Hospital Health Check 2018January 15, 2019
Acknowledging MakarrataJanuary 15, 2019
Parenthood presents a unique set of challenges for medical professionals – particularly doctors-in-training. Dr Tessa Kennedy and Dr James Lawler share their experiences with their families about what is often seen as gendered-issue.
Dr Tessa Kennedy
AMA Council of Doctors-in-Training Chair
Five months ago, had my first baby, exactly four weeks after completing my general paediatric training. It’s been simultaneously the most terrifying and awe-inspiring thing I’ve ever done, and very humbling for someone who thought they knew a thing or two about babies to feel completely at sea. (The first time he vomited out his nose I was packing the bag to bring him to ED for a clean catch urine, until a nonplussed grandmother brought me some perspective.)
It was perfect timing, they said – you’re done! Except that finishing one program also marked starting another. Becoming FRACP is my gateway into paediatric intensive care advanced training, which kicks the can of consultant practice four to five years down the road. At least.
I have joked that I find myself turning down the opportunity to exit training at this juncture because I’m a masochist who has made poor life decisions. As colleagues would know, medical training is neither synonymous with flexibility nor thought of as terribly family-friendly. In addition, my Award wage is maxed out at Reg Year 4 and set to go down once I’m a Provisional Fellow. And further proof that I’m bent on self-punishment – I’m going from a generalist specialty that can be practiced almost anywhere, to a very narrow tertiary field in which “there are no jobs” (though this seems to be touted about every specialty but psychiatry at the moment).
On the contrary, to get here we made a series of carefully planned and calculated moves to meet training requirements, time conception, deliberations about when to do rural terms… I had sought to control as much as I could, even though on reflection it probably just made life more stressful.
The perennial question, “When is the best time to have kids?” is particularly vexing in the context of medical training and the subject of much debate among students and trainees alike trying to plan their personal and professional futures, which can be difficult to align.
It is increasingly anxiety-provoking because, with more postgraduate programs, the average age of medical graduates has increased, and with more medical graduates, the time – and in many cases, CV-buffing activities – required to get into vocational training has increased. As such, the possibility of sprinting to the finish line of fellowship before having kids can become a race against dwindling fertility and indeed stifle opportunities to get out there and meet a partner you want to have them with in the first place.
But then, opting to have kids during training also seems fraught, with rigid barrier exams at infrequent intervals; temporary employment contracts that may start or end awkwardly within a few days of a due date; the fact that most long daycare is made for people who work 8am till 5pm, not till 9pm, or from 8pm. Or a different kind of roster every three months with only two weeks’ notice!
My carefully laid pregnancy plans nearly unravelled when my body threatened premature labour at 28 weeks and I was grounded from returning to my interstate rural term, four weeks shy of completion, with a fridge full of leftovers, my car and other belongings, not to mention a pile of unchecked clinic letters, left stranded. It was only the absolute magnanimity of my colleagues in both Sydney and Darwin and the General Paediatric team at the RACP granting me special consideration that meant I was lucky enough to complete my time close to home and a tertiary NICU, and before my contract allowing me to do so ended.
So, in the various tea rooms, social media forums and women in medicine events where this question is of perennial interest, I think the closest we get to a one-size-fits-all answer is that there is no good time or bad time – there is just your time. It would seem you’re less likely to be disappointed with the outcome in either domain if you aim to consider them separately, acknowledging the inherent uncertainty of biology and the capacity of training to become more flexible than we might think or have let it be to date.
The reality is despite the most meticulous planning, it could take a while to fall pregnant. Even then 1 in 10 babies is born prematurely, and even then my main parenting take-away thus far is to expect the unexpected – as soon as you think you’ve got this tiny human figured out they go and change it up again.
It’s interesting though that while male and female trainees become parents at similar rates, this question of timing so often asked by female trainees doesn’t seem to be asked by the men. It would seem they don’t have to, because our current systems conflate the biologically imperative differences between our parenting roles with ageing societal expectations. I get it that I’m the only one in my house who has the equipment to give birth and breastfeed, but I’m calling it: everything else is fair game.
The NSW Hospital Health Check survey gathered insights from 1351 doctors-in-training in mid-2018. In the last 12 months, 8% female and 6% of male trainees reported that they had applied for flexible work (such as part time or other arrangements), though women were slightly more likely to be successful in their application. However, a further 58% of female and 35% of male trainees would consider doing so in the future. Our workforce is ready to change, but are our systems?
Frankly, the time for debate has come and gone – flexible work and equal participation is the new reality, and our systems need to adapt. It’s critical to provide any semblance of work-life balance and mitigate the epidemic of burnout among doctors at all levels.
Now, I’m obviously only five months into this parenting gig so please forgive the n=1 anecdata, especially when I haven’t even returned to work. I don’t pretend to have all the answers. But from my collated vicarious experience through advocacy roles and many one-handed midnight hours learning from the ‘wise hive’ of medical mums and mums to be, there are some things I’d hope we can do to make the very personal decision to have children more compatible with our professional obligations.
We need to advocate to make parental leave more equitable and making flexible work options far more accessible for every trainee, removing outdated gendered assumptions and acknowledging that childbearing and rearing are not just an unavoidable reality in the lives of doctors-in-training, but deserve the time to be done properly. Conferences should have parents’ rooms for feeding and changing to allow participation without disrupting everyone else, hospitals need to have after-hours childcare, and every training post should be available part time – only 20% of 1351 trainees didn’t believe their current role or specialty training should be able to be undertaken less than full time.
