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Advice about delaying pregnancy or parental leave may be dismissed as an innocent attempt to help early career doctors achieve their goals, but it constitutes a breach of the Sex Discrimination Act. The fundamental human right to choose when or whether to have a baby is none of our business.
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.
Another intelligent, thought provoking and sadly, very necessary piece by Professor Rowe. Australia is known to be one of the most bullying societies in the world. We must lead change on this dreadful trend.
Shocking, just shocking. Something the AMA should really push for strongly and persistently.
Simple solution could be adding extra middling/senior trainees locums positions for maternity cover in Australia. Accommodation generous allowance, travel, per diem etc. Wouldn’t need too many to cover each State.
When I studied medicine I learnt that the best time for a human female to have a baby was between the ages of 18 and 25 years. I don’t think this has changed. Female Doctors are human so need to keep this in mind. In Country General Practice my Doctor wife had 4 children in her 30s with nothing but support from all the Doctors, Nurses and Administrators in the town. I found myself covering for her absences from our practice with pleasure. All the other Doctors in the town were happy to help cover her hospital work. No patient ever was unsupportive! Treating patients is very rewarding but so is having children.
If you are a female Doctor who wants the joys of a family, Country General Practice might be a great option to consider.
To the earlier commenter stating this is not purely a male vs female issue, talking about medical admin rostering needing to be covered etc, until men can carry a baby and feel what it is to work long hours and worry about putting a baby’s life at risk due to inflexible and unaccomodating practices around pregnancy, then this is in fact a purely a male vs female issue. Men can’t carry a baby and while you can relate to being a parent and feel resentful of carrying the “extra load” for those who are pregnant, it is a legal requirement under antidiscrimination law that women are not discriminated against due to pregnancy – it’s not a matter of convenience or inconvenience, but a matter of law. Medical administrators must therefore ensure adequate rostering to accomodate for pregnancy complications and those going on maternity leave. If women getting their legal rights makes you “resentful” Mr Anon, then perhaps some self reflection is in order and same basic examination of biology – it is not the same to be a parent and to be pregnant, so it’s a failure in logic to equate the inconvenience screaming children as a parent with the life or death circumstance of a potential pregnancy complications.
Excellent piece. I had three completed pregnancies while working in surgery. One as a registrar, one as staff specialist, and one in private practice. They were all difficult in different ways – but I’m a better clinician for my patients because of being a parent. Our support of pregnancy in the healthcare workforce needs to dramatically increase.
Saying this too plainly will sound harsh, so I must briefly acknowledge years of compassion for many colleagues bravely negotiating the truly painful decisions around fertility, birth, and breastfeeding. What this article neglects are two dimensions: firstly, administrators MUST cover their patient load 24/7/365, lest patients die then they face multimillion dollar lawsuits. They will never have enough back-up support to cover the sudden complications of pregnancy. Thus their insensitivity to giving worthy young women flexibility is not lack of humanity. And secondly, beware of glibly placing all this as a male vs female issue. Young men in training programs frequently have pregnant partners and are also under pressure. Speaking as someone who studied for the membership between the 10pm and 2am breast feeds of twins, with the 20/24 screamer between me and the books, I’d have totally resented having to carry extra rosters for pregnant colleagues. It’s naive to override this stressful issue as a basic human right.
Thank You for a brilliant article.
I am thank you for all the hard work women prior to my generation has done for me to have improve my working conditions however there is still a lot more to be done.
I have worked shifts while going through a miscarriage , fasted working on call shift and gone for a D&C straight after so it reduces burden on my colleagues and the system. Worked long shifts and never bring up being pregnant at work in spite been asked to review aggressive patients which will place myself at risk.
I have learned as I matured that these were not reasonable actions however only on past reflection sadly.
Having this discussion only will hopefully empower our younger generation to speak up early, encourage a shift in work place culture and introduce appropriate legislative support.
Thank you to all those that work in this space.
Thank you Professor Rowe for your brilliant article.
I conducted a survey of over 1,000 medical parents across Australia and New Zealand, which you kindly referenced, revealing alarmingly high rates of infertility and pregnancy complications. I received over 200 comments from doctors sharing deeply personal stories of how the system let them down. Some described being forced to end their pregnancies due to inflexible training requirements, while others felt they had no choice but to leave the training system entirely.
