16 minute read
A BALANCING ACT
by RCSI
Many factors make the experience of surgeons who are parents particularly difficult, but more flexibility and support ease the challenges. Here, surgeons explain how they balance their work and family priorities the challenges of combining a career with being a parent are not unique to surgeons.
Everyone who works and has children knows that it is hard to find the balance between doing your job to the best of your ability and being a present and involved parent. But, starting a family during surgical training and raising your children away from your natural support networks while on fellowship abroad presents challenges beyond the norm, particularly for female surgeons who take breaks for maternity leave during training.
Understanding, empathy and flexibility ensure that great surgeons can also be great parents – the roles must not be mutually exclusive.
Mr Ian Reynolds FRCSI
International Colon & Rectal Surgery Fellow, Mayo Clinic
I am currently on fellowship at the Mayo Clinic in Rochester, Minnesota for a year. My wife, Emma, and I have a three-year-old son, Ronan, and a daughter, Harper, who was born on 31 July this year. Ronan was born when I was working as a specialist registrar, just as I was moving between St Michael’s and St Vincent’s Hospitals in Dublin. That was a big adjustment. It was a busy time as I was trying to hone my technical skills and clinical knowledge, and build up an academic portfolio. The call rota was frequent but the job was great and I was learning a lot. Ronan’s birth brought positive change, and made me focus on the more important things in life, and in work. I learned how to be more efficient with my time, to say no to certain things and to prioritise what was important so I could free up time to spend with my family.
Emma is the Communications Director for Aon. Her work is important and she has risen rapidly to a leadership role. As surgical trainees, we have a tendency to focus on ourselves and forget about the amazing things other people do at work. The hard part is trying to balance what I do and what she does with having children. She does a lot of the heavy lifting at home and I’m lucky she is willing to take all that on. She has a little more flexibility than me at work, but not much.
Harper was born in Dublin. We had talked about whether Emma would move over with me and have the baby in the Mayo Clinic or whether she would stay in Ireland and have the baby there. For various personal and medical reasons, she decided on Dublin as she was very happy with the obstetric care she was receiving and would have been moving over very late in the pregnancy when flying was not advisable. The due date was 6 August and I planned to fly home on 2 August. But I got a call on 31 July while I was in clinic to say that Emma had gone into labour. I rushed to the airport, but halfway between Rochester and Minneapolis I got a call from Emma’s mum to say that Harper had been born.
I arrived 16 hours later having missed the birth, which was obviously very disappointing. We were lucky that Emma’s mum was around, and it was a happy occasion for her to be there for the birth of her granddaughter. Parental support on both sides has been hugely important. I was home for nine days, and it was very hard to leave. There was uncertainty about how long it would take to get passports and visas, and it was the first weekend in October when Emma moved over. We had been apart for August and September, which was hard.
Emma’s parents travelled over with her and stayed for a couple of weeks. Ronan has started preschool, which he loves; he’s a busy little boy who needs to be stimulated. I worry that the days could be long for Emma, but she’s an outgoing person, and is doing everything she can to get out and meet people through mother and baby groups and the local athletic club.
Emma will be on maternity leave until my year at Mayo is finished in July 2025. Had we been back home, she might have gone back to work after six months because she loves her job so much, but she’s taking the year off so that we can all be together. She’s making big sacrifices. Transitioning back to work after having a child is much easier for a man, because the time off is short – for women it can be a challenge to find and re-establish their place after maternity leave, so that’s another thing she’s taking on.
Every week is different here, but I finish on time more often here than I did at home. If I’m involved in a complex resection I might not get home at all, or only for two or three hours in the middle of the night and then I’m gone again before anybody sees me. I do some colorectal-specific on-call and I cover one weekend in five, but I get both evenings off. So even when I work weekends, we still get to have dinner together.
This is an adventure for us. We know that if I’m fortunate enough to get a job back home when my training is finished, that’s going to be it for the next 30 years, so we’re making the most of our time away. Last week we took Ronan on a boat ride on the Mississippi River which he loved. It doesn’t really matter what we’re doing, just being together is important.
We are lucky as male trainees, our decisions around balancing work and family are very different. I think for female trainees it’s much more challenging because the complex decisions around starting a family tend to be made at some of the most critical points in their training. I haven’t had to take much time off work or consider extending my training. If someone had said to me, you have to take six months or a year off when your wife has the baby, that’s the rule, I think it would have made us rethink the timing of our family, because I’m not sure how easy it would have been for me to pause my training, or how willing I would have been to do that. I’m very conscious that for female trainees it is a tough personal and professional decision. It’s important we listen to female trainees and make changes to help them manage maternity leave and transition smoothly back into training.
