The way that doctors approach their training is changing. The popularity of less-than-full-time (LTFT) training is increasing, with 28% of anaesthetists in training now choosing to work LTFT.¹

LTFT is defined as a reduced number of hours compared to a doctor working full time (the current average is 48h). Doctors can elect to work a percentage of the full-time hours to allow them to continue their training while balancing other responsibilities. This will extend the length of time spent in training on a pro rata basis.

Until last year, doctors needed to demonstrate that full-time training was not practical for them. LTFT was only permitted according to pre-defined and prioritised eligibility categories, including childcare responsibilities or the doctor’s own health needs. This recently changed so that all trainees may request to work LTFT as long as they have a ‘well-founded personal reason’.² Support for an application for LTFT is dependent on the ability of the training programme to accommodate the request. The approval process can take from three to six months.

Here, an anaesthetist in training and a supervisor discuss their views and experiences with LTFT.

The LTFT trainee experience

I started my training in anaesthesia in August 2020. This was, perhaps, a sub-optimal time to begin and certainly an unusual one. With most elective work cancelled due to the COVID-19 pandemic, I spent much of the start of my training in emergency theatres or lending a hand on ICU. Although I did not realise it at the time, this had a significant impact on me and left me feeling somewhat burned out and very tired.

I continued to work full time for my CT1 and CT2 years. Towards the end of my CT2 rotation, my partner gave birth to our daughter, and I decided to start training less-than-full-time. This was partly because I felt I did not want to miss out on her earliest years, but was also an attempt to juggle two anaesthetic rotas and childcare.

Since starting CT3, I work LTFT at 80%. As my home life has become increasingly busy, I found my new working pattern has given me a modicum of ‘breathing space’. I use my ‘free’ Mondays to look after my daughter, but sometimes manage to sneak in some portfolio or project work when she naps.

There are some downsides to training LTFT. My core training will be extended by three months and, if I continue working this way, my CCT date will be pushed further back. With years of training still ahead, this is a slightly daunting prospect.
My pay has also reduced just as my expenses have increased. However, I find that an occasional locum shift has enabled me to ‘top up’ the shortfall.

Overall, I am very happy with my decision to train LTFT and feel that it has helped me to make my training both more manageable and more enjoyable. For anyone considering it, I would recommend speaking with some current LTFT trainees as well as your supervisors in the first instance. I have found that there is a lot of support available if you look for it.

The trainer experience

I think that LTFT training is great, and have no hesitation in recommending it. For some trainees it offers a lifeline which allows them to remain in training and maintain progress.

For training programme directors, organising training rotations can feel like doing a jigsaw with seven corners and twelve side pieces. Training requirements and bottlenecks are pitched against service needs as well as trainees’ personal ambitions and requirements. LTFT numbers and slot-shares add an extra layer of complexity, demanding creativity and flexibility on all sides.

Individual departments may struggle if overburdened with LTFT trainees who, for very good reasons, may request a particular ‘off day’. Here negotiation and flexibility (both ways) are key again. Where training opportunities occur on fixed days of the week, care is needed to avoid logbook skew. Equally, cherry-picking and favouritism are to be avoided! Slot-sharing may result in similar whole-time-equivalent numbers but more actual trainees, all of whom require training and support. In England, Deaneries now provide additional funding to trusts hosting slot-shares which exceed their post base. Supernumerary trainees are also funded, but uncommon.³

Now, with potentially unlimited numbers of trainee applications for LTFT, there is a risk that training programmes may become destabilised. Currently there is no mechanism to recruit to LTFT slots – so inevitably, without over-recruitment, gaps may develop in a programme if LTFT numbers are high. This could lead to increased service expectations from all trainees, to the detriment of training and personal lives. In an effort to reduce this risk, the College recently issued guidance for TPDs to maximise their use of training slots.³

The benefits though, include trainees with wide whole-life experience, often with personal ties to their region and a desire to commit to it as consultants. Departments benefit from new consultants with ‘warts and all’ knowledge, and fellow trainees learn from peers with institutional memory.

I am proud that anaesthesia has a reputation for support for LTFT, and look forward to seeing how this develops further. Anaesthetists in training interested in applying for LTFT training should have an early conversation with their training programme directors.
 

Further reading

1. General Medical Council. National Training Survey, UK, 2022.
2. Conference of Postgraduate Medical Deans. The Gold Guide, 9th Edition, UK, 2022.

3. Guidance for TPDs on maximising the use of training slots and minimising gaps, RCoA, 2023.