said.

“There wasn’t a lot of support or understanding.”

When her second child was born she opted to take a year off.

“I’ve been back in training about 6 months now and it’s been a much better experience.”

The registrar said she benefited from friendships with lawyers who helped her stand up for her rights in terms of maternity leave.

“It’s very hard to organise to have the time off as a trainee”, she said. “I had to write some very strong letters to get the time off.

“If you defer your training before you are allocated a job then, effectively, you have no employer to take maternity leave from. So I waited until my job was allocated before I told them I was pregnant and put in for maternity leave.

“The board was unhappy, and some of my colleagues were exceptionally unhappy, but that was the best way I could see to get what I was entitled to.”

There are anecdotal cases of other female registrars hiding their pregnancy until their position is secure.

Dr Jill Tomlinson, a plastic and reconstructive surgeon in Melbourne and secretary of the Australian Federation of Medical Women, said she had heard a mentor advised a trainee to “do it first and ask permission later”.

“The principle is ‘get in, get pregnant, then get help’”, Dr Tomlinson told MJA InSight.

“In other words, get the job — because it’s difficult to be deselected once they’ve picked you — get pregnant, and then get support and advice about how to make it work.”

Dr Tomlinson said these cases showed that there needed to be a cultural change about pregnancy.

“It’s still the case that only 10% of surgeons are women and certainly women are still considered to be the ‘other’. It’s not considered normal to get pregnant while in training or indeed ever as a surgeon. It brings a set of problems that the culture is not used to and can’t deal with very well.”

Dr Kate Drummond, chair of the Royal Australian College of Surgeons women in surgery section, said the problem was not a medical one, but a societal one.

“Whether you’re trying to build your own small business or make partner at a law firm, or be an elite athlete, or a top surgeon, the issues of delaying pregnancy and childbirth are the same”, Dr Drummond told MJA InSight.

She said flexible training was gaining acceptability in surgical training but that the issue was “complex”.

“There is enormous support for flexible training as an idea”, Dr Drummond said. “But there are complexities. It’s all very well for the college to say it’s a good idea, but they are not the ones who design the jobs. That’s up to the hospitals.

“The job needs to be designed well with an appropriate mix of activities for training purposes. We’re looking for innovative ways of doing it but it’s not straightforward.

“People who do surgery are an ambitious, driven bunch, and generally they want to get the training over and done with”, she said.

An emotional commentary in the latest Annals of Family Medicine by two American physicians detailed the consequences of their decisions to delay pregnancy until their careers were established. (1)

One doctor endured four in-vitro fertilisation cycles and two miscarriages before she gave birth to her son. The other had a stillbirth during her fellowship, before having two children later.

 

1. Ann Fam Med 2013; 11: 381-382

 

45 thoughts on “Trainees keep mum to secure jobs

  1. Kimberly Cartwright says:

    This is a problem for all trainees not just surgical trainees.  One issue that has to change to improve bosses and colleagues support during this time is funding for locums to replace the trainee on maternity leave.  There is currently no such provision. This makes it very difficult to replace the trainee on maternity leave, meaning that colleagues and bosses have to take on the work the trainee would be doing if not on maternity leave because there has been no funding to replace the trainee  while they are on leave. The alternative would be to increase the numbers in the training program to allow capacitance to successfully accommodate leave but this too is unlikely to happen.

  2. Cara Winnall says:

    A big part of supporting female trainees to be able to access maternity leave and flexible work is extending the same acceptance and encouragement  to the male trainees. If everyone takes leave or opts for flexible training when their child is born then it will no longer be a gender issue. Also if men are allowed/encouraged to access flexible training as trainees, then they’re more likely to encourage their trainees to do the same when they are bosses.

  3. alfred schebesta says:

    With the large increase in medical student graduations over the next 3 yrs there will be greater pressure for more specialist training places and more need for maternity leave . These could be helpful to the above problem though the duration of training is lengthened in that there are more trainees available than able to be “adequately ” trained to College standards Thus a pool of trainees allows flexibility to pursue motherhood or other ambitions whilst the hospitals have a continued supply of Registrars. This may mean the position is funded centrally not at hospital level. 

  4. John Williams says:

    I am a recently-qualified surgeon, and male.  It’s not just female trainees who defer families while training.

    However, my experience leaves me with little sympathy for female surgical trainees who take time off during training.  In my experience it is the (often childless) men who are left to pick up the workload when people take maternity leave, especially in highly specialised fields where there is not a readily-available pool of people available to fill in the gaps in the service.  How is that fair?

  5. Kylie Webber says:

     I am in agreeance with the mentor who advised to secure the job – having a signed contract is the only way to ensure we get maternity leave.  It is a problem with the system that gives lip service to entitlements, then pressures administrators to not give contracts to women who are pregnant.  It is also a problem that the women themselves get blamed by their colleagues for being “unreliable” when all they are doing is looking after their families. We need to start practicing what we preach and stand up for both men and women who need time off for family reasons.

