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There has been gender parity in Irish medical schools for around 20 years now, yet female doctors continue to be grossly under-represented in senior medical, academic and leadership posts.
There are now a number of working groups and recently-published reports on how to achieve better gender balance in medicine in Ireland, which look at the various challenges that need to be addressed.
There have also been a number of positive achievements regarding women in Irish medicine in recent years, with the appointment of the first female Masters of the Dublin maternity hospitals, the election of Prof Mary Horgan as the first female President of the RCPI, and earlier this summer, GP Dr Rita Doyle was elected President of the Medical Council.
It is clear, however, that much more progress needs to be made. Only 7 per cent of consultant surgeons in Ireland are female, despite a third of surgical trainees being female, and only around 30 per cent of hospital consultants are female. Also, medical school and training body councils, faculty, examination boards and conference speaker panels are usually overwhelmingly male across the specialties.
Having a family is probably the biggest challenge to female doctors achieving their full career potential. So is there enough support during maternity leave and raising a young family for female doctors in Ireland?
When the Medical Independent (MI) sought to speak to female doctors about this topic and asked the above questions, the response was immediate and overwhelming, with dozens of doctors getting in contact to highlight their experiences. The responses mostly came from females, but male doctors also wanted to highlight their partners’ experiences. We spoke to doctors across the spectrum of career stages and specialties/settings about having children — from currently being pregnant, on maternity leave, or with grown-up children (see tinted panel).
Their experiences, while all giving a fascinating insight into the individual and parallel challenges faced, were mixed. GPs in particular experienced the most challenges in taking maternity leave. Given that general practice is seen as an attractive, family-friendly option for female doctors, with a majority of trainees now being female, this was particularly striking.
Maternity-related issues — including examples of heavily-pregnant doctors having to work night shifts and lack of facilities to allow doctors to return to work gradually at the end of their maternity leave — were raised in the seventh progress report on the implementation of the MacCraith Review published in June. Recent Irish research in the area, published in major international journals, has also revealed some strikingly negative findings with regards to pregnancy outcomes and career progression/choices for female doctors, particularly surgeons.
So what supports do the training bodies and health employers offer female doctors taking maternity and parental leave, and have unions sought more concessions in this area?
All of the training bodies of the RCPI have a policy to facilitate flexible medical training, the College told MI. “The training body recognises and supports part-time, interrupted, and other forms of flexible training and all trainees are eligible to apply for flexible forms of training for a period.”
Trainees can apply for part-time training either through the HSE National Doctors Training and Planning (NDTP) Supernumerary Flexible Training Scheme, while postgraduate trainees on the Higher Specialist Training and Basic Specialist Training Programmes can avail of job-sharing opportunities for a set period of time.
In relation to GP training, the ICGP told MI that it has a policy for providing flexibility during training that takes into account, as far as possible, the personal and family needs of the individual trainee.
With regards to GPs in employment, the College pointed out that it does not have responsibility for the terms of employment of GPs in practice, whether they work as locums, employees, assistants or partners, noting there is wide diversity within general practice.
“The College encourages that the profession offers attractive work conditions and flexibility to all GPs; this supports the retention of GPs as their career and life evolve. At the individual level, the terms and conditions under which GPs work together is a matter ultimately for negotiation and agreement between the individuals, be they employees, employers or partners. Where a person has employee status, employment law and regulation applies.”
As a provider of continuous medical education, the ICGP said it provides a suite of web-supported online learning opportunities accessible and flexible for members when they wish to engage and participate, including when they are on leave of absence from clinical practice.
The broader perspective on this issue is the question of capacity in general practice, stated the ICGP, and thus the serious challenges encountered by all GPs — “that of workload, capacity and serious staffing shortages, which has reached crisis level”.
Prof Mary Higgins
So what are the unions doing about these issues? Responding to queries from MI, the IMO pointed out that last year it published a position paper on women in medicine and negotiated with the HSE on the issues of parental leave. The outcome of this negotiation means that NCHDs can aggregate service in the HSE across multiple hospitals, including private hospital training posts, to contribute to the 12 months’ continuous service required to avail of parental leave.
A spokesperson for the IMO said practise in medicine must not be mutually exclusive from a healthy work-life balance, or the ability to comfortably meet family commitments.