The reality is that our system is failing doctors who want to have children. Until legal protections are actively enforced nothing will truly change.
Parental leave, safe working conditions, and protection from pregnancy discrimination are already legal rights, yet many doctors are too afraid to speak up for fear of career repercussions. The unspoken rule in medicine is that pushing back against unsafe expectations, whether it’s working through pregnancy complications, delaying parental leave, or returning to work before fully recovering marks you as ‘difficult’ or ‘not committed enough.’ This culture of silence allows hospitals to continue violating these legal protections with impunity.
The same institutions that claim to support family-friendly policies routinely fail to provide practical solutions, leaving doctors to shoulder the guilt and consequences alone. Without proactive enforcement of these rights and real accountability for breaches, not much will change. We cannot rely on goodwill alone. Meaningful change only comes when legal protections are upheld and enforced.
It’s time for the system to step up and support the doctors who dedicate their lives to caring for others.
Thank you Prof Rowe for opening up this important topic. The number of comments and the common themes highlight our need to talk about how to better look after each other so our health workforce and our families can thrive.
The strong but anonymous response to this article, along with my February piece on the abuse of doctors in training should serve as a catalyst for action by the AMA, CPMC, individual medical Colleges, and medical employers—especially public hospitals.
Many of the experiences shared by women in this article reveal breaches of the Sex Discrimination Act by medical employers.
Such breaches of Workplace Health and Safety (WHS) law could trigger an investigation by the Australian Human Rights Commission, leading to penalties for organizations and employers, including Directors and Officers – particularly if there is evidence of workplace physical and mental harm to women and their unborn babies. The anonymous comments reflect an unhealthy level of fear of speaking up by women.
This requires a formal response from our medical leaders – it would be far more constructive for the medical profession to address the concerns raised before the Commission steps in and mandates action. Our medical leaders must investigate these serious issues further.
I’m a HMO with a 1 year old currently trying to get onto a competitive training program after maternity leave.
There have been multiple times as a junior doctor where I have received unsolicited advice of “don’t get pregnant until you have gotten on to training/ passed the primary exam”. Most people were supportive when I fell pregnant but I still received comments from consultants in this speciality along the lines of “you’ll probably end up going into GP training after you have a baby”.
What is even more frustrating is that I have a male colleague with the same clinical experience who had a baby at the same time as me. While I have had career disruptions and negative comments about the impact of a baby on my career he has had a completely different experience and is now on said training program.
Thank you for your article. This is such an important issue. If my daughter goes into medicine one day I hope she doesn’t have to experience what current medical women do.
Thank you for the excellent article.
The Australian and New Zealand College of Anaesthetists (ANZCA) are working hard in this area. We have published articles from a recent survey on the issue. We are proactively writing guidelines to support those seeking to take parental leave and less than full time work. Nonetheless, ANZCA is not the employer of their members hence relies upon this kind of advocacy in public healthcare to improve working conditions across Australia and New Zealand.
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16281
One could perhaps try to balance the ledger amongst these largely personal experience comments.
The decision to have a child is a woman’s decision – perhaps in conjunction with a partner. It is up to that woman or couple to manage their time and resources.
But it is your pregnancy; it is not the pregnancy of your colleagues, department or College.
Colleagues should not be called upon to provide extra cover for you, or to fill in for you.
And from the other side of the equation – having highlighted the precious and scarce nature of advanced training positions in our training schemes – how are co-ordinators of such programs supposed to magic up a trainee (sometime even just a locum is hard enough) to make use of that training in the middle of a bloc, having then to promise to have that person vacate when you return? Flexibility of that nature is not inherent to such schemes: there are seldom unemployed but suitably skilled drones just waiting in storage to be called up, a key difference to maternity leave in the general workforce.
Having a child is a choice. It is difficult – especially if you’ve been told you can have it all – to accept that compromise may be necessary to accommodate it all. You may make it: others shouldn’t have to on your behalf.
I was a (pregnant) speciality trainee during the swine flu epidemic.
There was a sign on the door of the ‘Swine flu ward’ which said ‘ Pregnant women – do not enter!’.
