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I’m a mummy to two small children with a third on the way. I’m also a junior doctor and I work less than full time, so I can balance work and caring for my family. I love being a doctor and I’d hate to give it up, but getting the balance right is difficult.
As a family, we’ve moved across the country to follow my career, so we don’t have any local family support; that’s just one of the challenges of being a doctor. For many working junior doctors, childcare costs can be greater than our salaries – a statistic which really makes you wonder if it’s worth going to work. The small annual increments in pay I’ve received have helped towards covering the deficit in the past few years.
I’m very lucky, as if I didn’t have a supportive husband I couldn’t do it. Many women experience a ‘motherhood penalty’ which kicks in after they have children, affecting both career and pay and there is evidence that this is getting worse rather than better across many sectors.
Women earn significantly less over their careers than men. This is true in the NHS as it is elsewhere, but while our employer is not perfect by any means, it has some progressive elements. Thanks to the DDRB, some of these are now under threat.
The improvements in maternity leave, flexible working policies, and the development of (LTFT) less-than-full-time training are hard-won negotiating victories that have allowed thousands of doctors to reach their potential, and kept their talents in the health service.
If the DDRB’s recommendations are followed, the clock will be turned back to a time when being female was an inherent disadvantage.
The point of LTFT training is clear. The majority who take up this option are female, and the majority have caring responsibilities, either for children or other members of the family. If a typical medical career lasts more than 40 years, it’s clear that by enabling doctors to train LTFT for some of that time, the NHS is likely to retain them.
Getting back into medicine isn’t easy after an extended break to raise family, and a fulfilling career and thousands of pounds worth of training could be wasted.
To be clear, LTFT doctors already get paid less, as their salaries are on a pro rata basis. However, at present, pay for a LTFT trainee increments at the same rate as any other junior doctor. The recommendations made by the DDRB, where pay relates to the actual grade occupied, will see a whole cohort (of mostly women) whose pay lags behind other doctors.
So this is a regressive move, which will exacerbate the gender pay gap.
LTFT doctors already tend to be disadvantaged in other areas such as pensions, where the percentage of pension paid is based on full time equivalent salary. This quite often means that LTFT trainees fall into a higher percentage band for pensions contributions than they would if the calculation was based on their actual salary and can amount to several hundred pounds of extra payments a year.
The changes to pay progression will also affect women on maternity leave. Having a child is a wonderful, rewarding but often financially challenging decision. Some of the leave attracts lower pay, and if women choose to take the full year, in effect, a quarter of that year is unpaid.
At the moment, a parent taking this leave does not lose out on pay progression. Under the DDRB recommendations, they would. This effect is even more pronounced for partners who choose to take the new extended paternity leave of up to six months, as they receive some statutory paternity pay (about £400 per month) and some completely unpaid leave.
Women who chose to be LTFT trainees stay juniors for a lot longer than their colleagues, so these losses, over the years, can make a difference of tens of thousands of pounds due to the compound nature of earnings and pensions contributions. The proposals will make the gender gap even more pronounced.
As I mentioned, I love being a doctor and have been able to make really good choices about having a family. Being able to do that should be supported within an NHS career and we shouldn’t be risking the loss of women doctors by making their contracts look like a step back to the 1950s.
Lucy-Jane Davis is an ST2 academic clinical fellow in public health, based in Bristol.
Visit the BMA website for more information and updates on junior and consultants contract