“It is clear from the responses to the IMO survey on gender issues in Irish medicine, and from other research in this field, that concerns regarding family commitments and work-life balance operate as a behavioural determinant in specialty choice, and difficulties experienced during pregnancy or managing family commitments clearly exercises an unwelcome influence over many doctors’ lives. Included in the recommendation of the MacCraith report was the introduction of more flexible family-friendly options during training and in consultant posts.”
In addition to recommending flexible work practise, the IMO also wants the HSE to investigate the suitability of on-site crèche or child-minding provisions at its premises to better facilitate ease of access to childcare for doctors who are parents.
This recommendation on childcare provision was echoed by some of the female doctors who spoke to this newspaper about their experiences; they pointed out that crèche and child-minder hours are not compatible with a doctor’s hours, ie, out-of-hours, weekeknds and night shifts.
Female doctors also told MI that they welcomed seeing these issues being taken up by the unions and some of the colleges, as they felt their importance had long been underplayed, perhaps as a consequence of the largely male senior representation in medical unions and health employer negotiations, and at senior academic levels.
Currently, maternity leave in Ireland consists of 26 weeks’ paid and up to 16 weeks’ unpaid leave. The HSE pays full maternity leave cover but private employers do not have to, so women may only be entitled to statutory pay, if even that, depending on their working and tax situation.
In the Irish health sector, the current gender employment ratio (male:female) stands at 21:79, according to the HSE: “This brings challenges for both employees and employer, including the fact that the CSO statistics (2016) would suggest that in many families it falls to the women to act as primary caregivers to children and elderly relatives.”
In response to queries on what it is doing to support female doctors specifically in taking time out to have families, the HSE said its National Strategy for Doctors’ Health and Wellbeing 2018-2021 was launched earlier this year, which will apply from the first day in medical school and specifically addresses the unique challenges of every stage of a doctor’s working life.
In addition, research on the experience of working parents in the HSE on return to work following the birth/adoption of a child was recently conducted by the HSE’s Workplace Health and Wellbeing Unit to inform future policy in the area.
This research project looked at “how the organisation could further enhance the experience and support for post-maternity employees”, noting that returning to work was a difficult transition for new mothers.
Almost 200 employees responded, expressing interest in this research area.
“Supporting working parents and women in work is having, and will continue to have, a direct impact on the delivery and provision of high-quality healthcare. Supporting the ‘working parent’ should be placed high on the organisation’s corporate agenda,” according to the document.
In total, nine recommendations were made. One example is to extend the existing Women in Leadership Mentorship Programme to a specific mentorship programme for working mothers.
The HSE has agreed to action the research findings and recommendations and an implementation plan is currently in development to support the HSE in delivery of the recommendations, which is to commence this autumn.
There is particularly low representation of females in the surgical specialties, which are not seen as family-friendly. Research recently published by Dr Ailin Rogers, SpR in surgery, mother and Chair of the Irish Surgical Training Group, found female trainee surgeons were less likely to have children than their male counterparts (22.5 per cent vs 40 per cent). They were also more likely to experience infertility, which was likely due to delaying pregnancy for career reasons.
In the last few years, the RCSI has taken a number of specific actions to address the problem. These actions include putting together a gender diversity group, which has published a major report with key recommendations to make surgery more attractive to female trainees and provide better support for their needs when having children.
In July, the RCSI hosted the 2018 Women in Surgery conference, which focused on the experience and evolution of gender equality in surgery in the US and Ireland.
Speaking to MI, Chair of the conference Prof Deborah McNamara, a Consultant General Surgeon at Beaumont Hospital, Dublin, said one of the key messages imparted by the leading female US surgeons who spoke at the RCSI event was “that there are lots of ways of being successful”.
“I think when women surgeons are at the beginning of their career, they see only one sort of career structure as being what they envisage success as being. But we had lots of examples of surgeons who took pauses at different phases of their career, really depending on their personal priorities. It is possible to have a very successful and fulfilling career as a surgeon and still have a family, but it is important to prioritise and to accept the reality that sometimes, one aspect of life has to be prioritised over others and that doesn’t mean that the person can’t be successful — Prof Barbara Bass, President of the American College of Surgeons, became a professor of surgery when her youngest child graduated from secondary school. So there are a lot of ways to make a successful career.”
