A PGY4 unaccredited surgical registrar reflects on the challenges of planning for motherhood in the context of Australia's medical training crisis. 

I am standing alone in my small apartment at 10pm, whipping up scrambled eggs for dinner after an understaffed shift as an unaccredited surgical registrar.  The shift ended five hours later than rostered and finished in the emergency department after placing my first chest tube and draining 3.2 litres of pus from a man’s chest to stabilise him.  

While the eggs are cooking, I dial up the dosage, use an alcohol wipe to prep the area, pinch my tummy and inject.  It is day four of my IVF hormone injections and tomorrow, before my 7am ward round, I step up to twice daily injections.  The irony is not lost on me; for all the subcutaneous clexane injections I have charted, I didn’t know what it felt like to have injections day and night.  After all the times I have carefully educated patients on specific medication dosing and times, I, myself, am already three hours late for my hormone injection due to un-rostered overtime.  Countless times I have watched on as consultants advise couples trying to conceive to eat regular healthy meals, minimise stress, reduce caffeine intake, get adequate sleep and here I am halfway through a 90 hour working week fueled by five hours sleep a night, minimal water, lots of caffeine, one solid meal a day with a snack here or there – if I’m lucky –  and the pure adrenaline rush of constantly learning and developing as a first year unaccredited surgical registrar.  

Like the majority of medical students in Australia, in 2016, I completed a graduate medical degree at the average age of 28-years-old.  Settling into my first year of internship I quickly fell in love with surgery. I went on to complete my surgical residency (which typically takes two to four years) which brings me to where I am today; an unaccredited surgical registrar (typically another two to four years). 

Here, I am in the minority.  Females are disproportionately underrepresented in surgical training, with the gap widening in senior years - just 13.4% of surgical consultants are female, and few go on to undertake leadership, academic and teaching roles.  Surgical training is no doubt challenging – it requires dedication, commitment and skill-based competency – however none of these attributes are gender specific.  Pleasingly, in 2016 the Royal Australasian College of Surgeons (RACS) committed to understanding gender barriers and improving diversity, and in 2019 almost a third of successful Surgical and Education Training (SET) applicants were female. 

With training bottlenecks in Australia worsening, junior doctors striving to achieve a place in the SET program are facing more uncertain years as an unaccredited registrar, a precarious role that falls outside of the clinical governance of RACS and is instead left to individual hospitals to foster the training environment of our future surgeons.  Given the increased average age of interns entering the workforce, we are seeing a collision of professional and personal priorities in junior doctors who are chasing career training pathways and may also be considering starting a family. 

Many senior female colleagues have advised me that there is no  ‘good’ time to step out of medicine to have a baby, so instead of trying to fit it around training requirements, you should start or add to your family when it suits you personally and make work fit around this.  However, as an unaccredited registrar on 12-month job contracts, real and perceived barriers to family planning exist.  Specifically, the lack of job security has female doctors discussing precise timing of their pregnancies to ensure a follow up job contract has been signed and to avoid a visible pregnancy bump during job interview season.  There is no guarantee of career progression and a place in SET when women return to the workforce, and pre-selection requirements (such as research outputs and required rotations) may expire and need to be repeated.  Put simply, the number of unaccredited years can feel infinite and may be disproportionately longer in females who take maternity leave in their pre-SET years.

  The lack of job security has female doctors discussing precise timing of their pregnancies to ensure a follow up job contract has been signed and to avoid a visible pregnancy bump during job interview season. - @femalesurgreg