Less Than Fulltime Consultant Careers

By Dr Jayne Noden, Consultant Anaesthetist

Less than full time (LTFT), part-time or flexible are all terms used to describe the alternative to full-time working as a consultant.  Active promotion of less than full time working for consultant staff is unusual at the present time, although improving the work-life balance of its employees is part of the NHS Improving Working Lives Initiative. The current pension changes will necessitate large numbers of consultants having to work beyond 65 years of age and flexible or part-time working may be one of the solutions to enable the older physician to continue to contribute and enjoy work in their later years.

Consultant posts may be advertised as LTFT, usually described with 6-9 programmed activities, or an established full-time consultant can approach their employer to discuss flexible work arrangements. The law provides some employees (those having parental or carer responsibilities) with the statutory right to request a flexible working pattern. The right to request does not itself create flexible working but a formal response has to be received within 14 weeks (see the Directgov website). Types of flexible working that may be considered include:

  • Part-time: less than 10 Programmed Activities (PA)
  • Flexi-time: varying your start and finish times within agreed limits
  • Compressed hours: working your hours over fewer days i.e. working longer days
  • Annualised hours: working a set number of hours per year rather than per week. This can enable the individual to work longer days during term times and work less over school holiday periods. 
  • Structured time off in lieu: working longer hours at busy times and taking time off at less busy times
  • Job-sharing: the full -time duties are shared between two individuals (could be part-day, part- week or part- year). The salary and benefits are divided between them according to the amount of time they each work.

Any decision to request a change to flexible working must be planned well in advance and the impact of new working arrangements on colleagues and the department should not be ignored. There may be opportunities for others generated by a request to work fewer hours and collaboration with all those potentially affected may assist in generating a positive outcome.

A personal view

Our hospital has 43 anaesthetic consultants: 10 are female and 3 of us work less than full time because of family commitments. One of our male colleagues became part-time on health grounds.

Becoming a LTFT consultant: The four stories of our being part-time are slightly different, yet we have all been able to achieve the work - balance we wished for. We all trained in the Yorkshire region where, historically, LTFT training has been problem free and well supported. We work in a department where the majority of full time (FT) consultants  have 11 PA contracts and the established pattern for the LTFT consultant is 8PA’s :  5.25 PA for clinical work, 0.75 PA for on-call (FT have 1 PA for on-call) and 2 SPA.

  • Jill was a 60% LTFT trainee from the beginning of her registrar training until CCT and continued LTFT as a consultant. In recent years she has become lead College Tutor and in 2010 was appointed the Trust Simulation lead. This latter responsibility came with funded SPA time and as a result Jill is now on a 10 PA contract.
  • Jane became a LTFT consultant after having been a full-time trainee, applying for a full-time post and then negotiating to drop two sessions. 
  • I started out as a full time registrar then became a 60% LTFT trainee on return from maternity leave after the birth of my first child. Having had my second child and feeling fairly settled with childcare, I reverted to being full time because my training seemed to be lasting forever and people, younger and with less total training time than me, were being appointed to consultant posts. I was appointed as a full time consultant. When my third child arrived, even with a full-time nanny, life became rather too busy and I approached the Trust / department with a request to drop two sessions and become less than full time. These negotiations included the option to revert to full-time at some point in the future, if this could be accommodated by the Trust / department. 
  • John was a full time consultant but, after an unexpected period of ill health, completed a phased return to work programme and chose to remain LTFT. He has no on-call commitment in his 7 PA contract which includes 1.75 SPA.

All of our contracts are as stand-alone rather than job-sharing agreements. In our hospital there are two consultant surgeons in the latter years of their careers who have negotiated a job share so that they in turn work two months then have the next two months off. This does mean you need to find a like-minded colleague and have an understanding employer. Our Trust is currently considering a move towards annualised hours. This would allow part-timers to have a job plan which suits their individual childcare requirements, choosing to work more sessions during term-time, so making life easier.