Prof McNamara was also the lead author of the RCSI Gender Diversity in Surgery report (2017), and said that since its publication, an internal implementation plan has been put in place. Changes made already as a result of the plan include increasing the amount of notice trainees have about their rotations to allow better planning, as well as efforts to increase female trainee mentoring.
Prof Deborah McNamara
She also praised the HSE’s National Flexible Training Scheme, which facilitates over 30 NCHDs in a training programme to continue their training in a flexible manner (usually 50 cent) for a set period of time. It is particularly popular with female trainees with young children.
“When I compare it to what is available in the NHS, our scheme is far superior. Our part-time trainees in surgery are fully funded and that enables them to have really practical concessions made, which makes training part-time possible. Some of the feedback we had in our progress reports was that training 50 per cent was probably too little for surgical trainees. For many trainees, they just need a small bit of leeway in their week, they don’t need necessarily to work half-time; working 80 per cent would be a really good solution and, in fact, the HSE did fund some ‘80 per cent jobs’ within the year after the progress report, so we thought that was a very positive step,” she commented.
“And we were delighted when the Minister [Simon Harris] indicated last year that the HSE was going to undertake a major research project relating to the experience of parenthood among healthcare workers, so that is something we are very much looking forward to and there is also the HSE HR ‘Work Well’ website.”
Another area that is now being progressed by the RCSI, according to Prof McNamara, is the setting up of an award for international fellowships for senior female surgical trainees who have children, as they can find it particularly difficult to undertake fellowships abroad.
“That is a challenging thing for many of the surgeons who are mothers because they have a young family to look after and it can be a very expensive time and they don’t have a guarantee of a job, so we are very actively looking for sponsorship to set up a very competitive peer-reviewed award for a surgeon approaching the end of their training to enable them to specialise… I think that would make a real difference to a lot of women who are at the edge of making it or not.”
In relation to creating more family-friendly working structures at consultant-level, she acknowledged that “surgery is not necessarily a part-time career and it can be difficult to make that work”.
“One of the things we need to look at structurally is how we can have bigger departments, possibly across Hospital Groups, where there are sufficient consultants in surgery so some staff can work flexibly… which will be important in recruiting and retaining surgeons.”
This year in the RCSI, 44 per cent of new surgical trainees are female and their progression is being carefully monitored, she noted.
“So while there are areas that could be further improved, I think that it has been very much firmly put on the agenda and continued progress will happen.”
So is it a case of much done but lots more to do? We would like to hear your views. Tweet @med_indonews, email email@example.com or firstname.lastname@example.org, and write to The Editor, Medical Independent, Top Floor, 111 Lower Rathmines Road, Dublin 6.
Women in Irish medicine: Relating the real-life experiences
“I have two children now, aged two and four years.
I started my own practice in 2012. I had a zero GMS list to start.
During my first pregnancy, a list came up. I had to go for it to be entitled to pay towards a locum and also to give me the opportunity to take on someone. I could only get a locum from my due date.
I wasn’t able to take any time off at all throughout the pregnancy. With the work from the new list, I left work 7:30/8pm most nights. I didn’t eat properly. I frequently cried driving home. I wasn’t able to attend antenatal classes and never saw a GP. I did attend a consultant. From 30 weeks, I had polyhydramnios and the baby was very big. I couldn’t take time off. I had dreadful heartburn and rib pain.
At 34 weeks, I had pains. That day I had to do a house call to a psychiatric patient. His mother sat in the waiting room until I agreed to go out. He was one of the new patients. I only found out afterwards he was highly dangerous. I saw him, sorted it then took myself to hospital. All was okay. But I was at work a week later and I passed a ‘show’. I continued to work that day and had an appointment that evening. I was in the start of labour at 35 weeks. I was admitted. My secretaries managed to get someone to cover the following week but on that Friday brought me prescriptions into hospital to sign. I had my baby on the Sunday. I took eight full weeks off, then went back for a few full weeks, then managed to do three-day weeks for another few months. Throughout all that time, I logged in from home to deal with results, etc.
For my second pregnancy, I had taken on a [practice] partner; what a difference! I still took little time off, as my partner was going to cover most of the locum. We had another doctor for eight days. Cover was impossible to find. It was less stressful with my partner but I felt hugely guilty. I took 14 weeks off this time, mainly because baby number two was very colicky and cried all the time. And the créche don’t take them until three months old.
We would not have been able to afford six months of locums.
I was able to pay myself, thankfully.