  6. Dr Gary Champion says:

    “Get in, get pregnant then get help” – how deceitful an attitude from this current crop of “trainees”. How about “Get in, act responsibly, finish my training then get preganant” The sense of entitlement from Gen Y is astonishing. You get into a Training scheme then do not let down the people who put you there, nor the tertiary centres where you hold a special place. What is training coming to? As for the comments above – gutless – no names again typical of the social media  blogging set.

  7. Janette Haq says:

    @Gary Champion – It is precisely your sort of attitude that women do precisely “Get in, get pregnant then get help” These days, training times are becoming even longer due to the need to further subspecialise in specialist fields, often requiring at least one year of training overseas. And even after obtaining their letters, a considerable amount of time is required to start and establish a private practice. How much longer do women have to wait before starting a family, when its well known that there are increasing problems for older women having babies?

     

  8. dr gary champion says:

    Re Anonymous @ 12.50; you have just proved my point -rather than acting in the best interests of the training scheme & the hospitals involved, you want your own personal circumstances to come first -“I know my rights & I do not care regarding my reposibilities” Oh & you did not have the guts to identify yourself. Proves my point about you lot.

  9. Piera Taylor says:

    Interestingly I did not have the same experience with the two children I had while on surgical training. I also had two children prior to surgical training to look after, while training and pregnant.

    I dont feel that any one can be “deselected” for getting pregnant.

    Surgical training is hard and the hours are long, but jobs do have to be filled when trainees take time off for maternity leave. I felt it was better to engage with the director of training early so they were  not left in the lurch scrambling to fill positions. Taking off blocks of  6 and 12 months does make it easier to fill jobs. No lawyers or strong letters are required to negotiate the above. But whether you take one week off, 6 months or twelve months, once back training is even harder to juggle with children but no special considerations should be expected, you are there to do what the service part and learning part of the job and hours require.  I had the full support of all  I worked with ( bar one) in the various Major City Hospitals that I was rotated to. This is a very abbreviated picture of what happened over many years of my Accredited and unaccredited surgical training.

  10. Christine Morris says:

    It seems to me that the system needs to be revised to enable pregnancy or other leave to be supported and funded. Logical debate perhaps rather than sterotyping certain generations. I’m sorry Gary, but you are making a huge assumption that all of these bloggers are Gen Y. They probably don’t want the sort of repercussions that seem to be the undertone of your and other responses.

  11. Dr Kate Duncan says:

    In the face of the College of surgeons entrenched male chauvinism, it does no good to ‘keep mum’ – your charmingly competitive colleagues will spread whatever ‘news’ (real or manufactured) that they can. I recall looking after a young Surgical registrar through an unexpected pregnancy. She used only her annual leave for the delivery and didn’t miss a single allocated shift. Come the next set of job interviews – ‘so you’re the one who took maternity leave’. While trainees have responsibilities to their employing Hospitals, pregnancy should not destroy a career. In the current climate of sexism (and sometimes not-so-covert sexual harrassment) directed toward trainees – who either have to ‘suck it up’ or become whistleblowers – there is need for change on both sides before the profession loses some of its best and brightest.   

  12. Anneliese Perkins says:

    Wow. In what other profession are women expected to promise to not fall pregnant for a 6 year block while they train? Are we expecting women to wait until their mid to late 30s before even trying to fall pregnant despite the well documented increased risks of advanced maternal age in pregnancy? As a female obstetrician who has experienced infertility and stillbirth in my attempt to have a family I am appalled that anyone could suggest I have waited another 6 years before even trying. The attitudes I have seen both against myself and other female trainees exercising their right to have children is appalling. I have been refused jobs. I have been told by senior obstetricians to not tell people I was trying to fall pregnant (I chose to because I had to go through IVF). I have seen people harassed and bullied. It’s those of you with the attitude that women shouldn’t fall pregnant during training that bring  on the “get in, get pregnant, then get help” scenario. It’s called survival or none of us would have jobs. 

  13. Anne Saunders says:

    @ Dr Gary Champion I think you have missed the point. Medicine as a field needs to become more up to date with flexible working arrangements. Currently over half of our medical graduates have completed postgraduate medical degrees this means that those women who have complete medicine through this pathway will have difficult choices to make between timing of their families and completion of specialty training. Yes, trainees have a responsibility to keep their employers and colleges informed of their situations, but equally they have a right not to be discriminated against. Your statement reflects the current situation in medicine where discrimination is the norm. I know countless doctors in specialty programs who have taken maternity leave only to not immediately again be given employment. Hospitals are notorious for not giving contracts to doctors on unpaid maternity leave even if they then employ them after the year off which breaks continuity of service (important for LSL and other benefits). You use the emotive language of ‘letting people down’, I think you are confusing two issues: the right of women (and men for that matter) to take maternity leave, and the very tight funding of positions in public hospitals. The way you are balancing this tension seems to be blaming junior doctors for a HR budgeting error. These types of statements would be ludicrous in another field and I hope that hospitals and colloeges start to look at the effective models of job-sharing, reduced hours that can lead to increased flexibility in medical workplaces.

