Personal View: Flexible training for men and women—is this the way forward for medicine?
Authors: Christopher Schofield, Zena Schofield
Journal: BMJ (2005)

Historically, medicine in the United Kingdom has been a male dominated profession, but female medical graduates now outnumber male graduates (BMJ 2005;331: 569-72 [PubMed]). Many women will go on to have children, and a concern is how this will affect the profession. We are a married couple with two young children and have spent much time considering this issue. The importance of achieving a work-life balance is increasingly recognised in all areas of society. Calls are made for more flexibility in the workforce; and in the Improving Working Lives Standard the government has set an aim of improving flexibility at work in the NHS.

In this debate the role of men has received little attention. In the traditional model of the family in the UK men worked full time and women raised the children full time, but the changing nature of the workforce over the years has meant that women now have much more responsibility to work as well as raise children, while the man's role has changed far less.


It would benefit the medical profession to encourage doctor couples to both work part time and share the family responsibilities


Currently we both work as flexible trainees (one as a specialist registrar and one a senior house officer), both training half the time, which means each of us working 2.5 days a week besides our on-call duties. Thus there is always one of us at home to look after our children. We share all responsibilities at home and ensure that our on-calls don't clash. Our deanery has told us that at present we are the only couple in which both partners are training part time, yet we know numerous couples where both partners are doctors. So why are we unique?

We think it is generally assumed that flexible trainees are mostly women. Yet men are parents too and so are eligible for flexible training—so why don't more of them take it up? Certainly the reaction to this particular male flexible trainee has been mixed, but most colleagues are supportive, and some male colleagues have expressed a desire to do the same or a regret at not having done the same when their children were younger.

We think it would benefit the medical profession to help and encourage doctor couples to both work part time and share the family responsibilities. Such a move might improve retention rates in medicine, because men as well as women would feel that their work-life balance is improved. The children of these doctors would benefit from being able to spend time with both parents and from spending less time in child care. It would diminish the resentment often felt towards medicine by the children of doctors, having grown up with the demands that the profession has made on family life. Greater family harmony will in turn benefit the doctors and ultimately the patients.

At present women generally only work part time for part of their working lives (giving the characteristic M shape to plots of the number of hours worked in a week over a career). Similarly, when both parents work flexibly a time will come, when children have grown up, when both parents could return to full time work. How long doctors work part time will vary from situation to situation, but the duration of this part time working needs to be looked at in the context of a career potentially spanning 40 years.

The advantages of shared flexible training are also present if only one partner is a doctor and the other has a different career. The most obvious disadvantage of shared flexible training is a decrease in income while working part time, but if partners arrange their working lives around each other they can share the care of their children and so cut childcare costs. What about the cost to trusts of such arrangements and the effect on service provision? With the new agreement on flexible trainees' pay, such trainees are no more expensive per hour than full timers (BMA, Equitable Pay for Flexible Medical Training, 2005). With so many NHS staff on shift systems, it is easy to accommodate flexible trainees. Practical difficulties can arise in training grades at the point of changing jobs, as it may be difficult for couples to arrange working days around each other, yet these difficulties can be overcome with planning and discussion.

The overall benefit to the medical profession of having more people—women and men—working part time is that it will reduce old fashioned ideas about sex roles generally and in medicine, as well as making it considered more normal in medicine to work part time and so bringing greater acceptance of those who do choose to work part time. We think that men and women sharing flexible training and responsibilities at home is a way forward for doctors to achieve a positive work-life balance.