My only support is the crèche. It’s just bad luck for us. My husband is a vet with a new business and we have no family — both sets of parents are dead and no siblings locally.
In terms of work, even though I took so little time off, some patients left. I definitely felt guilty about that.
I would love to have more children but I could not ask my partner to cover again and the stress of having no guarantee of getting a locum would be too much for me. Other people are probably tougher.
So overall, I still feel very upset that what is such a joyous experience for so many was such a stressful one for me. I’m honestly still traumatised by it. I know a lot was circumstantial. But I feel we’re treated as if we are somehow superhuman. And I don’t feel there has ever been any acknowledgement of this difficulty when you are a GP.
It highlights the difference between the bigger cities and outside too. It seems to be much easier to attract locum cover in the cities.
In terms of having children, the difficulty with general practice is the unexpected house calls or even the paperwork. I have to collect the kids by 6pm. Thank goodness for being able to log in from home to deal with results, etc. Out-of-hours shifts are difficult, as I often need to get extra childcare.
I think that the current set-up, where we are self-employed yet have our GMS contracts, gives us the worst of everything from a maternity point of view.
Things are so much better now; my partner has young children too and we work in such a way that we never have to get locums. We have to keep our numbers down and cross-cover holidays.”
“I am currently pregnant with my first child.
I’m fortunate and do feel supported to attend antenatal appointments and adjust some workload — in public health, there can be a lot of travel and I am being supported to rationalise it.
My maternity leave will be paid, as I’m a HSE employee; I will have 26 weeks paid and can take 16 weeks unpaid following that.
I can see that it [having children] might impact on taking up a leadership role in public health. There is an expectation that half our time is spent on national-level work, so this might be more challenging from a childcare point of view.
I can only speak from my experience, but it has been mostly positive so far. I would like to see a clearer description of the appointments we can attend in our HR documentation — it should make it clear appointments for antenatal maternal immunisation are also covered.
I would also say that there is a large issue in relation to part-time working within the wider HSE. It is theoretically possible but, if I went part-time, for example, my service would not be able to recruit another person to fill the rest of my post. Additionally, if I stay part-time for a few years there is also the risk that my post will permanently be converted by the HSE into a part-time one. This means that if I leave the job, my service will only be able to recruit for a part-time job in future. This creates a pressure to stay full-time and I would recommend that more is done to facilitate part-time working for both genders.”
“I had my first child in 2017.
My working experience when pregnant was that I worked as an employed assistant in a four-doctor practice. My contract allowed for time off for appointments but I usually took them on my Wednesdays when I wasn’t at work anyway, as I don’t work where I live or near enough to my antenatal hospital. I was generally well minded though, and had a relatively uncomplicated pregnancy so there wasn’t the necessity for any time off. I was protected from house calls towards the end and generally finished on time. I felt supported.
I didn’t take as much [maternity leave] as I would like. I received only statutory leave, no contribution from my employer and even with savings, I needed to go back to work out of financial necessity seven months’ post-natal. I changed job on my return and the fact that my future employer will contribute to maternity pay was a huge factor.
It hasn’t affected my career so far, in that I did all of my training and worked in various assistant posts before starting my family so had relative stability and ability in general practice (vs hospital specialities) to be able to dictate what hours I worked, location, etc. I probably wouldn’t have had that option as a trainee.
I think general practice and GP contracts need to be reconfigured to address the fact that the workforce is now almost 50/50 female/male in general practice and that the current contract as it exists is not attractive to women with young families setting up in practice, taking on GMS lists with insubstantial allowances for maternity cover and leave. The option of a salaried GP within the HSE (and basic entitlements afforded to other HSE employees, such as paid maternity leave, protected study and annual leave) needs to be considered. A lot of female GPs I know who are starting their families, myself included, are putting off setting up in practice and taking over GMS lists, as we feel that it would adversely impact upon family life.
A GMS maternity locum pay is no good if you can’t find a locum or the subsidy is not reflective of current rates paid to private locums. I think the HSE needs to sharply recognise this, otherwise GP numbers will dwindle (or you may have more women moving into sessional private-only GP or work with corporates that can afford the above paid entitlements and pension).”
