The theme of this year’s International Women’s Day, ‘be bold for change’, is a timely opportunity to rethink what we mean by flexible working. In theory, in the modern era when women outnumber men in medical school and training, it should be easier to combine work with having a family.
This is my experience.
I had my daughter in my third year of medical school and have worked LTFT (less-than-full-time) since I qualified in 2013. As an LTFT foundation trainee my options were to work 100 per cent of the rota, including both in hours and out of hours, or work 50 per cent – although I managed to negotiate 60 per cent - without any funding for out of hours work.
As a single parent I felt that the second option was the only sustainable one although this was very challenging financially particularly while I was paying for nursery fees. My take-home pay before my outgoings was £1,000 per month in F1 and there have been many times that I have had to put food back at the supermarket checkout because my card was declined.
Most LTFT trainees will say that there are pros and cons to working part time. Overall I feel like it was the right choice for me and I am able to be a better parent to my daughter and to enjoy my time with her whilst she is young.
Juggling single parenthood with working as a junior doctor means that I am often exhausted and can be short tempered particularly on my working days, but at least working LTFT means that this does not become the majority. It is challenging having to be ‘everything’ for my daughter and fulfil the role of both parents, as well as being solely responsible for the finances, the domestic work, for her school work and for her well-being – both physically and emotionally.
Working LTFT feels for me the only sustainable option in these circumstances. It also means now that she is at school that I can have some time to myself – essential for your sanity when you have small children!
However, LTFT has been far from the easy option, there have been many, many challenges not least financial - earning half as much over twice as long with reduced contributions to my pension pot, increased length of student loan borrowing and increased training costs.
Having now done nine placements over foundation it is clear that a negative attitude to LTFT training persists within our profession. I have often felt there is a perception that you are not as committed to your job.
I have also felt that I have been offered fewer learning opportunities with seniors who will often prioritise my full-time colleagues if there is a procedure or skill that everyone is keen to be shown. In reality I have found that I have had to work harder to prove myself and to show interest, not to mention getting everything done in the day so that I can leave on time to pick up my daughter.
I have been told by clinical supervisors that I should not expect to leave on time as a junior doctor which is hugely stressful when you have the pressure of fines and social services if you are repeatedly late for nursery pick up or when your child is waiting by the front door with the teaching assistant at the end of after-school club.
I have had an unsuccessful annual review of competence progression for ‘not being at the same standard as my full-time colleagues’ despite everything else being complete. I have been asked not to join certain surgical teams on the ward round because I am only there for three days. I have had comments about ‘missing a lot of days’ when in reality I am just in for fewer days each week.
It has taken a lot of courage to continue in this environment and to maintain a sense of self-worth and enthusiasm for the job. There have been certain specialties where LTFT training has felt easier, for example in A&E, where because everyone is on such crazy shift patterns nobody notices that you are part-time.
The specialties where I have been working directly alongside and being compared to my full time colleagues have felt the most challenging.
Overall the pros of LTFT training have outweighed the cons, but only just. As a highly ambitious woman who graduated from medical school with a toddler in the top 15 per cent of my year it is disappointing to feel that I have had to work tirelessly to ‘prove myself’, to be recognised as a good clinician who is serious about her career and to receive a quality of training and education on par with my full time colleagues.
The negative impact of the 2016 junior doctor contract on LTFT trainees could well be the straw that breaks the camel’s back for many trainees.
The loss of automatic annual pay progression which mitigated to a small degree against the huge career losses (both pay and pensions) faced because of being LTFT, has been replaced with a mantra of ‘equal pay for equal work of equal value’, a principle that harps back to legislation from the 1970s and when applied in the 21st century fails to recognise the significance of the unequal distribution of caring and thus the disproportionately negative impact that such contractual changes will have on women.
Pursuing long, hospital specialty training is already becoming increasingly unattractive according to recruitment and retention figures and this is reflected in the shockingly low morale within the profession.
Reducing the remuneration for out of hours working in the 2016 contract will not only further disincentivise many struggling specialties - particularly those with heavy out-of-hours commitments such as A&E and paediatrics - but will also, for many trainees such as myself, mean that we are no longer able to meet the costs of out of hours childcare required in order to meet the demands of the job. As such for me personally, training in anaesthetics, which was always my ambition, is no longer financially viable.
Being bold to me means continuing in the face of adversity and pushing for positive changes in medicine to enable women to reach their full potential both at home and in the workplace.
Lauren Robson is the flexible working representative to the BMA junior doctors committee and sits on the JDC executive. She is also junior doctor representative to the Medical Women’s Federation which celebrates its centenary this year.
The BMA’s new less-than-full-time forum has recently been established to raise the profile and, improve trainees’ experience of LTFT training.
I am also a single parent- did my foundation, and nearly all training full time as falling behind and accepting to be a second class member of team was not for me.
I struggled doing lots of locum on top of the job so I can pay the live in au pair's salaries (so I can continue full time) and massive training costs.
