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AUSTRALIAN MEDICAL ASSOCIATION (WA)
According to a recent survey, the local arm of international accountancy firm Price Waterhouse Cooper ranks as the place Australian professionals most want to work in. As one of its parenting perks, employees are not expected to clock up the usual 12 months of employment before being eligible for paid parental leave, which is 18 weeks regardless of whether you’re a mum, dad, foster carer or dealing with the tragedy of stillbirth.
And it’s not just the big corporates that are supporting their employees.
INS Career Management, a small business in Sydney, knows what it means to keep its staff happy. A free onsite crèche, yoga classes and fresh food are just some of the benefits enjoyed by its 30 or so employees.
In fact, a look at some of the best places to work in the world will reveal family-friendly employers holding the top slots. It is generally understood that if employees feel valued, they are more loyal, committed and attentive to their jobs.
Yet there is strong evidence that medical workplaces are some of the last to acknowledge this reality and that many employers do not recognise even in the most basic way that if they look after employees, they will reap the benefits of a more engaged, dedicated and hardworking workforce.
One of the busiest departments within the Australian Medical Association of Western Australia is Industrial Relations. A team of four dedicated IR advisers led by Director, Industrial-Legal, Marcia Kuhne, receive enquiries for advice, help and representation every single day on a wide range of issues.
Perhaps the most common requests for assistance come from doctors walking the tightrope as they strive to juggle a demanding medical career and family commitments. The conversations usually relate to accessing parental or carer’s leave, the availability of flexible working arrangements and issues of discrimination.
These are just three examples and demonstrating the sensitivity of the issue, two have asked that their real names not be used:
Dr Jones* contacted the AMA advising of her experience during a recent interview where she was asked if she was planning a family and how she planned to manage her training commitments whilst bringing up children. Dr Jones later discovered that the male applicants for the role were not asked this question.
Dr Goodson* applied for two days carer’s leave in order to provide support to his 78-year-old mother who was due to be admitted to hospital to undergo an operation. The application was declined on the grounds that as his mother would be in hospital, Dr Goodson was not required to directly care for her during the period in question.
One happy to have her real name used is Dr Alison Soerensen, who in 2013 was working as a supervised medical officer at Rockingham General Hospital on a 12-month contract. Due to concerns about discrimination when reapplying for her job, Dr Soerensen followed the AMA (WA)’s advice not to disclose her pregnancy until a contract was secured. Subsequently she didn’t announce her pregnancy until 24 weeks, despite feeling conflicted about keeping it from colleagues.
Like Dr Soerensen, Dermatology Registrar Dr Sarah Strathie-Page decided against sharing the news of her pregnancy with her workplace.
“After hearing all of the (often true) horror stories of parent-sin-training, I was initially very anxious to tell my Director of Training and other consultants that I was pregnant,” Dr Strathie-Page says.
“However, there was nothing but genuine congratulations and support for my need for maternity leave. Although it was a path rarely trodden by others in my specialty, they simply resolved to make it work.”
Fortunately, for both Drs Strathie-Page and Soerensen, their respective heads of department showed great support.
Following the birth of her son Leo, Dr Strathie-Page reconsidered her original plan to return to work full time, and requested a change to a part-time position.
“Again, there was no hesitation at all from my faculty to make this work,” she says.
“It was deemed that the service requirement could easily be met by employing an additional, non-trainee registrar – a win-win, giving a DiT interested in Dermatology a chance to work as a registrar, an opportunity that had never before existed in WA.”
Dr Strathie-Page says being able to initially work part time allowed her to not lose contact with colleagues and get back to the job she loved.
“I would really encourage those specialties with little experience of flexible training to just say ‘yes’. The sky won’t fall in, and it is only good for your specialty!” she says.
Each college and hospital approaches this issue slightly differently.
For example, the Australasian College of Dermatologists recently updated its ‘Variation of training’ policy, which outlines leave options for trainees.
“Trainees accepted into the program can now to apply to defer their commencement date for six months (previously 12 months), ensuring applicants aren’t disadvantaged if they cannot start in February the following year,” says Brett O’Neill, Director of Education Services at the College.
Trainees can also apply for interrupted training (usually for 12 months; further extensions may be considered in exceptional circumstances) and part-time training (50 per cent of the workload across a 12-month period). There are also extended application dates to allow maximum time for planning.
Like many young parents, Dr Soerensen was eager to find a balance between her new role and her professional working life. She was able to negotiate a graduated return to work at Rockingham General Hospital, transitioning from 0.25 full time equivalent (FTE)** to 1.0FTE over a period of 2-3 months.
“My Head of Department, Dr Tim Patel, was very accommodating with supporting me to continue breastfeeding through protected expressing time at work and appropriate venue provision,” Dr Soerensen says.
During her second pregnancy in 2015-16, Dr Soerensen was in General Practice training and says she was well supported by the private practices at which she worked, both pre and postpartum, as well as by her training provider, WAGPET.