However I was informed by my head of department and co-registrars, that that sign only applied to pregnant relatives and pregnant nurses, but not to pregnant registrars.
Apparently it was my fault for getting myself ‘knocked up’, and unsafe work was a natural consequence.
Got to do an elephant- in- the- room here. I had three children in days of yore before maternity leave for doctors was a thing . I found that the empathy and helpfulness of my colleages was ( in DE-scending order)1. males whose partners had gone through similar situations 2. females who had gone through similar situations 3. males who had no experience of it and, finally and damningly,4. nulliparous females.Soured my belief in female solidarity forever ( I worked til I went into labour and returned at 2 weeks and I dont want that for anyone).You arent going to get everyone on board until we are empathic to all.
I worked as a resident in a busy o+g unit and while this sparked my passion for the speciality, during my terms I also lost two pregnancies, and then eventually, went on leave to have my much wanted baby. The unit knew of my health struggles to have a healthy baby.
I spoke to the training supervisor at length about applying for a unaccredited registrar position the following year after my baby was born, and was encouraged to apply. I wrote a cover letter, clearly stating the fact I could not start until mid year when my baby was expected to be 9 mo old and working full time was more realistic and sustainable. I got an interview with the four specialists and did well, however I was then blindsided – to be told at the close of the interview if I was serious about this job I would start full time in Feb (when I had a 3 month old). I was made to feel less than for having a baby, and essentially not given a job because of it. My experiences and resilience should have been seen as a strength that I could go back into that space given all I had been through. It easy to see the sex discrimination and bullying in retrospect for what it is, but honestly there’s no way a male colleague would have found himself in the same awful position in his interview.
Dear Professor Leanne Rowe, congratulations, this is one of your finest published articles!
It is spot on!!
As I read the article, it reminded me of my own choices during my early career when deciding the best time to fall pregnant.
I remember thinking, I was “not ready to have a baby” with my first pregnancy as I had to complete my training!
Yet my body was ready, I was pregnant! 🙂
I was lucky to have my husband’s and mother’s support and worked up to 2 weeks before my due date.
Not every woman has the choice and support of their family. It is so hard for many of our female colleagues especially in hospital training programs. Thank you for the excellent article.
Mature Age Medical Student. I was in labour through a zoom tutorial and I took two days off for my emergency C-Section.
Students in my year were failed for attending their high risk MFM appointments so I knew I couldn’t ask for more.
A breastfeeding student was forced to pump in front of a supervisor just in case she somehow had information in her breast pump.
Re- reading this conversation one thing which struck me is how the vast majority have elected to be anonymous.
This is very likely to be for fear of being evened-up, although privacy may also be relevant
It speaks volumes for the culture of fear under which many junior docs work
We have a long way to go
When I decided to pursuit O&G training, as a childless unaccredited registrar, all of my consultants were supportive – they encouraged me, offered to write references and help me secure the “right” terms so I could get adequate surgical experience in the lead up to my application. I had already worked in the hospital for 3 years, had higher degrees/research and always had positive feedback from patients/co-workers. Fast-forward 4 months, and I found out that I was pregnant. I disclosed the pregnancy to my seniors thinking I was doing the right thing (adequate time to plan cover etc).
The same consultants then sat me down and told me “it would be a good idea to not apply to training” as they didn’t want me to “waste an application”. The terms I was meant to start were also taken away from me and given to another reg who “needed them”.
I felt so much pressure to try and prove to them that I still was committed to o&g despite being pregnant, that I felt that I couldn’t take sick leave and had to work until 38 weeks. HR told me that my mat leave period would “really stuff” my work colleagues. I worked 12+hour shifts until that time, and walked out of the hospital on my last shift alone and without one person wishing me well. I had my baby 3 days later.
I returned to work 6 months later, and needed to accept a junior RMO position as that was the only option for a part time role. I had no additional support, and the pay cut associated with this role also meant my childcare options were limited. I was also told by a senior (female) consultant that my “pregnant brain” needed time to readjust to work.
When I told some senior trainees about my experiences, they were sympathetic, but said they themselves did not disclose their pregnancies, and even wore baggy clothes to work to conceal any signs of pregnancy. So, this was just a normal and accepted part of the hospital culture.