“Working in obstetrics, I was very well supported [during my pregnancies], though there were some things that in retrospect were not great. I came off-call after 24 weeks and instead of covering theatre and labour ward was asked to cover clinics, as that was considered ‘easier’ — at least in theatre, you can rest between cases, but in clinic, when one clinic finished the other started, so I had to be ‘on’ all the time. It was meant to be kind and supportive, but didn’t work out that way.
My daughter was born at 31 weeks and spent seven weeks in the neonatal unit. This has given me an amazing insight into how stressful and emotional it is to have a preterm baby, to leave a hospital without your child, to have to travel to see them every day, to worry about them… I think I am a kinder doctor for this experience but I still wish she hadn’t been preterm.
I took three extra unpaid weeks [of maternity leave] so I could go straight into a new job, and that was brilliant and everyone was very supportive in that job.
[Having children] consolidated [my career pathway] in some ways — I had responsibilities! — and in other ways (especially when she was in the NICU [neonatal intensive care unit]), having children puts everything into perspective, especially when you work in medicine, where you see sick children and think ‘I can handle anything as long as my children are okay’.
I sat my Irish membership 17 days after she was born and think I passed it only because I didn’t really care about it. I sat the English membership when she was nine months old and passed it because I suddenly realised I had to get it due to my responsibilities. I also learned how not to procrastinate and became better at prioritising things.
[What advice would I give to female doctors planning a family] Don’t wait — nearly all the women in obstetrics have their children early — nothing like covering a fertility clinic to put everything into perspective.
‘Part-time’ (40-hour week!) work is not just for mothers, and if used, why not have two part-timers working opposite each other so they can act as one WTE.”
“I had two girls during my higher specialist training in psychiatry. On both occasions, I experienced medical issues in the last six weeks and had to leave work early. There was no doctor employed to cover my maternity leave, which was obviously problematic. I took approximately eight months’ leave with both girls. I was able to attend all antenatal appointments but I was fortunate that these appointments didn’t fall on a clinic day…
I also needed to attend a physiotherapist for SPD and tried to schedule these appointments at 8/8.30am to avoid interfering with the work day. I struggled with walking in the last 10 weeks of my first pregnancy in particular and enquired if I could avail of parking closer to work — I was informed that if they made exceptions for one person, everyone would be looking for the same. I had been advised by my physio to enquire, as she felt that this would be a factor in my having to leave work earlier than my intended maternity leave.
I contacted my workplace to discuss the option of taking one day parental leave per week for the first few months, as my daughter was not settling well into the child-minding arrangement and this was met with some resistance. In the end, I only took parental leave one day per week for six weeks. I was also informed that parental leave would have to be taken into account and prolong my training, which I expected, and this also influenced my decision (no-one wants to prolong their training even further).
For me personally, my husband and I do not have any family locally and the transition back to work on both occasions was challenging. I also felt that there was little support around returning to work and acknowledging how difficult this can be both personally and professionally. There is a lot of catching-up following a prolonged period of leave, like maternity leave, both clinically and non-clinically (research projects and learning outcomes for training).
I feel that resources and recruitment are a huge factor in supporting women and men in the workforce when they have young families. I remember being acutely aware that when I was requesting parental leave after my maternity leave with my first daughter, that my post had been vacant for eight months and they were keen to have me back in terms of service provision, which is completely understandable. This didn’t help me though.
I think now as a consultant that if I had a trainee who was returning from maternity leave, I would be very aware of the challenge of this transition and would be as supportive as possible — I do think that even just acknowledging the transition and the challenges of early parenthood is helpful. We are generally very good at empathising with our patients and their families, but not so much with our staff.”
Dr Julie Reidy, consultant psychiatrist
“I have three children now aged seven, six and almost four years.
I always felt well supported [during my pregnancies] by my colleagues – both consultant and nursing particularly. At the same time I was a consultant during each of my pregnancies so if something needed to be done I would just have to fit it in another time to go to appointments etc. There is flexibility with being in a consultant post I think when pregnant compared to an NCHD post but also a greater sense of responsibility. What I found more difficult was the demands of the job – commuting, long days with few breaks, no lunch etc. Again as a consultant it is all within your own control but the work is still there and if you stop for lunch on a busy day you finish even later. Definitely no ability to reduce workload or finish early unless you asked colleagues to do you a favour but they are all overworked already too so it is not something I ever did.