  14. Kylie says:

    Dr Champion et al – how do you propose the women involved manage their fertility?  Would you advise them to not have families or not become surgeons?  Neither of these are acceptable options for many women in medicine, so after years of doing their very best they are seen as the flakes who made life hard for their colleagues purely because they happen to be the surgeon with a uterus.

    I am a mother in obstetrics & gynaecology training, and I have to say that the grand majority of my colleagues and seniors have been extraordinary in their support since I became pregnant.  I have, however, also experienced first hand the anger of both male and female colleagues because I had the nerve to withdraw (early I must say!) from a job with 1:2 on call, which I couldn’t manage with a newborn.  It is amazingly difficult to bear the brunt of this when you have gone above and beyond to help colleagues over the years, and are not even given the respect you feel you’ve earned, because of your choice to have a family.

    Dr Champion – we remain anonymous because we’ve been burned and suffered for speaking our mind on this issue over the years.  If we’d been treated well we wouldn’t be so cautious.

  15. Dr David De Leacy says:

    This issue is not about cultural attitudes as everyone above seems infer and it also is not about post-graduate medical training in particular, although the problems experienced by female trainees do highlight flaws in the present situation with respect to maternity/parental leave. The half of the equation not considered in discussion is the availability of additional financial resources required by training institutions or companies to fund extra staff for workload gaps that these vacancies will inevitably produce. Female trainees now have as a ‘right’ maternity/parental leave paid for by the taxpayer. The federal opposition also considers this as an industrial issue, not a welfare one. What has been missed in discussion around the federal funding model in Australia, is how this vacated quantum of work is to be funded. No consideration whatsoever has been given to the additional cost burden. It apparently is seen as something to be either passed on to the customer in private industry or in the case of hospitals and public institutions to be borne by departmental budgets. The most likely action that will be adopted by the managers is simply to increase the workloads of other frontline staff to create an ‘efficiency dividend’. It is an unfair position for any female employee or indeed her colleagues. An appropriate funding model fully reflecting the new laws require integration in to all public sector budgets. All regulations of the Specialist Colleges also must be changed for this change to occur without rancour.

  16. Katherine Hyde says:

    I agree with Dr Champion, we all have a responsibility to our respective training colleges, to our mentors, to our junior colleagues. We also have a responsibility to our patients and their families to do the best job we can. What I DO NOT agree with is that we should complete our training uninterrupted, in the minimum time allowed. Medical training and medical careers, with long work hours and the constant need to study, tend to de-humanise us. To be the best doctor we can be, we must be the best person we can be. Trainees and junior doctors are already an ambitious, motivated lot (for the most part). Constantly being told that we have to work harder and make more sacrifices is unneccesary and insulting. Our personal development does not stand still while our professional development proceedes. I have seen colleagues criticised for taking any time off (for pregnancy, mental health or other personal reasons). Some of the criticism came from other junior trainees, put out that they would have to “pick up the slack”. How can we show compassion or empathy for our patients if we do not have it for our colleagues? The sooner we allow our colleagues, and ourselves, to participate in life outside of work and training, without criticism or jugdement, the better. Half a person can never be a great doctor.

  17. Dr Una T'Russ says:

    Thank you Gary Champion, 

    I’m sure your wealth of knowledge on pregnancy and child rearing in surgical training is well grounded in your experience as a male physician.

    So good of you to comment with so much insight.

    It’s time to move beyond keeping things the way they were “in my day”
     

  18. Sue Ieraci says:

    As both a parent and an ex-head-of-department, I see this issue as requiring mutual respect and acceptance of responsibility. Any period of extended leave requires planning and potential hardship for the remaining employees filling the gaps. Dishonesty works against this, and can cause additional resentment when the colleagues and HOD are dropped a bombshell without the time to plan. Having said that, periods of leave are an entitlement, and should not be unreasonably withheld. A good manager should plan for their employees’ expected personal needs – whether that be a new baby’, a required break for burnout, a period of illness or severe injury, or the death of a parent overseas. This should be equitably granted, so that one person”s needs are not priotitised or judged over another”s, and so that each person who has the benefit of extended leave is willing to cover for the absence of others when it is their turn.

