Returning to work following parental leave: the experiences of Australian anaesthetists

Abstract

With increasing gender balance in specialist medical training and employment in Australia, there is a corresponding need to consider how parental leave and subsequent return to work is managed in the workplace. An electronic survey exploring the experiences of pregnancy and return to work following parental leave was distributed by the Australian and New Zealand College of Anaesthetists (ANZCA). The return-to-work component of the survey evaluated parental leave and return-to-work patterns, lactation practices and facilities, supports and resources utilised during the return-to-work process. We report on 391 return-to-work episodes from 219 respondents. One hundred and seventy-two (79%) were specialists at the time of survey completion. Six to 11 months was the most frequent duration of parental leave, and this duration was associated with higher satisfaction levels than shorter durations of leave (odds ratio 5.44, 95% confidence interval 3.18–9.31, P < 0.001). Breastfeeding continued in 246 (63%) return-to-work episodes, and absent or inadequate lactation facilities were reported in 239 (88%). In 227 (58%) return-to-work experiences, respondents received no formal support on returning to work. One hundred and thirty-five (62%) respondents did not utilise any existing return-to-work resources, and family and friends were the main source of support for 113 (52%) respondents. Return-to-work processes should be tailored to meet individual needs. Consistent with existing recommendations, satisfactory lactation facilities must be provided. We recommend that the period of one-to-one supervision be flexible and negotiated, to suit the unique return-to-work trajectory of each worker. Existing ANZCA resources could assist departments in supporting anaesthetists who return to work following parental leave.

Keywords

Gender issues < anaesthesia pregnancy parental leave lactation doctor’s health < anaesthesia personal satisfaction workplace mentors anaesthesia

Introduction

Medicine has historically been a male-dominated profession.¹ In Australia the intake of female medical students has exceeded that of male medical students by 1–3% for the past 10 years,² and this changing workforce profile is being reflected at the level of speciality trainees and new Fellows. Forty-eight percent of doctors accepted onto the Australian and New Zealand College of Anaesthetist’s (ANZCA) training programme in 2019 were women.³ This cohort also corresponds to the group most likely to be taking extended leave for parenting.⁴ Despite the social evolution of the anaesthetic workforce, the availability of flexible specialist and training positions that facilitate and support returning to work are often lacking.^5,6 Conflicting priorities exist when raising a young family and progressing a career in anaesthesia. These priorities are unique to the individual, often dynamic and are likely to affect decisions made by the anaesthetist surrounding parental leave and returning to work.

The determinants of a safe and supported return to work have never been clearly defined,⁷ although several specialist colleges and groups provide suggested pathways for their members.^8
–11 Until the publication of the ANZCA wellbeing special interest group documents in 2019,^12,13 there was minimal guidance for anaesthesia clinicians or departments about how to successfully navigate the transition back to clinical work safely following a period of parental leave. Despite the individual needs of anaesthetists, there are some important human resource management principles that can be applied when staff return to work after a period of absence.

Using a nationwide online survey, we explored the experiences of female Australian anaesthesia trainees and specialists returning to work after parental leave. We evaluated return-to-work patterns, level of supervision and respondent satisfaction with their experiences. We also evaluated lactation practices, access to lactation facilities, and the use of support and resources by respondents. Our goal was to collect data that will inform future policy development for ANZCA members working in Australian hospitals returning to work after parental leave. The survey was not undertaken on behalf of an organisation.

Methods

Following human research ethics committee approval (LNR/2020/QRBW/60272), an electronic survey was sent in April 2021 to a random sample of 1000 Australian trainees and Fellows registered with ANZCA, the national body responsible for the training and education of anaesthetists in Australia and New Zealand, who self-identified as women and were aged 45 years or less. Utilising ANZCA for survey distribution enabled access to a broad population of trainees and specialists practising anaesthesia in Australia. Completion of the survey implied consent to participate and a single reminder email was sent after 4 weeks. The initial questions of the survey restricted the subsequent responses to those who had experienced pregnancy and/or a return to work from parental leave within the previous 10 years. We collected information pertaining to experiences of working while pregnant and experiences of returning to work after parental leave. Responses were collected in three parts: participant characteristics, responses to return to work and parental leave statements recorded on Likert scales, and free text comments. In this paper we report on the participant characteristics and Likert or categorical scale responses relating to return-to-work experiences only. The results regarding pregnancy and the qualitative analysis of free text comments are published separately.

