Kiri West is a ST5 LTFT trainee in Mersey deanery and the LTFT trainee representative. She tweets @KiriWest2
I have worked less than full time (LTFT) at 60% for nearly two years. In that time I’ve been fortunate. I’ve had nothing but support and enthusiasm from my consultant colleagues and registrar peers. I have had the occasional interesting conversation with foundation and core trainees around my “never being there.” I’ve had no problems with my pay. I have encountered some LTFT specific rota challenges, and although frustrating and often time-consuming to resolve, they have, ultimately, been resolved. The results of the LTFT training survey demonstrated that I’ve had it relatively easy in the world of LTFT.
Increasingly the picture is painted that working LTFT can fix the work-life balance challenges that are being widely discussed amongst the medical profession, and it does help. I get to spend an extra two days with my three-year-old little boy, swimming and playing train tracks. Time seeing him grow up I would otherwise miss. I get to spend more time with my husband, who, also in the public sector, works three out of four weekends. Family time would be a rarity with his shifts if I was 100% on a medical registrar rota. But, as I’m sure many doctors working and training LTFT can attest to, it isn’t as simple as just not going to work one or two days of the week and having “a day off”.
For trainees, to work LTFT you have to have a reason; a caring responsibility, a personal development opportunity, a health problem. That means for most trainees (and many consultants) working LTFT, those days when they are not in work are not just “days off”. They are days in another role - another job. The question “did you enjoy your “days off”?” is a common one – both from personal experience, and expressed in the results of the LTFT training survey. To a LTFT trainee, this is equivalent to a geriatrician’s “acopia”. Those days aren’t days of rest, they are days to run around after toddlers, look after unwell relatives, a whole myriad of things. But rarely are they “days off”. This is without work from “proper” work overflowing into non-working days, which feels inevitable and inescapable when feeling the pressure to keep up with full time colleagues. As raised by the LTFT survey, I too am guilty of over-compensating, and feeling the need to “go over and above”.
I thought it might be useful to give an example of a recent “day off”:
06:30 (ish) - Up with the nearly 3 year old. Husband already left for work. Coffee (essential), playing, trying to tidy the kitchen/washing out/other household jobs, try and get everyone ready to leave the house
0930 - Head out to local climbing centre for some rock climbing fun
1130 - Grumpy 3 year old, climbing centre not yet serving lunch. Head home in search of lunch.
1300 - Lunch done. Story read and 3-year-old sleeping (phew!) Kitchen tidied. Morning playtime mess tidied. Floors swept. Time to squeeze in essay writing for management and leadership course (3000 words, it’s painful, but a course all trainees at ST5/6 are expected to do locally)
1430 - 3 year old wakes up. Only a couple of hundred words of essay written. Head out with the 3-year-old, his bike and the dog for a walk. End up carrying bike and 3-year-old home.
1600 - Make it home. Cave to TV time whilst making 3-year-old dinner and sorting the washing out
1700 - Cajole 3 year old into eating dinner. Most of it ends up in the bin. Husband home.
1830 - Bathtime
1900 - 3 year old in bed. Husband making grown-up dinner. Its ARCP time – form R, CCT date calculator filled in and uploaded to portfolio. A couple of reflections written, assessments linked.
2000 - Dinner, last tidy up. Internet food shopping.
2100 - Relax!
I’m not saying that doctors who work LTFT are the only ones who also work at home. That’s simply not true. I’m also not saying that doctors who work full time don’t fulfil other roles, or have other “jobs”. That’s also not true. What I’m aiming to illustrate is that for many LTFT trainees, a non-working day is so much more than a “day off”.
It might not be apparent why asking a question as simple as “did you enjoy you days off?” matters. But, with respondents to the LTFT training survey talking of subtle discrimination, or negative attitudes which are endemic but under the radar, it does. Those “day off” comments could be considered a microagression; contributing to the culture of seeing LTFT as “part timers”, and demonstrating limited understanding for the additional roles many undertake.
Organisational culture is defined as “the values and beliefs that characterise organisations as transmitted by the socialisation experiences newcomers have, the decisions made by management, and the stories and myths people tell and re-tell about their organisations”. Culture is often elusive, hard to pin down and even harder to change. By this definition, when foundation doctors join us and then LTFT trainees are asked “how were your days off?”, or as LTFT trainees we tell them “I only work Monday, Thursday, Friday” we perpetuate the part time message, undervaluing the contribution LTFT trainees make.
Recognising a problem is only the first step. The challenge now is addressing it. What message do we want to send about LTFT? I want it to be a message of positivity, of success and balance, and equality. When sending this message language matters; the language we use on a day to day basis is very much within our own control and something we can change as individuals.
To my LTFT colleagues, I challenge you to stop underselling yourselves with your language.
To my full-time colleagues, I challenge you to think of an alternative to “How was your day off?”
In response to the findings of the LTFT training survey the trainees council are setting up a LTFT training working group with the aim of setting out Gold Standards with regards to LTFT training within geriatrics.
If you’d like to be involved, please contact trainees [at] bgs [dot] org [dot] uk