I never put in an application for O&G training after that, and have left clincial medicine since (maybe to return once my children are older).
The discrimination faced by women who decide to have children, especially in the phase prior to being accepted onto training, is systemic and has to stop.
Thank you for highlighting this important issue. Now, let’s see if anything changes.
Great article and sad to see this is still a problem. As the first woman and first part-time consultant physician with 2 young children in a public hospital department I was often asked by female trainees when was the best time to have a baby ( never by the males) . My reply – when it suits you and your family. It is easier once the horror-show of physician training is finished , and the more senior you are the more power you have over your circumstances but the biological clock waits for no-one. 3, 6 or 12 months leave is a drop in the ocean over a 40+ year career and longer mat leave can often attract a locum . Women should not have to feel that they are a burden for taking this important leave – it is as valid as LSL or a sabbatical ! I had minimal departmental enthusiasm for my pregnancy/mat leave 30 years ago but at least no-one worked against me . It’s good to see some of the young male doctors taking paternity leave although it is usually a few weeks only
Disappointed to hear so many stories of ongoing discrimination of those who are growing their families and what that meant for their chosen career path, training and employment. I have been fortunate to receive nothing but support during my pregnancies. The only factor we had to consider during our family planning was whether we’d be able to afford it with no maternity leave apart from the government parental leave with my first born.
My first pregnancy ended in a miscarriage. I was a newly fellowed GP who stayed at the same practice I finished my final year of training at. I was lucky that they were supportive with me taking 10 days unexpected leave and were supportive when my antenatal consults required me to sometimes take a minute or two in the treatment or staff room to compose myself again after having to be professional while grieving during the consult. I remained at that practice for my second pregnancy and received nothing but support. Everyone was accommodating, including our reception staff who had to do extra admin work to screen for infectious symptoms by paperwork to determine whether some patients required masks vs telehealth. I worked up until 36 weeks even though I planned to do another week to 37 weeks – this was a decision I made suddenly after the QLD premier decided to open to borders to QLD early and I did not want to risk getting COVID19 at the time. They happily cancelled my appointments. They were also happy to have me back after a year maternity leave, my room remaining open for me to come back to at whatever capacity I chose to. A colleague also kindly actioned all my results while on leave.
For my second baby I was in a new government SMO position for 6 months when I fell pregnant. I was concerned about how it would be received given my recent appointment but again I received only support. My medical director was very accommodating when it came to when I wanted to go on maternity leave and advocated for me to utilize all my pregnancy related leave if needed. Again, I have a job waiting for me when I return to that position at the end of my maternity leave.
Horrifying to read of the blatant discrimination still happening regarding childbearing and child rearing and I hope with systemic change one day (soon) everyone can feel as supported as I did.
Thank you Professor Rowe, on point article yet again. The very real, raw and lived experience of individuals commenting here is additional testament to the long way we still have to go to address these deeply rooted systemic and cultural barriers. I agree more attention to use of fiscal levers and application of contemporary WHS law is necessary.
I work in a female dominated “flexible” specialty. I have have been told numerous unsolicited times not to have children during training, which I ignored. I was told I could not go part time when returning from leave because the number of weeks left in training was “awkward”, and had no ability to argue this as it was a directive of the hospital but my college. During my first pregnancy my maternity leave from the hospital was approved AFTER I went on maternity leave even though I had given over 3 months warning. One of the supervisors of training was of the belief that trainees became pregnant to avoid rural training positions.
So many times fertility concerns, pregnancy and motherhood were treated with cynicism, as trivial matters or as an inconvenience.
I was aware of the systemic bias that female doctors suffer in their career due to pregnancy, therefore like many previous doctors, I managed to time my pregnancy at the last 6 months of my training. However, this was not easy as this was a very busy job, with multiple busy oncalls (requiring driving into hospital). I also had to cover more than my share of on-calls as one colleague was on parental leave. When I had medical issues with my pregnancy, I asked my head of department for slightly less oncalls after 30 weeks, but this fell on deaf ears. During my last weekend on-call as a trainee (30+ week pregnant), I was onsite from 8am to 12am on a Saturday working non-stop, had to continue take phone calls overnight and continue my work on Sunday. My medical issues improved once I stopped work a few weeks early (was only able to do this because my term ended!)