Ms Catherine Gilliland FRCSI
Locum Consultant, Trauma & Orthopaedics, Northern Ireland
My husband, Conor Mullan, and I are both orthopaedic surgeons. We live in Belfast and have four children aged 7, 6, 5 and 7 months, all born in Northern Ireland while I was a registrar in surgical training, which I commenced in August 2013.
In 2014, I took a one-year out-of-programme career break to support my husband on his surgical fellowship abroad. Since then, I have taken three periods of maternity leave during training and a final maternity leave just after CCT. I reduced my training to 80 per cent during my third pregnancy. In total, it took me just over ten years to achieve my CCT.
Taking several periods of maternity leave during orthopaedic training is not a well-trodden path and, though most colleagues were encouraging, I did come up against occasional challenges. I found it hard to access accurate and up-to-date information on issues surrounding pregnancy in surgical training such as around screening in theatre, exposure to potentially harmful substances, and limitations on some of the more physical aspects of the job. My worry was always that my training would be impacted negatively by adjusting how I worked and there was no one who could advise me. Few of my trainers had encountered a pregnant trainee before. It was rare that I came up against anyone who felt my chosen career clashed with my decision to be a mother, but I had one bad experience with an older surgeon in theatre when I had been scheduled in surgeries that were not reasonable for someone 30 weeks pregnant. Although it was distressing at the time, I was delighted to be shown support by other surgical and nursing colleagues. Other challenges came in the form of dealing with the hospital trust’s administration teams, as reducing my hours to 80 per cent inevitably led to incorrect banding and pay every six-month rotation.
“Some weeks there are balls dropped, deadlines missed and fish fingers again for dinner.”
I feel blessed to have had four mostly healthy pregnancies and appreciate that I was able to continue training to the best of my ability. I love being a mother and when I was sitting the FRCS exams it was a difficult time managing small children and seeing them less frequently to facilitate revision and attendance at multiple courses.
Conor is a few years ahead of me and had already been appointed a consultant when we had our first child. For the first few years, gaining confidence and expanding your surgical abilities through high exposure to diverse and complex cases is so important that we never considered him reducing his hours. I also dearly wanted some balance between time with my children and training. We continue to support each other as both jobs, parenting and surgery, are fulltime. Some weeks it feels like it all falls apart and there are balls dropped, deadlines missed and fish fingers again for dinner.
In February, I am going on a one-year Fellowship in Paediatric Orthopaedics to Perth Children’s Hospital in Australia. Conor will take a career break from his NHS job in order to enable us to do this. I couldn’t realistically do a remote fellowship in the UK or Ireland as I want to be 100 per cent committed to the fellowship opportunity and not have to be thinking about getting home at weekends or worrying about being away from the children; it’s better for us all to be in the same place.
Conor may work in some capacity once we are settled but not full-time; he is going to take on the bulk of parental responsibility. Going back to Perth where he did his fellowship removes some of the unknowns for us and hopefully reduces some of the stress of the move – we know the schools and the areas we would like to live in, and still have some friends and colleagues out there. As a two-medic family you just have to get on and do it. It is chaotic some of the time and the house is not as tidy as we might like it to be. Sometimes appointments get forgotten. We are lucky to have the help of our parents from time to time and we set up childcare as best we can. Until now, I have been the parent who can be available when one of the children is sick, but that will be difficult going forward when we are both consultants and have commitments to a clinic or theatre list. How will we cope? I don’t have the answer at the moment but I plan to outsource as much as I can and accept there will be a degree of unpredictability.
Sometimes I feel I have missed out career-wise. Occasionally, I have to remind colleagues not to confuse my inability to go to something with a lack of enthusiasm for my career. My husband has also had this experience as, in supporting me through my training and being an involved parent, especially taking on the lion’s share of parenting in the months before my FRCS, he has missed out on career opportunities. It has been disheartening to watch male colleagues go past me, and have people whom I taught have to sign me off on an operation. There are some courses and travelling fellowships in which I would have aspired to partake, but couldn’t. It has not always been an easy journey but mostly an enjoyable one. I am proud of making it through and have an adorable family I wouldn’t change.
