Michael is a Foundation Year 2 doctor working in the North West of England. Today he is sharing his experience of working Less Than Full Time (LTFT) in the NHS. He explores the reasons why people may choose to work LTFT, the pros and cons of LTFT training, the process of applying and how working LTFT changed his experience of working as a doctor.
In Medicine, you have the option of doing Less Than Full Time (LTFT) Training, which is essentially where you work as a part-time doctor. You can choose to reduce your hours by a certain amount and extend the length of your overall training time instead. This allows you to have more time for yourself and any other commitments you have. You can choose to do this at any stage in your training and even as a consultant. This post will specifically look at going LTFT in the first two-years after qualifying as a doctor, also known as Foundation Training.
Hi! My name’s Michael and I’m a junior doctor working in the North West of England. I’m originally from near Southampton and studied at the University of Southampton but moved up North when I started my foundation training as a newly qualified doctor. We have to complete two years of foundation training after graduating, and I’m currently in my second year (Foundation Year 2/FY2).
If you’re considering going into medicine, you’ll likely have considered not just the upsides to it (a challenging and rewarding job, great career potential etc.,) but also the potential downsides. You don’t need to have worked as a doctor to have heard how the job can sometimes be tough and demanding, with long hours, horrible shifts and doctors regularly feeling burnt out.
It’s certainly true that medicine can be a big mix of the good and the bad, but there are ways of mitigating the downsides. One such way is working ‘less-than-full-time’ (LTFT). I switched to LTFT about 8 months into the job and haven’t looked back since – I feel I now have a much better work/life balance and recommend it to anyone who thinks it may be right for them.
If you’re thinking about applying for medicine but are put off by the idea of an inflexible job or career that will demand too much commitment/time/energy from you… read on!
Less Than Full Time training is the means for doctors to reduce their working hours and effectively work ‘part-time’.
Depending on what department you’re working in as a junior doctor, your contracted hours for that rotation (typically 4 or 6 months long) can vary – usually at least 40 hours per week, but it can be up to 48 hours. There are some individual weeks where you may be scheduled to work more than this, but it averages out with the other weeks where you’ll work fewer hours. LTFT can normally be anything from working 50% of the normal rota all the way to 80% (which is what I do). So what that means is if you’re normally working Mon-Fri from 9-5pm, working 80% gives you one day of the week off so you only work 4 days in total.
In some instances, I’ve heard people can work anything down to 20% (around 1 day per week) but this requires special permission.
The process of going LTFT can vary region-to-region, as each area’s hospital trusts work differently and they will have specific policies.
However, there are 3 ‘categories’ under which a junior doctor can apply to work LTFT, and each of them has different eligibility criteria.
Here are the criteria for categories 1 and 2 are as per healthcareers.nhs.uk1:
Those doctors in training with:
Those doctors in training with:
This category has only recently become an option in limited areas of the country but is on its way to being offered as an option everywhere in England. It is for personal choice, no ‘reason’ needed! It appears to be in the process of being rolled out across the country.
Note: hospital policies can get complex and vary between England, Wales, Northern Ireland and Scotland so it’s worth doing a bit of research to check about LTFT if you have a specific region you want to train in as a doctor!
The lingering perception among many doctors is that only those who cannot commit to a full-time role are able to apply: e.g. category 1 applicants, like those with children or other caring responsibilities. However, this is slowly changing and more and more doctors are choosing to switch to LTFT work, for all sorts of reasons.
Some of these reasons include:
- For better work/life balance
- Religious reasons
- Reasons due to medical conditions
- To better look after physical and/or mental health
- To have more time for other interests/hobbies
- To pursue other professional development/avenues
- For other training or to pursue another degree (e.g PGCE), do teaching or research alongside clinical work
…but this list is not exhaustive; maybe you have your own ideas!
You get extra days for yourself during the week for all your other commitments or to do with as you wish
It’s not just the extra time that I feel makes LTFT work as a doctor so much better, but how much more energy I have. This wasn’t something I was necessarily expecting, but I now have more capacity in my life for the things that matter to me: exercising, seeing friends, exploring my other interests etc.
By working LTFT, many people feel better rested and have the capacity to enjoy their job more when working, and as a result, get more out of it.