One other incident that makes me angry is when I returned to work, when I was looking for a room to pump and asked if an older female colleague wouldn’t mind sharing a room with me (facing away), she asked me to pump in the staff toilets.. I was so incredulous that a female would said that to me.
Thank you Prof Rowe for your article. Let’s open this door wide and confront these issues head on for our junior female colleagues (and male colleagues supporting their partners!) and female doctors to come. These attitudes are still pervasive through the hospital and training systems and they are affecting how our trainees, and pre-vocational trainees plan and navigate their reproductive decisions and pregnancies.
These attitudes are putting our female colleagues and their unborn babies terrible at risk. We are a healthcare profession and we should support and protect our own!
I was lucky to become a mother during medical school and did all my training (in General Surgery) with young children (and that was hard enough). I have had numerous female colleagues confide in my about their terrible fertility, antenatal obstetric experiences whilst working – having miscarriages on ward rounds/operating theatres, threatened and early labour whilst doing 12 hr+ shifts and all manner of foetal compromise due to the excessive work-hours and expectations we place on trainees. Most of the limited data on fertility and obstetric outcomes in medical practitioners show we have higher rates of infertility issues and obstetric complications, and with these prevailing workplace attitudes and behaviours we don’t need to wonder why,
Nobody would not these workplace attitudes and behaviours in any other workplace or happening to our patients or our partners, sisters or daughters. So let’s not accept them happening to our colleagues. As a profession we owe it to our junior and future female colleagues to actively talk about reproductive rights and considerations for female doctors. We need to actively engage with Health Care employers and training bodies to set policies and procedures around female fertility and reproduction (that many of them are trying hard to do), but more importantly to change Workplace & Training attitudes and culture as this is where these problems start.
When I was still an intern and single. A surgeon of high regard asked me if I intended to get married and have kids. I wasn’t thinking about it at that stage but the question stumped me. He proceeded to say surgery is not ideal for those who are pregnant or intend to have kids. This prompted me to find a different specialty that was more supportive ie radiology. Even then, I avoided getting married and having kids until I have fellowed as it was always difficult to find cover and I didn’t want to let my coregistrar down as we are stretched pretty thin as it is. Thankfully I had my first child without major issues but there are always concerns about having more kids given my advanced maternal age. Given the unsupportive nature of medicine, I am very keen my daughter does not go down the same path and would strongly advise her against doing medicine.
Thank you Professor Rowe for this much needed article. I had fairly recently started my Neonatology sub-specialty training when pregnant with my first child. I had hyperemesis and found it incredibly difficult working long retrieval shifts for the neonatal transport service. I was regarded as a nuisance and reluctantly eventually shifted to another role. The Consultant commentary behind my back was such that a senior nurse in the department advised me I should raise a complaint of workplace bullying. I worked a run of 5 consecutive 14-hour night shifts at 35 weeks then became so physically unwell I had to commence my maternity leave early. My daughter was born two weeks later with low birth weight, requiring special care nursery admission.
I later became the Chief Senior Registrar, responsible for the roster. One of my colleagues had symptomatic iron deficiency in her pregnancy and required some time of adjusted duties. In discussing this with my (male) HoD, he opened Instagram on his phone, showed a photo this Dr had posted recently of a night out with her husband, saying “she doesn’t look very breathless to me!” and “You need to understand – pregnancy is not an illness.”
Last year I saw a pregnant trainee work long physically-demanding shifts with the neonatal transport service in her third trimester, despite suffering from significant back and pelvic pain. This was due to the department’s expectations and scorn for anything less than total commitment to the full-time shift work roster.
Things need to change.
