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Both the medical literature and popular press draw our attention to the statistics on women in medicine and particularly the lack of women in postgraduate training programs. In 1998, 57.8% of general practice trainees but only 33.8% of trainees in other specialties were women;¹ in 1999, 44.1% of vocational trainees (GP and specialist) were women, but there were marked differences in the proportion of women training in individual specialties (ranging from 12.6% of surgery trainees to 66.7% of paediatrics trainees²) (Box 1).

Between 1989 and 1999 the proportion of women commencing medical training increased from 43.6% to 52.7%, while the proportion of female vocational trainees in the same period increased only marginally, from 43% to 43.7% (including trainees in general practice).² Thus, the increasing number of women entering the medical workforce is not reflected in the proportion of women in specialist training.

The problem

Male medical practitioners are more likely to be in a relationship than women, and female practitioners in a relationship are more likely to work part-time (rather than full-time) than those not in a relationship.³

It has been noted that "female practitioners are more likely than male practitioners to have curtailed their careers for family reasons".³ This may involve suppressing career expectations, restricting choice in favour of career paths that provide greater flexibility and allow part-time work, prolonging the training process and/or limiting their role within the profession.

Barriers to career advancement that influence the structure of the medical workforce occur most noticeably during vocational training and the child-rearing period of a woman's life.³ Women in training programs who want to have children are at a great disadvantage. When is the best time? — during an intern year, before the Part 1 examination, between Parts 1 and 2, before or after a PhD or master's degree? Or perhaps during an overseas fellowship?

I was fortunate at the start of my radiology training to be assigned to a department with a very supportive director. After completing my internship I began my training immediately (this is now not allowed — at least one year of hospital work is required). After about four months I became pregnant.

Members of the department, including my fellow registrars, were supportive. At that stage they were all ahead of me in the training program. I did all the work that I could comfortably and safely perform, passed my Part 1 examination, and had my baby.

After seven months of maternity leave, I reluctantly returned to full-time work. This was extremely difficult for me — I wanted to continue my training, but not at the expense of spending little or no time with our daughter.

The idea

The experience

Initially there was some opposition to our arrangement from our contemporaries in the program, who were concerned that we would not fulfil our duties and that it would add to their workload. I do not believe this occurred.

My working partner completed her training almost two years before I finished and, as there was no one to continue to job-share with, I was permitted to work alone part-time.

Training took over seven years (instead of the usual five), and had I not been given the opportunity to work part-time I would probably not have completed the training. Some women have described the "elongated journey" to specialist qualification in negative terms, but others have found it more "rewarding".³ Certainly, my experience was not negative; the reward for me lay in the fact that at the end of the journey I had maintained a relationship, built a family and completed my training, so the extra time taken was well worth it.

During the period of our training, my colleague and I between us had five children (almost six, as I completed the last six months pregnant). I now work two and a half days per week in a public hospital, which is far more flexible than working in private practice. Although my priorities lie mainly with my family, I make a significant contribution to my work environment and my input will probably increase as my children get older.

The problems for women doing specialist training are similar worldwide. For example, in the United Kingdom, Maingay and Goldberg found that the "combination of four factors — manpower, duration of specialist training, working hours and maternity provisions — means that in the UK it is particularly difficult for women doctors with families to combine successful full-time specialist training with raising a family".⁴ Importantly, they noted that "the health care system cannot afford to waste these doctors". The Flexible Training Scheme has been introduced in the UK in an attempt to redress the situation.

Changing attitudes

Opinions on the issue of allowing part-time specialist training are divided. The Medical Training Review Panel has stated that "Change is required in the organisation and management of many of the specialist training programs so that female practitioners can have the opportunity to better participate in the training program and then, ultimately, within the medical workforce".² Yet, general opinion among the leaders of the medical profession continues to favour full-time training. At a workshop in 1999⁶ to assess progress in implementing the recommendations of the Brennan Report,⁷ there was a strong view expressed that any changes to training schemes should not increase the overall length of vocational training "in the process of making work practices and training schemes flexible for women".²

There is also a concern that "With the increasing proportion of female medical undergraduates, if the current preference for [postgraduate training in] general practice continues to predominate, it could be expected to contribute to a continued shortage of specialists and to increase the gender imbalance between general practice and specialist practice".⁸

It is not just women who are asking for more flexible training arrangements. The career expectations of male doctors also appear to be changing, with choices influenced by flexibility and manageable hours.

My training was certainly different from that of my contemporaries. I can not judge whether it was better or worse, or neither, but it certainly allowed me to fulfil my ambitions to become a qualified radiologist and to have a family. I can only hope more women will have the opportunity to do the same.

References

1. Australian Institute of Health and Welfare. Medical Labour Force 1998. Canberra: AIHW, 2000. (National Health Labour Force Series, No. 16) (AIHW Catalogue No. HWL 15.)
2. Medical Training Review Panel. Third Report. Canberra: MTRP and Commonwealth Department of Health and Aged Care, August 1999.
3. Australian Medical Workforce Advisory Committee. Influences on participation in the Australian medical workforce. Sydney: AMWAC, 1998. (AMWAC Report 1998.4.)
4. Maingay J, Goldberg I. Flexible training opportunities in the European Union. Med Educ 1998; 32: 543-548.
5. Cohen-Schotanos J, Huisjes HJ. [Status of the job market of physicians who started their education in Groningen in 1982 and 1983.] Ned Tijdschr Geneesk 1994; 138: 1434-1437.
6. Medical Workforce Training and Employment Workshop — April 1999. Summary of outcomes. Sydney: Australian Medical Workforce Advisory Committee, 2000. Summary available at <http://amwac.health.nsw.gov.au/corporate-services/amwac/movingforward.html>. Accessed 5 February 2001.
7. Brennan PJ and Associates. Trainee selection in Australian medical colleges. Canberra: Medical Training Review Panel and Commonwealth Department of Health and Family Services, January 1998. (Publication No. 2291.)
8. Australian Medical Workforce Advisory Committee. Female participation in the Australian medical workforce. Sydney: AMWAC and Australian Institute of Health and Welfare, 1996. (AMWAC Report 1996.7.)

Reprints will not be available from the author.
Correspondence: Dr M T Gun, Department of Radiology, The Queen Elizabeth Hospital Campus, 28 Woodville Rd, Woodville South, SA 5011.
olmtosiATchariot.net.au

©MJA 2001
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