Experiencing the pitter patter of tiny feet is a life changing, challenging and wonderful experience but how do you manage it if you are also a junior doctor?
JuniorDr's Fareeha Amber Sadiq, recently a new mother herself, invites you to consider some ideas and strategies for planning a family whilst coping with the practicalities of working as a junior doctor.
A recent General Medical Council (GMC) report described the number of female doctors as rising and likely to overtake the number male doctors on the General Medical Register in coming years. As medical training is a long process and fertility reduces with age, many are understandably interested in starting families whilst they are in the earlier stages of their careers.
Creating a supportive workplace environment and more flexible working patterns is therefore fundamental to supporting this growing number of female doctors. However, as the GMC reportdescribes, some specialties are more flexible than others and female doctors are underrepresented in certain specialities such as cardiology, gastroenterology, anaesthetics and surgery1.
More recently there have been increased efforts to retain female doctors in paid employment - examples include the GP retainer scheme2 and Less Than Full Time Training (LFTT)3. Many argue that there is a strong need to change the culture in many areas of the NHS and to remove the barriers which are discouraging women from entering senior leadership positions4.
Many female and male doctors will continue to face the constant juggle of parenthood with their medical careers. Combining both of these can be rewarding, however it is important to be aware of ones resources and limitations.
Keeping an open mind
Planning when to have a baby will be based on your individual circumstances and how manageable you believe combining medicine with parenthood can be. Parenthood will always throw its own challenges but you can learn to cope with these.
With pregnancy it is vital that you keep an open mind. There are many uncertainties and although it can be incredibly rewarding, having children is definitely one aspect of your life that you have very little control over. Doctors are a group of adaptable and resourceful people and therefore this strength can counterbalance the uncertainty that comes with pregnancy.
As it can be stressful to look after a young child and work as a junior doctor it is advisable, as much as possible, to mobilise resources and people around you to help. It can be difficult to ask for help when you have been working independently, however having a strong supportive network of connections and caring people can enable you to feel less overwhelmed and for your anxieties to be better contained. This may be family, friends or paid help.
It is also worthwhile looking into childcare options prior to having your baby as there are often waiting lists and the more popular childcare places can be over subscribed. When considering childcare, it is also important to speak to other parents and consider the wide range available depending on your preference and budget.
Looking after yourself
For any prospective parent it is important to look after your emotional and physical wellbeing as these can be stretched both during and after pregnancy. This may also be the first time you come into contact with hospitals as a service user. Being on the receiving end of care can be challenging and is a different position to manage because of expectations and beliefs that you may have around providing effective care to others.
By looking after yourself well you are also preparing for looking after your child. Both of you will benefit from the extra care you take to ensure you remain in good health.
One of the key things to ensure is that you attend all your antenatal scans and review appointments. Getting adequate rest and eating a healthy balanced diet is important. These are not surprising messages, however with hectic and pressured working patterns sometimes these vital needs can be neglected.
In later stages of pregnancy you may find yourself experiencing tiredness or other health issues which may necessitate coming off your oncall rota. This decision will depend on you and your baby's health, and the nature of work that you are involved with. It is a personal decision and should be made after discussion with your GP and/or midwife.
Attending local antenatal classes can offer helpful support, particularly for non-medical partners, and can also help you meet other parents who live nearby and who could become great sources of support through the coming months and years. Depending on your health, gentle exercise such as swimming, prenatal yoga and massage can aid relaxation and reduce stress levels.
Dr Rebecca Viney, Associate Dean of Professional Development, Coaching and Mentoring Lead at the London Deanery suggests:
"Step back from the situation, imagine yourself in ten years time from now, what would you be saying to yourself looking back? It might be: get more sleep, more help, stop worrying, have fun and live in the moment."
To receive maternity pay you must have had 12 months continual service for the NHS and be still employed at 11 weeks before the baby is due to ensure that you are paid maternity pay.
Maternity leave can be up to 12 months and during this time you accrue annual leave and pension benefits as usual. You will receive eight weeks full pay, 18 weeks half pay and then 13 weeks statutory maternity pay. You are not obliged to inform your employer until after week 16. Maternity pay is calculated on the average of your weekly earnings between about 16 and 24 weeks of your pregnancy.
What you must do when you find out you are pregnant:
- Let your HR department and line manager (eg. TPD, consultant) know about your situation in writing, at least 15 weeks before the baby is due. When you provide this information, your employer will also request a MATB1 certificate. This will allow for an adequate risk assessment and also to enable maternity benefits to be put in place.
- The risk assessment should be followed by your employer making changes to your work environment as necessary.
- Inform your department regarding planned antenatal appointments in advance.
- Discuss your on-calls and how to modify these if possible and/or come off completely in the later stages of your pregnancy.
- Decide when you would like to take your maternity leave and communicate this with your organisation. Consider whether you will remain a full-time trainee or you will return as a Less Than Full Time Trainee (LTFT) and apply to work flexibly if this is your decision.
- Paternity pay is two paid weeks.
- Additional Paternity Leave and Pay (APL&P) allows eligible fathers to take up to 26 weeks additional paternity leave. This should provide more choice and a more equitable sharing of leave.
Maintaining a life work balance
Life does change dramatically during pregnancy and after the baby is born. As a doctor who is a parent, it can be helpful to remember to keep life in balance and that Winnicott's idea of "good enough" parenting is key. Rather than aiming for unrealistic ideals, the focus should be more on celebrating parenting's complexity and enjoying the journey that parenthood takes you on without any guilt or excessive pressure.
Dr Rebecca Viney's advice to those experiencing parenthood and a career in medicine is:
"Remember to be present and live in the moment. You are the expert when it comes to your family needs and values, and the balance will change over time. So it is worth creating time to set goals that you value, to work out your unique family priorities and to balance these with your career."
"Coaching and mentoring can help you to achieve this work-life balance. Make sure that you keep your career safe, and find a role model who has reached their potential even with children, just to remind yourself that it is possible to do anything - it just may be that you have a slightly more interesting and different career path."
London Deanery (for London trainees and doctors) offers a mentoring programme for doctors undergoing transitions and requiring extra support. Contact for more information.
British Medical Association
Women's Medical Federation
1. General Medical Council. The state of medical education and practice in the UK: 2011. www.gmc-uk.org/publications/10692.asp
3. Topley R, Ashwell G, Webb J, Brightwell A, Roden R, Corrado O.J. Trainees' tales of less than full time training" BMJ Careers. 22 Aug 2012. http://careers.bmj.com/careers/advice/view-article.html?id=20008522
4. Khan M. Medicine—a woman's world? BMJ Careers. 5 Jan 2012. http://careers.bmj.com/careers/advice/view-article.html?id=20006082
Fareeha Amber Sadiq is a ST6 in Child and Adolescent Psychiatry, London