The NHS has done some research on this, too. Just look what was found from doctors who went LTFT under category 3:
Impact of the LTFT Category 3 initiative on trainees:
You still need to complete the same number of ‘days’ worked as a doctor at each training stage, so where you’d normally progress to the next ‘level’ after a given point you’d need to make up that extra time. This is all dependent on how much time you’ve ‘missed’. For example, if you worked 80% of the time for 4 months as a Foundation Year 1 (FY1) doctor, you would have missed one day a week for four months (16 days in total). You’d therefore need to continue being an FY1 for an additional month to make up for those days (assuming you’re still working 4 days a week). This would mean you’d be an FY1 for 13 months in total, instead of 12. By extension, this means you may see your colleagues and peers progress to the next stage of training whilst you remain at the same stage for a little while longer.
The unavoidable main downside of LTFT is less pay: if you work, say, 60% of a normal rota, then your pay matches this; i.e. 60% of your normal pay. However, LTFT doctors are entitled to a £1,000 annual allowance. You can read more about the reasons behind this here. This of course won’t make up completely for the reduction in your pay, but it works out at about £83 per month, which certainly helps bridge the gap.
If there is an abrupt need to switch to LTFT, a hospital trust will usually consider on an individual basis: e.g. if the doctor had suddenly fallen ill (mental or physical health concerns) or had new caring responsibilities.
Otherwise, if approved, the doctor would normally need to apply well in time before they rotate to their next department/job. They will typically have to submit an application form and attend some brief meetings with their supervisors about 2 months before rotating. The same is true of switching back to full time or increasing hours from any given LTFT rota.
Yes, you can still locum whilst working less than full time. This is where you work extra individual shifts by choice at much better hourly rates. If you’re conscious of a reduction in your salary, then this is a good way to supplement your income; locum shifts for doctors are plentiful throughout the country.
It’s worth bearing in mind though that if you chose to locum for many of your LTFT ‘days off’, your trust could potentially ask you to switch either back to full time or a higher % working schedule (e.g. from 50% to 60% or 80%). They might wonder why you reduced your hours only to work on your days off
I went LTFT as I found working too many hours as a doctor was having a negative impact on my wellbeing, in terms of both physical and mental health. I found I was exhausted at work quite often, and where I’m normally a happy, active person and full of energy, I struggled to find energy for anything outside of work. When I’m at work, I want to be a productive member of the team and a good, safe doctor – I felt working too many hours was getting in the way of this.
Since going LTFT, I feel like things have been much more manageable. There are still some stressful days/weeks, of course, but this no longer feels like something unsustainable, but rather the expected stressors that come with being a doctor. I feel that I’m able to be a better doctor when I am at work and also able to get more out of the job in terms of learning and developing as a doctor-in-training.
I’ve occasionally thought about the ‘extra’ months I’ll need to do while my friends who started work with me will have already finished and moved on, but on any particularly tough weeks I remember why I went LTFT in the first place and remain thankful I made that choice for myself; it was the right thing for me and I don’t regret it.
Medicine is a challenging profession and vocation, and many do feel that it can take almost too much from you, if you let it. I hope that throughout this article I’ve illustrated that LTFT is one way of getting more control and the balance right for you.
If you’re a foundation doctor who’s persisted through medical school and really wants a change of pace from the constant slog, but don’t want to take a more substantial step back (i.e. a year out) from training, LTFT could be a great option. Conversely, if you have other goals or interests you want to pursue, but simply want to get a particular stage of training done and out of the way, then focusing on your work at a normal 100% rota could just as easily make more sense.
It’s utterly cliché to say but only you can decide if working LTFT is the ‘right’ choice for you, and entirely down to your circumstances, values and priorities. That said, it can be really helpful to discuss with your friends/family/teachers/seniors/any colleagues who are LTFT to help you make this decision. And remember, if you go LTFT but then decide to change your mind - that’s okay too, as you can always increase your hours back up!
I hope this article has shed some light on the LTFT option for students who are thinking of applying to medical school or are in medical school but have concerns about how intense being a doctor can be!
Author: Dr Michael Bingley
Editor: Dr Latifa Haque