Reinventing the surgical career for parents and caregivers

Women want to work in surgery, but for many it is an aspirational career (doi:10.1136/bmj.p449).1 Those who start often leave. Surgery is highly inappropriate for women (https://www.nuffieldtrust.org.uk/research/future-proof-the-impact-of-parental-and-caring-responsibilities-on-surgical-careers).2 One study found that women made up 50% of newly qualified doctors but only 15% of surgical consultants. Previous reports have outlined the challenges faced by women in surgical careers with little impact on outcomes. A Royal College of Surgeons review in 2021 acknowledged its failings in advancing diversity and inclusion (doi:10.1136/bmj.n998).3

This judgment matched the rhetoric of opening up surgical careers, a judgment better suited to Sir Lancelot Spratt’s era. It was the beginning of a meaningful conversation, at least. A new report from the Nuffield Trust says there is a ‘positive commitment to change among stakeholders’ (doi:10.1136/bmj.p449) but the problems identified by the university last year (doi:10.1136/bmj.02276) remain persistent. turn around14

Instead of a career that fulfills the responsibilities of parenting and caregiving, surgery forces interns to make difficult compromises in their personal lives. These challenges, from childcare to flexible working, exist in all healthcare professions, contributing to the working conditions that plague modern healthcare, and surgery remains perhaps the toughest work-life balance.

One difference in the UK is that while the proportion of doctors in training working less than full time has doubled over the past seven years to 27%, surgeries remain at 7%. The Nuffield Trust report also found that doctors were less likely to accept applications for training posts during early surgical training if they did not want to work full-time. This decision inevitably discriminates against women, although combining parenthood and a surgical career is also difficult for men. The Nuffield Trust report makes some constructive recommendations to improve the surgical career of parents.

The broader issue is a radical culture change in medicine, including primary care, to make it more compatible with modern working practices, providing an appropriate level of service (doi:10.1136/bmj.p334).5 The chasm between what is best for patients and what doctors in the health system can offer their patients is getting harder to bridge day by day (doi:10.1136/bmj.p470 doi:10.1136/bmj.p458 doi:10.1136/bmj.p459). doi:10.1136/bmj.p457).6789 Iona Heath and Victor Montori explain how a ‘bread and roses’ approach can underpin a better response to the care crisis (doi:10.1136/bmj.p464).10

This crisis has at least two dimensions, patient care and staff care, and the two are inextricably linked. It is a system-wide dysfunction due to the gap between what is best for clinicians and what politicians are willing to offer to improve clinicians’ working conditions and pay (doi:10.1136/bmj.p466 doi:10.1136/bmj.p474).1112 The day-to-day interactions of healthcare systems are complex and are best managed by people who understand these complexities. Politicians’ detachment from the reality of the health service —If you doubt it, Matt Hancock’s WhatsApp message leaks will convince you (https://www.bbc.co.uk/news/uk-politics-64807127)13-He is caught out paying £6,000 a day to senior Deloitte staff for a pandemic testing and tracing system that “largely failed to meet its objectives” (doi: 10.1136/bmj.p444).14

Achieving workforce diversity and fairness in care are fundamental requirements, the absence of which is manifested in many ways, such as slowing the progression of maternal mortality (doi:10.1136/bmj.p454),15 strengthening disparities in surgical outcomes (doi:10.1136/bmj-2022-073290),16 adoption of discriminatory health policies (doi:10.1136/bmj.p341),17 and the failure of international organizations to address the exploitation of vulnerable people (doi:10.1136/bmj.p410).18 These are deep-rooted challenges, and among them is the seemingly unbridgeable divide between being a surgeon and a parent; however, as with everything we face today, we must find our way.