I conducted a recent poll via social media amongst a large group of over 17,500 UK-based female doctors who also happen to be mothers. Of these, 27.84% work full time, whilst the overwhelming majority − 72.16% − work less than full time (LTFT) in varying amounts.

This trend for LTFT working has increased over the years, in line with more women being part of the workforce.

The annual survey of doctors in training has consistently shown that LTFT trainees feel more positive about their training when compared with their full time counterparts.¹ In 2017, 10.7% of doctors in training worked LTFT; 91.2% of these were female and the choice to train LTFT was largely due to childcare commitments.²

WHO IS ELIGIBLE TO WORK LTFT?

The British Medical Association (BMA) and the Gold Guide from NHS Employers outline eligibility criteria for those wishing to train LTFT, divided into two categories.³ Category 1 applicants are treated as ‘priority’ applicants.

Category 1

• Disability or ill health (this may include IVF programmes)
• Responsibility for caring (men and women) for children
• Responsibility for caring for an ill or disabled partner, relative or dependant

Category 2

• Unique opportunities for personal professional development, e.g. training for important sporting events, or short term extraordinary responsibility (a national committee)
• Religious commitment (e.g. involving training for a particular religious role)
• Non-medical professional development, such as management courses, law courses, fi ne arts courses or diplomas

Employers may be obliged to positively assess applications for LTFT working, but the decision to accept such applications remains with the individual employer. Even once an application has been accepted, the employer and employee may have differing views/needs regarding the kind of work pattern that is expected. The whole notion behind LTFT positions is to help accommodate flexible working for employees. Therefore if, after negotiations, the working pattern still fails to adapt to your needs, there is scope for appeal. It is best to give your employer as much notice as you can of your expectations, to help ensure the flexibility you require.

THE BENEFITS OF LTFT

Going back to work after my second maternity leave on an LTFT basis has allowed me to juggle parental responsibilities, a research degree and training as an obstetrician and gynaecologist.

While working LTFT in medicine moves the goalposts further away in terms of completing training, the length of training is taken into account pro rata. This means that the actual amount of time spent at work to finish training is the same. For example, if you work 60% LTFT, 12 months of full time training takes 20 months.

The annual National Trainee Survey commissioned by the General Medical Council (GMC) consistently shows that LTFT trainees rank their quality of training above that of full time trainees, from their teaching, to confidence building and usefulness of their posts to future careers.⁴ Concerns of being disadvantaged as an LTFT trainee have not been echoed in this survey.

THE CHALLENGES OF LTFT

I was hesitant to start working LTFT. My two main concerns were the stigma that consultants might attach to LTFT working and the effect on my training. Would I lose opportunities to my full time colleagues, impacting my career progression and confidence?

The nature of medicine and how we work has changed. The fi rm-based structure has steadily been diminished, with a move to shift work. This has favoured LTFT working, and so it is far less apparent whether one works LTFT or not.

Despite this, I have encountered disappointment and judgement through working LTFT from my seniors. Many people have not worked LTFT themselves, and lack understanding of the role of more flexible work patterns. This is being improved with the appointment of local and national LTFT Support Champions, to act as guardians for those working LTFT. The BMA also has a comprehensive guide for working LTFT and offers support for this purpose.

Financially, working LTFT does constitute a reduction in pay, but it directly reflects the amount of time for which one is at work. The BMA, the Medical Protection Society and the Royal College of General Practitioners all grant concessions to those on lower pay (e.g. those in LTFT working). However, some Royal Colleges charge the same annual fee to full time and LTFT workers. In addition, the cost of compulsory postgraduate examinations is not reduced for those working LTFT, nor that of the many courses required to pass them. On the plus side, the new study budget arrangements cover the costs of mandatory and many optional courses, removing any financial penalty for LTFT working.

IN CONCLUSION

Overall, LTFT training has benefited me personally and professionally. My positive feelings towards it are echoed by other trainees across specialties, both regionally and nationally. I have not heard LTFT trainees express regret, such as wishing they had finished their training quicker, only ‘I wish I’d taken longer’.

Alison Montgomery, Specialist Trainee Year 5 Obstetrics and Gynaecology, MD(Res) Student, Royal Surrey County Hospital, Guildford, and St George’s University Hospitals NHS Foundation Trust, London

REFERENCES

1. GMC 2017 Training Environments 2017, p 2, www.gmc-uk.org/-/media/documents/NTS_Report_20173.pdf_72689147.pdf.
2. GMC 2017 Training Environments 2017, p 28, www.gmc-uk.org/-/media/documents/NTS_Report_20173.pdf_72689147.pdf.
3. BMA 2015 Less Than Full Time Guidance, pp 3−4, www.bma.org.uk/-/media/files/pdfs/developing%20your%20career/bma%20less%20than%20full%20 time%20guidance.pdf.
4. GMC 2017 Training Environments 2017, p 29, www.gmc-uk.org/-/media/documents/NTS_Report_20173.pdf_72689147.pdf.