Dr Jo Szram shares how her experience has shaped her desire to create true flexibility in the NHS.
I had what I would consider a very ordinary start to life, although in retrospect, and with an adult perspective, I can see that being the child of Polish first/second generation immigrants made my childhood very special in so many ways!
Nevertheless, I attended a non-selective comprehensive school, from which no one had ever been to medical school or to Oxbridge in living memory. The assistance I received was limited to being wished good luck with my application! So turning up on my first day was certainly an eye opener, I had never met such confident and assertive people en masse. It was very overwhelming. Definitely a case of imposter syndrome, not a term I used of course, I used to say I thought they ‘had let me in by mistake’!
Fortunately I did well in my first year exams and built on that success over the next five years as I worked my way up the physicianly ladder. The current RCP president was my registrar (yes we were all young once!) and I chose respiratory medicine via neurology and radiology — anyone who knows me will understand that I found my tribe as a chest physician.
During my out of programme time as a registrar I had my first daughter, which worked well, although planning financially was pretty tricky — I am still not sure how much time I spent organising this, but it felt like a lot. I am not confident that it has got much easier, although shared parental leave is a fantastic initiative. Returning to clinical work full-time was challenging.
My maternity leave was punctuated by having to come into work to attend my penultimate year assessment at short notice, which involved having to express in the staff toilets beforehand.
Two weeks in, my father — who was our main childcare provider — died suddenly. As medical registrar I was taking evening handover when I got a call from my father’s local hospital resus team. I will never forget the kindness of the staff who took my bleep and put me into a taxi to the train station so I could get home to see him that night and support my mother. I was given two weeks compassionate leave and a lot of support from everyone I worked with.
Fast forward five years and all of a sudden, just after buying a house to renovate, surprise — I was pregnant again! We moved in and went for the 12-week scan, very excited to be having a second child, only to discover we were going to be having twins! 'Overwhelming' doesn’t do it justice. Life has been a rollercoaster ever since.
I was now a consultant, which in many ways was easier, however, negotiating my working pattern during pregnancy was challenging, as was my return to work. I was left feeling that the NHS and organisations within it could do so much more to support women through pregnancy and parenthood.
I applied for the post of director of medical education, in part due to my desire to ensure that all doctors in training received equality of opportunity in education and at work, regardless of their circumstances.
Highly pressured managers could be given the knowledge and skills to facilitate productive conversations aimed at maximising the workforce. Consequently, I have spent years training as part of a programme to support a return to clinical practice after a gap of 12 weeks or more. I would be delighted to see this approach introduced in other professions.
Shortly after I returned to work, I applied for the post of director of medical education, in part due to my desire to ensure that all doctors in training received equality of opportunity in education and at work, regardless of their circumstances.
Since then, my career in educational leadership (I am now a deputy postgraduate dean, incoming chair of the national association of clinical tutors and elected RCP councillor) has provided me with extensive opportunities. I have learnt new skills whilst supporting the development of others to deliver the best care possible to our patients and society.
Flexible working is not just about whether you want to work part time once you’re a parent, it is about true flexibility with empathy. There is increasing evidence that a kind and compassionate culture improves staff morale, productivity and in healthcare, patient outcomes.
I have a job plan that I really love, and work clinically, and in education, on causes that I am passionate about — to make work safer, prevent lung disease and ensure that we can all learn to make our NHS the best place to work and care for each other’s health.
What needs to change?
- Organisations need to empower trainees, staff and those who support them to say ‘actually this isn’t appropriate for me’. Trainees have support from Health Education England to apply for less than full time training, and the new contract includes a clause recommending a champion of flexible working — but this post is optional, and in its infancy as a role. Making these champions a requirement of local education providers across the NHS and creating a support structure for them will be essential to their success.
- Flexible working is not just about whether you want to work part time once you’re a parent, it is about true flexibility with empathy. There is increasing evidence that a kind and compassionate culture improves staff morale, productivity and in healthcare, patient outcomes.
- Pregnancy is variable — we have all made incorrect assumptions on behalf of others, instead of taking the time to check what might be best, or possible. It is also a temporary state (phew!) but if poorly accepted in a workplace can have lifelong professional consequences. No one should have to breastfeed and express milk in the toilets simply because there aren’t facilities to do so elsewhere. Feeding babies in cafes is great if you don’t have extremely distractible babies!
- Flexibility for parents around school holidays would be a huge bonus (August changeover anyone?) as well as more affordable childcare. Shared parental leave is fantastic but people need to be able to talk about it comfortably.
- Ultimately, we should be investing in the people who work with us. When an organisation ensures that workers feel valued, they will pay back any flexibility that’s been offered to them in spades and support others to do the same.
- Jane Dacre is right when she talks about leaving the ladder down for the next people to climb. This rang very true for me. My twitter feed makes frequent use of #leavetheladderdown
- It’s not a rite of passage that pregnant women should find it so hard at work — we should all be helping future colleagues to have better experiences. If everyone was empowered to speak up and advocate for others it would make a big difference. Perhaps a ‘baby on board’ badge for the NHS as well as for public transport?
My personal experience has given me a huge amount of learning through narrative and self-reflection, but as with all events in which things don’t go as well as they could have done, I am motivated to ensure that I can do — as much as possible — to improve circumstances for the next person’s experience. I am incredibly fortunate to be able to work with others to improve the systems we train, educate and practice in and make working life better for everyone.
If you’re interested in learning more about how flexible working and other opportunities can benefit both the individual and the workforce, book your place on our 1-day roundtable event Stop The Exodus on 16 September 2019.