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TRAINEES in obstetrics and gynaecology will benefit from improved flexibility in their part-time training options after parental leave under a revised training program.
Professor Michael Permezel, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), said the college board had approved the revised program in May and it was due to take effect from December.
The new program is expected to help relieve some of the problems, highlighted in a study published in the MJA, that trainees can face when returning from parental leave. (1)
The study found that although most trainees could access parental leave, some had trouble obtaining a training post on their return and others reported disparaging comments from consultants, other registrars and employers about their leave.
Of 261 survey respondents, 115 — all female — had taken parental leave during training and 107 answered detailed questions. Of these, 6.5% said leave was not granted automatically on application and 3.7% were refused leave.
Just over 13% had problems returning to employment after parental leave and 10.3% faced difficulties getting a college-approved training place on their return.
More than 40% fielded negative comments about their leave from consultants and 26.2% were questioned about their plans for future pregnancies when applying for jobs.
Almost half of 252 respondents said they had been affected by adverse roster changes such as more night shifts and a quarter reported effects on their holiday or other leave because they had to cover for trainees on parental leave. In all cases, many more male than female colleagues complained of being inconvenienced.
Professor Permezel, who coauthored the MJA research, said although the college could make credentialing for training more flexible, unfortunately it could not change parental leave arrangements as it was not the employer of registrars.
“We are always going to be dependent on the employing hospital or health authority to be both flexible and sensitive to the needs of trainees”, he said.
However, the changes planned to the college training program, which would credit trainees for fractional training of between 0.5 and 1.0 full-time equivalent, were more flexible than previous options of half- or full-time training only, Professor Permezel said.
Additionally, short stretches of training of as few as 2‒3 weeks within a 6-month training period could be credited, provided the curtailed period could be tagged onto a previous or subsequent longer block of training.
“Previously, short periods of training were not able to be credited”, Professor Permezel said.
Another possible solution was the introduction of “service registrars”, who could provide a pool of doctors able to step in for trainees on parental leave, thereby ensuring that the trainees had a post to return to and that their colleagues were not unduly burdened by excessive hours, he said.
RANZCOG Trainees Committee chair Dr William Milford said a number of trainees had faced great difficulties returning to their training post, getting maternity leave paid or gaining a contract for an upcoming year due to the timing of a pregnancy.
“[But] I know far more trainees who have had a number of children during their training who have been incredibly well supported by both their employer and the college”, he said.
Dr Milford, who is also chair of the AMA Council of Doctors-in-Training, said it was difficult to find a solution to the problem of trainees being disadvantaged by a colleague taking parental leave.
“I am aware of arrangements where obstetricians managing the pregnancies of some trainees have decreed such things as no shift work after 20 weeks of pregnancy”, he said.
“This is fine for one individual in a large department but in small departments or [those] with a number of trainees who are pregnant, it puts the after-hours burden on a small group of trainees who similarly miss out on valuable daytime elective training exposure.
“All trainees understand and are very happy to help out and cover their colleagues but there are limits to such generosity — 20 weeks of night shift being one of them”, Dr Milford said.
As a service registrar in Obstetrics in a tertiary hospital I already fill this role and no doubt have facilitated trainees parental leave however it inevitably does create a bottleneck. Those who have worked in that role for several years build up considerable skill however due to RANZCOG’s highly competitive yet mysterious selection process in some cases take quite some time to enter the program to become trainees themselves. Hence in our public hospitals we have a two tiered system where some service registrars are experienced enough to work with minimal supervision, in fact less than the first year trainee! Trainees in O&G are not empowered when it comes to choices regarding their family plans despite training during their most fertile years. Many are choosing kids over progressing to subspecialty training. No doubt as a consequence given the majority of trainees are female this will impact on the level of expertise our specialists posses in the future. We need a cultural shift and the changes that have been made are a step in the right direction at least.