Respondents reported their age and level of training at the time of survey completion, number of children they have, number of pregnancies, and number of return-to-work episodes they have experienced in the past 10 years. Each respondent’s return-to-work episode was numbered and the accompanying responses were considered to be entered chronologically (i.e. return to work episode 1 was the respondent’s first return to work in the prior 10 years). They reported their duration of parental leave, hours worked per week on return to work as a fraction of a full-time equivalent (FTE) position (FTE 1.0 = 40 h per week), and whether they received Level 1/one-to-one supervision on return to work. ANZCA defines level 1 supervision of trainees as ‘the ability of the supervisor to intervene immediately’ and refers to one-to-one supervision with no other duties. Information regarding lactation practices on return to work were collected, together with details of the available lactation facilities. Respondents were asked if they had accessed the following return-to-work resource documents available by way of the ANZCA website: ANZCA professional document ‘Re-entry into anaesthesia training for ANZCA trainees’,¹⁴ ANZCA professional document 50 ‘Guideline on return to anaesthesia practice for anaesthetists’,¹⁵ ANZCA wellbeing special interest group resource document 28 ‘The trainee returning to work’¹³ or a local hospital document. Respondents were asked if they had accessed ‘keeping in touch days’ during the return-to-work period. Employees on parental leave are entitled to ten paid ‘keeping in touch’ days. These are described by the Australian government as an opportunity for people on parental leave to receive payment to refresh their skills while facilitating a return to work.¹⁶ The survey is included in the Supplementary material.

Quantitative data were imported from Survey Monkey to SPSS¹⁰ and R (v 4.0.2) was used for further analysis. Frequencies (%) were used to describe categorical responses to survey questions. Due to low frequencies in some response categories, some categories were either combined or excluded in formal analysis.

To assess associations between survey responses for all return-to-work experiences combined, generalised estimating equations (GEEs) were performed with participant included as the clustering variable. GEEs allow for repeated measures or correlated observations, such as clustered data in this case in which return-to-work experiences are clustered within participants. For two category outcomes, binary GEEs using a binomial family and logit link function were used. For outcomes with three or more categories, multinomial GEEs using a multinomial family and baseline category logit link function were used. GEEs were calculated in R using the geepack (v 1.3.4) and multgee (v 1.8.0) packages. An exchangeable correlation structure was used for binary GEEs, and an ‘RC’ correlation structure (Goodman’s row and column effects model)¹⁷ was used for the multinomial (nominal) GEE.¹⁸

Results

There were 311 respondents (response rate 31%). Of those, 286 met the criteria of having at least one pregnancy/return-to-work episode in the past 10 years. This represented 28.6% of the initial 1000 survey invitations (true response rate unknown, as the absolute number of those invited to complete the survey meeting the inclusion criteria was not known). Two hundred and twenty-three respondents stated they had at least one return-to-work episode in the past 10 years, and 219 of these responded to the return-to-work questions. These 219 respondents provided information on 391 return-to-work episodes. Respondent characteristics (Table 1) show 142 (65%) were aged between 31 and 40 years of age, and 172 (79%) were ANZCA-qualified specialists at the time of survey completion. The majority reported having one or two children (n = 167, 76%) and consistent with this, 185 (84%) reported one or two return-to-work episodes within the past 10 years.

Table 1.

Demographics of 219 respondents who reported having at least one return-to-work experience.

Demographics	No. (%)^a
Age (years)
<30	1 (1)
31–35	36 (16)
36–40	106 (48)
41–45	76 (35)
Seniority
FANZCA	172 (79)
Provisional fellow	18 (8)
Advanced trainee	25 (11)
Basic trainee (including introductory trainee)	4 (2)
Number of children
1	58 (26)
2	109 (50)
3	42 (19)
4 or more	10 (5)
Number of pregnancies (within the past 10 years)
1	53 (24)
2	88 (40)
3	53 (24)
4	10 (5)
5	9 (4)
6 or more	6 (3)
Number of return-to-work experiences (within the past 10 years)^a
1	84 (38)
2	101 (46)
3	31 (14)
4 or more	3 (1)

FANZCA: Fellow of the Australian and New Zealand College of Anaesthetists.

