The growth in the number of female doctors has led to increasing demand for part time training and working in the medical profession. Formal flexible training first became available in 1969 when the option of part-time training became possible (introduction of COPMed Confederation of Postgraduate Medical Deans)[1]. [2] Following the Calman reforms and the introduction of the specialist registrar (SpR) grade, the appointment of flexible trainees was integrated with the appointment system of full-time trainees. In 2007part-time training and flexible training became referred to as LTFT training. Doctors can train LTFT in one of three ways: part time in a full time slot, slot share or in a supernumerary position. Most deaneries prefer LTFT trainees in slot share posts or as part time in a full time slot, as supernumerary training can be difficult to fund and has the disadvantage of trainees struggling to feel ‘part of the team’ with reduced exposure to out of hours work.

The most common reason to work LTFT is for childcare reasons, and thus the number of flexible trainees tends to closely follow the number of women doctors in a specialty. Paediatrics and general practice have the largest number of LTFT trainees,[3] whereas some specialties such as cardiology have very few. Given that approximately 60% of medical school entrants are female,[4] it is likely that even traditionally less feminised specialities are going to attract more women trainees who will expect to be able to work flexibly at some point in their career.

LTFT training is not just for women combining their careers with motherhood. Doctors opt to train LTFT to do voluntary work or to pursue other medical or non medical personal or professional development.

The benefit of LTFT is well acknowledged [5] with trainees reporting better work-life balance, increased enthusiasm for the work place and helping to retain doctors in training who might otherwise have been lost from the workplace.

Contemplating training LTFT for any reason can be a daunting prospect as there is a perception that not many SpRs have successfully negotiated training in this way. Cardiology is an extremely competitive speciality and there is a well-accepted view that to succeed you need to give more than 100%. Many people are put off training LTFT as they feel they simply won’t be able to compete with their full time colleagues if they are working reduced hours. Other factors such as reduced pay and longer time to finish training are also important factors. The recent introduction of academic fellows, where trainees work part time clinically and part time completing research, has potentially helped demonstrate that training LTFT is a credible option and has opened up the potential for future job share arrangements.

Training LTFT means that your training will be longer than if you had decided to continue training full time.

Table to show the time needed to train LTFT compared to full time equivalent

 

As a trainee in a post with reduced sessions you are doing the same job as your peers with the same relative on call commitment. This can be a great option as it means potentially, your training opportunities should be the same as if you were full time. However the main difficulty is that the hospital is under no obligation to fill the other slots with a locum and so you may find that your colleagues have to cover 'you' for the days you don't work or the on calls that scheduled on those days. This will impact on the quality of their training. Working in a post with reduced sessions with no formal locum cover will be challenging as it is almost easier for the Consultants to bypass  you and discuss your patients with the other registrars to save the patients being handed over mid week.

Finding someone to job share with is in my opinion, a better option. On paper it means that two LTFT trainees share the week often working three days each, and so there is the additional benefit of having both of you on one day. You clearly need to communicate well as a pair and with your team, but that’s pretty obvious. The difficulties are that there aren’t many other cardiology SpRs who wish to train LTFT and so you are unlikely to find some one else at the same stage of training with similar interests in the same region. Job sharing with an academic SpR who spends half their time in research is an option.  Difficulties can arise if your Consultant, for example, only has fixed cath or TOE lists as you may find you are not scheduled to work on that day and so miss out on certain training. This can be challenging as most mothers who train LTFT for family reasons do not have flexible childcare arrangements, although this can balance out when you rotate in the department working for different consultants.

The other option that I would recommend is working in a supernumerary position. The advantages are that you are truly an additional doctor and so can organise your working week around what you wish to learn and so potentially use this almost as an opportunity to develop a specialist interest. The disadvantages are that you may not feel ‘part of a team’ and that your pay is the fraction of the basic salary. You need to continue on the oncall rota and so need to take the oncall bleep during the day as you are not formally allowed to locum if you are a category one LTFT trainee. 

If you opt to be supernumerary, or work less than 50% you will then need to apply for educational approval. This is relatively easy as you write down your time table, check that your Consultant thinks the time table is feasible and appropriate to your stage of training and attach your CV.

The first thing you need to do when applying for LTFT training is to speak to your Training Director, contact the Deanery and check that you are eligible. Most deaneries have a very clear website and are very familiar with the system. You need to fill in an eligibility form request, which is pretty easy and self explanatory. There is no obligation to train LTFT once you have filled in this form.