I recently chaired a two-day face-to-face meeting of our AMA Council of Doctors-in-Training with a 10-week-old breastfed baby and presented twice at an interstate conference shortly after. From my partner and mother who travelled with us and entertained him between feeds, to my deputy chairs who directed the flow of conversation when I was directing the flow of milk; it took a village. But it was eminently possible, we just had to believe it.
Dr James Lawler
Co-Chair, AMA (NSW) /ASMOF (NSW) Alliance Doctors-In-Training Committee
Two years ago, my partner Elise and I made a bet.
At the time, Elise was in the penultimate year of her medical degree, while I was completing my internship.
Together, we had a vague plan for our future: finish medical school; finish our training; buy a house; have children. Neither of us are traditional enough to feel that those events needed to be in any particular order. But certainly our belief was, and the zeitgeist amongst junior doctors is, that the earliest we would consider having children would be after some or all of our training was done.
I had felt for some time we were ready to start our family, and Elise and I lamented our inability to do so before finishing training. But one day, Elise came home (as she tells it, having seen a particularly cute baby that day in Campbelltown paediatrician Andrew McDonald’s clinic) looked at me and said, “We can do this.”
At first, we spoke about it as an abstract concept, but we quickly realised there was little stopping us. Despite the dogma amongst my peers, I have never spoken to a senior doctor who said that waiting until after medical training is necessarily the best time to have kids. It may seem like there is no time in a training program to have children, but nor is it ideal to take time off after you’ve received your letters, when you want to be establishing yourself. After talking it through, we agreed to start a family.
Elise and I saw no reason for our contributions to raising children and managing a home to be unequal. We both grew up in regional areas, spent two years doing other things before entering undergraduate medical degrees – we even each spent a term as President of the Australian Medical Students’ Association. Our lives have taken remarkably similar paths. An age gap of a few years is really the only differentiating factor in our career progression thus far, and we both have dreams and ambitions for the future.
However, an expectation of domestic equality isn’t the norm for Australian heterosexual couples, as I learned when I read Annabelle Crabb’s book The Wife Drought on Elise’s recommendation. One of Crabb’s main theses is that both men and women nowadays often lack a “wife” to perform domestic duties at home since both partners are often working outside the home. Despite this, domestic and childcare duties still tend to fall to women. Crabb points to data from to the Australian Bureau of Statistics which shows that 76% of full-time working fathers have a spouse who is either not employed or working part time; however, only 16% of full-time working mothers are supported in the same way. On average, women are doing more housework per week than their husbands (regardless of each person’s hours of paid employment), and as more children are added to the family, men do even less housework. The reasons for this may be that as more children are born, gender norms become more enshrined, or perhaps that the male “breadwinner” increases his time at work since there are more mouths to feed and (perhaps ironically) that his wife is no longer making as much income as before. Many of these factors won’t change overnight in Australia. But they weren’t acceptable to us, so Elise and I have tried to split our domestic responsibilities as evenly as possible.
However, one of the obvious structural barriers which entrenches gender inequality in the workplace and the home is how we allocate parental leave to men and women. Lo and behold when I searched my entitlements under the NSW Health Award, I found that whilst mothers (appropriately) are entitled to 14 weeks paid maternity leave, fathers are only entitled to one.
Knowing that Elise alone takes on the responsibility of pregnancy and childbirth, I would never suggest that I ‘deserve’ the same amount of leave as her after a child is born. However, Elise deserves an equal partner in the first weeks of parenting, and our children deserve a father equally present in the first months of their life. Placing so little societal value on a father’s time with their newborn child only entrenches existing gender norms; if dad has no other way of making an income, he is likely to quickly return to work while mum stays at home caring for the baby, often assuming additional responsibility for domestic tasks as well.
This is actually one of Ms Crabb’s other propositions – that whilst many things have changed over the last century for women in terms of their rights and, in particular, how they access employment, very little has changed for men, which overall continues to enshrine stereotypes for both genders. Men are generally embarrassed to, or ridiculed for, working part-time in order to care for their children, and when they do ask for these arrangements they are often turned down. The NSW Health Public Medical Officers Award is a perfect example – if men are worth 1/14th of the value of their wives at home following the birth of their child, and are compelled to return to the workplace as a consequence, the system continues to compel women to assume the primary parenting role. Thankfully, NSW Health committed to working toward ensuring “equity in approach” around parental leave as part of the JMO Wellbeing and Support plan, and the work towards this goal so far has been positive.
So the bet that Elise and I made was that we might be able to have our cake and eat it too – that we could maintain our aspirations but also work together to raise a family. It has been the best decision we have ever made; we were grateful to welcome a beautiful, healthy daughter into our lives in March of this year. I took my one week of paid paternity leave, strung it together with a run of nights and some annual leave and ADOs, and was lucky to have a workplace that supported me to do so. Elise has taken this whole year off from her studies – time I have committed to paying back to her one day, so she can reach her goals. I want my daughter to grow up to be proud of her amazing mother and all of the things she achieves throughout her career. And I’m looking forward to spending more time with my incredible daughter too.