RCS England publishes Parents in Surgery report

The Royal College of Surgeons of England has published a new report documenting issues related to parenthood that affect surgeons, and recommending changes in culture and practice. ‘Parents in Surgery’ is a flagship initiative established by the College in response to recommendations made by Baroness Helena Kennedy QC.

The report features testimonials from surgeons who have experienced discrimination, were inadequately supported or felt judged, for working less than full time, being pregnant or being a parent. Some surgical trainees fear discrimination over job prospects if they discuss flexible working plans or take parental leave. Others defer starting a family, which could impact on their ability to have a family later, due to fertility issues.

The traditional surgical training route involves a minimum of 10 years training. For three years, trainees can be in ‘rotations’, moving every 6 months to a new city or area. Those who are parents face the challenge of caring for young children while moving frequently and fulfilling rota duties.

The Parents in Surgery report was developed through one-to-one interviews, focus groups, surveys, engagement with stakeholders and a literature search.

Key research findings include that:
• Planning a family or becoming parents typically coincides with the last years of surgical training. Time away from training and fixed commitments outside work can affect training opportunities and career progression.
• Increased pressure on surgical trainees linked to workforce gaps and increasing service demands are putting strain on individuals, affecting retention in the profession.
• Some US studies have found that female surgeons have first pregnancies later in life, fewer children, and report more issues with infertility. This needs further investigation in the UK
• There is evidence to suggest that those in male dominated specialties feel pressure to return to full-time work where other specialties may offer more flexibility. This is likely to affect the diversity we see in those specialties, and works against achieving gender balance in some specialties.
• Balancing flexibility with insufficient workforce numbers is an ongoing challenge, especially for rota planning. Managing childcare with short notice rota information is a particular difficulty.

Miss Fiona Myint, Vice President of the Royal College of Surgeons of England, commented on the findings:
“Wanting to be, struggling to be and becoming a parent, are part of everyday living. But while roles and responsibilities in society have changed, the surgical model has not kept up. Our research uncovered reports of punishing rotas, negative perceptions of less than full time working and unsupportive training models. Colleagues who train or work less than full time are no less passionate about their career. They are just as committed to their patients, and they deserve our support.

“As leaders of the surgical profession, we have a pastoral duty towards surgeons who are parents or carers, and a responsibility to understand and support their wellbeing. If we do not support young surgeons as they start their families, they will leave our profession. Neither patients nor the NHS can afford for that to happen.”

RCS England has committed to changing the culture of surgery to better support working parents who are following a career in surgery. In response to the report’s findings, the College will:

• Commission an independent review and impact study of the barriers to becoming a parent in surgery - to provide further insight and data.
• Develop a workforce strategy to understand the challenges faced at different points in the surgical career and by different groups.
• Work with the NHS in England, Wales and Northern Ireland, the British Medical Association, NHS Employers and other external partners to provide and update job planning guidance.
• Develop a toolkit for clinical managers and those overseeing training, to signpost resources to support their staff.

Researchers received scores of submissions and powerful testimonies. Here are some of the experiences sent in:

“I distinctly remember coming back to theatre after my first maternity leave having left my first precious bundle of joy in the new nursey. It’s that time period where they get any and every bug going and spike fevers at random without any warning and the nursery need to get your verbal permission to give Calpol. I was also a two-hour commute away and not able to leave mid surgery! So, I’m down in theatre with no phone signal, like a cat on a hot tin roof, worrying what if the nursery phone me! But equally empowered to be a female in surgery and back in the game! It’s a very mixed emotion!”

‘I was missing my wife and son, who had gone to my in-laws. It was Christmas and I would not be seeing them. This was the final straw. I resigned my training post and now work in a different specialty.’

“I am a male consultant and my partner is pregnant. I would like shared parental leave. There is little information about this and also stigma. It also feels like this is difficult to arrange, with ramifications on service. I feel there needs to be wider discussion about this to normalise it and make planning for shared parental leave easier.”

‘Despite all the regulations, a pregnant trainee is looked at negatively. Colleagues feel they have extra work due to pregnancy related leave. This is primarily because the post remains vacant because of recruitment issues.”

Notes to editors

1. The Parents in Surgery report is available here: https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/diversity/parents-in-surgery/
2. Parents in Surgery stems from a recommendation in the Kennedy Review (March 2021), into the diversity of the leadership of the surgical profession and the College. RCS England published a Diversity, Equity and Inclusion Action Plan  in September 2021.  This highlighted that the experience of parents in surgery at all career stages is challenging and stressful, prompting further work to support surgeons who are parents or carers.
3. The College’s Confidential Support and Advice Service (CSAS) is available, if you are experiencing problems in your work or personal life, or are seeking, legal and financial information and guidance. Surgeons who would like confidential support and advice from a trained counsellor please call the helpline* on 0800 028 0199. Advice is available 24/7.
4. The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance patient care. It supports over 28,000 members in the UK and internationally by improving their skills and knowledge, facilitating research and developing policy and guidance. 
5.  For more information, please contact the Press Office: Telephone: 020 7869 6052/6054/ 6055; Email: pressoffice@rcseng.ac.uk; or for out-of-hours media enquiries: 0207 869 6056