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Reconciling parenthood with a medical career
Authors: Bryony Alderman, Fiona Cornish, Jean McEwan
Publication date: 13 Feb 2013
The difficulties faced by those trying to balance a career with starting a family pose problems for the medical workforce and employers. Bryony Alderman and colleagues consider the issues
Fifty years ago most doctors were men, and those with children had a non-working wife to bear the children and care for them. Today the majority of doctors in training in the United Kingdom are women, and they will soon be the majority in practice. The issue of balancing a career with having a family is therefore critically important both to doctors and their employers.
Developing an adequate medical workforce and ensuring the wellbeing of doctors require a clear understanding of modern social and cultural needs and the pressures on families. There are unprecedented opportunities to reconsider what might be required to take these aims forward. The Department of Health has published its report Developing the NHS Workforce and local education and training boards are being established to commission and control quality of training.
Two areas are of particular concern to young doctors, both men and women, wanting to balance a career with starting a family.
Firstly, doctors in training have some difficulty in selecting a time for a pregnancy during a long and arduous undergraduate and postgraduate training programme. Momentum in training and development may be lost during maternity leave and time spent caring for young children. Frustrations, stress, and lack of a sense of fulfilment and value can also arise from a lack of flexibility, the linear nature of most training programmes, and the pressure of working in a service that is itself under-resourced.
Secondly, the long and variable hours of work required in medical practice, particularly in acute hospital service, where much of the early postgraduate training is undertaken, make it difficult to secure good and affordable childcare.
Medical careers and choices for pregnancy and its timing
Effective contraception has been liberating to women and their partners in apparently giving them choice in the timing of a pregnancy. In a medical career, choices are limited by the responsibilities and pressures of training for up to 12 years after graduation.
There may never be a right time to have a baby, but doctors do make decisions on timing pregnancies. By reviewing data on the timing of a first childs birth, predictions can be made to aid workforce planning and ensure accurate provision of flexible training and part time working opportunities.
The Royal College of Physicians annual survey for 2010 collated data from thousands of consultants across the UK and included a question on age at birth of first child, which attracted 2273 responses (Andrew Goddard, director of Medical Workforce Unit, Royal College of Physicians, unpublished data, 2010). Responses showed that 48% of women and 52% of men had their first child while in registrar or specialist training posts. However, 25% of women and 17% of men waited until becoming a consultant before embarking on parenthood.
The survey also found that both men and women physicians have their first child four years later than the national average in 2011 of 27.9 years.[1] The modal age at birth of their first child was 30 for physicians overall and for men, and 31 for women. In all cases, the median age was 32. However, there was a second peak at age 35, which coincides with the attainment of consultant posts and worries about the ticking biological clock (fig 1 ).
Fig 1 Royal College of Physicians census data: age at birth of first child
The Royal College of Physicians survey also compared the responses from baby boomer consultants born between 1945 and 1965 with those from consultants born after 1965 (fig 2 ). The mean age at birth of their first child in the two groups, to the nearest whole year, was 32 in both groups.
Fig 2 Royal College of Physicians census data: age at birth of first child among consultants in different age groups
An awareness of the pattern of childbearing among doctors is important as it means that demand for maternal and parental leave can be predicted and appropriate provisions can be made. Given that the survey showed little change in these patterns over 20 years, even retrospective data can be of use in workforce planning.
Employers are currently obliged to consider a request from a parent to work flexibly or part time. However, it may be difficult for doctors to take advantage of such opportunities because they are still engaged in lengthy training programmes at the time of childbearing, and flexible posts make up only a small proportion of the total available. Less than 8% of postgraduate training posts in medicine are configured as less than full time training (LTFT), and demand outstrips availability.[2] The most recent survey of LTFT training indicates that 245 trainees met the current criteria to be assigned an LTFT training post but awaited an allocation. [2] Eighteen trainees requested but were refused further consideration as they did not meet the current criteria.
