Today I presented as a keynote speaker at The Melbourne Clinic’s International Women’s Day breakfast. I spent a lot of time deciding what to talk about, given the audience was built from members of various disciplines. But I knew I wanted to incorporate my struggles to get through medical training as a doctor and mother, on behalf of all female trainees who fear speaking up.
I was asked by some if I could video the keynote but I decided not to, for it contained a lot of personal information that I did not want to reach the public domain. Nevertheless, I do wish to share some of the points I made about the rigidity and inflexibility of medical training and how that impacts on all trainees. But given it was International Women’s Day, I focused on motherhood and medicine. And being in a psychiatry setting, I drew on the work of Donald Winnicott, a paediatrician and psychoanalyst who defined the phrase ‘the good enough mother’.
This article describes eloquently Donald Winnicott’s actual definition when using the term, ‘the good enough mother’.
a mother is neither good nor bad nor the product of illusion, but is a separate and independent entity: The good-enough mother … starts off with an almost complete adaptation to her infant’s needs, and as time proceeds she adapts less and less completely, gradually, according to the infant’s growing ability to deal with her failure. Her failure to adapt to every need of the child helps them adapt to external realities.
The article states that being a ‘good enough mother’ is actually better than being a perfect mother when it comes to a child’s well being.
So, to examine the life of a mother who is also training to be a doctor, is this attainable?
When exploring this idea, I focused on my own journey through training. Motherhood waited until all of my formal training requirements were out of the way. I was lucky and fortunate that life turned out that way. Women are often blamed for delaying parenthood for the sake of the careers, but when I was brutally honest about my own predicament, I knew that the way training programs and workplaces run, with the degree of inflexibility and dismal variety of part time positions, I had to be a realist and wait.
After speaking to many trainees I know that the facts are that women are often asked (illegally) when they plan to start families when applying for roles, and women are looked down upon and viewed as ‘not dedicated enough’ if choose to train part time. Training colleges such as the Royal Australasian College of Physicians hold the most critical of exams on only one day per year. With he surplus of medical graduates and the bottleneck to attaining valuable physician training places, men and women, parents or want to be parents put their lives on hold to study for 1-2 years. It is difficult to comprehend in such an inflexible system, how one can adapt to a child’s needs to achieve being ‘good enough’. In many cases ‘good enough’ has to be re-classified as absent or at the very least inconsistent. A mother in this position would require enormous practical and emotional support to be able to meet all the training requirements imposed upon them to pursue their careers. Not all mothers have that. And why should mothers be expected to meet these needs at all costs, when they are such a vital component of our workforce?
Two years ago, The Royal Australasian College of Obstetricians and Gynaecologists added the following topic for debate at an annual scientific meeting – “Membership before maternity leave: Should every registrar have a Mirena?” (an form of contraception for women). It was designed to encourage debate about the very issues I spoke about today. But it was brutal, and deeply hurtful for many trainees around the world. Because to many it described what is actually spoken about in the workplace, and flies in the face of colleges who purport to offer flexible training conditions. There was no parallel discussion about the need for male registrars to use contraception.
In addition to this, our work, our training, our ability to enter medicine requires a degree of perfectionism. Our patients expect we don’t make mistakes. We are asked the most intricate and minute details of medical conditions in our exams. Things we may never see in real life, but we have to be on top of to pass. How does a mum switch out of the behaviour of a perfectionist when approaching or juggling motherhood?
In my case, and I know for most doctors employed in the public system, we are employed on one year contracts. This is so we can’t accrue leave entitlements afforded to most other women. So when I went on maternity leave, I was given around 8 weeks. My contract was not renewed, and I was told to contact my training hospital when I ‘felt like returning to work’. I was therefore unemployed, despite paying ongoing fees to my training college. This had financial and emotional repercussions on my family, and I did not return to that hospital to complete my training. In 2018, working mothers are rostered to be on call but there are still no child care options after hours available to them.
I make these points because as a consultant psychiatrist I am safe to do so. Trainees can’t speak up. So we must combine our efforts to fight for their conditions, as our successors.
The rest of my presentation focused on two issues I hold very dear to my heart when it comes to my approach to being a mother.
- Normalising mental illness so my son accepts it is common and treatable. Just like colleagues in other specialties in medicine, he came to the hospital and sat in the nurses station while I did my rounds. He knows what a psychiatrist does which is better than many in the population. He knows his mum is a doctor and helps people.
- The vital role mothers play in their son’s life about teaching them how to treat and respect women. Leading by example, standing up for myself if feeling mistreated and talking about good and bad experiences in the playground or society.
I’ll elaborate on the second point, one of the most amazing ‘a-ha’ moments of my life, and the one I reflect upon when unsure if I am being ‘good enough’ when fulfilling these goals. My son had to choose a famous Australian who had made a difference in society to research when he was 10 years old. He chose the Former Australian Prime Minister, the Hon Julia Gillard, without my knowledge or influence, and some of the key features he elaborated upon were that she proved women could change stereotypes, and her advocacy for gender equality. I was thrilled to be able to provide her with a copy of my son’s work at a recent event.
So, is it possible to be ‘good enough’ in medicine as a woman and mother? I argue yes, but it is all in the timing. And until we afford women the same rights as in other professions it will remain that way. At the expense of losing a significant amount of doctors from the workforce when we need them, because they have chosen to be mothers.
Dr Helen Schultz is a consultant psychiatrist, author, public speaker and doctor’s mental health advocate.