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JUGGLING a medical career with motherhood can be challenging at the best of times, and in 2020, Dr Dina Elhalawani has had more balls in the air than usual.
As a single mother and full-time GP in regional Victoria, Dr Elhalawani has had to manage her work alongside supporting her 11-year-old daughter, Hannah, who has been spending time being home-schooled during the Victorian lockdowns.
“I’m sure there are lots of people much worse off than me,” Dr Elhalawani. “We are managing, although working full-time and being single is a struggle. All my family are in South Australia so the border closures mean that I can’t see them.”
While Dr Elhalawani had the support of a nanny during the state’s first lockdown, she has been on her own during the second lockdown.
“We have managed because I have been able to change my work hours,” she said, adding that being able to provide telehealth consultations from home during after-school hours had helped her to be there for both Hannah and her patients.
Dr Elhalawani’s comments came as the MJA published a systematic review exploring the experiences of mothers who are doctors.
After reviewing 35 peer-reviewed articles, the authors identified three themes: the impact of being a doctor on raising children, the impact of being a mother on a medical career, and strategies and policies for combining motherhood and medicine. They noted that research on the experiences of mothers in Australia and New Zealand was lacking.
Speaking with InSight+, lead author Dr Rebekah Hoffman, a GP and Senior Lecturer in the University of Wollongong’s Graduate School of Medicine, said the review found that most tertiary educated women had their children at a later age than those with a high school education.
“And specific to doctors, there are certain milestones that people wait for to have children,” said Dr Hoffman, who has two children, aged 3 and 5 years.
“So often that is finishing their junior doctor years, or finishing their fellowship or finishing their PhDs, whatever that milestone … [that’s when] they feel that they can also juggle having a family.”
GP Dr Melanie Dorrington is mother to two children, aged 6 and 8 years, and has a very supportive partner. She said her second pregnancy was timed to work in with her fellowship exams.
“We had our first child at the end of my first year of registrar training, and fell pregnant with our second child around the time of my fellowship exams,” Dr Dorrington said. “These were specifically planned due to my age, for my first child, and fellowship exams for my second – I waited until I knew I had passed my written exams before starting to try to fall pregnant again,” Dr Dorrington said.
The MJA authors wrote that US researchers had found that female surgeons were twice as likely as male surgeons to delay having children until after postgraduate residency training.
“Women who had children early in their career felt less financially secure and more anxious than women who commenced families later in their career,” they wrote.
Dr Hoffman said many women also chose careers in general practice because they perceived this to be a more flexible, family friendly setting.
“I personally think that is a bit of a misconception, particularly in the training years, general practice isn’t entirely family friendly as a registrar,” she said, noting that there were no studies on this.
Dr Elhalawani had wanted to pursue a career in obstetrics and gynaecology – and was accepted into the training program – but declined the position because she thought general practice would be a better fit with motherhood.
“That decision was purely because I had Hannah, I was single, I had to find a career where I could continue working and still manage Hannah by myself,” Dr Elhalawani said.
“That would be the main career decision that was definitely affected by being a mother. It would have been extremely difficult to do [obstetrics and gynaecology] training with a toddler by myself.”
However, Dr Elhalawani concurred that general practice also had its challenges.
“Being a GP, you are pretty much a private contractor, so there is no paid leave, no maternity leave, even sick leave. When Hannah was little and sick and I had to take the day off, that was unpaid,” she said.
The MJA review included studies concerning the strategies and policies to assist women to balance motherhood with a medical career.
Dr Hoffman said US studies looking at hospital-based practice had highlighted some positive strategies for supporting mothers in the medical workplace.
“There are there are some hospitals [in the US] that offer breastfeeding rooms, day care on site, and do really good job share,” she said. “And [these hospitals are] consistently reported to be more attractive for employees that are female.”
Dr Dorrington said returning to work when her children were aged 10 weeks and 9 weeks respectively was made easier by having a supportive work environment.
“I have been supported to have time to express breast milk at work to be able to continue breastfeeding. I note that I have had female bosses and this may have an impact on this as well,” she said, acknowledging that her experience did not match that of many women.
Dr Dorrington said that many barriers experienced by mothers in medicine were based on the “socio-cultural norms surrounding women and mothers”.
“We know that for most heterosexual couples there is gender equality in the division of housework before children, but despite this there is, in general, a shift once children enter the household to them taking on more traditional gendered roles, with women doing more housework and childcare, which continues even when children are school aged,” she said.
“Feminism has done a great job of opening doors for women and expanding their horizons. Unfortunately, we are all raised in this patriarchal culture, and while options and expectations for women have opened up, they remain principally unchanged for men. There is no expectation that a man will need to make any changes to his working life when there are changes in his family life, for instance.