Due to rounding of percentages, total may not equal 100%.

The duration of parental leave and satisfaction with the duration is shown in Table 2 for each return-to-work episode. Parental leave duration of 6–11 months was most commonly reported (n = 232, 59%). As the number of return-to-work episodes increased, there was a trend towards leave periods of shorter duration. The majority of respondents were satisfied with the duration of their leave (n = 276, 71%). Compared with a leave duration of less than 6 months, a leave duration of 6–11 months was associated with increased satisfaction (odds ratio (OR) 5.44, 95% confidence interval (CI) 3.18–9.31, P < 0.001) even after adjusting for the return-to-work episode number (OR 5.43, 95% CI 3.15–9.35, P < 0.001) as demonstrated in Supplementary Table 1. Due to small numbers the following responses were excluded from this inferential analysis: parental leave duration of 12 months or longer, those who would have preferred a shorter duration of parental leave, and those for which there were four return-to-work episodes.

Table 2.

Return-to-work number and associated duration of parental leave, working time fraction, level 1 supervision and lactation responses.

	No. (%)
	RTW 1	RTW 2	RTW 3	RTW 4	Total
	n = 219	n = 135	n = 34	n = 3	N = 391
Duration of parental leave
<3 months	14 (6)	8 (6)	6 (18)	1 (33)	29 (7)
3–5 months	38 (17)	25 (19)	9 (26)	1 (33)	73 (19)
6–11 months	133 (61)	80 (59)	18 (53)	1 (33)	232 (59)
12–18 months	29 (13)	21 (16)	1 (3)	0 (0)	51 (13)
>18 months	5 (2)	1 (1)	0 (0)	0 (0)	6 (2)
Satisfaction with parental leave^a
Satisfied	154 (70)	99 (73)	20 (65)	3 (100)	276 (71)
Unsatisfied—would have preferred longer	57 (26)	33 (24)	11 (35)	0 (0)	101 (26)
Unsatisfied—would have preferred shorter	8 (4)	3 (2)	0 (0)	0 (0)	11 (3)
Working time fraction on RTW
<0.5 full-time equivalent	17 (8)	13 (10)	5 (15)	1 (33)	36 (9)
0.5 full-time equivalent	69 (32)	38 (28)	8 (24)	0 (0)	115 (29)
>0.5–<1 full-time equivalent	53 (24)	45 (33)	14 (41)	2 (67)	114 (29)
1 full-time equivalent	80 (37)	39 (29)	7 (21)	0 (0)	126 (32)
Receiving level 1 supervision
No	111 (51)	97 (72)	24 (71)	3 (100)	235 (60)
Yes	108 (49)	38 (28)	10 (29)	0 (0)	156 (40)
Lactation facilities^b
No formal lactation facilities provided	80 (56)	55 (56)	12 (41)	1 (33)	148 (54)
Lactation facilities provided but impractical to use on a regular basis (e.g. distance, no fridge)	48 (34)	31 (31)	10 (35)	2 (67)	91 (33)
Lactation facilities met all my breastfeeding and expressing needs	14 (10)	13 (13)	7 (24)	0 (0)	34 (13)
Breastfeeding practices on RTW
Continued on RTW	127 (58)	90 (67)	26 (76)	3 (100)	246 (63)
Ceased in preparation for RTW	45 (21)	28 (21)	8 (24)	0 (0)	81 (21)
Not breastfeeding at time of RTW (not influenced by work)	47 (21)	17 (13)	0 (0)	0 (0)	64 (16)

RTW: return to work.

n = 31 for RTW 3, (n = 388 total).

n = 142 for RTW 1, n = 99 for RTW 2, n = 29 for RTW 3, (n = 273 total responses).

