Future proof: The impact of parental and caring responsibilities on surgical careers

Amidst a multi-faceted and complex staffing crisis across the NHS, many health service staff are struggling to manage both their work and non-work responsibilities. Work–life balance is now the most common reason (along with retirement) for leaving an NHS role.

Support for working parents is a vital part of this balance, and the Royal College of Surgeons of England commissioned the Nuffield Trust to explore the impact of parental and caring responsibilities on participation, progression and experience in surgical careers in order to understand the issues within that profession. Our research included a literature review, policy analysis, a survey of those considering or in a surgical career, interviews with doctors working in surgery, a focus group with medical students and analysis of workforce data.

Although policies exist to support parents who work in the NHS, our research indicates a worrying gap between policy and reality. Some issues are apparent right across the NHS, and others are felt across wider society. But some factors – such as the length of the training pathway, nature of the role, and professional culture – make them more acute within surgery.

Key findings

• Considerations of parenthood play an important role in career choice. Two in five respondents to our survey suggested that their parenting plans, decisions and experiences had made them less likely to pursue a career in surgery and more than half indicated that these had influenced their decision about the surgical specialty they plan to or do work in.

• Parental or caring responsibilities also appear to affect career progress. Around two-thirds of survey respondents suggested that their parental plans, decisions and experiences had impacted on their likelihood of achieving their career goals – of taking on leadership roles or undertaking research.

• Parental responsibilities are often a reason for considering leaving. Just over half of respondents to our survey (55%) indicated that their parenting plans, decisions and experiences had meant they had considered leaving their role in surgery.

• For many, a career in surgery has had a tangible impact on their decisions around planning a family.  Three-quarters (76%) of survey respondents suggested that their career was likely to influence or had influenced when they would have children. The impact is not limited to timing, with two-thirds (65%) reporting their career having an influence on the number of children they have or would have and two in five (41%) reporting that it had an impact on whether they had or would have children.

• Doctors working in surgery are often not able to access the various entitlements intended to support those with parental responsibilities. For example, just 5% of respondents to our survey reported being satisfied with their access to facilities and support for feeding an infant, while only one in five (21%) were satisfied with their access to a phased or supported return to work after parental leave.

• Although the majority of women responding to our survey were satisfied with their access to parental leave, few male or female survey respondents (17%) were satisfied with access to shared parental leave. Men were around half as likely as women to be satisfied with the length of their parental leave.

• Childcare was consistently raised with us as a challenge. This is not an issue unique to doctors working in surgery, but training rotations and often long and unpredictable working days can exacerbate it. Most respondents to our survey reported that their childcare did not fit their working pattern, had inadequate spaces and was not in a convenient location.

• Around two-thirds of our survey respondents (64%) reported that information on pregnancy at work (including risk assessments) was insufficient for their needs, with some noting that it was too “ad hoc” or rigid to account for evolving needs.

• All too often, respondents who needed to make use of support systems were discouraged from accessing various entitlements or were not allowed to access them, including a phased or supported return to work (18%), time off for family and dependants (16%) and less-than-full-time working (15%). Some reported examples of bullying and discrimination.

• A lack of flexibility was often mentioned as a challenge for those working in surgery when seeking to balance parental and work commitments. Flexible working patterns and more flexible training pathways were – along with improved culture – the top three things highlighted in our survey as necessary to improve the experience and situation of parents working in surgery.

• Some 61% of survey respondents regret the family sacrifices they have made for the sake of their career. And while a small majority of those in or pursuing a career in surgery who responded to our survey thought it was compatible with parenthood, more than a third (36%) did not.

If the NHS is committed to making flexibility ‘the default’ and committed to ensuring that it has a diverse workforce, there is valuable learning to be taken from this work. Although there may be particular issues related to gender, it is important that action to address the impact of parenting and caring responsibilities within surgery includes everyone. Improving the experience of those with parenting and caring responsibilities who work in surgery will require concerted action from the surgical profession (including the Royal College of Surgeons of England), NHS trusts, NHS policy bodies and wider society. We make a number of detailed recommendations in the full report.