My want to have a family was a major consideration when I chose to enter the general practice training program. Despite the significant pay cut, in excess of $30,000 reduction in my annual base salary compared to being a hospital registrar, and no maternity leave offered other than government paid parental leave, the work life balance possible aligned with my aspirations and professional interests. I was naive to the rife sex discrimination within the discipline. My pregnancy spanned two separate general practice terms where I worked at three different practices. One practice full time then two practices part time. I experienced a level of discrimination at each practice disappointingly. At one practice, my supervisor and manager would only communicate with me in writing over email regarding my request to start maternity leave at 35 weeks gestation as they were exploring their “legal rights” to have this extended so I could cover the Christmas period despite me verbally notifying them at the start of my employment period I was intending to take leave by early December. Thankfully I didn’t need to negotiate them to pay for my maternity leave on top of that. At another practice, another supervisor made repeated comments about the shape of my body changing (not positive ones) in front of patients and fellow staff members. Another supervisor told me they’d love to have me back at the practice when I was done with having babies – he had three children himself. The practice I worked at failed to enforce PPE measures with known sick patients, e.g. suspected Covid-19 or pertussis patients. I requested for patients seeing me to be asked to wear a mask and this was denied by the practice owner and manager. I proceeded to contract Covid-19 as well as three other separate respiratory viruses within a 6 week period. Throughout this time, I was pressured to return to work sick and pregnant (late second/early third trimester), despite laboratory confirmation of infection. My supervisor also made comments about my reliability as a worker specifically during these times of illness not being up to his expectation.
Thankfully I have a great GP who supported me, having worked for the same supervisor during her IVF journey and experiencing similar difficulties, and provided me with a medical certificate to enter my maternity leave period without my employers approval.
I navigated this period with the guidance of my medical educator (a mentoring GP who is employed to overlook your training period). I was encouraged to report my experience as end of term feedback and on further discussion with the region’s training coordinator it was suggested that it may be a personality clash between myself and my supervisor as he had won a supervisor award four years or so previously. The next registrar at the practice the following term ceased her employment early due to working conditions – she was not pregnant.
In addition to this experience, I worked for the training organisation as a Registrar Liason Officer. My contract was not renewed as I chose to remain on maternity leave from clinical training beyond six months. This was not a stipulation of my contract, only that I be a GP registrar (the training program gives you up to 2 years for maternity leave period). I had previously offered to attend workshops face to face, but I was discouraged from doing so by my manager and advised this was not needed for the role. My manager pressured me to return to clinical training in exchange for renewing my contract. I was not able to do this at the time as a primary child carer without other options (protracted daycare waitlists are another issue). When I reported the experience to HR, I was advised even if I was to pursue action, nothing would be changed within the organisation to support parents on clinical parental leave to remain employed – they would just ensure they would update contracts to advise a maximum time of parental leave as this was not on my contract.
Needless to say, I am incredibly uncomfortable about returning to the workforce knowing we would like to grow our family and the widespread culture of intolerance for this within general practice.
I was a basic physician trainee a decade ago. I informed DPET immediately as soon as I realised that I was pregnant and would miss part 1 exam due to expected due date. I sought for guidance in planning my leave and career progression. The female DPET who’s just had a child herself appeared supportive and gave some guidance. Nevertheless, I was sat down three days later and told to reapply to a few other networks just in case I would not get a contract renewal/ extension. Who would have offered me a contract knowing I was pregnant and due end of Jan. I was heart broken. Given how small the physician world, I decided not to make this a case just in case I get blacklisted this if I ever decided to go back to training… which I never did.
There were a few more incidents that happened in that 1.5 years of training that changed me forever
– a consultant made me a scapegoat in a MDT meeting for a decision that he made himself and I only found out when I got confronted by another consultant who I was about to work with
– a married senior called me over the phone and offered to help with my study and invited me to his spare apartment near to workplace
– a junior during my relief term (for 5 days) had a discussion with patient on his own and made the patient palliated but told the consultant and team that I did so…
– a fellow colleague got reported for not being supportive to her juniors and turning up to work late as well as leaving work early. I was interrogated by a DPET in a different hospital as I’ve then moved onto a different rotation. I had to investigate myself by approaching all my juniors during that rotation and it turned out that the admin person mixed up Asian names
There were no investigations or apologies for any of the incidents above. Being discriminated against while I was pregnant was the last straw and I’ve not gone back to continue my training since.
I wish I’d had the opportunity to have a child while employed in public system as I would have have paid maternity leave etc…Instead once in private practice I couldn’t afford more than 6 weeks off as was self funded!