  19. James Webster says:

    This issue is wider than females wishing to have children. Disability of any kind is generally not tolerated well in medicine. I had to have several operations in 14 months an unusual occurence as a young male but in its own way debilitating. I now find myself coming out of this terrible experience with awful references for next year when previously I had excellent references from other jobs. It will take me a year at a hospital I dont want to go to that doesnt further my career to get good references again. Every area I underperformed in was directly related to my surgeries and now I have improved it is too late to have a hope of getting a decent job next year.

    I even only had 3 sick days after one surgery but it wasnt enough. A supervisor even told me that absenteeism was one of the best indicators of the quality of a registrar. In the end i only had 20 days off across the operations I had, plus rehabilitation appointments, in prior years I have never had more than 3-4 days off ever.

    Other people I know have had similar experiences , ie broke leg had time off was not allowed to return to work in a wheelchair by medical workforce and had to repeat the year of training due to too much sick leave being taken.

  20. D says:

    At least female surgical trainee has maternity leave. As a new single father, I cant imagine asking my HMO manager for paternity leave. 

    All this talk is very good, but we all know that no such equality or kindness will be given to us lot, who are meant to be perceived as superhumans… I was only allowed 2 days off to tend to my dying grandparent, otherwise my oncall consultant won’t have a registrar for the weekend….  Nuff said.

    Female trainees should just toughen up. Nothing will ever change.. nicenest is only face value in our business..

     

  21. Roger That says:

    @ Dr Gary Champion – Yes, how selfish of us women for wanting to have children at the time our bodies are SUPPOSED to have children. Sorry Dr Champion, we don’t live in the 50’s anymore – not all doctors are men, despite the best efforts of the “Boys Club”. This culture of “We had a terrible time at Med School, so YOU should have a terrible time at Med School” is sickening. Take a good hard look at yourself, Champ. You’re blinded by anger and tall poppy syndrome.

  22. Department of Health Victoria Clinicians Health Channel says:

    As a Paediatric Surgical Trainee and mother of two I have had very positive experiences working while prengant, while on interrupted training and returning to work with infants and breastfeeding. We all know the hours are long. The study requirements are demanding. But if you want to have your cake and eat it too then you must learn to take big bites and chew quickly!

  23. Katie Buzacott says:

    There are multiple issues at play here, and in the situation in the article, everyone loses

    • The employer loses as they are left in the lurch
    • Her collegues lose as they have to cover for her
    • The patients will suffer with staffing shortages, and grumpy covering doctors
    • She herself will lose when she tries to get a reference, or indeed another job – medicine is a small world, and everyone talks

    And most of all, all women of child-bearing age lose – because now everyone will look at us coming into an interview, and just think that no matter what we say, we’re going to take off on maternity leave with no notice, and lawyer up if anyone dare stands in our way.

    Are we going to have to stand up in our interview and present proof of contraception or infertility to get a job?  Because they’re not allowed to ask so it seems we’d best tell!

  24. Jacqui Baulch says:

    As a GP I didn’t get employer paid maternity leave, just the federal maternity pay. Perhaps this is why, when I told my employer I was pregnant, she hugged me and congratulated me on my wonderful news. Perhaps if the hospitals weren’t under such financial strain, and could backfill the positions vacated by people on maternity leave, there would be less angst about ‘picking up the slack’. Maybe this isn’t a terrible sexist vendetta against women but a symptom of a system trying to provide a high level if service within a strict budget, with a limited number of personnel.

     

  25. Sarah D says:

     

    It’s such a different culture in the paediatric world….it’s almost a little mortifying hearing what goes on in the surgical/obstetric professions!!! At my paediatric training centre having a large network based training program helps to accommodate a large volume of trainees over multiple sites and hence deal with rostering changes when staff go on maternity leave. No paediatric colleague of mine feels that they have to pick up the slack because women go on maternity leave. We all know that doing a relief rotation is the way we fill these gaps (for maternity leave, or holidays) and it’s how the system will look after us when we need some sort of leave as well.  Paediatrics overall is very family friendly. The arrival of trainee’s new baby is welcomed warmly with a picture in the weekly junior doctor newsletter for the hospital. There is great flexibility to job share and work part time.  Pregnancy is seen as a normal component of life, rather than something to hide from you hospital or training college.  Doctors young and old need to realise that at least 60% of current medical graduates are women. Whether they like it or not, the system will eventually have to learn to deal with women. General practice does it very well…and paediatrics is the first of the hospital based training programs to allow greater flexibility to women… It’s only a matter of time till all other training colleges will have to adapt. They won’t have a choice!!!   