Of the 391 return-to-work episodes, most respondents were working either at 0.5 FTE or between 0.5 and up to but less than 1.0 FTE (n = 229, 59%) as shown in Table 2. Compared with working full time, there was a significant increase in the odds of returning to work for return-to-work episodes two at 0.5 and up to but less than 1.0 FTE (OR 1.77, 95% CI 1.09–2.87, P = 0.020) and the odds were greater for return to work number three (OR 4.70, 95% CI 1.66–13.30, P = 0.004) as shown in Supplementary Table 2.

In 235 (60%) return-to-work episodes, respondents reported no time period under one-to-one supervision. One-to-one supervision occurred in 156 (40%) return-to-work episodes, in which three (2%), 21 (14%), 102 (65%), 25 (16%) and five (3%) received one-to-one supervision for parental leave durations of less than 3, 3–5, 6–11, 12–18 and more than 18 months, respectively. Supplementary Table 3 demonstrates that longer durations of parental leave had a significantly increased odds of reported one-to-one supervision on return to work. When parental leave was 6–11 months, the odds of receiving one-to-one supervision was 2.83 (95% CI 1.61–4.97, P < 0.001), compared with a duration of leave of less than 6 months (adjusted for return to work episode number), and this increased to 4.33 (95% CI 2.01–9.34, P < 0.001) when parental leave was 12–18 months. The percentage of responses reporting one-to-one supervision decreased with an increasing number of return-to-work episodes. For the first return to work episode, 111 (51%) received no one-to-one supervision, whereas for the fourth return to work episode this increased to 100%. Of those who received one-to-one supervision (n = 156), the duration of that supervision was reported as adequate to work independently in 124 (80%), inadequate in 29 (19%) and not applicable for the remaining responses.

Of the 391 return-to-work episode, 227 (58%) indicated that no formal forms of support were received. In 171 (44%) experiences, respondents utilised one or more of the following formal supports: emails (n = 130, 33%), a planning meeting (n = 62, 16%), ‘keeping in touch’ days (n = 32, 8%), ANZCA documents (n = 25, 6%), and other supports (n = 29, 7%). One hundred and thirty-five (62%) of the 219 respondents did not utilise any of the listed return-to-work resource documents. Eighty-four (38%) respondents utilised existing documents and these included in order of frequency: ANZCA’s PS50 ‘Guideline for return to anaesthesia practice for anaesthetists’, ANZCA’s ‘Re-entry into anaesthesia training’, other documents, ANZCA’s wellbeing RD28 ‘The trainee returning to work’, and local hospital documents. Respondents ranked the sources of support they received on returning to work. The three most important sources of support were: family and friends for 113 (52%) respondents, a mentor or colleague for 74 (34%) respondents, and the Supervisor of Training for 22 (10%) respondents.

The majority of respondents continued breastfeeding on return to work (Table 2). The number of return-to-work episodesin which breastfeeding continued was high; there was a 79%, 75% and 60% breastfeeding continuation rate when parental leave was less than 3 months, 3–5 months and 6–11 months, respectively. Of the 273 responses reporting on lactation facilities, 239 (88%) reported absent or inadequate formal lactation facilities. As the number of return to work episodes increased, an increasing proportion of respondents continued breastfeeding on return to work.

Discussion

The results of this national survey contribute to characterising patterns of parental leave and associated satisfaction, utilisation of workplace supports and one-to-one supervision, and breastfeeding practices of female Australian anaesthetists who have experienced parental leave. Six to 11 months of parental leave was most frequently taken, and this time period was satisfactory for the vast majority of respondents. Respondents’ return-to-work episodes were predominantly characterised by insufficient planning and supports. In particular, the majority of return-to-work episodes were characterised by an absence of formal support, under-utilisation of existing documents, and inadequate support from within the workplace. Breastfeeding continuation rates were high despite poor provision of lactation facilities.

