Overall, 32 participants responded who were working across different states and territories of Australia, with representation across genders, early career stages, specialist type and location of work (Table 2). Our findings indicated that six key themes represented the non-professional needs of early career doctors, shown in Fig. 1. These included: children’s education; partner’s career needs; family stability and support network; major life events; and spending time with immediate family (Table 3). These factors strongly interplayed with career and training experiences, with the potential to affect participation, satisfaction and completion
Table 2
Summary characteristics of participants (n = 32)
Characteristics | n (%) |
Sex | |
Female | 16 (50) |
Male | 16 (50) |
Early career stage | |
Junior – prevocational doctor yet to start a specialist training program but may have chosen a specialty of interest/ attempted to join a training program | 8 (25) |
Trainee - doctors who are at least in their second up to their tenth postgraduate year currently enrolled in a specialty training program. | 10 (31) |
Fellow - denotes fellows who have completed specialty training, typically from their fifth to 17th postgraduate year. | 14 (44) |
Specialist type | |
GP | 12 (38) |
Other specialist # | 20 (63) |
Rural background | |
Yes | 8 (25) |
No | 24 (75) |
Location of work | |
Metropolitan * | 18 (56) |
Rural * | 14 (44) |
# Other specialists included: anaesthetics; ophthalmology; surgery; physician; radiology; psychiatry; oncology and; dermatology. |
*Metropolitan location: Modified Monash Scale ranking = 1. Rural location: Modified Monash Scale ranking = 2–7 (33). |
Table 3
Identified themes related to the non-professional needs of early career doctors
Theme | Discussion |
Children’s Education | Doctors prioritised their children’s education and sought stability and high quality in the education received by their children. The geographical relocation often associated with postgraduate training requirements placed pressure on the early career doctors to regularly change their children’s schools or be forced to endure extended periods of separation from their families to meet training requirements. |
Partner’s career needs | Female doctors who had partners that were associated with a non-medical oriented profession, were well-educated or who held high-level leadership positions tried to obtain training in geographic locations that offered employment for their partners. This was sometimes to the detriment to their own career with missed opportunities in their postgraduate training and work. |
Family stability and support network | Male doctors indicated that they would move themselves, being apart from their partner and children, to undertake training and work, ensuring stability for their family. Female doctors, showed a need to work in in locations where their partner and family were located, being near extended family. This family network enabled the female doctors to receive support in caring for their children allowing them to work the hours required of them in the postgraduate period. |
Major life events | Life events such as buying a house, getting married, or illness were seen to influence a doctor’s early career. These events affected a doctor’s ability to geographically relocate regularly, as is often required in the postgraduate training period, or work the full-time hours required of early career doctors. |
Spending time with immediate family | Male GP’s were pleased to be able to enjoy life outside of medicine and spend time with their families, while female GP’s expressed an interest in working part-time hours to enable them to accommodate time with their children. |
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Children’s education
Participants prioritised a stable and high quality education for their children. They noted that the inflexibility in training requirements of early career medicine made it challenging to fulfil this interest. The expectation placed upon early career doctors to change geographical locations for postgraduate training, pressured doctors to choose between children regularly changing schools or absorbing extended separation periods from their children and partner. A third option, to avoid the upheaval for their families, was noted where doctors may resign from postgraduate training positions and pursue other opportunities, changing career directions.
I suppose having children in school would certainly change your flexibility, especially if you’re midway through a training program because there is requirement sometimes, depending on which region you’re training, to move around, which can cause instability in schooling and accommodation. (TM1_Male_GP)
I’ve got two young children and a husband who works full time... I was a little bit annoyed that they would send me away…with my children, having to take my children out of school. My husband was going to have to quit his job and, in the end, it was just easier for me to quit. (TM2_Fem_GP)
Interviewees tended to pursue employment opportunities based on where they perceive good schooling is available and this may shape their career in the postgraduate period. If based in smaller rural communities, boarding school or fly-in, fly-out work models were noted as possibilities to enable children to receive a stable education, but these can also be unattractive options.