“I think the particular challenges in medicine regarding motherhood/parenthood arise from the extent of training and timing of this training, as well as rigidity in training practices.”
Dr Dorrington added that some challenges had been amplified in recent years with the shift to postgraduate medical degrees.
“In my class I believe that 24 was the average age in first year, and we certainly had people in their 30s and into their 40s too, if I recall correctly,” she said.
“The university degrees are not flexible in delivery for parental or any other form of leave.”
And, she said, these pressures continue once doctors are in specialty training.
“It is hard studying for these major exams on top of working normal hours. This is definitely harder if you have a family who you want to be able to see and spend time with,” she said, adding that this did not only affect women. “A male doctor’s wife commented to me once after their first child that she was not having any more until he had finished his exams as she did not want to be a single parent again.
“Socio-culturally, it is much more acceptable for a female partner to take time off to raise children and allow the male partner to continue working on his career with no changes in work practice. It is much less accepted (or supported by workplaces) that the male partner does the same to allow a female partner to continue her work. This is where mother-doctors have difficulty, the expectation that they are the primary caregivers at home as well as meeting the commitments at work.”
Dr Dorrington said in terms of policies and strategies to assist mothers to pursue medical careers, it was important to broaden the conversation beyond maternity leave, return-to-work policies and breastfeeding.
“We need this to be viewed as ‘our’ problem, not as ‘her’ problem. The systems and structures need to be changed, not the people,” she said. “For parent/doctors, we do need to have changes that allow comprehensive, universal parenting leave, flexible/shared/part-time schedules, breastfeeding accommodation, and on-site childcare facilities, including being available overnight.”
In the meantime, Dr Dorrington said she was trying to improve her work–life balance by more often saying “no” to some work commitments and “yes” to family.
“I have recently withdrawn from my positions on the committees for the Australian Federation of Medical Women as well as the ACT and Region Medical Women’s Society, though I will continue to be involved as a member.”
Dr Elhalawani said some things were easier now that Hannah was older, but school holidays, and after-school care were more difficult than during the pre-school years.
She said she would welcome the introduction of more family-friendly policies in general practice, and medicine more generally.
“It’s definitely good that someone is talking about [the challenges of combining motherhood with medicine], maybe it will get better.”
It is a challenge for female doctors to look after children when they are working. Traditionally there has been little flexibility in the system. I remember asking my learned college if I could please, please have just 6 months break from CPD requirement when my daughter was a baby and was given the stern advice that I had to keep up my CPD for Medical Board requirements even if the College allowed an exemption. However I have to ask why – if some doctor / mothers feel that child care is a gendered role and they should be able to leave the childcare to someone else most of the time- why is it necessary to have children in the first place? Is it an extended family expectation or another “gendered” expectation? As the child of single parent / female doctor who worked full time till retirement, I would have far preferred my mother to be present at least some of the time after school rather than coming home to a babysitter or an empty house. Contractor parents (GPs predominantly) should also be able to access job protected, paid maternity and parental leave as for example, occurs on Sweden.
This is where one needs a very exxxxpaaandeeed family. As a GP I had and accepted help from all of my patients and there were many ‘grandmas ‘ and ‘grandpas’ who came to do various jobs and entertain my children as i was working. One would come and feed them breakfast, another for a walk to the shops, another for fun in the park, another to read stories. My 5 children did not miss out on emotional validation and attention, and my patients were thrilled to be loved and accepted by them. My youngest Daughter, who is a GP even wrote in a medical magazine about the happy time she shared with her entourage of adoring “nannies”. Such bonds last for life.
I think there is still a very great expectation by the general public and health systems that women in medicine will carry on with their work regardless, as though they do not have a child or children, whilst often still carrying the emotional, financial, and lack of career progress effects of being the primary caregiver, and as contractors in many cases, lacking the back-up of paid leave of any kind. We are supposed to give the impression that no juggling is taking place; as if t’s all happening by magic. I am finding, particularly at present in the midst of the pandemic that I am listening to many stories of other people’s sadness or difficulties with what has happened to their children’s lives, and yet I have my own teenager at home alone trying to educate himself for now nearly six months here in Victoria. I have reduced my hours to provide more company for him, which of course, combined with the current near-directive that I will bulk bill my services via telehealth, has affected my income. I find that patients have a high expectation of drawing on my emotional energy, because of my being female. They want to be ‘mothered’ as well. I feel undervalued and at the same time as though my reserves have been exploited down until the tank is just about empty.
‘A porsche is tax-deductible, a nanny is not’ as per Kate Duncan – says it all.