Thank you for your insightful and very necessary piece. As a doctor who has completed her family and thought to skip over this article as it is less relevant to me, the barriers you have brought up for doctors planning pregnancy are very important and for too long have been swept under the rug as an inconvenience by medical admin and HR.
We need to advocate for better systems to better support all our workforce.
This issue is deeply personal to me. During my first pregnancy, I experienced complications throughout but was determined not to let anyone down. I worked full-time in a physically demanding role until I was forced to take leave at 29 weeks due to threatened preterm labor. I emailed my head of department, consultant, registrar, and fellow residents—colleagues I considered friends—about my situation and inability to return. Not a single one responded. The only email I received was a generic one from medical workforce urgently looking for shift coverage.
I gave birth 2 weeks later at 32 weeks, and my baby spent four weeks in the NICU. It was the hardest time of my life, and I had no support from my workplace—not even a simple congratulations. I felt unseen, unvalued, and reduced to just another cog in the system.
My second pregnancy was also high-risk, requiring me to step down to desk duties. Medical workforce made it clear there was no such role available, and I was told to take unpaid leave until my maternity leave started. Thankfully, my head of department at the time was incredibly supportive and found a way to keep me on. But that support should not be the exception—it should be the norm.
Now, as I consider having a third child, I feel torn. I have always dreamed of a big family, but the lack of workplace support makes it feel impossible. For a profession built on compassion, we can be incredibly lacking in it when it comes to our own colleagues. This culture needs to change.
This article is spot on – life is much easier for makes, at least when it comes to climbing the greasy pole.
There is thing not mentioned in this article which is also very damaging and which has been an issue for advanced trainees whom I supervise for RACP, often after they have left my hospital and are working in the children’s hospital. I counsel that in order to be fully rounded as a specialist it is important to do sub specialty rotations during the AT years, especially as once free of the exam disaster one can actually get on with learning some medicine.
Those needing to do part time /job share arrangements almost universally report that the various subspecialy unit often have an internal rule that they will only have registrars or fellows who are full time. The excuse is @ continuity”
This means that the trainees are commonly excluded from the good jobs and just score round after round of service jobs, while those able to do FT get the good ones
It is not the responsibility of the trainee to ensure continuity. It is the job if the department to get themselves organised with rosters, handover procedures and consultant availability so that this happens. It requires though and effort but has many rewards, not least in the quality of trainees one attracts.
Thank you, Prof Rowe. Well written.
I admit that I braced myself before reading, as I had expected more of the same intrusive rubbish and pontificating about our bodies, that I heard throughout med school and postgrad training.
Lovely to hear from a GP supervisor, when I had a one year old, her unwelcome advice that ‘“people” should wait until they finish training to have a baby’. No one asked her. Her advice, to patients on personal issues, who consent to it, does not extend to your colleagues.
Great article. The system and the culture need to change, not just for the women but for the next generation. Male doctors aren’t seeking advice on when the best time to have babies is. Females should have that same confidence their career will be ok.
Thank you for this important article.
I am lucky that my employer has been supportive of my pregnancies, but even so it hasn’t been easy.
I was talked into working up to 38 weeks pregnant with my first. At 35 weeks I could not deal with the 12+ hour days anymore (as per law my days could be no longer than 10 hours). I asked if I could be exempt from staying until the work is finished and leave after 10 hours on the dot, the bosses said no, either I stay until the work is done or I take unpaid leave.
I was also very aware of the fact that my role was going to be left uncovered for the months I was off. The burden our choice to have kids puts on our colleagues really is not fair and should not be ours to carry.
Another difficulty is knowing once your maternity leave is up it is back to 50-60 hour weeks, no part time available where I work. If my partner wasn’t able to work part time, I don’t know how we would do it.
It feels like we have to constantly choose between being a bad parent or a bad doctor. Most often it feels like we end up being bad at both.
I think we’re slowly improving, but still got a very long way to go.
Thanks Leanne – what an important point. I especially like your first sentence: “The best time to have a baby? Preferably at the end of the third trimester.” It’s not just for hospitals – it’s for medical colleges and other professional organisations as well.