Added value: We all have additional roles and responsibilities in addition to being educational supervisors to CT or ST trainees. Jill has focussed on education and is lead College Tutor to our 33 trainees and Trust Lead for Simulation Training. I co-ordinate core training in obstetric anaesthesia and Jane organises the undergraduate anaesthetic teaching programme in Bradford in addition to being an RCoA examiner for the last 8 years (currently lead for physics in the Primary FRCA). Most of her duties coincide with school terms. As an aside, it is now possible to be considered as a LTFT examiner, after the first probationary year.

Meeting family demands: Most LTFT working is because of family commitments. Childcare is a major headache for all parents when your working week bears no resemblance to that of many childcare facilities. Knowing that your children are well catered for means that, at work, your attention is focused. We all employed nannies for some part of our children’s care. Jill had one whilst her children were pre-school, then used before and after school clubs. This relies on her husband being able to take and collect the children, as her working days are too long and, as we all know, unpredictable.

Jane and I kept our nannies until our youngest children went to senior school. The advantages of a nanny are legion: you don’t have to get the children dressed and ready in the morning before you leave for work, you don’t have to drop them off or pick them up and they will look after the children if the children are unwell. They allow flexibility and peace of mind and the more children you have, the more economical it becomes. A nanny also enables you to have ‘me’ time because being part-time doesn’t mean that you have to spend every non-working hour doing childcare.

What are the benefits? Less frequent on call has a beneficial effect on family life and to have a shorter working week means home life is less pressured. We can enjoy work and our families and are able to commit to both. It prevents you from “clock watching”: if a list runs late, you don’t resent this, as you have protected time with the family later in the week. As children get older, rather than increasing clinical workload, there is the option to take on additional educational roles or explore opportunities in other areas within the department / Trust. Having control over utilisation of your time may enable concentration of some work commitments into terms times more easily.

Are there any disadvantages? There is an impression amongst some colleagues that if you are part-time, then you are less committed to the work environment and this may make it a challenge for your offers to contribute to be taken seriously. Once credibility is established, then the reverse becomes true and you need to know when to say no, otherwise the stresses of not meeting deadlines at home and at work begin to destabilise your work-life balance.

There have been concerns around the impact of reduced clinical exposure on core skills and competencies as compared to full time colleagues but having a varied job plan (we all have flexible sessions) and using your SPA time to work alongside colleagues ensures this doesn’t become a problem.

Financial implications: Your salary is reduced but there is the benefit of a healthier work life balance and even as a part-time consultant, the salary is not insignificant.  The number of SPA’s allocated for non-clinical work are less than those of full time colleagues, even though you are expected to do the same administration tasks, teaching, training and continuing professional development.  A suggested 25% to 75% ratio for negotiation of SPA to PAs, mirrors that of the FT contract. Without a doubt, LTFT consultants commit to more hours than are recognised in their salary and employers get extremely good value for money from their part-time staff. 

You need to realise your pension will be less. On an 8PA contract, you will only accrue 4 years of benefits as compared with 5 years for someone on a 10PA contract. This deficit can never be made up. As your pension is calculated as a fraction of an equivalent full-time final salary there is virtually no benefit of working full time just prior to retirement. For further details on the implications of the current pension changes, the NHS employers website is recommended.

There are opportunities to enhance your salary by applying for an employer based Clinical Excellence Award. Seek help and advice from other part-time and full-time colleagues when completing your application form. It can be extremely difficult to ensure those scoring the forms are aware that the meritorious achievements contained in your form have been whilst working fewer hours.
It is possible to undertake private work at a time which is convenient to you but taking on evening and weekend lists defeats the object of prioritising your family.

We have a great admiration for those trainees who manage to juggle domestic commitments, exam revision and working shifts. It is important to realise that as a consultant, your job plan will generally make the working week more predictable than when training and, without shifts, life becomes easier than that of a trainee straight away. To then be less than full time is better than ever!