Less Than Full-time Training, Barriers and Future Needs (9 Apr 2025)

SPEAKER_00 0:13

Hello everyone and welcome to another episode of Career Conversations brought to you by the World College of Physicians of Edinburgh Training and Members Committee. My name is Marilena and I am the co-chair of the TNMC, and today I'm joined by Hannah.

SPEAKER_01 0:31

I am the other co-chair of the TNMC. And we've come on today to kind of talk to you about a recent piece of work that we did looking at less than full-time training across the United Kingdom. So Hannah, I guess the best place for us to start is to explain to our listeners what less than full-time training is. Yeah, so less than full-time training is essentially what it says, it's working at any percentage that is less than the 100% work banding stipulated by the job that you are on. So say for example, 100% is put into five days, at 80% you might be working four days, 60% working three days, etc. etc. However, it is more nuanced than that given the fact that people work weekends and nights. So the actual working hours will vary, which is why we often see people's rota as 80%, 60%, 50%, because it's obviously not a set day, a week, or what have you, given on-call commitments that the majority of doctors will have. And this can cover trainees in foundation training, I and T training, registrar training. So it goes across grades. Okay. And why would someone choose to go into less than full-time training? So there's numerous reasons that people will choose to adapt their working hours. And it used to predominantly be based on a requirement for either health reasons, academic opportunities, and then a kind of professional or lifestyle need. Now, this third category, the kind of lifestyle need, was developed as part of improving junior doctors' working life strategy, piloted back in 2017 by Emergency Medicine and then by Pediatrics Nobs and Gaini in 2019 to try and improve work-life balance and staff retention and I guess overall contentment really with the job. It then became available to everybody in England in 2022. And you know, you're now allowed to apply for less than full-time training without needing to state a particular need. You know, you can't just train less than full-time if that is what suits you and that is what you want to do. So we've come a long way from it being just for particular reasons, predominantly health, childcare, caring responsibilities, but it's not always as easy as that, which I think we'll probably delve into. Okay, so how can one apply for less than full-time training? So I think the first thing to do would be to chat with your supervisor and then probably your training program director. Where you are geographically will depend on what route you take. So I think whether you're based in England or Wales or Scotland, you should look at your training body, and on their websites, they will have information about less than full-time training and applying for less than full-time training. I would always talk to colleagues and friends that work in the same deanery as you, and your TPD should be up to speed with what the local requirements are, especially given that there still needs to be a consideration against local service provision when allowing everybody to go less than full-time that wants to.

SPEAKER_00 4:53

I will make sure that the link to the manuscript is on our footnotes. But from that, we were able to kind of ask trainees what any possible issues surrounding training in this way have been for them, what they've encountered.