The UK government has recently announced plans for new regulations. From 2015, anyone will have the right to work flexibly or part time. [3] Such legislation aims to bring the concept of flexible working into the mainstream.
Increasing the provision of LTFT medical training posts and removing the current restriction on eligibility may seem challenging. However, the results of the Royal College of Physicians survey show that it should be possible to predict maternity and paternity leave requirements and the likely need for LTFT training and consultant posts. Gathering, analysing, and using such information to inform workforce planning could lead to real improvement in the training and work experience of trainees and young consultants.
Childcare issues for doctors
The need for quality childcare for all children is universal, but high quality childcare is not cheap. A recent report for the CentreForum think tank by Elizabeth Truss indicated that the average family spends 27% of its income on childcare.[4] Motivated by that report, the Medical Womens Federation did a survey of men and women doctors with young children and has established that such figures also hold true in doctors families (fig 3 ).
Fig 3 Average spend on childcare as percentage of family income
Of those who responded, the average monthly expenditure for each child was roughly £590, with some families paying up to £2500 for nannies and nursery placements. One third of respondents relied on local nurseries for most of their childcare, at an average cost of £785 a month.
As might have been predicted, those in more junior positions, such as medical students and foundation doctors, spent the highest proportion of their income on childcare. Almost 30% of the family income of this group was used for this purpose. Senior trainees and consultants paid more for their childcare and it was a smaller percentage of family income than for junior doctors. Geography also dictated expenditure. Costs in greater London and south east England were much higher than in other areas of the country: on average, £874 for each child every month compared with £444 in the rest of the United Kingdom.
Financial help for childcare is weighted towards families with low incomes, and junior doctors do not fall into this category. Junior doctors, like many other professionals, may be part of the squeezed middle of families who earn just above the threshold for support. Nevertheless, they accept this, knowing that their prospects are good. While relatively expensive, childcare allows them to continue to train and work, and it is an investment for the future.
Within the Medical Womens Federation survey, medical students and junior doctors admitted that costs limited their use of professional and registered childcare and led to a greater reliance on the support of friends and relatives. This not only reduces costs but also allows for childcare arrangements that are more flexible and responsive to the needs of employers and patients and more accommodating of changeable rotas. Almost a quarter of those surveyed by the Medical Womens Federation relied on multiple sources of childcare, often alternating professional services with care by family members and friends to save money and maximise flexibility.
The role of breakfast clubs and after school activities groups was also apparent. These may offer valuable, low cost childcare when working hours and the normal school day are not perfectly synchronised, which is a common scenario for doctors. A few respondents reported that one partner had given up work to care for the children. In some cases sacrificing a second income is more financially viable than paying for childcare and adds weight to Trusss argument that reforms are needed to improve availability and affordability.[4]
Workplace nurseries, as currently provided, will not resolve the childcare challenges faced by doctors in training for a number of reasons. Firstly, junior doctors move between hospitals and, although they travel long distances to allocated posts by all available means, taking a child there would be impractical and unsettling, given the frequent moves. Secondly, workplace nurseries have waiting lists and junior doctors often have little notice of the work placement allocated. Thirdly, few general practitioner practices have nurseries, and general practice is the main destination of doctors in training. Care closer to the childs home is therefore needed.
Truss suggests that re-establishing the popularity of child minding may offer a solution to this problem.[4] However, there is a continuing issue with employing personal, adaptable child minders. Employers and those organising local rotas and work hours often ignore the needs of young parents, and a number of factors make life harder than necessary for young professionals. These include giving out rotas at short notice, a lack of opportunities to request modifications, and work hours that are based on traditions and outdated practices rather than real service needs.
An excellent trainee experience is part of the outcomes framework of the Developing the NHS Workforce report. In seeking to achieve this, those developing medical training programmes must understand the pressures on doctors who are also young parents and build in both flexibility and some predictability so they can plan their responsibilities to both their patients and their families.