“Unfortunately there is no employer-funded paid parental leave in community GP training, which can cause significant financial hardship for our trainees.
“I did have issues with the College (Royal Australian College of General Practitioners) when it came to accessing provisions to support me as a breastfeeding mother during my OSCE,” says Dr Soerensen who was sitting for the exam with a two-week old baby in 2016.
The challenges she faced drove her to advocate for change and with the support of WAGPET’s CEO, Dr Janice Bell, and other members of the College, Dr Soerensen drafted and submitted a breastfeeding policy to the College.
“The RACGP subsequently published a policy on International Women’s Day in 2017. It isn’t perfect but it certainly provides greater protection and clarity from future generations of GP trainees,” she says.
According to the RACGP, nursing breaks are allowed for up to 30 minutes for candidates appearing for the AKT and KFP computer-based exams. For the OSCE, however, no change to exam structure is possible. Candidates may breastfeed prior to and after the exam and may express milk during exam rest stations only. Infants are not permitted on the circuit/rotation during an exam.
The stories are numerous. The cases and contexts disconcertingly similar, with the processes and structures underpinning the health system in WA being complex and cumbersome to navigate.
Yet change is afoot, albeit slowly. For some time now, there has been an increasing shift away from the “traditional” approach of viewing the interconnections between work and family roles as related solely to women.
More and more legislation has been developed and introduced, which acknowledges that both men and women have family responsibilities.
Dr Chris Wilson, a Registrar at Fiona Stanley Hospital thought he had a reasonable idea of his entitlements when it came to parental leave – two weeks of allowance from the government and up to eight weeks of unpaid concurrent leave.
With a mortgage to pay, Dr Wilson and wife Tegan (also a registrar at Royal Perth Hospital) decided he would take four weeks’ parental leave from the birth of their child before returning to work.
“This was organised without fuss by the FSH medical workforce team, and I am grateful for their help. Tegan had also been well supported by the RPH ED from the outset – adjusting rotations and arranging for her to start a part-time contract when she returned,” says Dr Wilson.
But it wasn’t until talking to the AMA that Dr Wilson realised the eight weeks of unpaid leave could be taken in blocks, rather than one single allotment.
“We decided I would take a second period of four weeks unpaid leave over Christmas, allowing us to enjoy our first as a family. However, as we made the decision after Clark’s birth, this required some assistance from the AMA to organise, but overall was again done with minimum fuss.”
Dr Wilson says it’s easy to feel that people have gone above and beyond to make parental leave and part-time contracts happen.
“Don’t get me wrong – I’m very grateful for the help we had from both FSH and RPH, but at the end of the day it’s their job. We shouldn’t feel like we were lucky to get leave or contracts to fit our needs. This must be the standard, not the exception,” Dr Wilson says.
FLEXIBLE WORKING ARRANGEMENTS
A junior doctor trying to secure part-time work in Western Australia is a lesson in frustration 101. A look across the health services in Western Australia reflects a sluggish commitment to providing part-time work for doctors in training (DiTs). See table below.
Buoyed by unprecedented requests this year for part-time working options at Sir Charles Gairdner Hospital, a project team called ADAPT was formed with the aim to improve the quantity and quality of part-time work options across the WA health system.
The team undertook a survey1 of WA junior doctors to assess the availability and demand for part-time work. Twenty per cent (522 respondents) of WA’s junior doctor workforce responded.
Interim analysis has shown that half of the respondents (53 per cent) were already in a training program. For the 257 respondents not yet in training, 78 per cent indicated that the potential for part-time/flexible work influenced their choice of training program.
Seventy percent of respondents indicated that they’d consider part-time work now or within five years. Concern for career progression ranked as the main reason not to pursue part-time work.
The ADAPT team is now working to develop a focus group at SCGH to drive local change and will share the outcomes to help develop a statewide approach that can be locally adapted.
Where part-time working arrangements have been made available, the stories we hear are almost always good ones.
East Metropolitan Health Service (EMHS) registrars Soumia Oommen and Hind Al Abbasi are mothers of young children and very appreciative of being given the opportunity to work part-time.
With no extended family in Perth, Drs Oommen and Al Abbasi, who are both married to doctors say parenting and working full time would have been impossible.
“I am so grateful I have not had to decide between work or my children – I have the best of both worlds,” Dr Oommen adds.
While some specialties are more suited to flexible working arrangements, others such as surgery are traditionally uncompromising.
However, in what is claimed to be a first for WA, Dr Kateryna Sykes was until recently working part-time as a surgical service registrar at Fiona Stanley Hospital.
While she has now returned to full-time employment after only three months, she says she was delighted to have been given the opportunity.
As a service registrar, Dr Sykes is entitled to apply for a part-time position but admits she has been advocating for “flexibility within the surgical profession in WA for over two years”.
“I am saddened that it has taken until 2018 to achieve this in WA.”
