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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.
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.