This is due to the AMA and various specialist colleges not vocally enough to represent and advocate for DiTs and even public hospital staff specialists when it comes to parental leave. Parental leave is a complete non-issue for DiTs in the UK and much of Europe, and our unions and colleges being permissive to workplace abuses is the reason why this is still rifle in Australia. Take away their training accreditation if departments don’t submit a workforce plan that takes into consideration of any potential parental leave or practice unfair dismissal!
Great article. And there’s additional discouragement of women of colour and those with any sort of disability. We have a workplace culture (and systems that have propped up this culture) of “weeding out weakness” instead of seeing diversity and life experience as potential strengths in this caring profession.
“Surgical training is not suitable for your lifestyle” – said to me, a mum of a 2 year old, by a young consultant who is now a board member.
After a complicated miscarriage last year I began being asked about my “family planning” in supervisor meetings. I’ve also repeatedly been told I’m “not ready” to become a fellow when another single female AT has been promoted to fellow but has the same amount of experience and skills as me.
I’ve asked some other ATs in my department if they have been asked about “family planning” and they have not. Two of these ATs are male and one is a single female.
I’m now 28 weeks pregnant with a high risk pregnancy and felt a lot of pressure to get back to work < 48hrs after an antepartum hemorrhage last week. I will also try to work until 38 weeks if I can make it that far. This pressure comes from not wanting to burden my other junior colleagues with a sick call and also not giving the HOD any reasons not to promote me after my maternity leave.
She has already made comments that I “wouldn’t want to come back as a fellow” after my maternity leave. This makes me think my chances of getting a fellow job after maternity leave are zero no matter what I do.
I was verbally promised an advanced training position by my supervisor and reassured that having a baby would not affect my training just before going on maternity leave. I contacted this same supervisor after 6 months to arrange return to work and he said the position had been filled and he didn’t realise I would even want to come back to work. I had to find another job at a different health service, in a different city with an infant.
After successfully securing a highly competitive subspecialty training spot, I was asked to give it up upon disclosing my pregnancy. With guidance from my union and the AMA, I fought to keep my position and ultimately succeeded. However, I returned to training just 14 weeks after giving birth, and the challenges I faced during that time still haunt me. No medical mother should have to endure the struggles I experienced, and I am committed to ensuring better support for those who follow.
What a great article! I still consider how lucky I was to be able to have my 3 babies that I left very late (late 30’s to 40) due to the pressure of work. Fertility is an issue for many delaying due to training and work.
Thankyou for writing this piece Leanne. I am shocked to read that the issues I faced 25-30 years ago with childbearing as a young female doctor are still so relevant today. Your piece covers hospital medicine. At least there, there are financial provisions for maternity leave, if not physical or cultural support. So many of us left the hospital system for general Practice for the flexibility of work hours and independence with decision making around family planning. The price we paid was the loss of prestige associated with our careers and reduced future earning capacity. There is also the absence of financial support for taking maternity leave in general Practice. For me it felt like the only option as I wanted a large family and the ability to take as much maternity leave as me and my babies needed, without injury to my career. This proved to be not true when I returned from maternity leave after having my 4th child, having worked 4 days per week til 39 weeks at my corporate GP practice of 5 years in the Sydney lower north shore, to be offered just 2 half days of work as they no longer had room for me.
When I asked to extend my maternity leave due to inability to find childcare, “But who will cover your work?”
We delayed having our babies for 4 years due to exams and covid.
I dream of a day when doctors no longer consider making significant personal sacrifices to their reproductive plans for a workplace that couldn’t care less about them
In my training program each year we had to apply for a position, although trainees already on the program were meant to be guaranteed a job. One of my colleagues who was heavily pregnant at the time of interviews did not get a job for that year setting her career back a whole year and putting financial pressure on her at a time when I’m sure security would have been most needed. The impact of that decision was felt by all female trainees, both at that time and in the future as we realised despite choosing what many would consider a family friendly physician specialty, choosing to have a family would have a cost.
Brilliant piece Professor Rowe. I was asked those questions in an interview because apparently being married as an intern was the most important thing about me.
I watch my daughter go through her specialty training and it seems the hazing of our future workforce continues. Workforce administration attitudes to some of the hardest working people in our profession is shameful. That this structural failing and dysfunctional power play splits along gender lines is not surprising.
Thank you for highlighting this important issue.