Introduction
Doctors may take time out from clinical practice for several reasons including but, not limited to: parental leave, sickness, burnout, career breaks, research, or to seek out additional clinical experience or training.
Career breaks often involve caring responsibilities and overseas travel, whereas sabbatical leave enables a period of leave to pursue education and development opportunities. For doctors who are not enrolled in a training programme, this should be linked to the personal development plan at appraisal and be agreed through the job planning process. Policies for career break leave and sabbaticals are discretionary and locally agreed.
The RCOG Workforce Report 2022 explores flexible working options in chapter three. This includes outlining the benefits and challenges of employment breaks for both the individual and the organisation.
It is estimated that 10% of doctors in training are on approved time out of programme at any one time (2). Returning to work after a period of absence can be challenging and may precipitate a range of stressors, in particular a decline in confidence in one’s clinical skills and knowledge (2).
Length of time out of practice was identified as one of the key factors that affected a successful return to practice. The Academy of Medical Royal Colleges (AoMRC) published their own Return to Practice Guidance in 2017. Their research suggests an absence of less than three months may affect confidence and skills levels but is less likely to cause significant problems. An absence of longer than three months is more likely to significantly affect skills and knowledge, and an absence of more than 2 years is likely to require some form of formal re-training (3).
According to the GMC Workforce Report 2023, O&G has the highest percentage of female doctors (61%) including the highest proportion of female doctors in training (83%). It also has one of the highest percentage of doctors in training programmes that needed more than a year or two to complete their training (at ST5 and ST6). This is related to the high percentage of O&G doctors who opt to work Less Than Full Time (LTFT), or are temporarily not in training due to circumstances such as illness, parental leave, or Out Of Programme (OOP).
It is understandable that doctors returning to work may be anxious about resuming clinical duties. This may be compounded by additional stressors such as starting in a new hospital with unfamiliar systems and protocols, childcare, additional caring responsibilities or recovering from sickness.
All of these factors combined, in addition to some doctors feeling unable to voice their concerns about returning to work, can have an impact on both their ability to work, and on patient safety (1).
It is important to recognise that doctors returning to work after a period of absence may not be able to resume their usual, unsupervised duties immediately on return, such as night on calls, or to function at the exact same level as they had been working pre-absence.
For this to change, it is imperative that a cultural shift in attitude towards those who have undertaken a leave of absence is made and that measures are in place to provide a supportive environment.
The AoMRC guidance recommends a framework of ‘Pre-absence Planning’ and ‘Return to Work’ assessment to enable doctors and supervisors to mutually formulate action plans in which individual needs are recognised and acted upon, a system which is supported by the RCOG (3).
There are examples of good practice around the UK where similar systems are in place, but it is clear that the support is not consistently available in all regions. It is important that a standardised framework of care and support is offered to all doctors who have had a leave of absence to enable a safe transition back to the workplace and ensure high quality patient care.