Less Than Full Time (7 Dec 2022)

SPEAKER_02 0:00

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SPEAKER_03 0:50

I'm delighted to welcome Dr. Jonathan Badgett, who's an acute medicine trainee in the South East of Scotland. So Johnny's less than full-time trainee as of last year. Welcome, Johnny. Most of you who are listening will know Johnny as he's a very frequent host and plays an important and central role in setting up and delivering podcasts. So welcome, Johnny, and thank you very much for your time today. I guess it will be interesting for you to be on the other side of the host guest bench today, but I'm delighted to chat to you.

SPEAKER_00 1:20

Thanks, Sandra. Yeah, it's great to talk about lesson full-time training. So I'm a lesson full-time trainee in acute internal medicine, as you said, and I've been doing it for the last year, so August of 2021. Yeah, it's great to be able to talk about it because I think it's really important that actually we spread the word of what lesson full-time training is and demystify who can do it and how available it is across the United Kingdom. Because it's really important that actually, even just in this present climate, the GMC survey, we're talking about the key things that matter to trainees and I think work-life balance directly during the pandemic has been something that has been really important for people in presence of wellness. So it's great to be able to talk about less than full-time training with you.

SPEAKER_03 2:03

Thank you, Johnny. So yes, you're right. And also I just wanted to bring attention some work that we did a few years back. So I think it was 2019 when the TNC did a survey to look into the prevalence of less than full-time training across trainees, and also intention to go towards less than full-time training, but also went into things like the reasons behind it just to evaluate this area a bit more. So the results of the survey are published, and this showed that more than two-thirds of trainees that took part in the survey have considered working less than full-time. They cited a range of reasons, including childcare, pursuit of work-life balance suggested, and to prevent burnout. And these words ring a bell, particularly for the most recent GMC survey, as you mentioned. We also came up with a number of recommendations. One of them was really to get local national guidance to create that and to highlight the educational opportunities for those who choose to go to less than full-time training. So there have been some changes to the less than full-time training application system as of 2021, last year, and this has been in conjunction with improving the junior doctors' working lives, really to streamline the process across Scotland and the country. So now when we apply for training, internal medicine training, higher specialty training, we can start with the application, put in that choice of less than full-time training. I guess we'll talk a bit more about this and other aspects of you, Journey. Just wanted to ask you, just as a starting, opening question, about your experience when you decided to go less than full-time training, the reasons behind it, and how are you finding things?

SPEAKER_00 3:49

So when I think about when I was applying for less than full-time training, I remember knowing that some of my peers had had experiences before, but within different training programs, so GP training, I always had this feeling that it was something perhaps that wasn't achievable or wasn't attainable. But certainly during my SE5 training, during ICU in the height of the pandemic, doing four to 13 hour shifts essentially back to back after my little boy was born, I realized that actually, if this was an option that was available, then why shouldn't I do it? And why didn't I do it sooner? The things that really struck me when I was reflecting on this is that during GP training, so my friends that have done it, my male friends have done GP training, had gone less than full-time, both in their training and in their post-graduate training. So after they've qualified as GP, there's no problem with them doing it. They can have flexibility in their work in their life and they can negotiate their hours. And it struck me that actually throughout medical training, we were always quite adherent to the rota that's set to us and the time of annual leave or the time of study leave, and the flexibility in training may not always be as flexible as what you want it to be. Sometimes you're receiving your rota two weeks in advance of a job starting. And for me, the most important thing was actually having a fixed time where I could look after my son and be able to reliably know that I was there for my family. And that's something that I knew that I wouldn't be able to have had if I hadn't gone less than full-time. And so those are the main reasons. But I must stress that using childcare as a reason to go less than full-time is fine. But the process itself, you had to include it, you know, your reason for it. But my strong feelings are this that you shouldn't have to be a carer or a parent to want to go less than full-time. And I think that's something that I'm seeing a lot of my friends doing, and it's for their own welfare and their own work-life balance. And so I think really there's a the real shift that we need to highlight this and advertise this to our peers so that as you said about the GMT survey, we can help our peers become healthier.

SPEAKER_03 6:20

And provide better patient care, ultimately.

