In recent years, more than 50 per cent of medical graduates in Australasia and 80 per cent of new obstetrics and gynaecology Trainees have been female. Therefore, RANZCOG has the opportunity to be a leading light in adapting specialist training pathways to accommodate the changing characteristics of the medical workforce.
The stage of life of women when entering specialist training means, for many, the dilemma of how to fit training and having a family around each other is at the forefront of their minds. Some make the decision to complete their training before having children, but this decision may be easier for some compared to others. Many factors influence a Trainee’s decision about the best time to start a family; including age, medical issues, fertility concerns, partner’s career as well as the training pathway. As Trainees, we are often advised to focus on our career above all else to ensure progression to the perceived endpoint of becoming a specialist. However, this is a career of lifelong learning and as such there is no easy time to interrupt one’s career to embark on another challenging job women can face: becoming a mother.
Before beginning my training in New Zealand, I had already spent several years in the RCOG specialist training program in the UK. I relocated to New Zealand to get married and settle here. In order to continue my career, I had to take a backwards step, reapply to train and start again with the MRANZCOG exams. When I began a training position, it was not my intention to complete core training before starting a family; owing to my age and stage of life, I did not wish to risk my fertility to progress my career as I strongly believed it was possible to do both. Having seen many of my senior colleagues and role models combining training with having a family in the UK, I knew it was possible. At the time I started my first year of specialist training in the RANZCOG program, I was expecting my first child.
Having a baby to care for was easily the most difficult job I have ever done. It was far harder than managing a labour ward or Women’s Assessment Unit, with much longer hours and no breaks. Returning to work after 12 months of parental leave was daunting, but I felt I quickly settled back in and loved the balance of work and family life I had achieved. Having had the experiences of pregnancy, childbirth and caring for a baby, I felt empowered and believed I had a new level of understanding of the women I was working with. However, there were many challenges to come, including exams and moving in order to complete my rural placement.
To have a family and fulfil the expectations of being a RANZCOG Trainee, I have found having a supportive partner absolutely essential. Childcare options are generally inflexible, expensive and not well tailored to the needs of medical families. There is constant guilt from feeling that you cannot give either of your two jobs 100 per cent of your attention. There is time spent studying when your child is wondering why you are hiding away and not willing to play. The question of how it is possible to do it all at once is a common one. The answer is with the support of family and friends, making small sacrifices and being both efficient with your time and self-disciplined. Having a partner who can share the responsibility – from taking care of the children while you study at home, to tending to the children when you’re at work overnight – makes all these things possible.
After returning from parental leave, I worked full time because I wanted to reach the stage at which I could take my written MRANZCOG exam as soon as possible. I longed to spend days at home with my toddler and at times it was incredibly hard to leave her. I often questioned whether I was doing the right thing to continue pursuing a career in obstetrics and gynaecology. There seemed to be easier, more family-friendly options if I changed to career path, but I couldn’t convince myself that I wanted to do anything else. This time was a true test of my commitment to the specialty, but I found being in this position strengthened my commitment to my career. I have seen many colleagues facing the same dilemma. More often than not, they seem to choose to continue obstetrics and gynaecology specialist training; a demonstration of what an exciting and wonderful career it is.
I had to move to Rotorua (two-and-a-half hours from home) to complete my rural placement and, because of this, my family was forced apart. My husband has a demanding job in the city and his work commitments meant that he had to remain in Auckland. Thanks to the understanding of his employers, he was able to take six weeks off work to come to Rotorua with our daughter during the middle part of my placement and I am very grateful to him for taking that time out for our family. Having that time together was our reward for spending the first third and last third of the placement apart. During this time I was also studying for the written MRANZCOG exam. Life was a blur of working, studying and traveling to and from Auckland to see my husband and 16-month-old daughter. Getting through that time was incredibly hard, not to mention expensive. Other Trainees have moved their entire family for the rural placement, including school-aged children, which is also an enormous undertaking and can be disruptive to family life. I think the rural requirement is possibly the most difficult logistical aspect of training with a family and having completed this makes the rest seem more achievable and far less daunting.
In the past two years, the College has become more flexible in its approach to part-time specialist training, which can be of benefit to Trainees with families, providing the positions are available in hospitals where Trainees are placed. It is the responsibility of the Trainee to make the arrangement to job share. In most cases a job share arrangement of 0.5 full-time equivalent (FTE) is the only option for less than full-time training. Obviously, this leads to a doubling in the overall length of time taken to train and begins to stretch the limitations imposed by the College on length of training time, particularly where maximum parental leave has also been taken during training. A more desirable position for many would be somewhere between 0.5 and 1.0 FTE to allow Trainees to spend time with their young children, but continue to progress through training at a reasonable pace.
Accepting that women are likely to request alterations in their specialist training program as they progress, perhaps a co-ordinator within the College could have the role of placing Trainees into less than full-time roles as requested, thus enabling these natural variations with minimum inconvenience to the hospital or Trainee. It may also be helpful if the College could work with hospitals to look at ways standalone, part-time positions might be created to maximise opportunities for Trainees desiring part-time employment.
Childcare is in high demand and full-time positions in the most sought-after facilities in big cities are hard to come by. In addition, if a Trainee has a partner who also works long hours, it is often impossible to co-ordinate childcare drop-offs and pick-ups and still get to work on time. Leaving before the end of an over-running clinic or theatre list to pick up a child is not seen as collegial behaviour and leads to Trainees with young children missing out on learning opportunities. Onsite childcare facilities with flexible hours to accommodate the variations of a roster, owing to nights and long days, would be invaluable for many across all medical specialties, not just in obstetrics and gynaecology.
In the end, a Trainee may need to make career choices that fit with his or her wishes for family life. Not all sub-specialities are suited to those with a family, unless there is a particularly supportive family member available to care for the children or the option of employing a nanny. Even with these supports in place, some parents may find it undesirable to spend as much time away from their children. For others this may be the perfect way to ‘have it all’. I think it is heartening that we all have the option to choose our own pathway through this adventure.
For the future specialists in obstetrics and gynaecology, our College needs to continue to provide excellent support for women embarking on these most formative years of our careers and family and, in return, will be rewarded with capable, contented and passionate obstetrics and gynaecology specialists.