Eligibility for LTFT is categorised into category one (young children, ill or disabled dependent, unable to work full time for health reasons) and category two (to combine with other paid or unpaid employment or to follow non medical interests such as sport and music). Category two trainees need to reapply for eligibility each time they change employer as this category is entirely at the employer’s discretion.

You will then be sent a Flexible Training Approval Form (FTAF) which ideally should be submitted to the Deanery 2 months before you intend to start work. This can be stressful if you are applying in a hospital where you have never worked and don't know anyone. The first time I filled in the form I worried that I wouldn't be allow to train LTFT if the Deanery didn’t receive it in time and getting the right signatures seem to take an incredibly long time. When filling in this form it is sensible to request to train LTFT for one year irrespective of when you plan to start work, although you will be asked every August to fill in a new form for the October change.

When you complete the FTAF you need to have a clear idea of whether you intend to train in a post with reduced sessions, slot share (and so you need to name your slot share) or in a supernumerary position. Your training director or educational supervisor should be able to help you with this. There are benefits and potential disadvantages of each as I have mentioned above and it is important that you and the Consultant agree on what would be best for your training, and not necessarily the hospitals’ finances.

The FTAF has to be signed by medical staffing and a nominee for the Director of Finance. Tracking down exactly who should sign the form can be time consuming and I would recommend emailing people to check exactly who will sign the form and confirming exactly when they are free to do so, and then literally taking the form to them. One form I filled in got lost in the hospital post, but thankfully the deanery accepted the scanned copy that I had on email.

The Deanery wish to place you either in reduced sessions in a full time post or in a job share as it is more financially attractive that supernumerary training.

Your pay reflects the number of hours you work and not necessarily the number of sessions. If you choose to work 3 days then it is likely you will be between 0.6 and 0.8 of FBS (full basic salary) depending on how many hours your full time colleagues are contracted to work. It is worth taking time to speak to medical staffing about this. Your banding supplement (for reduced hours in full time slot or job share) is the percentage banding (ie either 20%, 40% or 50%) of your flexible basic pay. For example if you are working 70% and working oncalls (colleagues contracted to 50%) then you will be paid: 0.7 + (0.7 x 0.5) which equals 1.05 FBS.

Understanding the finances around LTFT can help in ensuring you negotiate what you want from LTFT. Trusts are understandable reluctant to spend additional money on LTFT trainees. There is normally no cost pressure if you choose to work reduced sessions in a full time slot as the training post is already fully funded from the MADEL (Medical and Dental education Levy). If you were working full time the Trust would pay you a banding supplement. In fact the Trust potentially make money from this option if they choose not to employ a permanent locum but pay locums for your oncall, as your training post is fully funded (ie 1 FBS) and you will only be paid a fraction of the FBS with a reduced banding supplement.

For slot sharing posts there is usually a financial incentive for Trusts as they receive the full funding from MADEL and receive a funding contribution towards the second trainee at the mid point of their payscale.

For supernumerary posts the Deanery will make a funding contribution at the mid point of the trainees’ payscale and so your salary is essentially covered. The trust would however, be expected to pay for out of hours oncalls and this is often a sticking point as the trust would argue with a full complement of SpRs they do not wish to pay additionally for you to join the oncall rota.

The two main challenges in working LTFT is first organising, designing your job and getting all the paperwork completed, and second making your post work for you and ensuring that you get the training you require.

I would recommend taking time to speak to medical staffing to calculate how many hours you are planning to work from your timetable and work out what fraction pay this would equate to. Email and organise who is going to sign your FATF which is particularly relevant if you have never worked in the hospital before. Apply early for educational approval and ask medical staffing to confirm your annual leave allocation (if working 0.7 should be 70% full time equivalent). Most study leave budgets are the same as full time equivalents.

Making the job work for you day to day is essential. As I work LTFT for family reasons,  I found having reliable childcare the most significant factor which allowed me to enjoy work, and not feel as if I had done a full days work before I had even arrived! Good communication is clearly essential.

There is now a LTFT officer in the BJCA who can be contacted for any help, support or advice for any trainee who is considering working LTFT.

1 Clay, B. (1998) Flexible training – what are the opportunities? BMJ Classified (23 May) 2–3.

2 Cremona and A. Etchegoyen (2001) Part-time training and working for male and female psychiatristsAdvances in Psychiatric Treatment, 7, 453–460

3 Making Part Time Work – Medical Women’s Federation report, 2008

4 HEFCE: Annual Medical and Dental Survey 2006

5 Topley, Ashwell, Webb, Brightwell. Trainee’ tales of less than full time training. BMJ Careers August 2012