For the whole time Raka Maitra worked at a London children’s hospital, she never mentioned to her team that her son had spent a year there as an inpatient with a life-threatening condition. She told no one she and her husband have continued to manage his complex care needs for 12 years.

Her office was close to the corridor where she and her husband had faced the possibility their son might not pull through, where memories still lingered of families they had befriended and whose children did not survive.

Even during an interview for a promotion at that same hospital, she could not allow herself to talk about her son. It would have been her first substantive post as a consultant psychiatrist, and allowed her to keep ‘giving back’ to the hospital that had helped save her son.

‘In the interview panel, they asked me: “How has a child ever changed your practice?” I just sat there with tears in my eyes: I could not say a single word. How has a child changed my life? If only they knew all that it had taken for me to be at that table.

‘I got zero on that answer. And I didn’t get the job.’

Dr Maitra’s silence on the subject of her son – even when career ambitions were at stake – is self-imposed. She doesn’t name his illnesses, ‘for his sake’, but he has faced life-threatening situations several times.

She has learnt to be circumspect about discussing life at home because she has found people sometimes question her commitment to her work. ‘These are extremely difficult conversations,’ she says, ‘because you do face bias and people completely miscalculate what you’re capable of.’

Others in the Women in medicine carers network Dr Maitra set up – a group of doctors with complex caring responsibilities who advocate for parent carers in the NHS – have also experienced ‘unconscious bias’, she says.

‘Sometimes this is from a colleague but mostly it’s from a healthcare system that has not yet learnt how to gain from the expertise of those who have been on both sides of the patient journey.’

There should be no doubt over these doctors’ commitment to medicine. Like all the women in her network, Dr Maitra has determinedly pursued her training, despite all the odds and with little support from the system as a whole.

She finally achieved her goal of becoming a consultant child and adolescent psychiatrist last year, about 10 years later than her peers.

Life changed abruptly when Dr Maitra travelled to Germany with her husband and their three-month-old son, to defend her thesis for her MD in psychiatry.

Their child fell dangerously ill and spent four months in hospital in Germany, then 12 months in the London hospital where Dr Maitra later worked.

Dr Maitra and her husband were suddenly full-time carers and unable to work. Dr Maitra had neither the time nor funds to sit her final MRCPsych exam and there was a real risk the validity of the other MRCPsych exams she had passed would lapse.

Ultimately, it was the consultant looking after her son who wrote to the Royal College of Psychiatrists explaining that complex circumstances meant Dr Maitra needed a two-year extension to her MRCPsych eligibility. Later, a Royal Medical Benevolent Fund grant paid her exam fees and a local hospice provided respite care so she could sit it.

Since then, as her son’s health has faltered and rallied, Dr Maitra’s training pathway has been far from linear. For two years, her husband sat in on their son’s class at school because there was no nursing provision for him.

Returning to work to build up a competitive CV for specialty training was challenging. It was individual consultants who helped arrange honorary contracts so she could build up clinical experience and engage with the appraisal process.

Later, the onset of hybrid working during COVID helped, as did her husband being awarded a grant for a PhD so that he could support with childcare – especially useful when Dr Maitra was juggling erratic hours on call.

‘We’ve both learnt to nurture our growth within systems that are still learning to listen,’ she says.

The job interview for her current consultant post at Kensington and Chelsea CAMHS was the first where ‘being a carer mattered’; Central and North West London NHS Foundation Trust is a Carer Confident-accredited trust, which supports the carers of patients and has a staff carers’ network.

Previously, she had always sensed a question mark over where her priorities lay.

‘Immediately, people think: “Oh, my god, you're dealing with so much. You must be super stressed, which means you're not functioning optimally, which means we're not sure if you're a safe doctor.” You're somehow less capable because they presume all your energies are still there with your child, which is not true.’

As Marta Cohen became internationally known for her award-winning work on sudden infant death syndrome, she received several invitations from overseas to collaborate – but one made her weep.

It should have been a matter of pride for Professor Cohen to hear from pathology colleagues in her native Argentina but instead it brought back painful memories. Some of them had, years earlier, turned her down for a postgraduate course because they knew her son, Emiliano, had severe disabilities. 

‘The question at interview was: “How would you manage with your son? Who is going to look after your son?” I was a woman, therefore I have to look after my son.

‘I didn't have the guts at that stage to say: “That is discriminatory.” There were three men asking this question to a woman with a disabled child. I didn't get the place.’

At that time, a young Dr Cohen was struggling to care for a child who was fitting up to 35 times a day. Despite being well connected and a high achiever, she could not find work in pathology. She uses words such as ‘embarrassed’, ‘weak’, and ‘stigma’ to describe how she felt, as a doctor and a mother.

She, and potential employers, knew that Emiliano’s diagnosis of Wolf-Hirschhorn syndrome would mean a lifetime of specialist care. Now 34, her son still has the mental age of a six-month-old.

It was only after Dr Cohen challenged a government minister about unemployment on a topical debate TV programme, posing a question from the audience, that she was offered a job.

Soon afterwards, Dr Cohen and her husband made an important decision: they would hire a live-in carer for Emiliano for life.

‘Thinking with the head and not with the heart, I decided I will work very hard to have a good income to provide Emiliano with a good quality of life. I will love him and do the best for him, but I need to have a life, to develop a profession as a paediatric pathologist. I love my work.’