SPEAKER_00 6:23

Exactly, exactly. If you can't look after yourself, then you can't look after patients. But just in answer to your second part of the question, the process itself was easy. I did a bit of research before applying. The Scottish Deanery or the NES website, which we can add into the show notes for this, is very clear. It's got a section dedicated to less and full-time training, and it gives you the appropriate associate postgraduate dean for less than full-time training contact for the region that you're training in. I guess in my situation, I was already within a training programme, so it was easy for me to know who to contact. First of all, I contacted my training programme director for acute medicine, and then I contacted the postgraduate dean for less and full-time training within the region of Scotland that I'm training in. After I'd already spoken to some of my friends who'd done less than full-time training, who are now consultants, who were able to give pretty good comprehensive accounts of their experiences. So I think a bit of research is required, and that's really important because you need to have an insight into what amount of time of training you're wanting to reduce your hours by and having a realistic expectation about how long that will extend your training by. But once I'd made the inquiries and completed the forms that were sent to me through the deanery, the decision was made pretty quickly. Although I did give them about six months' notice before the next training year. So I started less and full-time training in August of 21. And I was thinking about it and submitted the forms by about probably around February, March of 2021, which gave them ample time to process the paperwork and make sure that the incoming rotation supervisor knew that I was less than full-time. It was already sorted, and knew that I wanted to choose every week as my less than full-time day. And generally speaking, all of my educational supervisors, all of my rota coordinators have been supportive and I've been given what I've what I thought I was going to get. So generally, the experience has been excellent.

SPEAKER_03 8:15

It's great to hear that, Joanny. Thank you very much for sharing your own experience. You're talking about timing of putting in your application, and just as we're on that topic for our listeners, is there a specific guidance when that should be done? Are these more formalized now? Or is it again, as you said, in discussion with your rotor coordinating supervisors?

SPEAKER_00 8:37

Yeah, so generally I think the sooner the better, but I think you do have to give them at least three months notice so that they can process things through your training deanery. I don't know if I might have got my application in before the application system changed, as you said, but for me, the the timings of it didn't really come to my mind because I did it quite early, but it certainly helped them process the application. I must add, I had to have an interview with the lesson full-time training postgraduate dean as kind of a face or a Zoom meeting or Microsoft Teams meeting, just to basically meet me as a person and go through the reasons why I wanted to go less in full-time. I guess one of the things that I was sort of alluding to earlier is that if you're entering training, you've acquired an ST4 number or an ST3 number whenever I was at that stage. You can apply to be less than full-time in your application on Oriol. And maybe there may be a certain view that if you wanted to go less in full-time, subconsciously, you might not choose that option because it's for some reason it might reduce your competitiveness. I don't know if that's something that people think think about, but that's just something that I reflect on that perhaps we should encourage people who enter training programs to consider this as not a barrier, but something to really consider because it helps workforce planning. And I guess that's one of the things that only we talk about fine, you go less than full-time, but you have to have the appropriate time that you've taken away replaced by someone else. And that's important so that the rotors are um appropriately staffed.

SPEAKER_03 10:03

From your research knowledge and experience, speaking generally, at what stage in training do you think going less than full-time is good? Is there any considerations towards that? Or as you say, is that quite flexible and should be encouraged at whichever stage the trainee feels would be good for their circumstances?

SPEAKER_00 10:24

Yeah, so when I had the conversation with the less than full-time training postgraduate dean, the the message was that you can apply at any time really, but you can also decide to go back to full-time or change your percentage of your lesson full-time at your annual review of competency and progression. So you still have an ARCP, and that happens in line with everybody else's ARCP. So it just means that your stage in your training is staggered, and so it reflects on where you are in that point of time. So essentially, my feeling is that I was told that I could be flexible in the way I wanted to go about my lesson full-time training. And if I wanted to go full-time again, then all I have to do is speak to the postgraduate dean again. And that was kind of the message that was given.

SPEAKER_03 11:10

Thank you. And how it does seem that you had prepared in well in advance and you communicated with your deanary and you had a positive experience through your application. How are things going and how have you found the training aspects of the job over the last year?

