Junior doctor General practitioner Wales

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Adventures in flexible work and training

With increasing numbers of doctors of both sexes moving to less than full-time working, employers and the General Medical Council are facing up to the need for more flexible employment and training patterns

On being elected chair of the BMA junior doctors committee, Tom Dolphin was aware that it would mean a lot of extra work. He also knew it would be tough to combine the role with life as a specialty trainee 6 in anaesthesia at Imperial School of Anaesthesia, which involves working at various hospitals in north-west London.

So how did he cope? He went part-time. In so doing, he joined a growing group of doctors who are seeing some value in working LTFT (less than full-time).

Although this group is still overwhelmingly female, a substantial minority are men. Figures from the GMC show that 14 per cent of the 4,079 LTFT trainees are male. Responses to the 2012 National Training Survey confirm it is still a relatively small proportion of trainees overall (2.4 per cent of men, compared with 12.7 per cent of women), but it can’t be entirely accounted for by BMA committee chairs.

The popularity of LTFT working has led to calls for action. Last month, the GMC published The State of Medical Education and Practice, which warns that more flexible training and working patterns are needed.

Way to work

The report says: ‘As the number of female doctors on the register grows, working patterns and preferences may well change. At the same time, male doctors’ expectations have changed.

‘The changes in the profession point to the need for greater flexibility in employment and training arrangements, as well as an honest debate about what will and can be expected from doctors at different points in their careers.’

There have already been moves to make it easier for doctors (male and female) to train flexibly. In 2005, the BMA, NHS Employers and others agreed a set of principles that should mean that all doctors can apply for flexible training, and the applications will be treated positively.

Those applying should have a ‘well-founded individual reason’ and fit into one of two categories: the first covers disability and caring responsibilities; the second includes doctors with ‘unique opportunities for their personal or professional development’ — such as training for sporting events, or having short-term extraordinary responsibility for national committees.

In February, the Centre for Workforce Intelligence published the report Shape of the Medical Workforce: Starting the Debate on the Future Consultant Workforce. This largely covers doctors working in secondary care, not GPs, and focuses on holders of certificates of completion of training rather than doctors in training or any other group.

Upward curve 

It does, however, note that more doctors are training flexibly than previously. It adds that this doesn’t necessarily translate into more consultants working LTFT: ‘Evidence suggests trainees who train flexibly often choose to work as full-time consultants.’

NHS workforce figures for September 2011 showed that there were 59,352 male hospital and community doctors (apart from GPs), of whom 6,173 worked part-time. This compares with 46,359 female doctors, of whom 11,080 were part-time. Around a third of female consultants worked-part time (4,257 out of 12,363). In contrast, there were 3,467 male consultants working part-time (out of 26,725).

The proportion of female doctors working part-time continues to grow at a faster rate than that of men (in some specialties at least), and Royal College of Physicians of London director of workforce Andrew Goddard reckons that trend will continue.

‘LTFT will become increasingly prevalent, especially for women,’ he says. ‘The NHS needs to have robust workforce planning to allow for this and to sustain high-quality patient care. The main challenge will be ensuring continuity of care for inpatients in acute and community hospitals.’

Dr Dolphin says his own LTFT was viewed positively by most colleagues — including two of his (male) peers, who work LTFT because of family responsibilities. And he thinks that this level of acceptance will only grow as today’s juniors become consultants.

‘I think it’s generational, rather than gender-related,’ he says. ‘There are obviously still some doctors around who don’t think we [trainees] are working long enough hours as it is, but I think attitudes are changing — men and women have a right to have a life outside training.’

Three doctors on different paths

 

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Read why his flexible role is more important than the 'status' of being a GP principal.