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Training LTFT in Interventional Cardiology
Dr Edwina McNaughton, Interventional Fellow and previous LTFT trainee
Interventional cardiology training and indeed medicine has historically consisted of mainly male doctors. In recent years, increasing numbers of females have graduated medical school and pursued careers in both Medicine and Cardiology. The ability to work less than full time (LTFT) has become more mainstream in the last decade. Previously it was predominantly females who worked LTFT for reasons such as childcare, dependents etc, gradually it became more accessible in harder to recruit specialties mainly to encourage retention. However, despite this very few trainees who are less than full time have pursued a career Interventional Cardiology.
In 2018, the Royal College of Physicians (RCP) noted that 15% of physicians worked LTFT, 90% of those were women.1 In 2018, the British Junior Cardiologists’ Association (BJCA) performed a Trainees’ Survey. They noted that only 4% of Cardiology trainees worked LTFT.2 27% of all cardiology trainees were female, and of those 137 women, only 30% had chosen intervention as their subspecialty compared with over 40% of men. This pattern was reversed in all other subspecialties. Of those working LTFT, more than 70% were women.3 Currently in the UK, around 10% of interventional Cardiologists are female.
In a further survey performed by the BJCA in 2019 of LTFT cardiology trainees, only 10% of trainees had decided to subspecialise in Intervention. This was compared to 40% of their full-time (FT) colleagues. Although it is not only females who wish to work LTFT; of the LTFT interventional trainees, 30% were male, and over 80% were LTFT for family reasons.2
There is a perception that Interventionists are a special breed of hardcore work fanatics without family, social lives or alternative interests. As a young female doctor starting off in medicine ten years ago, I was ‘suggested’ other specialties and subspecialties that were more ‘family or time friendly’. Luckily it did not dissuade me. I pursued a career in Cardiology, and after my first child was born in 2018, I decided to apply for LTFT to help juggle life as a new mum with work. Working 80% LTFT, allowed me to continue working four days a week and take one day to reset and restore harmony both at home and at work. I applied for Intervention as my subspecialist interest and shortly afterwards suddenly COVID struck. I returned to FT training to help with frontline efforts and when I rotated to my next placement, things had stabilised. My new job consisted of longer working days, which meant taking one day off a week for the rota to remain compliant. This suited my needs as a trainee and a parent.
Our mindset needs to change. We need to continue to engage with younger doctors and medical students to encourage open-mindedness when considering careers. We need to support trainees to choose the career path they wish to undertake. Providing good mentorship and having visible role models in Intervention and increasing flexibility in training will further support trainees to consider all their options. This is likely to improve as more women and more LTFT trainees progress to consultant roles.
There is no doubt that working LTFT can be difficult. The variability in the understanding of LTFT rotas by human resource departments often lead to incorrect rota allocation, pay etc and trainees end up spending a considerable amount of time rectifying this. Along with uncertainty regarding distribution of training time, study leave and zero days, this can lead to inequity compared with opportunities given to FT colleagues. Despite all this, many trainees report a better work life balance, with decreased stress levels since working LTFT.
Another group of doctors who divide their time, between clinical work and research are academic trainees. These trainees tend to split their interests 50:50, and therefore are often in clinical training half of the time. They too will come across similar inequalities in training provisions as often, depending on their research interests, will have fixed days in labs/university. Other trainees wish to spend time focussing on alternative aspects of medicine and these should be supported. Flexible Portfolio training (FPT) is an initiative within higher specialty training, run by HEE and the RCP London, which protects one day a week (20% whole time equivalent) for additional professional development in domains such as medical education and leadership.4 Previously it seems doctors were discouraged from skills-based specialties due to the perception that extra time outside the working week was spent in theatres and labs learning those skills. Other practical specialties such as Obstetrics and Gynaecology have welcomed LTFT training for many years with good results. We should align with these specialties so we can learn from their experiences to make training better for all involved.
Health Education England (HEE) published a report in July 2022 ‘Enhancing junior doctors’ working lives’.4 Since 2016, This programme has aimed to make improvements in medical education and training to positively impact doctors’ working lives and wellbeing. In 2022, HEE agreed that doctors in postgraduate training across all specialties could apply for LTFT (category 3). This allows doctors to opt to train on a LTFT basis for individual, professional or lifestyle needs, aiming to improve their work-life balance and promote workforce retention.4
In order to retain our workforce, reduce burnout rates and improve work life balance, we need to give trainees the opportunity to map out their professional careers. It is essential that all cardiology trainees receive appropriate support to enable flexibility in training including LTFT working. This will only serve to strengthen our specialty by diversifying the qualities and attributes of our colleagues. In the wake of issues including difficulty retaining doctors in medicine, higher rates of burnout and morale at an all-time low, we need to plan for the workforce of the future to avoid major casualties.
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