Redefining Progress: My Less Than Full Time (LTFT) Foundation Journey

Having my daughter in my final year of medical school was arguably one of the hardest things I’ve ever done. I set myself a goal to attempt my final year exams four months after giving birth (with a cheeky PSA slipped in four weeks post-partum). It goes beyond the scope of this piece to delve into detail about what I had to do to achieve this, but as I said, it was tough. By some stroke of miracle, (and admittedly sheer determination and grit), I passed all my final exams. When I got my results, I was due to start work in two months. I was suddenly hit with the realisation I couldn’t do that; well, I could but I knew in my heart it would break me before I had even started. I thus made the decision to take a year out prior to starting FY1 to enjoy invaluable time with my daughter and learn how to be a mother without the pressure of work. I was certain in my decision that when I did return, I would be training LTFT. That was non-negotiable.

Everyone has their own personal reasons for working LTFT. The beauty of positive change in postgraduate medical training over the years means that traditional reasons such as caring responsibilities and issues with health are no longer the only factors considered when a trainee requests to work LTFT. For me, the option to work LTFT was a blessing that allowed me to fulfil my various roles of doctor, mother, wife, daughter, sister and friend without becoming seriously unwell. As the fog lifted on the heavy post-natal depression I experienced, I knew that being a doctor was a key part of my identity and going back to work was a vital part of my personal and professional fulfilment.

What I didn’t realise however, was how much of an anomaly I would be entering FY1 as a LTFT trainee in a DGH in the midlands. To my knowledge there were two of us, and we shared a job. The initial plan was to share a job with them however as I deferred my start they had already completed one year of training. This professional relationship turned in time into a deep friendship and we have supported each other through a plethora of things in both our working and personal lives. This bond is something I will always treasure and am thankful for. From late-night WhatsApp messages scrutinising our rotas for our upcoming rotations, to emails to various people copied in defending our right to pro-rata bank holiday leave, together we navigated the labyrinth of LTFT foundation training.

As there are not many LTFT foundation trainees, in my experience, the support systems aren’t as developed and robust; I learnt that there is a high degree of self-advocacy needed to ensure equity with full-time counterparts. There is support available, but you must use your own initiative to seek it out – something that I know people are doing a lot of hard work to make more accessible. I was also lucky to have both an amazing Educational Supervisor and Foundation Programme Dean who saw me as a person and made it their priority to support me to thrive in my career.

It also must be recognised that your training will be prolonged which comes with mixed feelings when you least expect it. I will complete the foundation programme in three years as opposed to two, and this will differ on a case-to-case basis depending on your LTFT percentage. I clearly remember my first ARCP day when my full-time colleagues were elated with their outcomes meaning they were progressing to FY2, and I had received an ‘other’ outcome meaning I had more time to complete. Although this was expected – I was under no illusions, all the hard work I had put in throughout the year didn’t seem to mirror up to an outcome of ‘other’. However, the feeling of passing my ARCP after a couple more rotations, knowing in my core that LTFT training was right for me, was unequivocally unrivalled.

Training LTFT has meant that I have had increased exposure to different placements as I will do nine rotations in total. I have also had the opportunity to revisit placements twice and I have seen first-hand my growth as a doctor when returning to a rotation. Beyond this, it has allowed me to breathe, to have space to show up as my best self both professionally and personally. I remember a nurse in charge once giving me some verbal feedback during my general surgery rotation that I was such a great doctor they wished they could have me at work all the time. I told her that if I was at work all the time, it was unlikely I would be such a good doctor. The way I see it, training and thus life itself is not a race. I had to accept that concept for my own sanity as a graduate entry medical student that had worked in another field prior to entering medicine, coupled with other personal responsibilities.

If it had been a race, I would’ve lost before I had started. But an extra year is a drop in the ocean when I looked at my whole career and life spanned out. Life as a foundation doctor is hard, you are often the most junior in the room, constantly learning without realising how far you’ve come. The most important thing is to enjoy the ride. I can confidently say that I have enjoyed my life as a foundation doctor despite the difficulties and this is due to the fact I have trained LTFT. If you’re finding that the bursts of enjoyment are becoming few and far between, remember you are not alone in this feeling. Speak to your colleagues, supervisors, LTFT champions within your trust as there are so many options to consider. Working LTFT may give you the space to breathe and live just a bit more freely, enabling you to flourish in your chosen career as a doctor.

Sabea Sanderson

F2, Trent Foundation School

All previous HOFP articles can be found on our HOFP webpage