And [town X] was really good as far as schools. It’s got good schools, so I think the reasons I’ve been - well, my point of view, is for the kids. So some people send their kids to boarding school… it’s probably less of an option [for me]. (FR2_Fem_GP)
And it might be that we move to the city and I fly in, fly out one week in three or something…once the kids get to high school. That might be something we have to consider. (FR1_Male_GP)
…I could work as a GP anywhere I chose too. But I would be restricted as far as my children’s education...we’ll probably stay in [metropolitan city] until at least the kids have finished high school. (FM2_Male_GP)
Partner’s career needs
Female doctors whose partners had non-medical careers perceived unique impacts on their own career. In contrast, male doctors expressed minimal concerns regarding their partner’s careers. Female doctors indicated choosing geographic locations in the postgraduate period, where there was work for their partners, particularly for those who were training and working in rural areas. If their partner’s job allowed for flexibility regarding the location they worked, this offered more options in the postgraduate period, and potentially the chance for females to work in smaller rural communities.
Me personally, my partner is not in a medical field, which just makes it hard. If I am potentially moving around for the next few years of my training…you have to make sure there’s work available for your partner. (TR4_Fem_Spec)
I headed to [X] because when I applied to anaesthetics, that was the position I was offered, and my husband and I discussed it…and decided that would be the easiest place for him to find a job as well. (TR1_Fem_Spec)
My husband had a flexible, really supportive work environment at [X] and he was allowed to work from home for a year, so that allowed me to choose the rural destination. (FR6_Fem_GP)
Female doctors with well-educated partners or those who held high-level leadership positions indicated more limitations on where they could work. This could influence where female doctors in the postgraduate period trained and practised, including their availability to work in rural areas.
…for him to move to a rural community would be very difficult. He’s in business, so he used to own his own business and he does CEO type roles…we’ve negotiated that [X] is more rural than [Y] and then less rural than I’d like to be. (TR1_Fem_Spec)
…my husband, what he wanted and needed work-wise…he was doing his PhD and I didn’t want to, generally speaking, live apart from him…it certainly influenced where I applied for Fellowship jobs… (FM1_Fem_Spec)
… with my husband being too well educated to work in a rural setting…no one predicts that your husband’s going to do a PhD and be overeducated and you’re going to have children, which are going to be difficult to move… (TM2_Fem_GP)
The consideration that female doctors gave to their partners’ careers may result in missed opportunities in their early career. Female doctors tended to place less importance on their own careers in comparison to their partners’ careers.
I make do with wherever I work to support my husband. (JM5_Fem_Spec)
…I probably would’ve got on the [college training] program if I’d taken those [PHO and SHO positions], but my husband’s career meant that we couldn’t move…I had to turn both of those down. (TM2_Fem_GP)
Doctors’ who had partners also in the medical profession, regardless of gender, were more willing to support each other in early postgraduate career milestones. However, this played out in different ways depending on the partner’s position and where they worked.
…Townsville, Darwin, Sydney, Brisbane; four cities in four years. I’ve been able to do it because I have to, not because I want to, and I do admit that I’ve only been able to do it because my partner is also medical and she understands the need for constantly moving around long distance as well. And she’ll have to do it too. (JM3_Male_Spec)
Sometimes it makes things easier if you have a medical partner…if they do have to move around the state, or even interstate, if their partner’s also medical, they can also kind of work anywhere at the same hospital. (TR4_Fem_Spec)
Decision to move to [X] was actually influenced by my husband who is a GP. So, he’s finishing up his training here and he wanted to move from [Y] for a few years. So, he moved and I got a job here as a result of that. (JM5_Fem_Spec)
Family stability and support network
Beyond maintaining educational stability for children, a broader focus was on stability of the family unit and its proximity to extended family support networks. Male doctors indicated that they would move by themselves in the postgraduate period, prioritising their own instability rather than relocating the whole family.
