Building families

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Morven Allan: General Surgical Trainee, south-east Scotland

Although improving, surgery is still a long way from having a gender balance in its workforce. Women account for almost two-thirds (64%) of the 2021/2022 medical student intake¹, but make up only 41% of core trainees, 30% of higher trainees and 14% of consultants². Many state that parental or caring responsibilities as reasons why trainees choose to leave their role in surgery. Over half of respondents (55%) surveyed in the Nuffield Trust 2021 survey³ indicated “their parenting plans, decisions and experiences had meant they had considered leaving their role in surgery”.

In April 2015 the government introduced new flexible leave allowances that made it easier for both working parents to share leave after the birth or adoption of their children. Due to the nature of training contracts, only basic statutory pay was available for doctors taking shared parental leave (SPL), rather than enhanced occupational pay such as for maternity leave. This meant that if doctors split their year of parental leave between two parents rather than the mother taking a full year, they would be financially worse off.

This changed in April 2019 after lobbying from the BMA, and the SPL pay was enhanced to the same levels as occupational maternity and adoption pay. This translated to parents making a choice on how they split their parental leave based on what was best for them and not just financially. Despite this change, only 17% of trainees are satisfied with access to SPL, with men half as likely to be satisfied with the length of their parental leave³.

Parent experiences

We spoke to a number of trainees, men and women, from various surgical disciplines about some of the joys and challenges they faced being surgical parents.

An ENT registrar took two one-month blocks of SPL at ST5 and ST7 when his children were 11 months. These were taken to coincide with his partner’s last month of maternity leave. He found the benefits of his SPL included being able to spend more time with his family and help with childcare, and that it was financially beneficial to do so. When asked about the drawbacks of SPL he commented that he found a poor awareness of what SPL was among his colleagues and trainers, the paperwork/application process was frustrating, and the need to confirm dates and arrangements multiple times. When asked how his colleagues perceived him taking SPL he said the responses were universally positive.

“While it is difficult to incorporate flexibility into a shift pattern rota, every effort should be made to do so”

Another trainee, a general surgeon, took eight weeks and 12 weeks of SPL with his first and second child, respectively. These were taken at ST3 and ST5 levels and in both cases his children were around eight to nine months old. When asked about the benefits he said enjoying spending time with his children in this key developmental stage, both he and his wife noted a change in the way his children acted towards him after SPL, and the appreciation of what was involved in parenting his children and leading to a more even split in household life.

Prior to going on SPL he said consultants were concerned about the impact the time away would have on his training and surgical skills and that some consultants (not necessarily the ones he expected) were perhaps more negative about him taking SPL. Equally some colleagues were hugely in favour of him taking SPL and stated they wished they had done the same. Final comments included a lack of knowledge about what SPL was among his colleagues, confusion between statuary paternity leave and SPL and a difficult-to-navigate HR process in order to take SPL.

We then spoke to an orthopaedic trainee who took eight months of maternity leave and shared the remaining parental leave with her partner. She stated that one of the difficulties of returning to work was that she was still breastfeeding in the morning and evening. Expressing at work was difficult and at times uncomfortable with lead gowns and long operations. She also went back 3.5 days electively and with a full on-call rota. Interestingly, she was not well supported in this decision and was labelled as part of the cause of the department’s staffing issues, either directly or indirectly. She found the lack of flexibility in working times difficult, particularly around childcare pick-ups and drops-offs.

Finally, we spoke to a surgeon who is a single parent with two children. On her return to work after maternity leave she was placed on call within the first few days, handed the bleep and told “oh you’ll be fine, it’s just like riding a bike”. She was less than full time (LTFT) at 80% as it was not financially viable as a single parent for her to work full time, but was well supported in this.

When asked what the greatest barriers are to being a parent in surgery she stated the “working hours make the normal childcare arrangements challenging and in addition the rotational nature of training adds a commute into that”. She felt flexibility was important for improving the work–life balance of a surgical parent, with some control over where and when they work. She noted that she had a very accommodating employer in her current post and appreciated what a difference that made.

Finding a balance

It seems the underlying message is that flexibility is key. While it is difficult to incorporate flexibility into a shift pattern rota, every effort should be made to do so. Trainees should not be criticised if they wish to go LTFT and allowances should be made for this. Equally if we wish to improve the gender balance in surgery, encouraging partners to take SPL is vital.

The RCSEd Trainees’ Committee recently put together an e-learning module on parental leave, which is available on the RCSEd website. It focuses on maternity leave and returning to work, and also gives advice on topics including SPL, undergoing IVF and miscarriage/stillbirth. I would strongly encourage anyone looking to start a family to go through this.