Flexible Trainees

Introduction

The Renal Association Education and Training Committee, chaired initially by Edwina Brown and now by Sue Carr, are very conscious of the changing nature of the renal workforce - the majority of today’s medical graduates are female and this is the future !!

We have already established an email contact network for LTFT trainees and consultants, with link person Alison Brown (Consultant Nephrologist in Newcastle). This has proved to be a useful source of advice and has allowed sharing of experience and good practice, especially with advice from current job-sharing consultants to those trainees trying to set up workable job-sharing contracts.

We expect the demand for LTFT training and consultant working to increase in future and we wish to increase the help and support available.

This new improved webpage aims to ;

  • Help you set up LTFT training by providing useful links to the information you need
  • Help you join the current renal LTFT email network –just email Alison.Brown5@nuth,nhs.uk to have your details added
  • We hope to set up a list of numbers of full time and LTFT trainees in each deanery to help those trying to find job share partners

Updates from the Renal Workforce Committee with latest workforce details, trainee numbers and predictions about future trends. Future “noticeboard” for trainees to post comments and share experience about LTFT working

Anonymous examples of LTFT and job-sharing job plans as examples for everyone to access

Information about setting up LTFT training

Flexible training is available for hospital posts when training on a full-time basis would not be practicable for well-founded individual reasons. The usual reasons include pregnancy, the need to care for young children, ill or disabled dependants, or the doctor’s own health or disability. Both men and women are eligible.

If a trainee is already working full-time in the same grade and hospital as they wish to train flexibly, no further interview is necessary. A new applicant to the grade must be appointed in open competition. The process for appointment to a post is the same for both full-time and flexible trainees, but you are entitled to request flexible training if you have a valid reason, as above.

Funding from the Deanery, educational approval of the job plan from the Renal SAC, hours of work and the agreement of the Trust to accept a flexible trainee all have to be organized in advance.

Flexible Trainees usually work either six sessions (24 hours) or seven sessions (28 hours) per week. On-call commitments should be a maximum of 6/10th or 7/10th of the full-time doctors equivalent. Time for protected study/research should be included within a normal working week, pro-rata, as for full-time trainees.

The length of contract is usually extended pro-rata compared to the full-timer so that equivalent training is completed. For example , ten months working 24 standard hours (60% full-time) per week. Is equivalent to six months full-time training.

Funding

This varies between Deaneries , but many currently have no funds available for new supernumerary flexible training posts . This means that the only available option is for trainees to be funded on a slot-share basis - where a trainee shares a training slot with another trainee, or works less than full-time in a full-time slot. This is often difficult to arrange in Renal Medicine, where there may not be enough LTFT trainees in a region, or two trainees may have very different training needs and cannot realistically slot share.

Workforce Issues

The Workforce Group of the JSC, chaired by Dr Phil Mason, was created with the aims of:

  • To critically review the current estimates of the required numbers of consultants (or specialists) to deal with the number of patients both on RRT and with specific renal disorders over the next 7yr.
  • To estimate the numbers of trainees completing training over the next 7yr. and review the trends in the number of consultant appointments.
  • To suggest possible solutions to deal with the workload and the likely excess of fully trained nephrologists over vacancies.

The Group originally reported to the JSC in June 2008

Current Situation.

This is described in the JSC Report June 2009. It should emphasised many of the predictions are based on inadequate data and we are working hard to improve the quality of this and improve the modelling to better determine the number of trainees required to fill existing and the estimated growth in consultant/specialty posts.

Growth in numbers of WTE Renal Specialists: This is based on the predicted growth in the number of RRT patients, which is not expected to plateau at least until 2018 (UKRR data), and should include the increased involvement of nephrologists in patients with AKI (acute kidney injury) as recommended by the recent NCEPOD report (http://www.ncepod.org.uk/2009aki.htm).

Numbers of Specialists required: As discussed in the Workforce document, this will partly depend on patterns of working of recently appointed consultants and current trainees.

Trainee Census: A trainee census was carried out in late 2008/early 2009 in an attempt to gauge the views and aspirations of current trainees. Unfortunately, despite the efforts of the Workforce Group, the Royal College of Physicians and the Renal Association, less that half of all trainees made a census return and many were incomplete and so the reliability of the census is uncertain and the data may be unrepresentative. However, data from those who did make a return revealed:

Male 60% Female 38% Unknown 2%

Flexible 5% Full time clinical 63% Research 29% Maternity 1% (The Flexible % agrees with JRCPTB data)

Single (renal) accreditation 16% Dual (mostly GIM) 83% but 34% of these were considering

swapping to single (renal) training

50% had done or were doing OOPE and 63% of those who had not wished to.

Median age at estimated CCT-35yr (mean 36yr)

Planned to work FT 80%

LTFT 20% (most (85%) aspired to work ≥60% WTE;15%-50% WTE)

Contemplating career break as a consultant: Yes: 10%; No: 83%; Not sure: 7%

Type of Job preferred: With on-call-88%; without-12%, Would consider job with clinics but no ward work-30% Limited to e.g. dialysis/PD/transplant – 43% Prefer a GIM component: Yes 43%; No 57%

Current position on trainee numbers:
There is a general consensus that there are currently too many trainees although more work is required to determine the appropriate number. Currently it is expected that WAPPIG (Workforce Availability Policy and Programme Implementation Group, the body with authority to control training post numbers) will recommend a reduction in the number of training posts in August 2010 by a modest number (probably ~13).

Advice to trainees: Be as competitive as you can! Continue with dual accreditation unless there is a nephrology-only job for which you could apply if you were to drop GIM (but remember if you do drop GIM, you cannot later re-instate). There are still jobs with a GIM component, although these may become less frequent as “Acute Medicine” trainees are awarded CCTs. Strengthen your CV with anything that demonstrates that you have something “extra”, e.g. publications (even case reports), strong audit projects or any innovations that have made a real difference to your unit/Trust, demonstration of a real commitment to teaching/education (some jobs have a significant trainee supervision compon.

Academia, Research and Flexible Training.

Undertaking research is perfectly possible on a flexible or less than full time basis. Attitudes have changed a great deal and in general people, including funding bodies, are supportive of the idea of women attempting to combine proper careers and families and being able to have enough time for the kids. Providing you are organised and motivated, it can be done without stress, and can be both enjoyable and fulfilling. A supportive partner and family is very helpful and having the ability to arrange the best possible child care that you can afford, will help to ensure that kids have a great time too. However, research is demanding and one needs to be realistic as to what constitutes less than full time in this setting. Four days a week is very possible, three days a week is more difficult and competitiveness will be that much harder. Two days a week is probably not viable except in very special defined settings.

To quote one Clinical Research Training fellow undertaking a PhD: "As with many things, there are challenges, but for me I greatly enjoy the combination of thought provoking research and engagement with the intelligentsia of the university and the opportunity to spend lots of time with my children. I would recommend it."

In general, clinical duties should be kept to a minimum whilst undertaking a PhD - no more than one session a week is the usual advice. As a lecturer, the challenges of combining research and clinical medicine are more stringent, even for those working full time. Having a clear idea of goals, setting time lines, and having a mentor who understands the pressures and challenges of an academic trainee is essential. Advice about mentors can be obtained from the Academy of Medical Sciences.

Dr A Brown Alison.brown5@nuth.nhs.uk  

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