That means that I've never been to my son's sports days (he is going to secondary school this year) and he knows mummy has to work hard to pay the mortgage and all his clubs, but also for nice holidays.
We all make choices and clearly when you work LTFT you don't have the same training opportunities- as some procedures are occasionally available- but being there daily means you have a higher chance of doing one.
You can't have the cake and eat it- you can't get the same training as in a full time job and quite frankly equal pay for equal value work is a fair thing.
Otherwise people like me who chose to sacrifice their family life to progress their careers ended up on the old contract being in a higher year of training with more experience but paid less than LTFT trainees. How was that fair?
No choices are easy, but yes, I have colleagues and friends who are LTFT and they are not regarded as full members of team as they are not present.
I think expecting to leave on time in medicine is utopia as emergencies come up and people get unwell and it's not always possible to hand over/ or fair.
My speciality has lots of outpatient clinics and you finish the work when last patient is seen and that's usually an hour after 5- when officially the job finishes.
However, what I came a Ross is also colleagues passing their work to others - patients from their clinic list- on the base of picking kids up from nursery. That leaves colleagues like me (who sort out their childcare as such that they don't need to rush through the door at 5 pm) being unfairly penalised and staying and seeing their patients while paying extra for childcare and not being paid extra time. And it's really annoying.
So I don't have a special solution but equally there has to be fairness in a system.
You can't expect the same career progression working 60% as me working 120% (since I never leave on time) simply because you'll see half the patients, spend half the time and get half the experience compared to me. Equally you probably know your daughter better , do more fun things and are more present in her life than I am in my son's. I accepted what comes with my decisions and don't feel I must cry out loud what I loose through my own choices. I find it quite irritating hearing and reading the complaints of LTFT trainees and other part timers about what they loose professionally because they are part time.
This is from a feminist
Choosing your career and choosing the size / time of your family and how to handle both are choices, and whichever way to mixe them up you can't have it all. Something's gotta to give.
Best of luck with the rest of your training
To the comment above. You don't sound terribly feminist. Also as a LTFT trainee I found this piece was fair, honest and highlighted the difficulties of being a single parent who has not unreasonably chosen to have a relationship with her child.
so sorry to hear this - despite 'equality' this is no surprise and one of the many ways that women are still discriminated against in the workforce. I am 80% and have lost count of the number of times people comment on me being "away" or "off" when the reality is that I do not work fridays... and, now I am in Psychiatry (which I would recommend for all LFTT!!) , the hours and flexibility is fantastic but it is clear I still carry a 100% caseload....
what can we do?
I'm saddened by the first comment. It gives the impression that the person who wrote it is feeling bitter about their choice to work full time....and that's exactly what it is about - choice! In this case there is no perfect one, we have to choose between career and family. In reality it is impossible to work full time and have a good work-life balance, due to the ridiculous culture of 'you're only commited/talented/hard working if you stay late every day' it means our families always come second to work. It shouldn't be that way, we are all only human too, we devote our lives to caring for other people so we should have a work culture that allows us to look after ourselves as well. The system is to blame here, it's inherently broken and well done to anyone who has managed to be strong enough to say no to unreasonable demands and look after themselves and their family.
I'm really saddened that a thoughtful piece highlighting the culture that exists in the NHS around ltft training is responded to by judgement and criticism.
No doctor should stay late. We have a duty to balance our lives to maintain our wellbeing. I appreciate that we want to put patients first and I have done the same myself but why must we bully one another for recognising our limits and making choices. Ltft trainees are not a problem, maybe they can be a solution. Why not celebrate the fact that a person chooses to work for you at all? Perhaps if we were more grateful and supportive to our colleagues then we would have better retention.
This is toxic, the way we doctors treat one another and I want to be part of a better future.
Firstly, a huge "thank you" to Lauren for this touching article. As a single mother and LTFT trainee it moves me to read about your struggles and experiences. Thank you for being so open and honest as it can often feel like a lonely position to be in. I have chosen to work 80% LTFT as this was the best balance for me financially, career-wise and most importantly having a special day to dedicate and spend with my child. The first comment really disturbs me as it demonstrates how as women we can be so cruel towards one another. I hope the person that wrote the comment reflects on their words and realises that it is that attitude that leads to so much negativity in medicine. Of course we know that there is no perfect solution but I find it extremely sad that the person that wrote this admits to their lack of presence in their child's life all for the sake of not wanting to be a "second class member of the team". Those early precious years of your child's life cannot be relived; however one can always catch-up on career progression; that is the beauty of medicine. I hope that this article touches many others as it did me and I wish Lauren and all other Single mothers juggling out there the best of luck!
Lauren- thank you for your courage and openness- its wonderful and your daughter will be so proud of you and all that you do for her by following your instinct and being as available as possible to her. Wishing you well in the next stage of your career. Hang in there.
To the first comment, I recognise where you are coming from as a single parent myself. However I do not share what sounds like your judgment and hostility towards the person who bravely and honestly wrote this post about her own attempt to have a life-work balance. You have chosen to make the trade offs you have made, which choosing to follow your career has necessitated ie, missing key events in the school calendar. But that comes at an emotional cost. Perhaps it is seeing the cost which makes you most angry.