60% of these important, honest and challenging responses are anonymous – what picture does that paint about the support caring mothers get from their medical colleagues?
We were blessed to have worked in a hospital that supported job share in intern/junior years, and have shared our parenting and work responsibilities throughout our career! The benefits are multiple – to our kids; both parents personally and professionally (avoiding burnout!) as well as to hospitals (a job shared position has scope to flex up to cover workplace shortages – within limits of our approval). We now enjoy our rural/remote GP/proceeduralist roles, still finding opportunities to share a job as we travel the country.
I am a mother of a 6 and 9 year old who had my first child at the end of medical school. As a 2 doctor family, our BYO job share partner/spouse has no doubt helped to carve out this opportunity – but I can highly recommend the equality on many levels! Workplace flexibility and improved roster diversity for mothers and fathers is a worthy goal to strive for throughout the field!!! Where viable, asking for and only accepting positions that suit our family needs pushes evolution of flexible roles, and a culture shift! Hospitals we have worked for have specifically commented on this. Most notably one hospital emergency department went on to offer more job share positions by preference, thus creating increased positions and improving workforce availability in the event of sick leave/departing staff.
I recognise how lucky I am to be in the minority with this experience, but in some ways this luck has been created by finding workplaces that would be prepared to be accomodating. I have also job shared with other mothers at times, and done an occasional full time stint while my husband worked part time. Possibly practicing in a rural context helps (demand for employees drives scope to negotiate). But the medicine in this context is so fascinating and diverse, I do not feel this comes with any lack!
I’m an anaesthetist and pain specialist and mother of 3. We have a division of labour very much along traditional lines, despite my best efforts. It has been tough but much easier than it was for Medical women before me.
Having children whilst contributing to the work force should be a society issue rather than a women’s issue. Access to affordable good quality childcare should be available to all families 24 hours a day.
It was interesting how hard won paid maternity leave was. However when paid paternity leave came in it was lauded by all! The patriachy is still alive and well
I was lucky to have the help of my parents. My husband is very supportive but when he took time off work to look after our children, people would often make comments about how lucky I was to have him. My male colleagues on the other hand, whose wives organised most aspects of their life, never received any praise about their wives.
I found our society’s expectations to be very different and I was actually told by one of my older GP partner ” you ladies want to do men’s work”….
Telling that in the 21st Century we still don’t hear about doctors having to ‘juggle fatherhood and medicine’ – that seems to be almost unthinkable that a male doctor could be hindered in their blossoming careers by having children – after all that’s what women are for, right? A bit like the College of Emergency Medicine that only had ‘maternal leave’ – no parental or paternity leave on their forms when I handed in my request to utterly blank faces. Long way to go yet…
The hardest juggle I have done in my paediatrician life is between patient and my own children;
One of the best strategies was to have hospital oncall handover at 9am instead of 8am which meant that I could do the school delivery (which includes breakfast and talking and encouraging and sometimes an activity before dropoff).
This so needs to be addressed and discussed. I can relate to the last Anonymous writer about taking children into hospitals when called in myself and finding him/them a corner to sleep. Despite having a totally supportive partner, it was very very hard physically, emotionally and financially to train as a (max fac) surgeon and be a parent. I hope arrangements for 24 hour flexible childcare may become more availalble for the next generation as well as job sharing and parental leave for either parent.
As an Obstetrician in private practice with a consulting engineer husband who was often overseas, I had to have 24/7 childcare usually with a live-in nanny. Private school fees are cheaper (sorry, less expensive ) than 24/7 in house child care and there is nothing else available at 5 minutes notice at 3 am! A Porsche is tax-deductible – a nanny is not.
Kudos to those doing the advocacy and much needed research. As a mum and doctor, keeping those balls in the air is all I can manage, I am awed and grateful to those that manage to take on these advocacy roles, both officially and unofficially, to try to improve things for everyone.
Very well said Dr. Dina Elhalawani. Your patients appreciate the effort and sacrifice, I am sure.
My daughter has left home and pursuing her own successful career and marriage. As a paediatrician and single parent I still bear the scars of dragging her out at 2 in the morning for an urgent resuscitation and letting her sleep wherever I was ED SCN etc. The decision on what age to leave her alone at home whilst I went to a hospital for a variable amount of time is a decision no one will give an answer to confidently probably even now. Daycares even in hospitals don’t uniformly provide 12-14 hr care required for registrar shifts as then and possibly now it is not deemed appropriate for child wellbeing yet in effect these are timeframes that are rostered in hospitals for training registrars. 24hr daycare costs needed to provide cover for on call rosters that you may not actually be called for can lead to $100000 bank loan that takes until the child’s adult years to pay off! This is an important issue and great it is being discussed.