Tick Tock Goes the Biological Clock
In one month, I will turn 30. While I try to reassure myself that this year will be no different, there is a heightened awareness of the mythical biological clock. This is almost certainly influenced by the growing number of friends and colleagues who have had one or more children in their late 20s to early 30s. I don’t feel ready to have a child. I don’t yet feel I have reached a point in my career where I am happy to take a step back, take time off or work part-time. In an era where everything is evolving at such a fast pace, particularly with regard to research, I fear the thought of falling off the ‘conveyor belt’ of specialty medicine training and being forgotten in the academic world.
I am sure this is a sentiment shared by others. When we embark on this long, rewarding journey, it initially seems like a fantastic and open pathway to explore a variety of specialties among medicine, surgery and general practice. The further along the training pathway, the more absorbed you become, until you realise your personal life has taken a back seat. This is even more true for Cardiology training in particular, as the on-call commitments tend encroach on one’s personal life.
I am extremely lucky. I met my husband outside of work at the end of medical school. Given that his work is not in the healthcare space, he has found it difficult at times to understand the expectations and pressures of our training program. Despite this, he has continued to support me, even when I had to relocate for 2 years to a regional centre as part of my core specialty training. He continues to support me through every academic achievement, every paper, every conference, without a single complaint. He listens to my reflections from my workday, each and every day, regardless of whether he understands the content.
We share a desire to have children, however, we are both acutely aware that this is largely dependent on finding a manageable time as dictated by my training program. We both feel somewhat at a loss to determine that “ideal” time. Additionally, we have had numerous discussions about shared parental leave as we feel his vocation is more flexible to enable him to work from home and part time, which would allow me to continue to pursue my career aspirations.
There is a growing proportion of women, like me, who want to continue clinical work while pursuing a family. The choice and timing are uniquely individual. I, along with my peers, look to female mentors who have navigated this path. Unfortunately, very few have reconciled specialty training with family planning, prior to starting fellowship or consulting work. Moreover, longer training timelines and increasing requirements such as higher education (PhD, MPH) during cardiology training means trainees will only start consulting work in their late 30s. This is in conflict with the usual time female trainees would otherwise be considering family planning.
In Australia, very few cardiology trainees have interrupted our 3-year specialty training to take maternity leave. For those considering their options, we are advised to explore the Royal Australasian College of Physicians’ (RACP) policies regarding parental leave. Unfortunately, the governing bodies within Australasia, both the RACP and the Cardiac Society of Australia and New Zealand (CSANZ), do not have clear policies or provisions to support trainees interested in part-time or interrupted training for family planning purposes. The existing process is vague and unclear, leaving many reticent to risk career prospects in favour of asking for part-time or interrupted training. Moreover, women specifically worry that there may be bias regarding their age, family plans and desires to enter into cardiology specialty training.
At the institutional level, many hospitals are willing to explore initiatives to support family planning, however in the absence of a firm infrastructure to manage this, this is unlikely to materialise. There is still significant heterogeneity across different institutions, and to date, no meaningful progress has been made in this area.
In general, there is a lack of consensus related to institutional training absence policies, interruptions to advanced training and supporting parents transitioning back into clinical work such as providing access to childcare and lactation facilities in the work environment. As a result, many trainees, myself included, are not inclined to interrupt training or consider family planning during cardiology advanced training, out of fear that it may jeopardise training opportunities and career progression. To my knowledge, very few female cardiology advanced trainees have fallen pregnant during their advanced training years, opting to wait until fellowship or beyond when they feel they have more certainty about the future and more control over their work conditions.
More recently, a growing number of female cardiologists and trainees in Australia and New Zealand have shared the concern both within the Women in Cardiology network and to the RACP around the absence of transparent and standardised parental leave provisions and are advocating for flexible training and provisions for parental leave or other interruptions to specialty training. This, in part, sparked the formation of a Victorian Women in Cardiology working group, as we felt there was a need for greater advocacy for females within the field of Cardiology. While current efforts are being made within Cardiology, this issue extends to other specialties and affects both genders in the face of a more contemporary family structure.
I, for one, intend to continue to ask the uncomfortable questions and seek clarification regarding existing policies and intend to advocate for more transparent and realistic flexible training for trainees to shift the balance toward better work-life stability. I am so glad that this is no longer a taboo subject and that trainees can feel more empowered to voice their opinions and have some autonomy regarding their training experience. There is still a long journey ahead toward establishing policies that better serve the needs of trainees. I am hopeful that our current and ongoing efforts may act as a platform for a more contemporary and flexible approach to training that better reflects our evolving workforce.