For me, working LTFT was less of a choice and more a necessity to enable me to work, to make medicine a sustainable career. During my third year of medical school, I experienced several health challenges which made clinical placements incredibly difficult. Ultimately, I was diagnosed with generalised anxiety disorder and postural orthostatic tachycardia syndrome (POTS).

The combination of these made the clinical years of medical school even more demanding and exhausting than the already are, especially since there is simply no such thing as LTFT medical school… Unfortunately, due to the intense curriculum requirements and fast-pace rotations, it is very difficult to implement reasonable adjustments at every placement for several reasons; clinical placements vary in durations (some of which are under 6 weeks), this leaves minimal time to communicate and implement suitable adjustments for individual students amongst the wider scale timetable; chronic illness/invisible disability is still surrounded by stigma and, whilst many seniors are supportive, there can be some seniors who are less willing to acknowledge these conditions or accommodate small supportive changes.

As I approached final year and the reality of working in the real world settled in, the anxiety of how I would physically cope with the long hours grew. Thankfully I had discussed this with my pastoral support team and head of year - who at her discretion, allowed me to complete some of the demanding rotations at 70% (such as 5th year A&E with shift work), as this was my proposed % I would commence FY1 at. So, although there is a lot of work to be done to support medical students with chronic illnesses/disabilities during our clinical years, it is still possible to manage them, it will likely require a lot of self-advocacy, persistent communication and open honesty from ourselves with the medical school - but it is doable!

Hi there, 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 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%, along with other reasonable adjustments that should be considered.

However, it is important to mention that my experience is not the only one. In recent years there have been changes to the LTFT training application process, following these, trainees no longer need to meet certain criteria to go LTFT. There will be individual applications for each foundation school, and the processes may vary regionally, but the overall concept remains the same. Whilst you will be asked to declare a ‘reason’, this can be anything, from physical/mental health needs, childcare, you have a side hustle or simply want a better work life balance!

My experience of LTFT training at Leicester…

As with everything I have had great benefits along with some difficulties whilst completing my FY1 at 70% LTFT. Working at 70% LTFT roughly equates to working 3 days one week, 4 days the next. However, this can vary a great deal when factoring in on-calls or variations in shift pattens between departments etc…

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.

In addition to factoring in some R&R, occasionally my rota will fall in a way that enables me long weekends without using any A/L. Despite having less A/L to use (since it is pro-rated), I only need to use a couple days strategically to give myself an entire week off!

The biggest benefit of working LTFT is the ability to create a much more balanced life; I would be physically unable to pursue my medical career without this adjustment.

Top Tips

Be friends with your JDA/MSA (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! Everyone will have different needs/reasons for going LTFT so your shift pattern may need adjusting slightly; initially my rota did not include on-call shifts, however after 4wks of working, I communicated with the JDA that I would like to trial a phased ‘return’ to the oncall rota (still at 70%). This had several benefits for me including increased pay and significantly more professional development due to the clinical exposure you get OOH.
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 (if you feel comfortable with them) - 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

Unfortunately, there are elements of working LTFT that are less than ideal… The two most obvious topics that people are aware of are: reduced pay and extended training.

As an FY1 doctor working LTFT, the reduction in pay can cause some financial stress. For the most part, I have been fortunate enough that it hasn’t been a huge issue due to the rotations that I’ve worked on having a high number of on-calls. But this is something worth being aware of, especially if you’re working rotations with no/limited out of hours work. This hopefully becomes less of an active issue as we progress through training as pay increases with experience. On the topic of pay - it is paramount to check your payslip! Although incorrect pay is not an issue exclusive to LTFT trainees, it can be difficult to understand a LTFT payslip initially due to the added complexity of working different percentages (our on-call allowances will be adjusted to reflect the pro-rata amounts). The BMA have published a guide to help with this - there is a link at the end of the blog!

In terms of extending training, I always knew this would be the case for me. While it does sometimes cross my mind that I am “falling behind”, I remind myself that medicine is the ultimate marathon, most definitely not a sprint! Once we reach consultancy… that’s it! We reached the end… There will always be extra-curricular projects and teaching opportunities, but they can be taken at any point along the journey, no one said you have to wait until you're a consultant for those things. So, if anything, by extending our training to make medicine manageable, we have so much more time to enrich our professional (and personal) lives with other projects and passions!

The biggest difficulty I have personally faced as a LTFT FY1, is the lack of awareness from supervisors regarding how our training programme is structured. Throughout FY1 itself, I had a fairly seamless experience going into each rotation at LTFT. However, coming to the end of working year, when the majority of F1s have their ARCP to progress to F2, my supervisor had very little knowledge of how I should be proceeding, what forms he needed to complete or when my ARCP should occur. I still ended up completing my ‘Form R’ as advised by my FTPD and underwent my ARCP, the outcome of which was “Other - LTFT with no concerns”; simply meaning I will have another ARCP when I have completed the ‘full-time equivalent’ training year (which for myself at 70% means my F1 year is extended by 5 months, so my F2 will start in January).

Ultimately, the lack of awareness and complexity of LTFT foundation training leads to a lot of self-advocacy and chasing communication from higher-ups. Whilst we can all appreciate the massive volume of employees the admin staff at our NHS trusts have to manage, I have had several challenges throughout the year that have required many difficult conversations, one of the most frustrating and concerning being the lack of communication regarding my progression from F1 to F2. Whilst this has ultimately been clarified since, the stress this issue caused was exhausting and I hope that as more foundation trainees take up LTFT working, the NHS will adapt to better support and inform their LTFT trainees, rather than us being, what seems like, an afterthought.

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 70hr 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 (LTFT)