In 2016, there were 1,065 surgical advanced trainees in Australia – just 313 were female.2 In 2017, just 12 per cent of total active Fellows were women.3
The Royal Australian College of Surgeons says it has a policy that is applicable to all specialty training programs to remove the overt and hidden barriers to flexible forms of training. The policy is in place to allow for interruption to training and this option is frequently used to manage parental leave and family commitments.
The College adds that it has contacted all training hospitals to determine if the hospital can offer flexibility and to identify specific training posts in the hospital that could be other than full time.
According to Dr Sykes, offering part-time positions in surgery would be of great benefit.
“It is significantly cheaper to employ two registrars to work a combined total of 80 hours per week than it is to employ a single registrar to work those hours,” she says.
“This is because penalty rates come into effect when they work beyond their allotted hours. If two part-time registrars were sharing a role that would otherwise require a single person to occupy an 80hr/week role, they would be better rested than their full-time counterpart which would likely result in fewer errors made due to fatigue, leading to better patient care and at a lower cost to the employer.”
The RACS, however, says that approaches to flexible training differ between specialties, in part due to differences between numbers of trainees and training posts per specialty. Flexible training hours (at least 50 per cent FTE) are available while recognising the complexities involved in meeting the needs of the surgical training program as well as the needs of the employing institution or surgical unit.
Orthopaedics is another surgical specialty where male surgeons grossly outnumber females.
In 2016, of the 236 surgical advanced trainees in Orthopaedics nationally, just 25 were female.4
However, the Australian Orthopaedic Association (AOA) says it is committed to increasing the diversity of its workforce and has taken significant steps to address some of the perceived barriers to flexibility in orthopaedic training.
AOA Chair of Education and Training, Dr Omar Khorshid (who of course is also AMA (WA) President) says they have developed a new competency-based training program, AOA 21, which is innately flexible in its design.
“Combined with flexible training policies and a requirement that all major hospitals provide access to part-time training positions, future male and female trainees should not face the difficulties accessing flexible training that have been experienced in the past,” Dr Khorshid says.
Unsurprisingly, it is the specialties with larger cohorts of female trainees that are working hard to improve flexible arrangements and support.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has made a number of changes over the last few years to make training more family friendly.
RANZCOG WA’s Trainee Representative Dr Fiona Langdon says the College is very aware that 80 per cent of its current trainees are female with the large majority of them being of child-bearing age.
“The College has had to recognise that women in training and trainees having a family is the norm, not the exception,” Dr Langdon says.
She points out that up until a few years ago, RANZCOG trainees could only consider training in six-month blocks.
“If you worked less than six months, it wouldn’t be counted. Therefore, if you didn’t time your pregnancy to exactly line up with your training term, you would lose out.
“Now, however, training is recognised in blocks of weeks rather than months. Therefore, a shorter stint of training in a 10-week block would still be counted as such.”
RANZCOG’s training program is six years long, but trainees can complete it within 11 training years, and take 12-24 months of leave at a time either for maternity or other reasons for which they may require leave.
“After the first year of training, trainees can work part time and undertake fractional training. The College is very supportive of this but does recognise that you have to find a hospital that offers a part-time training position.” Dr Langdon says.
The case for part-time training and working positions and the provision of flexible rosters cannot be overstated. Every health workplace and training college that we approached in the writing of this article espoused the correct policies and said all the right things. See pages 33-37 for responses from some of our major healthcare employers and training institutions.
The Royal College of Physicians (RACP) has a Flexible Training
Policy that details provisions for part-time training and interruptions to training including parental leave.
An RACP spokeswoman says that attitudes to work-life balance is undergoing generational change and what may have been considered acceptable by us 20-50 years ago may not meet expectations of the current generations.
Dr Panchi Kumarasinghe, a Registrar at Sir Charles Gairdner Hospital says ultimately we need a system and culture of support for each individual’s choice, be it for extended periods of parental leave, a return to work six weeks post-partum, fulltime or part-time work.
Dr Kumarasinghe returned to full-time work six months after giving birth to twins. She says she couldn’t have achieved this without the incredible support of her family, colleagues and “a wonderful nanny”.
“I was also fortunate to have been allocated a job with less after-hours commitments, which made the balancing act of breastfeeding, bedtime routines and work a little easier,” she says.
“Expressing while writing up e-consults or dictating clinic letters felt strange at first, but soon became the norm.
“The nursing and clerical staff even reminded me to take the liquid gold from the fridge at the end of the day!
“I had a lot of support, but most significantly, I was supported in my own decisions about how to be a full-time working mother,” Dr Kumarasinghe says.
*Names have been changed to protect the privacy of individuals.
** FTE – Full-Time Equivalent. A standardised measure used in converting number of persons in parttime employment to number of persons in full-time employment
1. If anyone is interested to receive the final survey report or to participate in the focus groups, please email ADAPT@health.wa.gov.au