  26. Katherine Hyde says:

    I am very glad that my colleague, above, has had such positive experiences as a Paediatric Trainee. I have to say that that is very different to what I have seen during my training. Whilst everyone at my previous training hospital was very glad at the arrival of a new baby for a colleague, there was a lot of whinging that went on regarding roster changes etc. And I witnessed colleagues who needed to take leave for family reasons, such as caring for a sick child or parent, or for mental health reasons, who were not treated with compassion or empathy. We should all be able to take leave entitlements (maternity/paternity, sick leave etc) without fear that our commitment or job performance will be judged as sub-standard. WIth respect to “male surgical trainee’s” comments, nothing will ever change if we all take that attitude. Whilst some groups of trainees are definately worse off, positive changes are already being made, with respect to safe works hours, for example. Changing attitudes is a big job, but perpetuating these attitudes that are destructive to our profession does no one any good. Each junior doctor/trainee/consultant who refuses to accept these attitudes, who stands up for colleagues when they are treated unfairly, and speaks out for positive change in our profession, makes that job that little bit lighter. You may never change the attitude of some individuals, but maybe you can stop the toxic attitudes from consuming our junior doctors of the future.

  27. dr gary champion says:

    Well my comments have certainly led to “interesting” responses, varying from my lack of knowledge of pregnancy, to Tall Poppy, to anger with some correspondents agreeing with my views. Yes I am a Physician & was trained in an era when the job, our superiors & the care our patients received were sacrosanct including working without pay. My wife & I have 3 children & she worked during all three pregnancies – no maternity leave then; there were situations whereby we, generally male registrars would work a full Saturday shift for a colleague because of his religious views. We respected him. However, that was a different situation than exists now as exemplified by some of those opposing my views where it is considered their RIGHT to do what they please in terms of pregnancy & damn everyone else. So sweethearts if you are lucky enough & talented enough to obtain a specialty training postion then have the integrity to honour the responsibilities that go with it.

  28. ingrid lipka says:

    Infertility due to advanced maternal age is tragic, Tragic because we know it is coming and know it is inevitable but as female doctors we choose to ignore it believe we are superhuman and strive to do our expected best to finish our training with as little disruption to our collagues and patients and hence put off having children till it may be too late. This problem is only going to be more common with more female trainess and is perpetuated in the medical culture by male and femal doctors. 

    Medicine is not the only culture and its not just male doctors. In my previous career as an engineer I encountered lack of opportunity and promotion because I was female. So I retrained and put off having a family.   I found medicine overall to have far more opportunity for women. I suffered a miscarriage on a hospital rotation and found it hard to cope with what to me was the death of my child . My feedback from a male senior collague for that rotation was ‘poor time mangement’, and I was told by a fellow female HMO that they wish they were sick also so they didnt have to do extra work.

    Hospitals need to plan now how to fill maternity or mental health or prolonged sick  leave. I agree with other posts that relieving rosters and a federally funded scheme are possibilities. It’s time for medicine and other professions to enter the 21st century. It should be a right to have children for all women and men.

    I am now  a happy GP registrar with a healthy baby  through IVF and he is what makes being a doctor worthwhile. My GP training provider have been excellent with maternity leave but as you know in GP land it’s self funded.

  29. Department of Health Victoria Clinicians Health Channel says:

    Most of my friends who have had children during their training have been subjected to significant bullying for “letting the team down” by expecting collegues to cover their maternity leave. They have been required to do extra oncall time whilst pregnant to “make up” for the time they will be away, even if there is someone to cover.  It needs to be remembered that we might well have many years of expected training time, but our hospital contracts are yearly. If you do not have a contract you lose all leave entitlements, including maternity and long service leave. There are no training positions that offer contracts less than a year and enable you to stay enrolled. For other reasons I took 6 months off (planned) and arranged a 6 month contract so noone else was disadvantaged by my choice to take time off- but this disadvantaged me – I was not able to sit my exams for an extra full year, I was required by the college to pay for a full year of training (although the 6 months accredited i did was not considered sufficient to qualify me for the exam) and i lost all leave entitlements. As a woman without children it is expected I will do extra oncall over school holidays and have worked about every third christmas oncall, in an otherwise 1:9 system. I dont expect any of this will be taken into consideration if i one day am able to have my own children- I expect given the culture in the hospital system I too will be told the time and energy i have put in in the past and the future work i will do count for nothing, my biology requiring me to take time off work (a whole 6 weeks! wow!) to have a family of my own is disappointing to the profession. In any other profession this attitude would just not be tolerated.

  30. Department of Health Victoria Clinicians Health Channel says:

    This is an extremely difficult situation for me as a person responsible for training and the operational side of staffing. I am very torn between trying to ensure reasonably steady staffing levels throughout a year, a stable set of rotations for trainees rather than fairly regular re-organising of rosters for absences (unexpected and expected). Unfortunately maternity leave is ofen one of the more challenging areas because of duration. perhaps with the surfeit of trainees vs availabhle places it might be easier – not a good situation for aspirant trainees but beter for employers.

