(Caveat – this rage piece was written while the author was isolated and actively dyspnoeic due to COVID-19 – hopefully she was not too hypoxic to make sense)
The last decade has seen an encouraging amount of discourse around the need for flexible training. Many colleges have developed flexible training policies, designed to allow trainees wishing to train part-time to do so without sacrificing accredited training time. While there are issues which still need to be ironed out (for example maximum time allowable for training), this flexible training option is an important step which ensures that trainees of all genders, with varying levels of commitment in the home or elsewhere, have equal opportunities for competitive posts across the country.
As chair of WIN-ANZICS, I was disheartened to find my experience, which was as recent as yesterday, in trying to secure part time employment as a hospital-based trainee is that it is easier said than done. As a dual trained Intensivist/Physician, I have found that rounding out the last six months of my respective training programs has resulted in lost opportunities and much stress. And while there are many who are stepping up to the plate, colleges – who are reluctant or unable to dictate how hospitals staff their workplace – and training sites – the hospitals themselves, have reached a stalemate.
Enter the “solution”– the concept of job share.
For the uninitiated, job sharing involves finding a partner who also wishes to work part time in your chosen field. You need to have identical training requirements, live geographically close to one another, have a roster that suits you both and be able to work together. You must apply as a pair - that is, you both have to actually get the job/pass an interview process – so you are relying on your partner to also succeed at the recruitment process, even if you are a superstar with references which knock the competition out of the park.
While there have been many successful job share partnerships, and some fantastic “matching” services such as the VMWS, there are some very concerning features . The first, and most obvious one is that it puts the onus on the employee to do all the work in securing flexible employment. This is a bitter pill to swallow when most ICU trainees are re-applying for training positions yearly for a decade or more. And it is really, really hard if you’re juggling a newborn, recovering from childbirth or studying for exams. There are no rules - you kind of have to make it up as you go and hunt around for an organisation "kind enough" to take you on - a very, very, time consuming process. There is no other industry that I can think of that essentially forces their employee to match up to make up a 1.0 FTE with a random person, for the “privilege” to be able to work part-time. This really shouldn’t be their responsibility. If you don’t actually find a match in time, you miss out or have to work full time. Many trainees have approached WIN explicitly stating their return to work from maternity leave is delayed because of lack of availability of part time positions. Some trainee matching services are “unable” to accommodate part time trainees – these trainees must seek training positions outside the match – creating more work. It disincentivises organisations from making necessary changes to accommodate flexible training (because they don’t need to change their rosters to accommodate part time trainees). Simply put- it’s not good enough.
If employers of trainees were serious about embracing diversity, then they need to properly invest in systems which accommodate flexible working arrangements. Indeed, many major metropolitan and regional hospitals state that “innovation” and “embracing diversity” as part of their strategic plans, but we are yet to see any concrete plans from any of them to incorporate hospital wide flexible working policies within their trainee doctor employment budgets. Yes, it will require investment and some supernumary posts, but if we had a pool of part-time trainees working through COVID-19, some of them may have been able to “flex up” to cover additional shifts and we might not be scrambling as much to cover the absences and illnesses due to COVID-19. This concept was reported as early as 2011 by Mahady et al and it is likely that a combination of job-share and supernumary positions will be the answer. Men, who are less likely to seek flexible training, may be more comfortable in doing so if it was the norm. Those with chronic (or acute) illnesses, who are struggling to pass exams and who have passions outside of medicine could thrive in a workplace that valued their life outside medicine.
There are some great organisations who are stepping up to the plate – but this is the exception not the rule. The norm is being told “we tried to do part-time but it was too hard” (for a 7 on 7 off roster!) and “we can’t guarantee the employer that the job share arrangement would work for them”. The norm is that it’s too expensive. It’s been in the too hard basket for too long.
This request, gone unheeded for so long is part of the reason why many trainees balk at “wellbeing” symposiums. We don’t want brunch. We want our employers to get with the times.
**For a list of ICUs who offer part time work – see https://www.womenintensive.org/part-time-training