SOURCE: http://careers.bmj.com/careers/advice/view-article.html?id=20010863
Authors: Bryony Alderman, Fiona Cornish, Jean McEwan
Publication date: 13 Feb 2013
The difficulties faced by those trying to balance a career with starting a family pose problems for the medical workforce and employers. Bryony Alderman and colleagues consider the issues
Fifty years ago most doctors were men, and those with children had a non-working wife to bear the children and care for them. Today the majority of doctors in training in the United Kingdom are women, and they will soon be the majority in practice. The issue of balancing a career with having a family is therefore critically important both to doctors and their employers.
Developing an adequate medical workforce and ensuring the wellbeing of doctors require a clear understanding of modern social and cultural needs and the pressures on families. There are unprecedented opportunities to reconsider what might be required to take these aims forward. The Department of Health has published its report Developing the NHS Workforce and local education and training boards are being established to commission and control quality of training.
Two areas are of particular concern to young doctors, both men and women, wanting to balance a career with starting a family.
Firstly, doctors in training have some difficulty in selecting a time for a pregnancy during a long and arduous undergraduate and postgraduate training programme. Momentum in training and development may be lost during maternity leave and time spent caring for young children. Frustrations, stress, and lack of a sense of fulfilment and value can also arise from a lack of flexibility, the linear nature of most training programmes, and the pressure of working in a service that is itself under-resourced.
Secondly, the long and variable hours of work required in medical practice, particularly in acute hospital service, where much of the early postgraduate training is undertaken, make it difficult to secure good and affordable childcare.
Medical careers and choices for pregnancy and its timing
Effective contraception has been liberating to women and their partners in apparently giving them choice in the timing of a pregnancy. In a medical career, choices are limited by the responsibilities and pressures of training for up to 12 years after graduation.
There may never be a right time to have a baby, but doctors do make decisions on timing pregnancies. By reviewing data on the timing of a first childs birth, predictions can be made to aid workforce planning and ensure accurate provision of flexible training and part time working opportunities.
The Royal College of Physicians annual survey for 2010 collated data from thousands of consultants across the UK and included a question on age at birth of first child, which attracted 2273 responses (Andrew Goddard, director of Medical Workforce Unit, Royal College of Physicians, unpublished data, 2010). Responses showed that 48% of women and 52% of men had their first child while in registrar or specialist training posts. However, 25% of women and 17% of men waited until becoming a consultant before embarking on parenthood.
The survey also found that both men and women physicians have their first child four years later than the national average in 2011 of 27.9 years.[1] The modal age at birth of their first child was 30 for physicians overall and for men, and 31 for women. In all cases, the median age was 32. However, there was a second peak at age 35, which coincides with the attainment of consultant posts and worries about the ticking biological clock (fig 1 ).
Fig 1 Royal College of Physicians census data: age at birth of first child
The Royal College of Physicians survey also compared the responses from baby boomer consultants born between 1945 and 1965 with those from consultants born after 1965 (fig 2 ). The mean age at birth of their first child in the two groups, to the nearest whole year, was 32 in both groups.
Fig 2 Royal College of Physicians census data: age at birth of first child among consultants in different age groups
An awareness of the pattern of childbearing among doctors is important as it means that demand for maternal and parental leave can be predicted and appropriate provisions can be made. Given that the survey showed little change in these patterns over 20 years, even retrospective data can be of use in workforce planning.
Employers are currently obliged to consider a request from a parent to work flexibly or part time. However, it may be difficult for doctors to take advantage of such opportunities because they are still engaged in lengthy training programmes at the time of childbearing, and flexible posts make up only a small proportion of the total available. Less than 8% of postgraduate training posts in medicine are configured as less than full time training (LTFT), and demand outstrips availability.[2] The most recent survey of LTFT training indicates that 245 trainees met the current criteria to be assigned an LTFT training post but awaited an allocation. [2] Eighteen trainees requested but were refused further consideration as they did not meet the current criteria.
