The best time to have a baby during a medical career

The best time to have a baby? Preferably at the end of the third trimester.

When or whether to have a baby is a deeply personal choice and a human right. Advice like “Don’t get pregnant it will ruin your career”, is not only harmful, it’s unlawful in all Australian workplaces. Unsolicited comments  about the timing of pregnancy, parental leave or the ‘inconvenience’ of motherhood, constitute sex discrimination.

And yet, public hospitals are renowned for unfavourable attitudes to doctors who temporarily require lighter duties or leave entitlements — mainly because management does not adequately pre-budget or plan for cover for doctors as they do for nurses (here, here).

In my February opinion piece “Public hospital leadership must eliminate workplace abuse of doctors in training, not perpetuate it”, I argued for specific government funding to resource government-legislated work health and safety (WHS) standards such as safe hours and roster cover. I also noted that directors and officers are not exempt from significant financial penalties when hospitals breach the Amendment to the Sex Discrimination Act by failing in their positive duty to prevent discrimination.  

Following the popular piece, the damaging nature of gender bias and discrimination of doctors, who are pregnant or contemplating pregnancy, was prominently debated on multiple social media channels. The discussion focused on workplace risks to maternal and fetal health and safety — as well as a sense of overwhelming guilt from letting colleagues down by taking leave.

Here is a representative sample of paraphrased comments:

“As an advanced trainee on a 1 in 2 roster, I asked my head of department who covered the on call when previous trainees took maternity leave. He replied: ‘the only other trainee did it all’. I knew then I couldn’t have a baby until I finished training”.

“There were lots of opinions at work on when to take maternity leave. I pushed myself to work until 38 weeks with my first baby because I felt guilty. I stopped at 36 weeks for my next to make it easier, but it was harder physically, juggling work with a toddler at home”.

A review of sex discrimination in training programs is due

It is positive that the Australian Medical Association and many colleges (here, here and here) have made significant improvements in gender equity in training program recruitment.

In the not so distant past, there were reports of medical women being asked about family planning during and outside of interviews for training positions. While overt unlawful sex discrimination in interviews is now unlikely, structural and cultural barriers continue to deter women from entering competitive specialist training and completing examinations successfully.

Although gender parity has existed in most Australian medical schools since the mid-80s, these barriers continue to contribute to the under-representation of women in certain specialties. Of course, there are complex reasons why orthopaedics comprises only 5% of women, surgery 16.3%, cardiology 15% (interventional cardiologists 5%), occupational and environmental medicine 24.7%, intensive care 24.9%, sport and exercise medicine 25.1%, ophthalmology 26.5%, and addiction medicine, pain medicine and radiology about 30%. An objective review of exit interviews in these specialities may shed further light on the discrepancies.

“When I tried to arrange a meeting to express my interest in a training program, the head of department told me not to bother because I would fall pregnant and not be able to finish”.

“I was told my two-year position would be terminated after only one year after I requested parental leave. They cited performance issues while I was pregnant as the reason, but only after I complained about their failure to cover my leave”.

While medical women now dominate some specialties in numbers, their participation may be deterred by inflexible, discriminatory medical workplaces. Of course, it is true that many women choose to take time off to spend with their families. Nevertheless, there are many other negative factors influencing women to reduce their hours, such as the expectations to regularly work late without notice, physically and psychologically unsafe working conditions (here, here) and gender pay gaps (here, here) – all of which are breaches of Fair Work Legislation.

Despite the lip service of public hospitals to the importance of maternity and parental leave, and family friendly, flexible work conditions, many doctors are currently justified in their belief that a request for safe hours, temporary leave including parental leave, or a period of reduced participation or lighter duties in competitive specialty training programs for ‘family reasons’ will result in permanent career damage.

The themes in these comments reveal common systemic barriers:

“Hospitals make all the right noises about being supportive, but here is very little support for our colleagues who are left carrying the weight in our absence. Resentment boils up as my friends at work are already overworked”.

“Medical administration didn’t count my training terms when I told them I was pregnant. They refused to change their position despite admitting it was illegal”.

“When I tentatively ask about future contracts as a pregnant doctor, I’m very conscious that I'll be a weight on department budgets”.

Discrimination is more damaging than currently recognised

Discrimination can occur in many forms in a health system in crisis. In this environment, trainees in certain specialities who are pregnant can find themselves in situations where they are at risk of occupational hazards due to the immense pressure to “pull your weight like everyone else and prove you are up to it”.

Occupational risks for pregnant women working in the health system include physical strain and ergonomics, infectious diseases, radiation, exposure to hazardous chemicals such as anaesthetic gases or sterilants, long shifts and night shifts, violence, and a lack of peer support resulting in stress and burnout. The onus to prevent and manage these major WHS risks is on the workplace, not the pregnant individual.

“I worked six days straight plus on call as the only doctor, and a few days later, I realised I had been working with preeclampsia. My very premature baby was born soon after and she required a prolonged stay in neonatal intensive care. HR only contacted me to question why I was taking so much sick leave”.

Doctors who delay pregnancy due to work-related demands are at greater risk of higher infertility and pregnancy complication rates. Although the contribution of poor working conditions to poor pregnancy outcomes such as miscarriage, premature birth, low birth weight, fetal growth retardation or hypertensive disorders is difficult to prove, workplaces can face penalties for unsafe working conditions, pregnancy/parenting-related discrimination, failure to provide job-protected leave or wage and roster replacement while on maternity or parental leave (here).

The 2024 Medical Training Survey (MTS) of over 24 000 doctors in training revealed 19% agree or strongly agree that they are considering a future career outside of medicine. The issues raised in this opinion piece are contributing to this adverse finding in the MTS as women in their reproductive years now constitute a significant proportion of the medical work force.

“I was in agony when I delayed expressing milk at work because there was no provision for staff pumping rooms. I left my job not only because of the pain, but because I was treated like a nuisance.”

“I love public hospital medicine but as a new parent, I could no longer cope with the inflexibility, so I left.”

Based on these considerations, further investigation by colleges and public hospitals is important not only for the wellbeing and retention of doctors, but to ensure specialist training programs are complying with the Workplace Health and Safety Act.

Personal reflections and conversations about the human right to a safe workplace

On reflecting on my 45-year medical career (and counting), a few years of unpaid maternity and carer’s leave in my late 20s now pales into insignificance compared with my overall contribution to patient care. For decades, I covered more than my share of overtime, 24-hour shifts and all weekend rosters in rural areas, and yet, I found many of my workplaces were hostile to occasional requests for leave due to my responsibilities as a primary carer at home when my own children needed me more than my patients.

I wish to acknowledge that it was my family who most encouraged the longevity of my career throughout the inevitable personal and professional challenges, not my workplaces — and I remain immensely grateful to my sons for their continuing support.

This opinion piece has outlined the government-legislated WHS standards required of our public hospitals and the need for more support and resourcing of doctors who temporarily require physically lighter duties or leave entitlements for pregnancy and family responsibilities. In my experience, family friendly and flexible work policies are the key to increasing the participation of doctors in the medical workforce — regardless of gender.

The goal of my article is to prompt discussion about practical ways to apply contemporary WHS laws including the new Model Code of Practice on Managing Psychosocial Hazards at Work in all medical workplaces while upholding the highest standard of patient care.

I also wish to reiterate that the fundamental human right of everyone to choose when or whether to have a baby is none of our business.

Clinical Professor Leanne Rowe AM is a GP, non-executive director, and co-author of the international book “Every Doctor: healthier doctors = healthier patients” published by Taylor and Francis.