SPEAKER_00 11:27

Yeah, so I'm currently in general internal medicine, part of my training program. And as I said, I get every Tuesday as my my medicine full-time day. So you have to be mindful about what shifts you're doing. So my training a lot of on front door medicine, so a lot of the front door assessment of patients, which is fine for those, for that pattern of shift. I'm fortunate that in my training program, every every Wednesday I have as my specialty skill day. So I know that on a Wednesday I do ultrasound, and that's that's what I do. So I've got that certainty that on a Tuesday and a Wednesday, I know what I'm doing. But on the flip side of that, you could always say that for continuity's sake, I maybe miss the week on a ward when it's just me running a ward. I usually get two or three days either side of that, doing that. And so it's the the balance of that continuity versus your lesson full-time training. And so that's one of the things that I don't get as much now, but within the rota that I'm on, that doesn't necessarily deviate too much from what everybody else does. So, like an example of my working week. So yesterday, which was a Monday, I was on call. So I was in from 10 till 10. I was busy, I was seeing patients. I was in the ecumedical unit. Tomorrow I know that I'm doing ultrasound all day from nine to five. And then Thursday, I'm doing nine to five in the ecumedical unit. And then on Friday, I'm on call over the weekend doing 13 hour shifts. And then I've got my my rest day on the Monday and my lesson full-time day and a juice day. So I hope that by sort of describing that's kind of rota, I'm showing that just because I'm doing less than full-time doesn't mean that I'm doing ours. I'm still doing every equivalent of everybody else's rota. It's just I just have a day where I don't work. So I hope that's demystified the feeling, or if there is a feeling that less full-time trainees don't work, because we do. Um it's just percentage less.

SPEAKER_03 13:31

And what about those on calls? As you mentioned, so your on-call this coming weekend. There is a lot of questions from speaking to colleagues about on calls and routas for less than full-time trainees. My understanding is that we participate in the on-call rota. How how has been your experience of that? Have your on-calls been reduced as a result of less than full-time training, or are you doing the the same on calls as you were doing before?

SPEAKER_00 13:58

So I think it it may vary from department to department, hospital to hospital, rotor to rotor. Generally speaking, I still do the same number of on-calls. Although the thing that you need to review whenever you're going into less than full-time training is wherever you get your contract, you will be given a breakdown of the number of hours that you do. But your at the end of the day, when we're talking about what your pay is, it's something that we don't really discuss, I think. You get your regular in-hours time and then your out-of-hours time. And so if you're doing less out of hours, then your pay will be less. And so, some in fact, in all the jobs that I've done, the out-of-hours time has been sufficient enough to still keep me within that pay bracket that I was in previously. Because that's another thing that you have to consider about it. Essentially, you're going to get less money per month because you're working less hours. And that's something that you have to balance. Actually, I'm going to have less time in the hospital, but I think fair and reasonably, you're not going to receive as much pay. And that's something just to consider whenever you're researching your decision to go to lesson full-time training.

SPEAKER_03 15:03

And what about study leave and opportunities for training? So, say you want to do a course or attend your training days. Is there flexibility around that and how is uh that affected?

SPEAKER_00 15:14

Yeah, so essentially, as you know, and that with each year of training, and the higher you you are in your experience, you get more days allocated to annual leave. So at my stage, because if you're above ST4 or ST3, you get, I think, 35 days a year of annual leave. Correct me if I'm wrong. And then you get that is including public holidays. And then I think for study leave, you can I think it's up to 30 days. So the the less full time is 80% for me. So it's 80% of that. So it's quite it's quite clear. But in answer to your question about planning your leave requests, you just request them as if you would with any other post. And I think planning your holidays. I think it's important just to make sure that your rota coordinator understands that Tuesday's your off day, if that's what you choose to do or how you ever proceed. And so that's not included in your on your leave. I think most people understand how the process works because if you enter into rota creation, then you need to know about this because there are there are more and more people doing less than full-time to varying degrees. So by and large, it's been easy. Um, it's been a straightforward process for me.

SPEAKER_03 16:24

Excellent. And Johnny, you suggested before that there is some variability across specialties. Again, from your research and speaking to colleagues, do opportunities for less than full-time training that vary across specialties? What examples can you give us?

SPEAKER_00 16:40

Yeah, so I mean, I'm an acute medical registrar. The things that I have, as I said, are as a constant are my ultrasound sessions as my specialist skill. I think if if it was clear that my ability to access that was made difficult because said ultrasound couldn't happen on a Wednesday and it could only happen on a Tuesday, then you need to consider that. And I guess that's something that you make a decision on on your way up and you change the day that you want to ask to go less in full time, perhaps. But you know, it's thinking about your own personal reasons and your own rotor coordinators' flexibility. I think if it was, say, a different specialty like cardiology, then that might you know influence your ability to enter procedural sessions. So you know, you may you may miss out in an angiogram list on a Tuesday or whatever other specialist skill it is. So it's important that your educational supervisor, your clinical supervisor, your training program director appreciates that that is your situation. And generally speaking, I think trainers are supportive, but if opportunities are more challenging, then you just have to work a way around it. And at the end of the day, the message from my lesson full-time training educational supervisor is that if you're not meeting the curricular competencies, the ARCD requirements, because of whatever reason, then they have to help you, and that's what they're there for. And so they they're that intermediary person that can negotiate on your behalf. So that's I think was one of the key messages that I got is that there's always someone to support you. You've got various different types of supervisors in your training, and they deal with that because they know the system.