The UK government has recently announced plans for new regulations. From 2015, anyone will have the right to work flexibly or part time. [3] Such legislation aims to bring the concept of flexible working into the mainstream.
Increasing the provision of LTFT medical training posts and removing the current restriction on eligibility may seem challenging. However, the results of the Royal College of Physicians survey show that it should be possible to predict maternity and paternity leave requirements and the likely need for LTFT training and consultant posts. Gathering, analysing, and using such information to inform workforce planning could lead to real improvement in the training and work experience of trainees and young consultants.
Childcare issues for doctors
The need for quality childcare for all children is universal, but high quality childcare is not cheap. A recent report for the CentreForum think tank by Elizabeth Truss indicated that the average family spends 27% of its income on childcare.[4] Motivated by that report, the Medical Womens Federation did a survey of men and women doctors with young children and has established that such figures also hold true in doctors families (fig 3 ).
Fig 3 Average spend on childcare as percentage of family income
Of those who responded, the average monthly expenditure for each child was roughly £590, with some families paying up to £2500 for nannies and nursery placements. One third of respondents relied on local nurseries for most of their childcare, at an average cost of £785 a month.
As might have been predicted, those in more junior positions, such as medical students and foundation doctors, spent the highest proportion of their income on childcare. Almost 30% of the family income of this group was used for this purpose. Senior trainees and consultants paid more for their childcare and it was a smaller percentage of family income than for junior doctors. Geography also dictated expenditure. Costs in greater London and south east England were much higher than in other areas of the country: on average, £874 for each child every month compared with £444 in the rest of the United Kingdom.
Financial help for childcare is weighted towards families with low incomes, and junior doctors do not fall into this category. Junior doctors, like many other professionals, may be part of the squeezed middle of families who earn just above the threshold for support. Nevertheless, they accept this, knowing that their prospects are good. While relatively expensive, childcare allows them to continue to train and work, and it is an investment for the future.
Within the Medical Womens Federation survey, medical students and junior doctors admitted that costs limited their use of professional and registered childcare and led to a greater reliance on the support of friends and relatives. This not only reduces costs but also allows for childcare arrangements that are more flexible and responsive to the needs of employers and patients and more accommodating of changeable rotas. Almost a quarter of those surveyed by the Medical Womens Federation relied on multiple sources of childcare, often alternating professional services with care by family members and friends to save money and maximise flexibility.
The role of breakfast clubs and after school activities groups was also apparent. These may offer valuable, low cost childcare when working hours and the normal school day are not perfectly synchronised, which is a common scenario for doctors. A few respondents reported that one partner had given up work to care for the children. In some cases sacrificing a second income is more financially viable than paying for childcare and adds weight to Trusss argument that reforms are needed to improve availability and affordability.[4]
Workplace nurseries, as currently provided, will not resolve the childcare challenges faced by doctors in training for a number of reasons. Firstly, junior doctors move between hospitals and, although they travel long distances to allocated posts by all available means, taking a child there would be impractical and unsettling, given the frequent moves. Secondly, workplace nurseries have waiting lists and junior doctors often have little notice of the work placement allocated. Thirdly, few general practitioner practices have nurseries, and general practice is the main destination of doctors in training. Care closer to the childs home is therefore needed.
Truss suggests that re-establishing the popularity of child minding may offer a solution to this problem.[4] However, there is a continuing issue with employing personal, adaptable child minders. Employers and those organising local rotas and work hours often ignore the needs of young parents, and a number of factors make life harder than necessary for young professionals. These include giving out rotas at short notice, a lack of opportunities to request modifications, and work hours that are based on traditions and outdated practices rather than real service needs.
An excellent trainee experience is part of the outcomes framework of the Developing the NHS Workforce report. In seeking to achieve this, those developing medical training programmes must understand the pressures on doctors who are also young parents and build in both flexibility and some predictability so they can plan their responsibilities to both their patients and their families.
SOURCE: http://careers.bmj.com/careers/advice/view-article.html?id=20010863