Let's not mince words.
It is a gargantuan struggle, not just a 'challenge' - but a struggle to bring up a child or children alone *and* try to have a fulfilling career. Some days it can feel like trying to climb a mountain with one leg.
I chose to make the sacrifice to walk away from one career I loved, to take up another which was more practical, in order to be available as much as was possible for my child, but whatever you do or don't do - it never feels enough as a single parent.
We don't have nice holidays- I can't afford it - but I would rather do a less exacting and time-demanding job so that I can be available for my child and keep my sanity. I don't however judge other women who make different choices.
Ultimately instead of judging and back-biting it might serve us working mothers better to remember that we do the best we can, and that has to be good enough.
I sympathise with all the previous comments, and feel I have been very fortunate in how my life has worked out.
I went back to education, as a single mother in the 1980s, only after the youngest of my three children had started primary school. That involved doing 'O' level chemistry and physics, then 'A' levels before even applying to do medicine. I was fortunate in living in London at the time, and finding one medical school, UCL, which after an interview, was prepared to offer me a place. No other London medical schools would even consider my application as I was over 30 years of age.
It was a struggle, and I failed 3 out of 4 of my final exams the first time, but made it in the end. I am eternally grateful to UCL, who were encouraging and supportive throughout.
I then moved back to live in N.I. to start my JHO year. I got a job in a small local hospital, where we lived in hospital accommodation....pretty awful, but it meant that when I was on call (1 in 3.....with no time off the next day!) the kids were close by, and I could pop back and forward to the flat when things were quiet. They were young teenagers by this stage, and my parents lived nearby. My children never lived with them, but they were able to keep an eye on the kids at weekends when I was on-call.
It wasn't easy, but it worked, and I am glad I had been at home full time during all the children's young years.
After starting work I found the worst thing was being too exhausted to continue studying. I briefly attempted to study for MRCPsych, but quickly realised it was making my life unbearable. So, I settled for a non-consultant career, and have been SASG for the last 13 years.
I am now 64, still work full-time, and have 8 grandchildren, who keep me busy every weekend. No peace for the wicked....but I have nothing to complain about.....except maybe the drudgery of annual Appraisals.
Lauren, your post was incredibly honest, open and admirable. Please take note of the many positive comments and the lone criticism and judgement. Unfortunately we will be faced with prejudice, underhand comments and suggestions on how we should do things but ultimately we are all individuals and our families are all unique and we have to do what we believe is right for us all. Congratulations on a great post, for stimulating such discussion and for being such an inspiration.
A career as a SAS doctor has worked well for me juggling motherhood and full time work-regular hours and geographical stability in a beautiful part of the country working in the specialty I love
Laura, thank you very much for this article. I have been there, and have made some pretty unconventional choices in order to make things work. You cannot have it all straight away. You are very young and at an early stage in your career. Please do not see anything as a sacrifice or loss, see it as a choice. Carry on the hard work, and everything will fall nicely into place soon.
A well written and thoughtful article, I could not not be a single parent, you are doing an amazing job. This is not about the NHS, it is about medicine as a profession seeing equal value in those who work LTFT, male or female. The profession should value family life, we should see it as a positive. Balanced happy doctors provid better patient care. We have to stop measuring success by staying late, missing lunch, not taking a break at night - their is clear evidence our practice is unsafe, the airline industry has been recognised this and regulated.
My wife and I both work LFT, I am a GP and she is finishing her training - she was a high flyer but since starting LFT work she has been told she is no comitted! No wonder so many women leave hospital medicine. It is our problem and our responsibility to change attitudes.
It is unacceptable to be discriminated against in the workplace because you are LTFT, for example sidelined on ward-rounds or less exposure to procedures, or having unrealistic expectations of you at appraisals. You have done an incredible job to balance two demanding vocations. I am not sure, though, one can escape the fact that reduced hours 'at the coalface' will affect your true progression and development into the clinician you want to be. It will be slower. I am not convinced there is a simple way to balance the two vocations.
I'd say choose your speciality wisely. I left a LTFT surgical ST6 post to retrain as a radiologist. LTFT is common in our speciality in both training and consultant grades. There are both women and men who train LTFT (it's not just women who want to see their children more). There is a very positive attitude. Lots of consultants leave at 3pm to pick up children. Or work long days on certain days of the week to have other days off. I rarely have to worry about leaving on time to pick up children as most people leave on time. They are desperate for consultants so you will not have to uproot your family from schools and can settle in an area knowing that you will be able to end up working in that area. It's intellectually stimulating and interesting. I do miss some things about surgery but you can't have it all. I wasn't willing to sacrifice seeing my small children grow up and this to me has been an excellent compromise. A&E and anaesthetics are similar in their positive outlook to LTFT so there are options. Choose wisely and you won't be a 'second class member of the team' and you won't miss a sports day. And you will be a valued member of the team with an interesting job.