    There is also the fact of having to fill rotations away from the central hospital and nights that is troublesome. Why should single males, or those without kids be the “go to” individuals whilst Mums (single or otherwise) are spared this? Is this fair?

    the “best” situation (in my experience) is where the Dad is able to be the home parent (and is not working) – so the entire little family can pack up and go and enjoy the countryside for 3 months. these are few and far between but it is my observation that where this is the case – the Mum trainee is a very valuable member of the service (a stand out trainee) – perhaps it reflects on the emotional resilience and maturity of the individuals and the family unit.

  31. Fiona anderson says:

    Re dr champion. I’m interested if your wife with no maternity leave was indeed training in a high stress position with long working hours. If so, maybe she would have taken some leave under such demands. perhaps a respectful colleague/who ‘respected’ her (as you did your colleagues with certain religious beliefs)  would have rallied to pick up slack. I wonder if it is also in the best interest of children and parents to endure such stresses. It certainly is not in societies best interests to increase morbidity of these families due to higher risk pregnancies because of later maternal age. 

    Regardless, women are in medicine and surgery. Women will have children. Some will obviously put their families first at the time it is most important. It doesn’t mean their service to date and in future won’t lead to exceptional doctors and services to hospitals and community.

    I believe your “you can’t have your cake and eat it too” attitude has been disproven by the female surgeons who have successfully negotiated this path with support.  It is inevitable it will continue and it will improve. 

    I don’t see how request for maternity leave makes any trainee less grateful to be offered a position.  Things will always need to change with changing needs of society. Help figure out how to make things fair for all,instead of complaining ‘it’s not fair!’. 

     

     

    It’s this lack of understanding that makes me concerned about the ability to relate to any patient under the age of 50! 

    . Instead of us putting up with difficult conditions, I believe you should get used to change and be more flexible. It does , however, become more difficult with age.

  32. Suzy LeConcombre says:

    @gary champion

    I have completed my specialist training and a PhD so I can qualify for a specialist post in a major teaching hospital.

    After telling my boss I was going to try to get pregnant, my hours were cut. I am now suffering from infertility due to advanced maternal age, and it looks like I cannot have a child. I am also struggling financially as I am trying to afford IVF on the reduced hours. My partner is in a low paid job.

    I have done everything correctly according to my duty as you describe.

    Is that good enough for you?

  33. Toby Loch-Wilkinson says:

    This is a problem bigger than just maternity leave. The RACS effectively runs the training and has all of the power in that they allocate trainees to hospitals in certain positions. However as they are not the ’employer’ they are free of any responsibility to the trainee from a workplace point of view. Thus it is free from freedom of information laws, unfair dismissal laws and can get away with paying lip service to modern day workplace concepts like flexible training for new mothers. The RACS should be able to be held to account in the same manner as an employer.

  34. Neela Janakiramanan says:

    @ surgical registrar above – you will find that this is not actually the case. RACS actually are constrained by workplace and equal opportunity legislation, and is in fact able to be held to account in the same way as any employer. Any good workplace relations lawyer can take you through the steps under which the legislation is applied. 

    @Rebecca – it is wonderful to hear that some specialties are changing and providing rights and opportunities. Unfortunately there is no unified stance across all the RACS training boards, and the situation varies essentially by the personal philosophy and biases of the regional or state supervisor for that particular program. Despite RACS having a position statement on the matter, it is certainly not applied evenly across the board.

    @male surgical trainee – more fool you then. Many surgical registrars DO take paternity leave, carers leave and all other sorts of leave. I have recently had the pleasure of working with a male surgical registrar who is deeply involved in the lives of his twin preschoolers. He has taken two periods of interrupted training, and over the last six months had multiple days off to care for his sick children while his specialty registrar wife worked. Remarkably – you know what? The world went on. Patients were appropriately treated. There were no delays. And only a few people worked marginally harder to make up for it. I would encourage all registrars, whether they be male or females, to fight dinosaur attitudes like Dr Champions – unless ALL medicos work together to change the inherent culture of medicine, then there will be no change and women will continue to be castigated. 

  35. Neela Janakiramanan says:

    @ Dr Champion – you are making a major logical fallacy that we female registrars who have children during training do NOT honour our responsibilities to our training program, our hospitals or our patients. In fact, in my experience, parents are among the very best young doctors I have ever worked with, because they have the persepctive to treat the patient as a WHOLE, rather than as a clinical problem. Training programs take women of childbearing age; it is then disingenuous of them to be surprised and act with outrage when women of childbearing age decide to (surprise surprise!) bear children. There ARE good training boards and training programs out there. There are some who have contingency plans in place for what to do in an entirely expected scenario. There are those that manage their trainees in a way which is compliant with state and federal legislation. These laws, entitlements and outcomes are not surprises – and if a hospital or training board chooses not to act in advance to form contingency plans when these things are well known to every other industry – then that is a failing of the training program or hospital, NOT the individual trainee who is acting entirely within his or her rights. And please don’t call women ‘sweetheart’ – we are strong, intelligent and professional individuals and don’t need to be patronised by men like you.