Most periods of parental leave were 6–11 months duration, with longer periods taken only 15% of the time. Our survey did not explore the rationale behind the duration of leave accessed; decisions for doctors regarding duration of leave are multifactorial, and are likely to be a result of factors both within and outside the respondent’s control. Considerations include family finances, industrial relations, de-skilling, knowledge retention, stalling of career progression, stigma associated with taking prolonged leave and burdening colleagues.^7,19
–24 Employer-paid parental leave in Australia is dictated by state-based enterprise agreements which vary between 10 and 18 weeks,¹² with longer periods of leave likely to be unpaid and therefore financially disadvantageous. The financial effect of parental leave is further magnified for anaesthetists working within the private medical system. Other practical considerations include return to practice requirements stipulated by ANZCA^15,25 and the Australian Health Practitioner Regulation Agency.²⁶ These external factors may in part explain why it is unusual for Australian anaesthetists to take more than one year of parental leave.

Access to paid parental leave has numerous benefits including maternal physical and mental health, child health and increased breastfeeding rates.²⁷ Based on historical parental leave trends, four ANZCA-accredited training departments within New Zealand appointed an excess number of trainees during annual recruitment drives to ensure adequate staffing.⁵ Aside from the obvious benefits to the department of maintaining adequate numbers, there are likely to be positive psychological effects for the individuals taking parental leave in knowing that colleagues are not required to take on extra work. Funding for additional positions to facilitate these beneficial effects may not be an option for many departments and extra department funding would be necessary.

There was greater satisfaction reported when utilising parental leave of 6–11 months duration (compared with less than 6 months) and this may inform individuals and departments considering what duration of parental leave to suggest. This may not be applicable to the groups that were excluded from the comparative analysis due to low numbers. Anaesthetists may feel pressured to return to work at times that suit their departments, such as the commencement of new training rotations or at the start of the calendar year, thus shortening or lengthening the desired length of leave. Research from the United States, where the average period of leave for physician mothers is 7 weeks, demonstrated that shorter periods of leave were associated with lower satisfaction levels.²¹ Flexibility and open communication are enablers of family-friendly practices within anaesthetic departments.⁵ Flexibility surrounding start and finish dates and the duration of parental leave would assist practitioners dealing with the unpredictable nature of early parenthood, which can include maternal and neonatal health complications, breastfeeding difficulties and parental fatigue. Conversely, cultural barriers to combining parenting and medicine include negative comments from colleagues and administrators about covering leave and requesting doctors to arrange their own leave.²⁸

ANZCA defines extended leave as greater than 26 weeks for basic trainees and greater than 52 weeks for advanced trainees and provisional fellows.²⁵ ANZCA mandates a formal re-entry to training or work process for this group, which includes a period of level 1 supervision. It is recommended by ANZCA that Fellows who have been absent from clinical anaesthesia for greater than 12 months undertake a return to practice programme, which may include an initial period of one-on-one supervision.¹⁵ However, the Australian Health Practitioner Regulation Agency (AHPRA) only mandates a formal return-to-work process after 3 years of absence.²⁶ While we did not determine the seniority level associated with each return-to-work episode, our results suggest that departments are meeting the ANZCA requirement for one-to-one supervision; only 15% of return-to-work episodes were associated with 12 or more months leave and 40% had a period of one-to-one supervision. It is noted that readiness to return to practice is negatively associated with the duration of absence from work.²⁹ Despite this, the delineation of 12 months as an arbitrary timeframe may not meet the needs of all those returning to work, and return-to-work support for shorter periods of leave may be useful for some parents.⁸ Consideration of other factors such as the number of times a parent has returned to work recently may be worthwhile. The association between reduction in one-to-one supervision and increasing numbers of return-to-work episodes may be related to increased seniority and clinical experience, improved confidence in return-to-work logistics and previous success in overcoming the challenge of this transition.

While ANZCA recommends a period of one-to-one supervision in certain circumstances,^15,25 there are no recommendations regarding the context or duration of that level of supervision. Concerningly, 19% of respondents who received one-to-one supervision felt it was inadequate to prepare them for independent practice. A return-to-work plan based on the preferences of individual anaesthetists may have enabled this cohort of respondents to address their perceived lack of readiness for unsupervised practice. There are several settings in which this period of supervision could occur: on formally recommencing work, prior to this during paid ‘keeping in touch’ days, or on an unpaid ad hoc basis. Our survey identified that ‘keeping in touch’ days were used in only 8% of return-to-work episodes, despite the Australian Medical Association strongly supporting this programme.⁹

