For me, working LTFT was less of a choice and more a necessity to enable me to work and make medicine a sustainable career.

During my third year of medical school, I experienced several health challenges which made clinical placements incredibly difficult. During this year I was diagnosed with generalised anxiety disorder (GAD) and postural orthostatic tachycardia syndrome (POTS).

Living with GAD and POTS made the clinical years of medical school especially demanding, as there was no option for LTFT study at that time. The intensity and rapid turnover of placements left little time to arrange or implement reasonable adjustments, and stigma around invisible disabilities meant that, while some supervisors were supportive, others were less willing to accommodate small but necessary changes.

As my final year approached, I grew increasingly anxious about coping physically with long hours. With the support from my pastoral team and head of year, I was allowed to complete certain demanding rotations at 70%, reflecting my intended LTFT FY1 working pattern. I believe that while much more needs to be done to support medical students with chronic illness or disability, with self-advocacy, persistence, and honest communication, it can be managed. This is totally doable!

Hi, my name is Molly, I’m a foundation trainee working in Leicester and currently enjoying my rotation in the Paediatric Emergency Department!

I work less than full time (LTFT) which is not so common for foundation doctors so this blog is a bit about my experience for anyone else out there in a similar position, those considering LTFT work or anyone who simply just wants to understand a bit more about the ups and downs of foundation trainees working LTFT.

I started my F1 in August 2024 and am currently on track to progress to F2 at the start of January 2026.

So how does applying for LTFT foundation training work?

I was fortunate to have a supportive team at Leicester Medical School who was able to refer me to the local occupational health team; following my occupational health review, I was given the equivalent of a health passport letter which advocated for me working at 70% for the foreseeable future, along with other reasonable adjustments where required.

However, it is important to mention that my experience is not the only one.

Recent changes mean trainees no longer need specific criteria to apply for LTFT training. Applications are made to individual foundation schools, with some regional variation, but all follow the same principle: you simply state a reason — whether health, childcare, other commitments, or work–life balance.

My experience of LTFT training at Leicester…

Completing FY1 at 70% LTFT has brought both benefits and challenges. In practice, this equates to roughly three days one week and four the next, though on-calls and departmental rota patterns can cause significant variation.

Benefits

My rota arrangement has worked brilliantly, when I get the generic rota template through, I usually discuss with the admin/HR teams regarding my days off.

We have been able to accommodate my shifts in a way that means I never work for than 3 days in a row, this enables me to factor in a rest day and balance my week so that I can reduce the likelihood of exhaustion/illness (which is essential for my own wellbeing, but also my colleagues and patients!)

A side note for anyone that might require a set day(s) off for whatever reason, as long as this is communicated to your department's rota coordinators in good time, they should be able to accommodate this.

Even with pro-rated annual leave (A/L), careful planning means a couple of days can create a full week off, and rota patterns often allow long weekends without using any A/L.

For me, the biggest benefit of working LTFT has been the ability to create a much more balanced life; I wouldn’t be physically able to pursue my medical career without these adjustments.

Top Tips

Be friends with your Junior Doctor Administrators/Medical Staffing Administrators - they are invaluable and the only people who will adjust your rotas! Emailing them as soon as you know your rotation/their contact details, introduce yourself and give them a heads up on your adjustments. They will be your first point of call for any rota queries or concerns and usually will be able to sort it out for you!
Find a shift pattern that works for you! LTFT needs vary, and shift patterns may require adjustment. After four weeks without on-calls, I arranged a phased return at 70%, which increased both pay and professional development through valuable out-of-hours exposure.
Talk to people who work LTFT! It still isn’t super common for foundation trainees to be LTFT so getting an inside perspective is so useful!
Be honest and open with your supervisors - the more they know about your situation, the more they can support you individually and help you get the best out of your rotations!

Difficulties

Working LTFT does have drawbacks, most notably reduced pay and extended training.

As an FY1, reduced pay can be stressful, though frequent on-calls have helped offset this for me. It’s also important to check payslips carefully, as LTFT pay can be complex; the BMA provides a useful guide.

Training inevitably takes longer, but I see medicine as a marathon, not a sprint. Extending training makes it more sustainable and creates space to pursue other professional and personal interests along the way.

My biggest challenge as a LTFT FY1 has been the lack of supervisor awareness around how our training is structured.

Each rotation itself ran smoothly, but nearing the end of the year, when most F1s undergo ARCP, my supervisor was unclear about my progression, required forms, and timing.

With guidance from my FTPD, I completed my Form R and ARCP, which recorded “Other – LTFT with no concerns,” meaning I will have another ARCP once I finish the full-time equivalent year (at 70%, my F1 is extended by five months, so F2 begins in January).

This lack of awareness adds complexity and places the burden of self-advocacy on LTFT trainees. While I appreciate the heavy workload of NHS administrative staff, I faced several difficult conversations and significant stress over my F1–F2 progression. Although resolved, the experience was exhausting, and I hope that as LTFT becomes more common, systems will continue to evolve to better support and guide trainees.

All-in-all…

Sometimes imposter syndrome does rear its head, and it is difficult to accept my reality of not being a ‘real doctor’, because I can’t keep up with my friends and colleagues; this mentality is rooted in the old (and toxic) perception that to be a doctor is to be always stressed, high on cortisol and working 70 hour weeks - which I am very glad to see is changing. Being LTFT simply makes it possible for me to be a doctor and enjoy it!

Doctoring is a difficult job, so if there is anything you can do to make it more manageable for yourself - do it!

You’re not taking the easy way out… there is nothing easy about this profession, no matter how many hours you work.

It has taken me several years to come to accept that my career will look a little different to how I imagined it, and some days comparisons still seep in and there’s an element of grief for the doctor I imagined I would be. When this happens, I remind myself I’m only human, it’s okay to feel like that, and the fact that I’ve adapted and continued to practice medicine despite it all is something to be proud of.

Like most things, it isn’t always easy or seamless, but for me it is worth it - with the added bonus of having more long weekends to go home and see my dog!

If any of this resonated with you, I hope it’s helped you feel less alone and reminded you that you are just as valuable a medic as your full-time peers!

Useful links:

East Midlands Deanery Policies
NHS Help

A central online query submission page for trainees in the midlands - a new set up to save us the detective work for “who should I email???”. We can now submit a query online and choose a category that it relates to and they will initially “triage” our questions so we get answers from the appropriate people!

BMA Less than Full-Time Trainees’ Pay Explained

A Guide to Less Than Full Time Training