     

  36. Charles Darwin University says:

    I would be interested to know what sort of specialist is Dr Gary Champion? Did he go through Surgical training himself? I also have a little bit of advice for the “paediatrician” above who is now struggling with her fertility. Leave your major teaching hospital if you can, and go somewhere where you will be appreciated. Go now before you (and I sincerely hope you do) have your children. I work as a paediatrician in a rural hospital that struggles to get Australian graduates but am currently on maternity leave after having my second child. She was born one month before I turned 40. I am so grateful that my hospital has allowed me to have maternity leave, without any concerns regarding cover while I am away. The “major teaching hospital” where you work does not deserve your effort or loyalty.

  37. Charmaine Lim says:

    Having children in during training is no doubt one of the hardest things to do. It takes determination, strength and yes, a thick skin. A supportive partner and extended family are indispensible! But you will still need a nanny unless he is a house husband. I had two during my surgical training and now have three as a consultant. But it is a great privilege to have this choice. As women living now we have choices to use our education, talents, intelligence skills to contribute to society, to have a fulfilling career and to provide for ourselves and our families if our partner is unable (or if we have not partner). Cultural change takes time and will occur as more women enter into a previously male dominated world. Even patients can have a negative view of you just because of being female or what we look like. If we want to contribute to this change in a positive way, we have to work damn hard, make some sacrifices and find solutions! This includes seeking legal advice if you are being discriminated against. Some of my male supervisors were my best advocates. I feel indebted to them for their encouragement. Typically these were men who had great respect for their wives and were devoted fathers. Others appeared chauvinistic and voiced anti- female sentiments. But without any positive role models, who can blame them? And anyway, we can never please everyone. Some sentiments prevail beyond logic. Women in medicine should be the first to advocate having children at a healthy age. Training is only one small part of your career. If you can find a way to cope with kids during the training, its good training for parenthood and making responsible, effective decisions for the well being of both your children and patients!

  38. Ulf Steinvorth says:

    Few male speciaists or trainees are ever asked how they manage to combine their career with their families and children – yet in female specialists and trainees that’s the first thing that everyone feels entitled to ask.

    What also strikes me is the first sentence of the article which seems to follow that line: ‘surgical trainees wanting children are in some cases not revealing their pregnancies’ – are we talking surgical trainees here or are we talking only women?

    Nobody seems to consider it a problem for the career, ‘letting the team down’ or ‘being selfish’, ‘having it all’ to have children during training if one is male – other than of course the few males who themselves undertake child-rearing duties and ask for consideration in roster-writing or god forbid parental leave.

    In the Emergency Training program there is not even a term available for parental leave, only for maternity leave – goes to show that we still have a long way to go until one doctor is treated the same way as another, independent of their sex. We are probably nowhere near where we think we are when it comes to assessment independent of illness, disability, country of birth, skin colour, religion or sexual orientation – let’s hope this discussion about equal rights for women opens up the closet of all others suffering discrimination, active or passive.

     

    ?

  39. Genevieve McKew says:

    Only a few commenters have raised the correct issue here: the problem is not really an issue of training (flexible training options are available through the colleges) but an industrial issue. Doctors in training are just like all other employees on short term contracts – vulnerable to unemployment and loss of benefits of a permanent (or longer) contract and continuous service.

    There needs to be a more sensible arrangement for employment conditions of doctors in training – five year contracts with the state health department, a co-ordinated selection into training policy, and extra trainees employed to cover the expected periods of parental, sick, carers’ and mental health leave.

    God forbid junior doctors may even have to organise to obtain reasonable conditions of employment!

  40. Sally says:

    I am interested to know what Dr Gary Champion means when he says his wife ‘worked during all three pregnancies – no maternity leave then’. Perhaps he doesn’t understand the definition of ‘maternity leave’? People generally work during their pregnancies and take maternity leave close to and AFTER the birth of the child – to allow the mother to recover physically and care for their newborn in what is an extremely vulnerable part of both their lives. 

    If Dr Champion’s wife really took no maternity leave that means she went back to work straight after the birth of the baby… I’d be very surprised if this was the case, given how physically exhausted most mums are the weeks following a birth. I could barely carry on a conversation or walk properly for the first few weeks post-partum! 

    Maternity leave, at least in the first 6-10 weeks, is necessary for health reasons, not for convenience as it seems some would assume. Yes, it does cause an inconvenience to hospital administrators, but have we considered the alternative? The alternative to maternity leave is simply for women to lose their jobs when they have a child during the training years. This was the case just one generation ago. Dr Champion and supporters, is this what you are really advocating?