SPEAKER_01 5:10

Do you mind maybe just summarising what the main issues were? Yeah, sure. So as you said, the kind of the main aim of our study was to really have a look at the current demographics of less than full-time training doctors and to explore their perceptions of the benefits and limitations of both full-time and less than full-time training. So people that undertook this survey could either be in full-time training or less than full-time training, and they could have had experiences, either one or both of them, for example. Because it can be fluids, you can go in and out of less than full-time training depending on what stage of life, career you're at, and whether it kind of meets your needs at that present time. So a survey was 40 questions under five headings. And essentially, we had about 650 respondents, which is really good. And most people were undertaking less than full-time training for a variety of reasons. So about half were involved in caring responsibilities, be that for children or family members, you know, we didn't need to stipulate that in the survey. But those from previous surveys over the last kind of six, seven years or so, that's has been the main reason. Followed by kind of well-being and welfare, and then disability or ill health. And a small proportion train less than full-time for you know other development needs. Most people thought that this was going to be uh longer than a five-year plan, which I think is important for workforce planning. So I think that's a useful thing to bring out into the open that people aren't just planning to do this for a short amount of time. It might be something that they consider for the rest of their careers. And the common themes were that less than full-time training gives people a better work-life balance. That was a real theme. There was more opportunity to combat exhaustion and fatigue, which is ever present. And they also highlighted the fact that you're not hardly working, you know, you're not doing no hours. Less than full-time work can still be a 40-hour week, which is more than what a majority of people do as a full-time job. So we're cutting down from a 48-hour week to 40 hours for 80%, and that is still more than what your average person works in a week. So it's still a high workload, but it allows people to just balance a little bit better. So that was a real positive. And lots of people equally said, you know, with regards to full-time training, that working a 48-hour week average, and it's average, so it can be much higher than that in a week, is simply just not sustainable. At the intensity that we are currently delivering work, I think most people can agree that the intensity of work over the last couple of years has just exponentially increased. And so people also highlighted that the feelings of stress and burnout and this sustainability is just really tricky. There are some negative side of things that people felt with regards to less than full-time training, and that particularly revolved around training opportunities. So, say for example, teaching might always be allocated on a set day of the week by the department that you work in. And if you don't work that day of the week, the likelihood is that you're going to miss it or you're going to end up coming in on your day off, which is what you shouldn't do. Ironically, a lot of people actually said that they use that day off to catch up with things like portfolio, like extra academic activities, just so that they could fit it in, which, you know, it's not the aim. That stuff should be done within hours. But actually, I'm sure the majority of people listening do work outside work in order to do their portfolio audit work, for example, with, as I said, the intensity of work that's going on, people just push it to free time. And that is impacting those in full-time training and less than full-time training. And other things like, you know, clinics might be on set days. And again, if you've got that day off, you might miss an area of specialty. I guess particularly within surgery and kind of more procedural-based specialties, there could be issues with getting like numbers of procedures signed off and things if you are missing out on that time. Other areas that we looked at were, you know, continuity of care, teamwork. And some people did highlight the fact that they might feel that they don't get the continuity of care. Perhaps, I guess the lower down the percentage of less than full-time you train, the continuity of care can be harder. And again, sometimes teamwork with that. I think what's also worth discussing is the stigma perception that can go with less than full-time training, which was highlighted in our survey. You know, people noted down that there's a perception from others that you're maybe not as committed as other trainees, which I think that needs to be addressed, or that you weren't as dedicated to the specialty, which really just highlights the lack of understanding that some people may have around the kind of new working role that there is. Though there were a lot of comments that actually, you know, because this is becoming more mainstream for people to work less than full-time, that actually, you know, the stigma or perception of that is reducing, but it is still present. So I think that's an area that again needs to be addressed through for re-education of peers. Yeah, I think going through the results. The main things that said to me I took away from this, and I hope that the listeners will take away from our podcast and the readers from our manuscript are that whilst it is an amazing opportunity, and you know, if that's what you need to have a better work-life balance, because that is why most people were choosing to work in this way, then you shouldn't be disadvantaged in doing that. And I think it's also very important what you said about doing our work in hours. Personally, I don't know a single trainee that does their portfolio in hours, and I appreciate that it's our normality to do that. Whether that's right or wrong, I think is a whole different story. But I do think it's important that that day off is used in the way that it's supposed to be used as opposed to to catch up on work. But I would encourage the listeners to have a read of the manuscript. I think it's really important to say at this point that what you're reading isn't our personal opinion. It is based on the let me get the precise number, the 648 trainees across the UK that did participate in our survey. But I think the unfortunate thing is that we don't quite have an answer for how we fix the current issues. Other than I think the more we increase awareness, the more we can work towards uh minimising stigma around it. And I think as it becomes a new normality that will also help to decrease stigma. But I think we all need to work together to try and see how we can make it a more efficient process and an easier process. So I think essentially higher up need to listen to these facts and figures, and ultimately it needs to be used to really educate workforce planning because the fact that at the moment a training number is assumed a 100% work time equivalent, where in reality that's not the case for a lot of people, you're then getting significant rotor gaps, which could be avoided if workforce planning is done correctly and based on what the actual people on the ground are working. Because say if you appoint five national training numbers and everybody works at 80% equivalent, well then you've just lost a whole person, essentially.

SPEAKER_02 14:09

Yeah.

SPEAKER_01 14:09

And that's very hard to fill on a rotor gap, but has significant implications for both patients and staff. So I think it's aspects like that that need to be addressed from this. And I also think that the current state of burnout, which is massively highlighted in the GMC training surveys and has been there for a number of years, but the positive perception that Lesband Full-Time has on addressing a healthier work-life balance and the sustainability and the longevity for staff in order to be with family, friends, do your hobbies, you know, see your kids, etc. If we can actually get that balance a little bit better, then issues of burnout, mental health, stress, risk of suicide, you know, all of that adds up and it's so important. Yeah, totally great. I do think there's anything else for me to add there. I think you've highlighted everything great, other than encourage all our listeners to read our work.

SPEAKER_00 15:24

Also, I guess it's a good place to highlight that if anyone as trainees does have anything that they feel that the college can do for them, then you can write in on your quarterly newsletter. We do ask your opinions to see if there's anything that we can do to help with your training.

SPEAKER_01 15:42

So please feel free to contact us, engage with us, and we'll see what we can do kind of from our end of things. Thank you for listening. I hope people found it insightful. The papers out there, and as well, if listeners have got any other questions that we could address with a piece of work like this, then do send ideas in because you know, hopefully it can make change. Yeah, exactly. And that's what we really want for everyone. Thank you all so much for listening, and we hope that you'll join us again next time. Thank you.

SPEAKER_00 16:37

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