Why male trainees should consider the flexible option

Over the past decade, junior doctors’ working lives have changed considerably. Medicine has traditionally been perceived as an extremely demanding career in terms of work hours and intensity, with little time for extracurricular commitments and many barriers to a good work-life balance. However, the European Working Time Directive has substantially reduced most doctors’ working hours. Furthermore, the now widely available option of training flexibly or less than full time (LTFT) offers the chance to combine commitments outside work with career progression in a way that previous generations have rarely enjoyed.

The 2012 General Medical Council national survey of trainees reported that 8.0% of trainees are LTFT, up from 6.1% in 2011. Interestingly, a further 6.6% “wanted to train flexibly but were ineligible.” 1

Although LTFT training is becoming increasingly common, it remains dominated by women. The 2011 NHS workforce census reported that, of almost 20 000 female specialty and specialist registrars, 14.6% were LTFT, compared with only 1.6% of male trainees.2 Within my own specialty of anaesthetics, 95% of LTFT trainees are women.3

I believe there are two main reasons why LTFT training is dominated by women.

Firstly, men are more likely than their female partners to be the main breadwinner in their household. According to the 2011 census, 60% of men aged 16-74 work full time, compared with 36% of women.4 In addition, men work more hours a week and still earn 10.5% more on average than women, despite supposed equality of opportunity.56 Fortunately, this discrepancy doesn’t apply within medicine—for all its faults, the NHS does at least pay men and women in equivalent posts equal salaries. But, if men overall are more likely to be the primary earners in their households, it is perhaps unsurprising that they are more reluctant to reduce their earnings by working shorter hours.

Secondly, gender roles are still deeply engrained in society. The 2011 census found that less than 1% of men are classed as “economically inactive (looking after family),” compared with 8% of women. Only 6% of men, compared with 21% of women, work part time. The obvious inference is that many mothers of young children still consider childcare their first priority but that few fathers do. Men may also be more likely than women to define themselves by their careers and so be more likely to perceive LTFT training as entailing a loss of status.

Whatever the underlying reasons, the growth of LTFT training and the paucity of male LTFT trainees clearly have some long term implications for the medical workforce.

The first is that we are likely to see more demand for LTFT consultant posts. Consultant posts are rarely advertised as LTFT. At the time of writing, only 18 of the 259 substantive consultant posts advertised on bmjcareers.com were part time. Creating more LTFT consultant posts could help satisfy demand for such posts and solve the widely anticipated problem of the United Kingdom having too many trained doctors within the next decade. Surprisingly, the Centre for Workforce Intelligence’s 2012 report Shape of the Medical Workforce does not mention the role of LTFT consultants in the future NHS workforce.7

The second consequence of having so few men in LTFT training is the danger of creating a gender divide within the profession. If men are barely represented among LTFT trainees, the risk arises that they never engage with their LTFT colleagues and begin to undervalue the substantial minority of almost exclusively female LTFT doctors. Medicine has long been a male dominated profession and, although there are now more women at medical school than men, only 32% of consultants are women.2 This gender divide has disappeared at trainee level, but to allow the emergence of a new gender divide along full time and part time lines risks allowing male dominance to creep back into the profession.

Male trainees should therefore think twice before ruling out LTFT training. Regardless of one’s personal circumstances, the work-life balance benefits are not to be underestimated. Furthermore, if LTFT working among trained doctors becomes common, being prepared to work flexibly may increase one’s employability. Employers may also find that the long term goal of 24 hour consultant delivered care is better served by employing a large pool of LTFT consultants than a smaller pool of full time consultants.

Patients may benefit as well. For example, LTFT doctors may be less likely to suffer burnout and less likely to resent time spent at work. Spending more time away from work may also help doctors relate to patients and see the big picture when making difficult decisions about patient care.

The future of the UK’s medical workforce is fraught with uncertainties. However, we can reasonably expect it to reflect three trends in the wider world: greater participation of women in the workforce, greater participation of men in childcare, and increasing demand for flexible work patterns.

Other countries have for a long time encouraged men to look beyond traditional roles to provide for the family. Sweden, for example, has offered 480 days of paid shared parental leave for each child since 1974. The coalition government’s proposal to allow mothers and fathers to share a year’s maternity leave, due to take effect in 2015, is a step in the same direction.

The medical profession is well placed to embrace this zeitgeist, but it can do so only if men and women alike are open to the benefits that flexible working can offer.