     

  41. Greg Hockings says:

    The overall issue is one of fairness, not sexism. As a middle-aged male physician, I still strive, often unsuccessfully, for an appropriate work-life balance. I feel that I am just as entitled to a family life as my trainees. If my registrar (male or female) is absent from work for any reason, I have to spend considerable additional time in the wards in the evenings, as a replacement registrar with the same expertise and knowledge of my inpatients will not be available.  I may also have to see additional outpatients at clinic to cover for the registrar’s absence. This is where the concept of “letting the team down” arises. 

    I succeeded in physician and subspecialty training where others did not because I put in the long hours and the hard work at the cost of my own personal and family time; this is where the concept of “I did it tough, so you will too” arises. Why shouldn’t I feel resentful when I have to “babysit” a basic trainee registrar for six months with all the extra hours checking what they done in the wards, because the advanced trainee registrar has unexpectedly taken maternity leave? I would feel the same way if it was a male advanced trainee registrar who took six months leave for a purpose which could have been deferred, as opposed to something beyond their control such as a serious illness.  It is not sexism or misogyny at all.

    It could also be considered discriminatory for administrators to deliberately choose only unmarried or childless trainees for rotations outside the large cities and teaching hospitals.  There could be many other valid personal reasons for not wanting to go on such a rotation. Fair treatment means equal treatment for everyone.

  42. Sue Ieraci says:

    ”I feel that I am just as entitled to a family life as my trainees.” Greg – if you regret having had to work ”at the cost of my own personal and family time”, don’t you want better for the generation that is coming through now? I agree that long unexpected periods of leave are difficult to manage, and that they can take a toll on those still working, but the point is this: as far as possible, leave should not be unexpected. It is the responisbility of heads of department and workforce managers to anticipate these requirements – employees in specialty training schemes are right in the middle of their reproductive years – whether they are male or female. Nursing – being a largely female workforce, has to manage this all the time – as well as leave required for sick children and ailing parents. Why not accept that it can be done better? What we don’t want is to drive people to secrecy, leading to their sudden disappearance, without the time to plan. If we know that our workforce is likely to require some flexibility, why not set up structures that anticipate the need for various people to have long periods of leave, for whatever reason?

  43. Greg Hockings says:

    Sue, yes, absolutely I do want better for the next generation of doctors – just not at the cost of further sacrifices by myself and others at my stage of life, or by other young doctors who  have chosen to delay having a family until they have completed specialist training. My generation have done it once to get where we are, now it appears that we’re meant to do so again to give some of the younger generation a better quality of life at our expense.

    The balancing act is really the quality of patient care and postgraduate training versus family committments and personal life. I don’t think that the comparison with nurses is valid; they finish their shift, do handover and go home.  Whereas medical practitioners often stay late if they have sick patients, rather than compromise a patient’s standard of care by dumping them on to an overworked DMO/ward call resident.

    It would require a massive increase in staff funding for public hospitals to have additional shifts of junior medical staff throughout the wards; until then, junior medical staff are always going to have to be prepared to work long and unexpected hours to cope with the clinical workload.  The only fair way to do this is for everyone to be treated equally.  We all have our reasons for wanting to knock off on time – personal, health, family, young children etc.  

    I don’t believe it can be disputed that being one doctor down on a busy hospital unit vastly increases the workload of the remaining team members. It is not a matter of saying “suck it up” to the rest of the team; it is a matter of fairness and equity to the other team members and the team’s responsibility to provide optimal care to their patients.

  44. Ulf Steinvorth says:

    Of course a team of two cannot do the work of three without damage to quality or private life. But we are repeatedly told to learn safety from aviation – would they start with the co-pilot down or with reduced crew, expecting to fly that thing safely and deliver high quality ‘care’ in-flight??

    If they don’t – why do we?

    And is it really the trainee’s/women’s/sick doctor’s ‘failure’ to take leave when needed – or is it a system failure for not allocating the resources needed to accomodate for these facts of life?

  45. Sue Ieraci says:

    Greg – I don’t know whether you have ever been responsible for workforce planning, but the only way to avoid the danger of ” vastly increases the workload of the remaining team members” by expecting and planning for it. We might not know exactly when long periods of leave will be required, but we can expect that, sooner or later, they will be. Being treated equally doesn’t mean it has to be equally badly – it can mean that everyone has the right to request special leave for their own needs, and not to have it reasonably refused. Being able to do this means recruiting and rostering with some inbuilt redundancy. There may not be extra staffing to do this, but, instead, one can look at what duties are essential and which ones can be deferred, or do not add value to patient care at all (in which case, they should be scrapped). We currently do this for things like exam preparation as well as family needs. Instead of making people feel guilty that they haven’t squeezed in child-bearing somewhere between the HSC and post-grad training, why not have everyone feel that they are entitled to leave for their individual needs, but they are also responsible to be flexible enough to help cover others during their leave.

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