SPEAKER_03 18:24

Again, sounds like you had a very positive experience. As you alluded before, I think we're hearing more and more about less than full-time training, and this is becoming more prevalent. We're more aware about the opportunities and how it's impacting the training and also quality of life of our colleagues. I wanted to get your view on you know, what was the attitude of your colleagues at work, seniors, juniors, towards this change in in training pattern? How did you feel?

SPEAKER_00 18:52

So when I did my first shift in my rotation where I went to less and full-time, I didn't really announce to anybody that I was less than full-time. I think realistically, maybe that's reflective of a department that you work in, but if it's a busy unit that's like an acute medical unit, the staff are changing so constantly that people may not even realize that you being off on a Tuesday was a less and full-time day. It could be just a oh, you're not rooted that day, you're somewhere else. And so my feeling is that being less than full-time, I don't think people have changed the perception of me. I think it doesn't really reflect on who I am or what I do as a clinician. It's just I just don't work a Tuesday. I think that's generally how I I see it perceived. I think people would just acknowledge that that's that's just a flexible working. But of course, if you have colleagues that are in that situation themselves and they understand it. But unless you know about less than full-time training, which is why we're doing this podcast, then you you may not even understand the processes. And so you may just be aware of what actually is required and what we go through.

SPEAKER_03 19:53

Thank you. And thanks again for giving all that practical advice regarding the application process and your experience of less than full-time training. Where do you see the future of less than full-time training? And what's your views on job sharing and other opportunities in clinical medicine?

SPEAKER_00 20:10

So I think the future is that we should encourage it. And I think generally speaking, the training numbers that are created for different specialties should be changed to meet that need. If there is one year where in advance of you know August, we're changing the new recruitment comes in. If they know that they're having four trainees going less than full-time, then the deanery I think should adapt to that and ensure that more training numbers are created for the next year so that that balance is made. That that's something that I think it maybe goes beyond what they can control. I think ultimately it's a decision on how many doctors are required to be trained in the UK, and that's something that maybe is a bit more in a political sense, something that we can't control. But this is why we're monitored whenever we do our clinical placements. This is why we have our rotors observed, and this is why we do feedback with our DMT survey. And just going back to the rates of burnout increasing, so I think you mentioned about the survey this year, and I don't know if anybody's read or seen this yet, but one in five of us will experience burnout. That was one of the most surprising, or maybe not surprising, statistics that I re-reviewed. And I think we need to think about that. And I have to say, during my time of being less than tooltime, my feeling of fleeting burnout has diminished a lot and compared to previous jobs where you have been working longer hours or in the situations where you you have sickness on a rota, you're you're then maybe having to cover more as locums, which is something that you know you sometimes will choose to do, but sometimes there may be no other choice because of clinical availability. So I think it's really important that we talk about that for full-time training, and it's really, really key that college, and that's why we're doing this, and other training programs talk about this because it's so important.

SPEAKER_03 22:05

I agree with you, Johnny. I think it's important to give these insights, but also to consider how we can prepare, you know, the workforce in the future in the medical field to have healthy, happy doctors to provide good patient care for you know our aging population, comorbid population. Thank you. Well, that was a very kind of great insight and run through what's less than full-time training been for you. As you say, I think we all should increase awareness of this and discuss openly. I'd like to finalise this by just asking you to give us some kind of take-home messages from your experience.

SPEAKER_00 22:41

My advice is if you're thinking about it, then you're probably best talking to someone who's done it. And if you're thinking about it and you've done that and you're still thinking about it, then you probably should just do it because you won't regret it. And I think the sooner you do it, the sooner you will reap the benefits of what you hope to have achieved with it, knowing that actually you're still a clinical healthcare professional and the empowerment that you get with controlling at least an element of your training is very gratifying. And I think it should be noted that at the end of the day, you will still CCT and be a consultant at whatever point that is. It just depends on when that is, but it's about the journey, and I think if you can if you can ensure that you have a pleasant journey, then you'll be better for it.

SPEAKER_03 23:34

Excellent. Well, on that note, again, thank you very much for your time today, and thank you very much to our listeners. Thank you.

SPEAKER_00 23:43

Thanks again, Anda. Thank you. If you would like to learn more about this, then please go on to the Royal College of Physicians of Edinburgh website for more information. Thank you.