The Way I See It

Some doctors are less equal than others

Publication date:  19 Oct 2011

Trainees who work less than full time are treated as the poor relations of junior doctors

I am a less than full time (LTFT) trainee. I have not undertaken other employment or locum work while training, although my trust often asks me to do so. I don’t particularly want to do such work. However, my deanery has recently reminded all LTFT trainees that such extra work is forbidden by the Gold Guide.[1] Along with many of my colleagues, I was completely unaware of this stipulation.

The guide states that LTFT trainees will “not normally be permitted to engage in any other paid employment whilst in less than full time training.” This is based on NHS Employers’ principles underpinning the new arrangements for flexible training,[2] which were agreed by the BMA’s Junior Doctors Committee, NHS Employers, the Department of Health and other UK health departments, and the Conference of Postgraduate Medical Deans.

Trainees are required to fulfil eligibility criteria to train flexibly. Most LTFT trainees have a disability or illness or are responsible for caring for children or an ill or disabled dependent adult. Most are women with children. Mostly these families will have other carers—the father or grandparents—who also undertake childcare, but more often than not this other care is limited during the week or restricted to evenings and weekends. A few lucky LTFT trainees have enough family and friends to provide childcare during the working week but still choose to train flexibly simply to spend time with their children and achieve a better work-life balance.

Full time training as a junior doctor requires, as a minimum, working Monday to Friday, 9 am to 5 pm (although realistically often an extra hour either side). In addition, most trainees are required, for at least some of their training, to work some shifts out of hours or on call. Most trainees with care commitments therefore need to work part time or they would not be able to continue their training.

A number of trainees who apply for LTFT training are required to train in an unbanded supernumerary capacity, most often because of the lack of a suitable job share partner. The income of these trainees, and that of trainees who train in rotations without out of hours commitments, is much reduced, with the “double whammy” effect of also having to pay high childcare costs.

Surely, if anyone needs to supplement their income occasionally it is these trainees?

In addition, hospitals have continual problems with gaps in rotas, and junior doctors are asked to work more and more in-house locum shifts. If an LTFT trainee, who may do little in the way of out of hours work, would like to do an occasional extra shift, then it would seem a win-win situation, in which the trainee gets extra experience (general practitioner trainees often get short rotations in each specialty) and the department gets the shift covered.

There may be a theoretical situation in which a trainee has no well founded reasons for LTFT training but chooses to do so while also undertaking other regular employment to earn more money than he or she would have done while training full time. This could be an abuse of the privilege of LTFT training. However, this seems a far fetched scenario and one that few mothers would choose at the expense of the time they get to spend with their young children.

Perhaps there is also the argument that additional paid employment will be to the detriment of training. But surely by being given a national training number trainees are already entering into a “training contract” whereby they take the adult responsibility of ensuring that they keep on top of their training needs?

I see the Gold Guide’s stipulation as treating LTFT trainees in a paternalistic manner, assuming the worst of them. I cannot rationalise it in any other way except to see it as a direct form of discrimination against LTFT trainees, which reduces their earning potential in comparison with their full time equivalents for no well founded reason.

A report from the Royal College of Physicians and Surgeons of Glasgow, A Flexible and Functional Workforce,[3] notes that “attitudinal problems still exist towards those working in part time/flexible roles: less than full time continues to be equated with lack of commitment.”

Sadly, it seems that the Gold Guide’s stipulation clearly shows that this discriminatory attitude still exists and starts from the top.

Competing interests: None declared.

The author can be contacted through the editor:


  1. Gold Guide. 4th ed. A reference guide for postgraduate specialty training in the UK. June 2010. [Link] .
  2. NHS Employers. Doctors in flexible training: principles underpinning the new arrangements for flexible training. 2005. [Link]
  3. Royal College of Physicians and Surgeons of Glasgow. A flexible and functional workforce. June 2008. [Link] .

Cite this as BMJ Careers ; doi: