Less Than Full Time, More Than Possible: Insights into Flexible Training

In this episode of Wents and Friends, host Alex Ashman is joined by ENT trainee Mairead Kelly to discuss the practicalities, benefits, and challenges of Less Than Full-Time (LTFT) training in the NHS. Drawing on their personal experiences, the conversation explores how LTFT supports workforce diversity, well-being, and retention, enabling doctors with varying responsibilities, from childcare to personal health, to continue training effectively. 

Mairead reflects on the administrative process of going LTFT, including the importance of proactive communication and meticulous planning. The discussion also addresses the often-overlooked challenges, including reduced continuity, slower procedural repetition, and blurred boundaries between work and personal life. Together, Alex and Mairead provide practical tips, such as securing remote access, being deliberate with training opportunities, and negotiating rosters strategically, to help others maximise their LTFT experience without compromising career progression.

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Thank you to all of our guests for this season and to Karl Storz UK and the ENT UK Foundation for sponsoring season two of Went and Friends, the podcast of Women in ENT Surgery.

This season’s episodes are hosted by Alex Ashman. Produced and directed by Heather Pownall @heathershub of Heather's Media Hub Ltd. The podcast was created by Ekpemi Irune. The rest of the team includes Anna Slovick, Katherine Conroy, Marie Lyons, Tanya Ta, and Alex Ashman.

Transcript

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Alex Ashman:

This is WENTS and Friends, the podcast of Women in ENT Surgery UK. I'm your host, Alex Ashman. This season, we'll be looking at key career advice on returning to training, working less than full time and applying for fellowships. And we'll be looking at factors that can make the working lives of women and minority individuals more challenging and what we can do about them.

Today, we'll be talking to Ms Mairead Kelly, ENT registrar in Oxford, about less than full-time training and ways to make training more flexible. But first, a brief word about our sponsors.

WENTS and Friends podcast is sponsored by Karl Storz UK who've kindly supported the podcast from the beginning and continue to do so for a second season. The podcast is also sponsored by the ENT UK Foundation who've supported the season with an educational grant. Thank you to Karl Storz UK and the ENT UK Foundation for their support.

Ms Mairead Kelly is an ENT registrar in Oxford having successfully transferred from North Thames Deanery. She also has experience working as a clinical fellow in Head and Neck, was a BMA less than full-time rep and currently works less than full time.

So, Mairead, thank you for joining us on the podcast.

Mairead Kelly:

Delighted to be here. Thanks for inviting me.

Alex Ashman:

So I mean, I thought we'd start off talking about the benefits of less than full-time training. I mean, obviously some people, it makes a lot of sense, but for some of our listeners, they may not immediately be thinking about it. So from your point of view, what was your experience?

Mairead Kelly:

So I think I'm going to turn it around a bit and say that there's a huge benefit actually to the NHS of having letter of approval. And I think that is that it essentially contributes to diversity in the workplace because it allows flexibility and time for all the different reasons that people want or need to be less than full time. So it means that those with caring responsibilities can carry on being doctored. And as you'll know, there's a kind of raft of reasons that you can go less than full time. Most of them are to give you time to do something else or to give you time to take care of yourself and still be able to do a job that you love or start loving the job that you're doing again because you're able to do it in a bit more of a kind of balanced way and not be so stressed about fulfilling the other commitments that you have in your life.

Alex Ashman:

Yeah. So it's about workforce retention really for the NHS as well as making sure everyone is able to carry on and do what they need.

Mairead Kelly:

And I think over time, the categories for which you can apply for less than full time have started to reflect that. And you know, the gold guide now says that all well-founded reasons will be considered. And I think there's a slightly kind of different description of the reason that you'll be considered for being less than full time, depending on what region of the UK you're in. But they do cover things like welfare and wellbeing now.

in the past wasn't such really there. was caring responsibilities basically, previously. There are lots of other criteria now. And in fact, the gold guide says, as I said, all well-founded reasons should be considered.

Alex Ashman:

So I know that some people will be off because they have caring responsibilities for children, some will have caring responsibilities for adults, some will have disabilities or ill health, some will have religious or sporting reasons. The list is quite long. It's a bit of a curb cut effect as in there may be one group of people who've started this off, but actually everybody benefits ultimately from this existing. And we may not all need it at any particular time, but we will benefit from it being that.

Mairead Kelly:

Exactly, exactly. And we all benefit personally from the knowledge that perhaps we might need it one day, or we might like the flexibility of having it one day. Yes, it's pretty much essential. And one of the best bits about working in the NHS is the expectation that applications to be less than full-time will at least be considered, which separates it from some of my friends working in the private sector, for example, who say to me that there's just no way that they can.

Alex Ashman:

How did you find the process of applying for less than full time?

Mairead Kelly:

I suppose I had quite a typical process in that I went off on maternity leave with my first child and then made sure I gave the sufficient notice of 16 weeks. I told my TPD that I'd like to be less than full-time when I returned from maternity leave, filled in the forms, got the signatures I needed. It was pretty much a done deal then.

Subsequently, each year I've just filled in another form as it's signed by my TPD and it's rolled over in kind of a pretty straightforward way. As I know, perhaps you've had a different experience. How was it for you?

Alex Ashman:

I'm 80 % which I think in some medical specialties doesn't exist at the moment from what I've heard as in they say well you've either got to be 50 or 60 or nothing basically in terms of less than full-time. So going in saying I want to have the time to look after my children and the response I had first off was you need to get a nanny then and carry on working full-time which is entirely possible to work less than full-time and still need a nanny. What with the gap between what school provides in terms of childcare and what work.

requires. So there was a bit of resistance, but ultimately I think as adults and adult learners as trainees, sometimes there is a temptation to not take everything the trainee says at face value and say, actually have you thought about this? But actually most people applying for lesson full-time training will have thought about it, discussed it with their family, looked at the alternatives and will only come to the TPD asking for this one they have thoroughly thought it through.

It can be disappointing to get pushed back, at the same time that pushback can usually be overcome by saying, no, I have made a balanced decision about this and this is what I would like to do. There needs to be an adult and be organised both in applying for it and also in organising your roster with colleagues, making sure the days work out with what your children, your family or your other needs reflect. Because it's no good saying, I don't know, you've got the nanny on a Monday, you don't need to be

less than full time off on the Monday, you need the Wednesday or the Thursday, say, and the rotor will need you to be around for X, Y, There's a little bit of compromise to be had, but usually it works out, but it's, I don't know, coming from a place of being organised usually. I don't know if that was your experience.

Mairead Kelly:

Yeah. And I think you can kind of, when you say what's the process like, there's different layers to that process. There's simply getting it signed off on a form, which is generally okay. And then there's the negotiations with your TPD or your team and with others who might have opinions about how this is going to reflect on your career progression as a whole.

And then there's the more local negotiations that you're going to have with your road coordinator in the department you're working with about the nuts and bolts of when you're going to work and so on.

Alex Ashman:

That brings me nicely on to the second thing I want to talk about, which is the challenges of being less than full time and the tips on how to sort of manage that apart from being bloody minded, you know, sometimes I'm finding compromises. don't know what challenges have you found otherwise?

Mairead Kelly:

People and myself were surprised that I actually think working less than full-time is harder than working full-time for a few reasons. of use that continuity of seeing patients, the same patients every day. So when the boss suddenly asks a question, it's harder to have that information at your fingertips. And I think in a practical specialty like surgery, repeating a procedure several times within a short space of time helps you to master that procedure. So being less than full time, that's going to be extended. And you have to, I think, partly you have to accept that and you also have to think of ways around that, which we can talk about maybe in a minute or two. And then I think the other things are, this is a bit more of an esoteric one, but being less than full time, you really have to play two different roles. You've basically accepted that your job is going to be at work some of the time and it's going to be doing something else some of the time. that's quite difficult. Switching between those two things is actually quite difficult. I've had periods while I've had children of being full time and I found that easier because I was a timetable of childcare that was, I knew exactly what I was doing and I only had to do, it felt like I only had to do that one thing, which was to go to work.

So it can be really challenging. think also the fact that pro rata you're getting less time in a subspecialty is challenging because just as you started to understand something or get good at it, you're often moving on to the next subspecialty. And then we've kind of alluded to negotiating a timetable with the department that works or what's happening in your personal life, what your training needs are, what days your consultants are operating on and what the department needs in terms of service provision. That's also a challenge. Any that you'd add? I'm sure there are plenty more.

Alex Ashman:

Yeah, I don't know, all of the extra curricular stuff that you're supposed to fit in obviously has to be fitted into moments of temporary quiet, know, sort of, I don't know, sitting in the dark next to your child watching videos of sinus surgery say, you know, can be done. You can end up doing all this background work that everybody does at home, but you just have to somehow magically fit it in. It just takes a bit more work. And sometimes you then you find yourself having to not just, you know, sequentially multitask and have right now I'm at work, right now I'm at home, you find the lines getting blurred and I guess having to set a few boundaries, not for others, but for yourself to make sure that you spend that time at home doing what's needed and not sort of stuck on the computer ignoring the children the whole time, etc. can be challenging.

Mairead Kelly:

I think you're, you're hitting the nail on the head there in terms of why I find that separation of roles quite difficult. It's difficult to not let particularly the work bleed into the, into the non-working days when you're meant to be doing other things. And I've had to be quite strict with myself about that. I used to go to training days on my non-working days, but then I found I was essentially working four days a week instead of working three days a week. So I've had to kind of set aside my FOMO and just think, I'll get that training day the next year. I'm going to be in training for longer. So I will pick up these training days. can't, you have to have some boundaries with yourself.

Alex Ashman:

Absolutely. We had Michaela Cameron on the podcast and she talked about, I don't know, the sequential multitasking to paraphrase, you know, saying, right, I'm going to do this thing and I'm going to do this well. And then I'm going to do this other thing and I'm going to do that one. I'm not going to try and do everything at once because nobody has the bandwidth or the ability to do multiple things at once. Truly. We have to take one thing, say right now I'm focused on this, I'm focused on the kids, I'm focused on sorting this thing out. And then, you know, I'll make time for that other thing later.

See, I think boundary is very important.

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I mean, a lot of people say, can you, can you train at 60 %? You know, can you train, you know, three, three days a week? Do you get enough surgical experience and how do you, how do you manage to get more if you need it?

Mairead Kelly:

Yeah, it's a good question. guess I'm quite early on in my training. I'm an ST4. So it's that question will loom larger for me a bit later on, but I think you can do it. And I certainly think that being less than full time possibly exposes you to more clinical scenarios over the lifetime of being less than full time. There are other benefits that might, that to counteract.

But I think in terms of procedures and repetition, you need to think of ways that you can repeat that procedure without actually being there to repeat it. So whether that's running the steps through in your mind, writing everything down, trying to draw the steps, watching a video, you need to kind of think of virtual ways to get that repetition in. I don't know if you found any pearls.

Alex Ashman:

Yeah, I think you're right that you have to be very deliberate in your practice. And I think I do see a variety of, know, sort of a spectrum of how much people aren't deliberate in their practice or whether they just turn up and sort of soak in the sheer volume of surgery they have access to. I think as you get more senior, you definitely become more deliberate in your practice because there are specific things you want to take away, specific things you want to overcome. And, the crux of the procedure may well be, you know, one day I want to do this particular thing. I can't do this yet. And then I'll be able to do the whole thing skin and coming in, having specific conversations with your, you know, your, your list coordinator, you know, waiting list manager saying, can we put these particular cases on this day so that I can do them, you know, back to back talking to boss and saying, right, I need this. This is what I need, which everybody should be doing, but it becomes a more heightened situation when you are less than full time and you have less, you know, and making sure that you don't take leave when the boss is around and vice versa if you can. All the usual things. mean, I'm not saying anyone should have to turn up on their rest days and go to theatre, but it's a common thing in surgery. And if you are not exhausted and if you are actually fresh, then it may be a shame to miss out on that particular procedure that next day. But it's an individual choice and it's really is a matter of just maximising what you can get out of it.

Mairead Kelly:

I agree. there's something, you know, I don't want the answer to be how do you succeed in less than full-time training? You try harder and you're more organized and you give more of your non-work life to it. That can't be the answer. But at the same time, you have to be strategic about it. So for example, I'm very choosy about what training days I go on. that, you know, I really weigh up whether a course is going to be worthwhile because I'm out from being with the boss. It's a valuable time.

Alex Ashman:

Yeah, one of the consultants has said to me, know, when you're junior, you shouldn't be sky-view off training days to go to theatre. And when you're senior, you shouldn't be sky-view off theatre to go to training days. But there is certainly a balance. If you know something inside out and you have a case you need to do, then maybe reassess, you know, that we're all adult learners. We have to remember this. We have to have a conversation with our boss and say, you know, actually, is it okay if I go to this training day and is it okay with the training coordinator actually if I actually go to this theater list instead. But I think when you're more junior, you probably want to ask your trainee rep or your boss, you know, your TPD, rather than just never turning up to training days. Training days, especially the simulation days can be very useful. I mean, if you've got a temporal bone day or a fez day or what have you, you might get more cutting time there.

Mairead Kelly:

guess I mean more courses outside of the deanery training. I'm quite picky about what I sign up for and try to make sure that they're going to give good band for their buck, guess, in terms of both finances and particularly time out.

Alex Ashman:

Yeah. I think as we see the postgraduate learning environment take over a lot of the book learning and sort of PowerPoint presentations, bit of learning, hopefully there'll be more simulation available in Deanery and hopefully there won't be an expectation that we have spent thousands of pounds to go out every year doing this. And it's more we wait until we have specific learning needs and then choose those courses carefully as you say. I guess the final question would be, is there any way that the whole system of less than full-time training could be improved and are there any other ways of doing this that might work equally well or differently that could make surgical training easier?

Mairead Kelly:

wonder, I definitely noticed that as more people do it specifically within ENT, it's becoming easier. So I think that's part of it. As more people become less than full time, systems will improve to deal with it. And I wonder, I don't know, could you have a more sessional approach so that, you know, I just, I meet you and I say, I'm in ENT training, do X sessions a week, how many do you do?

Alex Ashman:

It normalises it. Yeah. A lot of people outside medicine laugh when I say, yeah, I'm less than full time. So I only work 40 something hours a week. And they say, are you sure? That's how that works. I mean, outside of medicine, think less than full time is, I don't know, 20 hours a week or something, depending on, on how it is. I mean, I guess also if there's enough people, you know, if we normalize it, if there's enough people less than full time, then

Mairead Kelly:

It just normalises it, yeah.

Alex Ashman:

there won't be this thing of as the one lesson full time trainee, they're going to have the dregs of the rotor. And I have seen honestly, I don't know how it is everywhere else, but actually the rotors I've seen recently being less than full time have been pretty good. They've been very kindly organized and that's very encouraging for the future.

Mairead Kelly:

Yeah, and I don't find too much trying to force job shares where they don't make sense and things like

Alex Ashman:

It's also an issue of funding. If you want to be effectively a 50 or 60 % supernumerary as opposed to job share, the deanery has got to cough up that money or someone's got to cough up that money. And I wonder whether that whole system could be overhauled. I don't know, this is well beyond anyone's power to do, whether it ought to be that, I don't know, there is funding for a certain number of whole time equivalents and then that money gets spent on employing that number of whole time equivalents rather than saying, if you're not a full time trainee then, Oh, it's tricky. Certainly you be 80 % in a full-time post, but being 50 or 60 % with other job shows is a different matter, isn't it?

Mairead Kelly:

Yeah, and obviously a genuine job share does bring its difficulties in terms of different training needs for different trainees and different stages of training and so on and a limited number of trainees who are going to be allocated to each hospital and be able to do job share. It's that thing that happens throughout training where you're told that something's very difficult and then you say the price of not tackling that difficulty is that you don't get diversity in the work.

Alex Ashman:

Absolutely. if you, I don't know. I had a colleague who once said to me, it's a real strain on the full-time, you know, full-time workers to have all these part-time workers not pulling their weight. But I don't think they necessarily realize that if those part-time workers aren't retained, it'll be even worse. I don't know. I don't want to describe being less than full-time as the lesser of two evils or something. It's more along the lines of we're all pitching in what we can. We have families. We have other caring needs or other things we need to do in life. And also that reproductive labor is not paid. you know, I mean, there is honestly, it becomes also a societal level issue of the, you know, reproductive labor not being paid for and people saying, well, isn't it terrible that you're not here half the time? It's like, yes, but the other half of the time you're doing something else. You're not sitting watching Netflix. You're busy. And that's not always sort of seen, you know, I often get asked sort of a what do you do on your day off? Then it's like, it's not my day off. Thank you.

Mairead Kelly:

I still struggle with what we should call it because even a non-working day doesn't really cut it.

Alex Ashman:

No, no, I think I tend to call it a less than full-time day, which is not, it's clumsy, but at least it says, it is what it says on the tent. Thanks so much for talking us through all that. And did you have any other tips for our listeners before we go?

Mairead Kelly:

One thing practically that I found really important is to make sure that you have remote access early on in a job. Because often you are not in the building the day before that you're going to have a theatre list. So in terms of being able to prepare, that's really important. And you want to be very meticulous about handover, being less than full time given, well, I always do, given that I feel like that's a potential criticism of being less than full time, you lose that continuity. sometimes it's useful to be able to look up a patient in advance, know that you have that detail at the tip of your fingers like you would if you'd been in the day before.

Alex Ashman:

And in terms of continuity as well, mean, how do you get sort of continuity of the firm structure? How do you get to know the boss, you know, when you're not there as much?

Mairead Kelly:

That's a good question. One thing that I always do, and I think I'd do this if I was less than full-time or not, is send an introductory email a few weeks before I start. I'm very clear in the email about which days I'm working, what I'm doing on those days, and I drop in the fact that I've got two kids just to explain why I'm less than full-time and a bit about what experience I've had already so that I'm trying to get off to a start that is going to be well-suited to both me and the boss.

Alex Ashman:

Yeah, of course. I mean, what about jobs where, you know, there's sort of four months or six months and then you're whizzed off to work with someone completely different, sometimes on a different site.

Mairead Kelly:

Yeah, that is a big challenge and especially if you've got a job where you're working with a different boss each day for your three or four days a week. So I think if there is any flexibility about requesting longer placements, so to do a year rather than six months in a subspecialty, that's worthwhile exploring.

Alex Ashman:

Absolutely. So we've covered how you get into lesson full-time training, how we prepare and sort of how to get the most out of it. To be honest, I would encourage any of our listeners who feel that they would benefit from it or who, you know, expect to need it in the future, definitely to read up about it, chat with your colleagues who are lesson full-time, chat with your educational supervisors who may well have been through, you know, a path before that you don't know about and, you know, learn about it because I think as we saying earlier, it is for everyone. It's not something that's just for specific few people anymore and is not something that is necessary for now but might be for later.

Mairead Kelly:

Really, fully agree with that.

Alex Ashman:

Thank you for joining us for another episode of WENTS and Friends, the podcast of women in ENT surgery. If you've enjoyed this episode, please make sure you subscribe on your podcast app of choice, leave us a review and share it on social media. 

Don't forget that we have a back catalogue log of episodes on a range of subjects from mat-leave and menopause to surgical training and culture change. We're on Twitter, threads, Instagram and LinkedIn, so make sure you follow us for details of upcoming episodes and events. 

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Thanks again to all of our guests for this season and to Karl Storz UK and ENT UK Foundation for sponsoring season two of WENTS and

Friends, the podcast of Women in ENT Surgery UK.

WENTS and Friends is produced and directed by Heather Pownall of Heather’s Media Hub. The podcast was created by Ekpemi Iruni. The rest of the team includes Anna Slovick, Katherine Conroy, Marie Lyons, Tanya Ta and me, Alex Ashman.

That's the last episode for this series. We hope you've enjoyed season two of the podcast and hopefully we'll see you again soon. Until then, take care and thanks for listening.