A growing number of junior doctors are investigating flexible working as a way of achieving a better work-life balance. In this issue foundation doctors Emma Tyson and Ellie Galloway discuss the process of applying for less than full time training (LTFT) after switching from full time to part time working and share their experience of a successful slot share.
As of April 2011 there were 3777 trainees working less than full time (LTFT) in the UK - 6.6% of the total number of doctors. Although 95% of these were women there were also a significant proportion of male doctors would also like to work LTFT in the future.
Helped by the changing demographics of the medical profession and demands for greater flexibility along with better work-life balance, the opportunities for LTFT have increased over the last decade.
So who can work part-time?
All trainees are eligible to apply to train less than full time and any 'well founded reason' which would prevent someone training on a full-time basis would be considered.
Doctors who wish to train LTFT mainly fall into two categories which have been defined by the deaneries as -
- Trainees with a disability or in ill health (may also include those on in vitro fertility programmes)
- Trainees (both men and women) with a responsibility of caring for children
- Trainees with a responsibility for caring for an ill/disabled partner, relative or other dependant
- Unique opportunities for their own personal/professional development eg. training for national/international sporting events
- Extraordinary responsibility eg. a national committee
- Religious commitment - involving training for a particular religious role
- Non-medical professional development (eg. management/law/fine arts courses)
Trainees may train less than full time from the outset or transfer from full-time to LTFT (and back again if required). Most LTFT trainees now work part time as part of a 'slot share' arrangement with the remainder managing to carry out reduced sessions in a full time post.
Slot sharing is when two trainees share one full-time post and manage the out-of-hours between them. Slot share partners are not expected to cover unexpected absence, such as sickness or maternity leave of their slot share counterpart.
The deanery can sometimes provide the additional funding for slot shares where the total hours worked between the two trainees is greater than a 100% full time equivalent. This can act as an incentive to the employing trust as they can end up with more clinical time, however the availability of this funding can vary between deaneries.
In general slot share trainees need to work at least 50% WTE and this may involve sharing with a different person on each rotation.
How it works
The initial process of applying for LTFT is fairly standard nationally and, although not complicated, it is a fairly paperwork heavy process. At a local level, once you've got deanery approval, there is a little more variability as some trusts may be able to be accommodating than others.
My FY2 post was at the Royal Surrey in Guildford and the coordinator there could not have been more helpful. There are two main issues that need to be resolved - firstly finding a suitable job share 'other half ' and secondly finding a job that lends itself to less than full time workers.
My job share partner Emma and I are currently working in A and E along with nine other SHOs. The shifts are each ten hours long and follow a fixed nine week rota with some weeks comprising 70 hours and others just 30 hours.
We are treated as one person so simply divide the line between us. Emma works half of the shifts and I do the other half plus three extra shifts over the nine week period thereby increasing my hours up to the 60% of full time that I am contracted for. A and E is the perfect place to work less than full time as continuity is not an issue.
We were very fortunate that we were allowed to choose our own shifts as long as we covered our allocated line of the rota. We particularly liked the fact that this allows us to be an integrated part of the team and also experience the full range of shifts - neither of us would feel that we had truly worked in casualty if we hadn't had our fair share of intoxicated Saturday night patients and rugby injured Sunday ones.
The reduced hours that Emma and I work means that we have much more flexibility for swapping shifts for child care reasons. Whilst this is obviously beneficial for the two of us it has had the unforeseen advantage that we are invariably able to perform shift swaps with others. It is extremely difficult for the full time SHOs to swap duties due to the almost impossible task of finding a replacement shift that does not clash with the duties they are already rostered for. We are both really pleased that we are able to help in this way.
Another concern that we both had was that we would be adversely affected by our reduced exposure to cases. Although we clearly do see less patients than our full time colleagues, we do have the time (and energy!) to read around the interesting cases that we have seen.
Emma and I also meet weekly to discuss the patients we have treated so that we each get the benefit of learning by experience - albeit indirectly. If one of us is unable to attend formal teaching we take notes for our 'other half '.
... and the negatives
Being out of sync with other trainees does have disadvantages. The main one being the need to find a job to cover the 'gap' between the end of FY2 and starting core training. Although neither Emma nor myself are at this stage yet I can see that it may be problematic. We have also found that although we are less than full time there is still the need to fit in formal training/audits etc and this has meant that we sometimes need to come in to work on our days off. Finally, working reduced hours mean receiving a dramatically reduced salary.
Words of advice
If I could sum up how to make a successful slot share work well it would be that there needs to be good communication, fairness and flexibility in division of work. On balance, job sharing is a perfect solution that enables progression as a doctor without compromising family commitments. We would thoroughly recommend it.