Lifestyle Profiles - Less Than Full-Time Training

Alexandra Roper,
ST4 Otolaryngology trainee,
on maternity leave and flexible training

I am a specialty trainee 4 in Otolaryngology, or second year registrar in old money, at the Royal Bolton Hospital, a busy district general. I graduated from Dundee University in 1999 and I knew I wanted to do surgery then (I found  medical ward rounds far too long!). I did ENT as part of my Basic Surgical Training and found a specialty that clicked.

ENT, as with many specialties, is competitive.  After spending several years as an ENT SHO and clinical fellow in and around Manchester, I got one of the first ST3 posts in the North West Deanery, a week after the birth of my eldest son. I decided to train as a LTFT(Less Than Full Time Trainee) working two and a half days a  week.

My week consists of a full day list, two clinics and a study afternoon.  In ENT, as I suspect in most surgical specialties, there are strata of operations which you ascend. My objective in this job is to get better at the operations I can already perform and to learn more complex procedures. Am I getting enough surgical experience? No, but find a surgical registrar who feels that they are. My list is busy but the unit is used to having trainees so I do get a reasonably big bite of the surgical cake, with my consultant observing and teaching me. I am ambitious and really enjoy operating but I have to remind myself that I am not training full time so I will progress more  slowly which is frustrating.  I have to accept this as inevitable given the  choices I have made.

My on-calls are pro-rata. I am on-call from home and as I currently live fairly near the hospital, it is easy to go in. I worry about getting enough experience dealing with emergencies and enjoy going in especially if it is an interesting or challenging case. Otolaryngology is a fascinating specialty. As a registrar, there is a lot to read and assimilate and being an LTFT you certainly don’t get away with knowing half as much – it is a part time job with full time responsibilities, study and career commitments.  In addition to reading round the subject, there are the requisite audits and research which I have been able to further even working part-time and whilst on maternity leave.  I am lucky enough to have a supportive husband who accompanied me to Vienna with my four month old son when I presented a paper at a the European Congress of Otorhinolaryngology and Head and Neck Surgery, so I have found most things possible when you have a bit of help.

If you look after a child under six years old, you are entitled to request to train flexibly. There are an increasing number of LTFTs in hospital medicine, although, maybe not surprisingly, there seem to be fewer in surgery than in other specialties. I am currently the only LTFT in ENT in the North West Deanery.  Part of the difficulty with surgery, is that you have inflexible clinics and theatre lists as well as emergencies which would be impossible to manage with inflexible personal arrangements.   However, anyone who has children in nursery will know that changing the day on which your children attend, at short notice, is well nigh impossible. Therefore planning to ensure you make the most of every professional opportunity whilst your children aren’t abandoned takes a certain amount of forethought. Given the flexible working arrangements required by an increasing number of medical personnel (for child care arrangements, part-time study etc.) that I will have to manage in the future, my working arrangement gives me an understanding of the issues this creates.

This brings me to my next point. I find it mandatory to have a Plan B, a Plan C AND a Plan D (if possible!). When I am working, I am working and I do not leave early, arrive late or miss clinics or lists. Being a LTFT, just as a full time registrar, I attend meetings and courses and over the last year, I have been involved in teaching medical students and more junior trainees. However, I am very lucky in that my parents and in-laws live near enough and generously collect my children from nursery or look after them, if necessary at short notice. My sisters, who live in Birmingham and London, have also been drafted in at times and I don’t think you can underestimate having that kind of support.

If you do the math’s it means that it will be 6 years before I can apply for a consultant post. If I’m honest, I do find this a little disheartening. However, I know that I am lucky to be able to do a job I find worthwhile and stimulating whilst being able to spend time with my sons.