In the Australian population, 60% of mothers are still breastfeeding at 6 months;³⁰ this is the same percentage reported in our survey, with 60% continuing to breastfeed at 6–11 months. The population surveyed is extremely health literate and more likely to be aware of the benefits of breastfeeding; therefore, we may expect higher breastfeeding rates than in the general population.^31,32 Barriers to the continuation of breastfeeding while working in anaesthesia include inadequate opportunities, inflexibility, long working hours and lack of a dedicated space.³³ This may partly explain why 21% of respondents’ experiences involved ceasing breastfeeding in preparation for returning to work. The Australian Medical Association and state enterprise bargaining agreements have recently attempted to address such practicalities to facilitate breastfeeding continuation.⁹ While breastfeeding practices are a personal choice, the high breastfeeding rates in medical mothers despite poor lactation facilities²¹ suggests additional factors, such as workplace culture, are pertinent in determining the duration of breastfeeding. A survey undertaken in the United States suggested that one third of physician mothers had experienced discrimination, and of those 48% experienced discrimination related to breastfeeding.³⁴ Barriers to ongoing breastfeeding for anaesthetists included a lack of support from co-workers to continue and guilt over taking breaks to express breastmilk.^21,33

Australian anaesthetists work in a variety of locations, including regional and tertiary public hospitals, as well as small and large private hospitals. This heterogeneity may contribute to the significant numbers reporting no formal return-to-work supports.^13
–15 Most respondents did not utilise any documents to support return to work in anaesthesia, possibly reflecting a lack of knowledge of their existence by both respondents and departmental leaders. Despite 85% of anaesthesia department leaders in New Zealand perceiving ANZCA’s re-entry to practice guidelines to be appropriate for returning to work after parental leave,⁵ we demonstrated that less than 40% of respondents used any ANZCA document during their return to work. The Australasian College of Emergency Medicine has recently published a position statement ‘Parenting in emergency medicine’;¹⁰ it addresses topics including rostering, pregnancy safety and return to work. The benefits of ANZCA developing an anaesthesia-specific statement would include the provision of a framework in which the needs of individual anaesthetists can be consistently catered for, regardless of their work environment.

ANZCA and the Australian Society of Anaesthetists recommend all anaesthetic departments appoint a wellbeing advocate who is not a supervisor of training or head of department.³⁵ Our results demonstrate that this resource was almost never accessed on returning to work, and sources of support external to work were most commonly utilised. These findings reflect a gap in workplace support; there may be a specific role for a pregnancy and return-to-work coordinator within each department’s wellbeing group. The presence of mentors and role models with children within anaesthesia departments is perceived to be of high importance;⁵ the positive impact of this has been identified among female Australian doctors, alongside the benefits of having supportive senior department members and peer support.²⁸ These workplace cultural factors are particularly important for first time mothers²⁸ and trainees who face a power imbalance and subsequently may lack the ability to advocate for their needs.

Our method of survey distribution has allowed a national sample to be obtained, and we have provided detailed information on contemporary return-to-work experiences for female anaesthetists that has not previously been reported. However, there were some limitations due to the nature of the survey administration: we were unable to determine an accurate response rate and unable to compare the demographic details of the survey respondents to the rest of the population of female anaesthetists aged 45 years or less and registered with ANZCA, due to the deidentified nature of the information collected. Due to the intent of our survey to explore both the experiences of pregnancy and return to work we did not invite male anaesthetists to participate. We acknowledge that it is not exclusively female anaesthetists who take parental leave and it would be invaluable to investigate the return-to-work experiences of male anaesthetists following parental leave. Anaesthetists based in New Zealand were excluded from our survey due to the existence of limitations on hours of work for pregnant employees in the multi-employer collective agreements for both trainees and specialists.^36,37 The majority of respondents were specialists at the time the survey was completed; however, the proportion of the return-to-work experiences occurring during training cannot be accurately estimated. Bias may have been introduced if respondents with particularly positive or negative experiences were motivated to respond to the survey. For more than two return-to-work episodes, the overall number of responses was small, thereby limiting the conclusions drawn. Return-to-work episodes that occurred more than 10 years ago at the time of survey completion did not meet our inclusion criteria. This means that the return-to-work episode number outlined in this study does not necessarily correspond to the return-to-work episode number from the first child. Therefore, the return-to-work episode number may only be viewed as a proxy measure of return-to-work order. Recall bias relating to the time elapsed between return-to-work episodes and completion of the survey is a potential limitation of this study. Some questions were worded such that conclusions were unable to be drawn from the responses provided. The survey asked about the presence of level 1 supervision but did not explore its context or duration and whether it was required by ANZCA based on the respondent’s level of seniority and leave duration. Future work could examine the relationship between the use of ‘keeping in touch days’ and perceived confidence and competence on returning to clinical practice.