She has faced no further discrimination as a parent carer, including in the UK where the family moved in 2003, bringing their nanny with them.

This, she believes, is because she and her husband have built a strong support system for Emiliano, on their own, and she has never had to ask for adjustments at work. Prof Cohen is now head of the histopathology department at Sheffield Children’s NHS Foundation Trust.

‘From being embarrassed by our situation, now I am the opposite. I am proud we have managed to overcome and achieve so much despite having a very severely disabled son, and I am proud to say he lives with us.

‘It is because Emiliano needs us so much that we are strong. We have achieved more than we would have achieved without him.’

When Katherine Walesby describes her day job in an over-busy NHS as her ‘respite’, she means that literally.

Life outside her work as an specialty trainee 7 in geriatric and internal medicine in Edinburgh is beyond challenging.

Her eight-year-old daughter has an ultra-rare, life-threatening neurological condition called alternating hemiplegia of childhood, and needs 24-hour care. Her symptoms, which occur most days, can include seizure, paralysis and painful muscle rigidity. She can also stop breathing without warning and has had to be resuscitated several times. Early on, ‘emergencies’ became part of the family’s normal.

‘I never pushed my daughter through the park, because if we're in the middle of the park, it's hard for paramedics to reach you,’ says Dr Walesby.

Their child’s complex care needs include being fed through a gastrostomy and a medication regime that runs from 5am till 10pm. ‘As a consultant colleague put it to me: “It’s like you’ve done a full day before even coming to work.”’ They have the support of carers and some respite care at a children’s hospice – but Dr Walesby and her husband are always on call. As she points out, it’s ‘very different’ from organising childcare for their three-year-old son without complex needs.

Inevitably, all this has taken its toll: the family’s health and finances have suffered. Dr Walesby’s husband, who has progressive multiple sclerosis, has given up his eco-tourism consultancy to care for their daughter. Dr Walesby is officially the carer to them both.

Little wonder then that Dr Walesby’s PhD took nine years, including two periods of maternity leave and extensions.

Against all her expectations, the support she has had during her PhD and in her return to clinical training in 2024 has been ‘really good’.

‘I came into it thinking I would have to use the words like “battle” and “fight” for this or that, and I didn't have to.’

Her training programme director, educational supervisor, associate dean and the trainee development and wellbeing service have collaborated to create a workable training programme for her. Her daughter’s needs mean that Dr Walesby can only work 20 hours a week in geriatric medicine and does not work nights or out of hours.

She is grateful – but worries how such adjustments look to hard-pressed colleagues, including those who might be involved in selection panels when she comes to apply for consultant posts.

‘There is this feeling of guilt when there are major gaps in the rota but, to do a week of nights, I’d literally have to put my daughter in a hospice or something. I’m not sure there’s an understanding that if I could do more hours, I would, 100 per cent, because my pay would be better, I’d move through training faster, and I feel I’d give more to the team.’

Within their respective medical royal colleges, Dr Maitra and Prof Cohen have become strong advocates for those with complex caring responsibilities. Dr Maitra has created a Health Education England resource intended as a discussion framework to help employers better support those returning to training.

They both know doctors who have left medicine to care for loved ones. According to the latest NHS staff survey, a third (32 per cent) of all participants said they supported someone with a ‘long-term physical or mental ill-health/disability, or problems related to old age’.

An NHS which is struggling with retention and workforce shortages needs to go further in accommodating staff carers’ needs, says Prof Cohen, who is vice-president of the Royal College of Pathologists.

Carers should be offered greater flexibility and paid carers’ leave, she says – and those caring for others with complex needs should be more clearly distinguished from parents with ordinary childcare responsibilities.

Prof Cohen is concerned that many colleagues with complex caring responsibilities either don’t ask for flexibility or aren’t listened to. Trainees especially are loath to ‘rock the boat’.

‘The system should offer adjustments, rather than people needing to ask for them,’ she says.

Far from shirking their responsibilities at work, doctors with complex caring responsibilities tend to value their jobs as a counter to a challenging home life.

‘Someone who has a difficult life at home is going to be efficient at work and is going to enjoy it because it’s a way of balancing their life,’ says Prof Cohen. ‘You are no longer a person that has a stigma: work is what makes you equal.’

Parents with ‘lived expertise’ of complex care needs also bring invaluable experience to their work as doctors, especially in shared decision-making and communicating with patients and families, says Dr Walesby.

Sadly, in her case, that experience includes ‘bad care’ and times when she has been dismissed as an over-anxious ‘medic mum’.

Yet, these negative experiences compel her to press on with training, even though it may take years before she can apply for a certificate of completion of training in internal medicine and geriatrics.

‘You can either say: “I can't be around that environment,” or: “I don't want that environment to not have enough people that really care.”’

For her part, Dr Maitra insists her advocacy is not driven by a need for sympathy: psychiatry has given her ample exposure to ‘people’s difficult life experiences’. All she wants is for doctors in her situation to be given opportunities.

‘No one else can fight your fight. The only thing they could do is stand next to you. I’ve had some amazing people stand next to me. They are the creative thinkers. You just need someone to believe in you.

‘I don’t come from a place of anger that I didn’t get this or that. What I’m saying is, my goodness, if you do support people, have you seen what can happen?’