I think that training schemes are beginning to adapt and develop to make surgical training more flexible for the next generation and I hope that we continue to make improvements. We need to be mindful that not everyone’s journey to parenthood is an easy one. Time out may be required to attend multiple appointments for assisted conception and parental leave will be requested by couples of the same sex, or people having children by surrogacy, not just women needing to take maternity leave. It is going to be challenging, but to retain and expand a workforce, and attract diverse and passionate individuals to the surgical disciplines we need to learn to be flexible while ensuring that the craft of becoming a surgeon is not diluted.
Ms Helen Mohan PhD FRCSI FRACS
Consultant Colorectal and Robotic Surgeon, Peter MacCallum Cancer Centre, Austin Health; Director of Clinical Research IMRA; Senior Lecturer, University of Melbourne.
When it comes to parenthood and surgery, there is never a perfect time and things don’t always work out to plan. I’ve been very lucky in that I have a family of four kids: a boy of 7, twins of 5 and a little girl, Siobhán, who has just turned one. Each of them was born at different stages of my training journey. I had my first in the middle of my SpR training, the twins as a final year SpR and Siobhán as a consultant, but I also lost a little girl, Fiona, at 18 weeks gestation when I was on fellowship here in Australia and had a previous miscarriage.
Parenthood isn’t a given and it presents a lot of challenges. It’s very common for female surgeons to have fertility and pregnancy issues, as Dr Ailín Rogers has highlighted in her research, and I’m aware of many colleagues and friends who have had IVF or experienced pregnancy loss. It is important to be mindful that people may be struggling on their journey to have kids. I really appreciated good colleagues for both the happy and sad events along my training journey. I was lucky to be very well during my last pregnancy and, because I do a lot of robotic surgery, I was physically able to operate until quite late. However, I believe it is important to empower female surgeons to take whatever time they need to protect both their own health and that of their babies, and not champion working until super-late in pregnancy no matter what. In previous pregnancies, I ended up taking time off work with severe hyperemesis and finished up early with the twin pregnancy. It was a very small percentage of surgical and training time overall; we need to have enough flexibility and capacity within the workforce to accommodate pregnant surgeons.
I was lucky to get the PROGRESS Women in Surgery Award when I was coming to Melbourne on fellowship. The funding helped me maximise my fellowship experience, because at the time the twins were very small and we didn’t have our normal backup and support. Being able to get additional childcare to be able to fully embrace the fellowship and do a high case load was great.
One of the things that hasn’t been done as well as it could have been historically is supporting people with intentional training opportunities and encouragement as they return to the workforce after periods of leave. I notice in our trainees coming back from leave that while their skills are there, their confidence isn’t back to normal.
Improving efficiency in how healthcare organisations function can facilitate more family time. My husband and I are both doctors so if we have a sick child we end up negotiating. If it’s a theatre day for me, then my husband does the pick-up but if I am in clinic and can convert some to virtual consultations then I do it. Having a good electronic medical record system that I can use from home helps with this. We still rely on finding emergency childcare sometimes.
If starting again I would tell myself that ‘good enough’ is okay and not to be sucked into peer pressure about parenting non-essentials. I think you can put yourself under huge pressure over things that probably don’t matter in the long run; it doesn’t matter what other people are doing once your little family is happy.
Childcare is a huge issue. In Ireland I had lots of family support at home, whereas in Australia I had no regular family support until recently when my cousin moved here. It is very expensive to work the hours we work because we end up having to pay for out-of-hours and unpredictable childcare, particularly in training. When I was in training, all of my salary would go on our childcare, particularly since we had twins. I think there’s an argument for more statesubsidised out-of-hours childcare for healthcare workers.
While it is a huge joy to be a parent and a surgeon, it does have its challenges and there’s lots we can do to make it easier for those coming behind us.
Professor Brian J. Mehigan FRCSI FRACS
Consultant General & Colorectal Surgeon, St James’s Hospital
“I would encourage all trainees and young consultants to use the flexibility to get stuck in as the kids will be gone in no time.”
As a father of five – Ogie, 15, twins Michael and Claire, 12, and identical twins, Florence and Helen, 8 – I feel very lucky that my architect wife, Emily, gave up work to become a full-time stay-at-home mum when our eldest was born. I recently moved to a half-time role in my HSE job so I have some quiet weeks when I can do school runs with my three daughters and enjoy that. I never managed any school runs before and only realise now how the local national school is the cornerstone of the community. I meet lots of other dads as well as mums at the school and enjoy those interactions. I think less-than-fulltime commitment to HSE jobs will be the future and I would encourage all trainees and young consultants to use the flexibility to get stuck in as the kids will be gone in no time. No one on their deathbed wishes they spent more time at work! ■