I was a rural-bonded scholarship holder, so, I had to work outside capital cities…I chose to travel for the six years every day…so that they [family] didn’t move, but I did. (FM5_Male_Spec)
As an advanced trainee I got told I had to come to [X] for six months…so once again, my wife stayed in [Y] and they accommodated me in [X]. (FR8_Male_Spec)
In our data, female equivalents did not use this option; instead, they trained in locations where their partner and family were based, as was further shown in the partner’s career needs theme. For some female doctors the ability to live near extended family and receive support in caring for their children was an enabler of working the hours required of them in their postgraduate training.
… I’ve really advocated for myself to stay in [X] for next year [relocated for family reasons], whereas with public health training they were wanting me to rotate out again. So, I just said, “You know, my daughter’s in school now, I really rely on these people around me to support my career and support me looking after her with the demands”. (TR2_Fem_Spec)
…we sort-of stayed in [metropolitan location] because my extended family is there and my husband’s extended family are all in [metropolitan location]. (FM1_Fem_Spec)
Major life events
Respondents relayed some tension in fitting major life stages around training. Some doctors considered minimising major life events to reduce their intrusion on early career goals. For others, their career stage made it inevitable that major life events like home ownership, would have a big impact on the capacity to move for career development.
Do all your training before you consider having a life. It makes it a bit easier… the young, single, mobile registrar trainee versus the person married with a mortgage, having to mow the grass on the weekend after being away for a training course. (FR3_Male_GP)
…once you’ve got to the 12th year of your training…most people have a partner…or have a family…are thinking about or have property or a home or assets that are somewhat fixed. At that point, it becomes very difficult and they’re much less likely to move locations. (FR6_Fem_GP)
The lengthy periods of postgraduate training meant that life events had the potential to influence career decisions.
…soon I’ll be getting married. That’s something that has restricted where I’ll be working next year…I specifically chose to remain in [X] purely because I’m getting married next year and I don’t want to be moving around again…. (JM3_Male_Spec)
Illness, both personally and within their families, are major life events that can influence a doctor’s early career, through the need to work part-time to meet their personal needs or constraints.
…I then asked to go part-time because my dad was dying at that point. He had weeks to live. They said, “You can have two weeks’ leave, but you won’t be allowed any more than that, and when you come back, we expect you back full-time shift work.”…I resigned and my dad took a bit longer to die than expected… (JM6_Fem_GP)
I’m part-time purely because it’s easier around my treatment and the children. (TM2_Fem_GP)
Spending time with immediate family
Interviewees of both genders expressed interest in spending time with their families. Male GPs related to being content in their career during the postgraduate period because they could enjoy life outside of medicine and spend time with their families.
So, it’s not all about a career, is it with our lives? I don’t want to spend Christmas Day at the hospital. I want to open up presents with my kids…that’s the thing many people in medicine forget is they’re all some form of type-A personality, strive, strive, strive, read books…Stop thinking and enjoy. (FR3_Male_GP)
…my time is now as a family person…and community is a really important thing. So, I could’ve forced other things here, but I’ve come back and said, “Okay, I’ve got a great life and a great thing with my family as well as lovely medicine and great people to practice medicine with… I’ve got to look after my family a little bit.” (FR1_Male_GP)
In contrast, female GPs expressed a desire to formally adjust work hours or accommodate time with their children, but a lack of flexibility affected their career directions. No male equivalents, nor specialists, expressed interest to work part-time.
I took it to the director of the department and I said, “Oh, this is what I want. I really want to work part time and I really want to see my children more and do my training over a longer period.”… So, she basically just said, “No, we don’t do that. I’m not going to support you… (FR6_Fem_GP)
… one friend was told by someone at a very large hospital, a tertiary hospital in [X], a head of a department, that she had to choose between being a mother or a doctor because they would not accommodate her as a mother…I’ve had two friends that have left because there’s just been no flexibility at all and they’re both single mothers… (JM6_Fem_GP)