Conclusion

Multiple factors, including legislative and individual preferences, contribute to each anaesthetist’s parental leave and return-to-work experience. Our survey has identified a number of possible interventions, and the authors suggest the following recommendations. For individual anaesthetists, this research highlights the need for self-advocacy for the desired duration of parental leave, increased awareness and use of existing documents that support return to work, and the importance of planning for a successful return to work. At a departmental level, a specific pregnancy and return-to-work coordinator and an active mentorship programme would improve advocacy and support on return to work. Departments should address the return-to-work process for all anaesthetists regardless of seniority level, duration of parental leave and previous return-to-work experience. This includes safeguarding a period of one-to-one supervision that is deemed adequate by both parties, in addition to complying with ANZCA and AHPRA requirements. While state agreements have added mandatory lactation facilities for doctors in Australian healthcare organisations, it is hospitals that must ensure these are fit for purpose, and departments that are responsible for enabling and supporting anaesthetists who wish to continue breastfeeding. At the hospital level, employment structures should be parent focused, without roster constraints impacting parental leave, and with staffing numbers that anticipate the need to cover parental leave, and allow staff to return to part time employment if desired. At College level a policy outlining strategic action for anaesthetists during pregnancy and on return to work following parental leave would assist in achieving uniformity between departments, and provide information for departments and individuals to refer to. Finally, the effect of workplace culture should not be underestimated. As a speciality, we have a responsibility to support anaesthetists adequately at all stages of their career, including those who embark on a parenting journey.

Supplemental Material

sj-pdf-1-aic-10.1177_0310057X241265726 - Supplemental material for Returning to work following parental leave: the experiences of Australian anaesthetists

Supplemental material, sj-pdf-1-aic-10.1177_0310057X241265726 for Returning to work following parental leave: the experiences of Australian anaesthetists by Isabelle L Cooper, Anna F Pietzsch, Rosmarin Zacher, Lachlan Webb, Anita Pelecanos and Victoria A Eley in Anaesthesia and Intensive Care

Supplemental Material

sj-pdf-2-aic-10.1177_0310057X241265726 - Supplemental material for Returning to work following parental leave: the experiences of Australian anaesthetists

Supplemental material, sj-pdf-2-aic-10.1177_0310057X241265726 for Returning to work following parental leave: the experiences of Australian anaesthetists by Isabelle L Cooper, Anna F Pietzsch, Rosmarin Zacher, Lachlan Webb, Anita Pelecanos and Victoria A Eley in Anaesthesia and Intensive Care

Footnotes

Author Contribution(s)

Isabelle L Cooper: Conceptualization; Formal analysis; Methodology; Project administration; Writing – original draft; Writing – review & editing.

Anna F Pietzsch: Conceptualization; Formal analysis; Methodology; Writing – review & editing.

Rosmarin Zacher: Conceptualization; Formal analysis; Methodology; Writing – review & editing.

Lachlan Webb: Formal analysis; Writing – review & editing.

Anita Pelecanos: Formal analysis; Writing – review & editing.

Victoria A Eley: Formal analysis; Methodology; Writing – review & editing.

Acknowledgements

The author(s) would like to thank ANZCA for their assistance in disseminating the survey to members.

Declaration of conflicting interests

The author(s) have no conflicts of interest to declare.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Isabelle L Cooper

Rosmarin Zacher

Victoria A Eley

Supplementary material

Supplemental material for this article is available online.

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