I was happy enough with the amount of maternity leave I took – about six months on each of them. My first maternity leave I just received statutory maternity benefit, as I didn’t have a permanent contract. I was working in a temporary post and they didn’t renew my contract when I was close to my due date. They advertised that permanent post instead and a few other posts in the same CHO. It was really stressful doing the applications and interview preparation at that stage. This includes things men never need to worry about like getting a new suit that fits post partum. I did the interviews when my baby was eight weeks old. I was breastfeeding at the time and had to leave the baby to go to the interviews, express milk on the way etc. It was all very new to me at the time. I didn’t get the post I had been in but got one of the other posts. [During] the rest of that maternity leave I also finished my masters in CBT in Belfast so it was quite a busy time.
“On the pregnancies for my second and third children I was in the new permanent post but commuting an hour each way on bad roads … I got paid maternity leave thankfully. I did have to come into work for internal teaching sessions to get internal CPD points, which really annoyed me at the time. I think they have changed that now – you can do more internal CPD online etc. When I was towards end of maternity leave with my third I took the opportunity to have an elective procedure on my knee, as I didn’t want to have to take sick leave at work. (I know I would have been entitled to but at the end of the day a lot of these things fall on your colleagues).
I don’t think having children impacted hugely on my career because I was very conscious to try to minimise the impact. I did put a lot of additional stress on myself at the time and was lucky it paid off. I was also lucky that I had finished higher training and so did not have a delay in my training. The consultant salary allowed me to pay for childcare to be able to do some of things I needed to do also to progress my career.
I was very happy with support I received in my current post when I asked to take parental leave and I now take one day a week – the post was restructured to facilitate that.”
Dr Ann Hogan, specialist in community medicine (principal Medical Officer) and former IMO President
“All of my pregnancies occurred while I was working in the community medical service. I had two children in the 1990s and I got paid maternity leave on both occasions. At the time maternity leave was 14 weeks paid and four weeks unpaid. I was facilitated to take additional unpaid leave after my first maternity leave. I also had a miscarriage, after which I took some sick leave. I did not need to take any sick leave during the two full term pregnancies. I was facilitated to attend antenatal appointments. I worked up to 37 weeks in both pregnancies and I do not recall needing to reduce my workload.
There was no particular support on going back to work.
Before and after my first daughter was born, I was studying for a Masters Degree so I was back studying and attending lectures when the baby was a few weeks old, even though I didn’t go back to work until she was nearly five months old.
I don’t think having children impacted on my training or career progression, but planning for having children did influence my career choices.
Following graduation I worked in a variety of NCHD jobs with a view to getting a broad range of experience and eventually working as a GP. I worked as a locum GP in west Clare for one year before I joined the community medical service. At that time, there was no GP out of hours services and I was on a one in three rota on call. As my husband was on shift work it was clear that the combination of on call commitment in general practice and his shift work would make childcare very challenging. I was lucky that an opportunity arose in the community medical service in my local area and when I got that job there was no on call commitment.
Things have improved a lot in relation to maternity leave since I had my children. I did feel at the time that more time off after the babies were born would have been great so I am delighted to see that maternity leave is now six months paid with possibility of several months unpaid leave also and the introduction of parental leave.
I was very fortunate also with two great child-minders over the years, both of whom were a great support to me.”
Dr Jennifer Donnelly, consultant obstetrician and gynaecologist
“I availed of the HSE’s flexible training scheme while having my children, who are now 11, 13 and 14.
“When I was doing that, in the early 2000s, there was an impression that you weren’t committed to your specialty. It was a very difficult line to tread, as on the one hand you almost felt guilty for not working full time and you also felt guilty that you were not with your kids. Also during this period my husband, also a doctor, was finishing his training thus had a lot of on call, extra work, committee commitments, etc and I was also writing up my thesis.
Part time training allowed me to work at 60-65 per cent for a couple of years and I had my last maternity leave during that time and that allowed me to spend time in the lab and write up my thesis… I went abroad to do a fellowship and my husband took parental leave and came with me for part of that time so having a supportive partner and really, really good childcare was really important in terms of allowing me to continue. I have no regrets whatsoever but it did take me a little bit longer to get there but it was certainly worth it.”
She also echoed Prof McNamara’s belief that mentorships are also very important for female doctors trying to balance training, working and having young families.
*Thank you to all the doctors who spoke to us for this piece. We welcome and encourage letters, tweets and website/Facebook comments from those who wish to continue this conversation.