#ILookLikeASurgeon – A Female Unaccredited Surgical Registrar’s Experience of Egg Freezing
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
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This is how I found myself sharing the waiting room of my fertility specialist on my half day, with couples trying everything they can to start or add to their family. I am once again in the minority, a single female trying to combine an unpredictable work week and long-term career, with precisely timed assisted reproductive treatments to freeze my eggs and preserve my choice to have a family ‘one day’. The process is extensive, and I was somewhat naïve as to what the next 10 months would bring in an emotionally, mentally, physically and financially taxing round of treatments. I now know that female physician infertility rates are double that for age-matched general population (24.1%), and that female doctors are also more likely to experience high risk pregnancies, increased incidence of miscarriage and other neonatal health complications. Initially though, I blindly went into the process thinking it was as easy as one egg freezing cycle and I would be done.
Whilst we are still trying to understand the real and confounding factors that reduce a doctor’s fertility compared to the general population, I cannot help but wonder what the years of stress and imbalanced work-life has on one’s overall health. Unfortunately, my journey started with a diagnosis of reduced ovarian reserve for my age and translated into three egg freezing cycles – 10 to 16 days of hormones, one day procedure under anaesthetic and a few days of recovery. I’ve frozen 22 eggs after more than 100 self-injections, countless blood tests and supplements and seven invasive ultrasounds. I have spent close to $10,000 for the privilege (add to that another $4,000 if your health insurance doesn’t cover assisted reproductive medicine) and I have at least one more cycle to go.
The more I have begun talking about my experiences, the more I realise how hungry junior doctors are for information about family planning and balancing this with demanding pre-training professional development requirements. Unaccredited surgical training positions are an imperfect answer to training bottlenecks and increasing numbers of medical school graduates. However, the reality is that the current training system is unlikely to change any time soon. My aim in sharing my experiences is to normalise conversations around family planning and talking about our values and life outside of the hospital.
My hope is that these conversations can carve out opportunities for female medical graduates to chase a successful and fulfilling surgical career, without sacrificing other things that may be important to them. With RACS’ commitment to identifying and improving gender-based barriers to pursuing surgical training, there’s never been a better time to challenge the stereotype of who a junior surgical trainee needs to be. If we never see someone who looks like us, talks like us, thinks like us, fosters a life like us, and is a competent and successful surgeon, how will junior female doctors realise their dreams of becoming a surgeon too?