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Allowing more doctors to work less than full time could reduce burnout, says royal college

BMJ 2019; 366 doi: (Published 27 September 2019) Cite this as: BMJ 2019;366:l5778

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Re: Allowing more doctors to work less than full time could reduce burnout, says royal college

Whilst useful to know that trainees feel that the less than full time working (LTFT) could prevent burnout [1], this in itself is unsurprising. More importantly, I feel it is a disservice to the multitude of factors leading to so many of the NHS workforce feeling overworked and experiencing the hallmarks of burnout: emotional exhaustion, depersonalization, and lack of personal accomplishment [2]. According to the 2019 GMC training survey, 39% of trainees find work emotionally exhausting and 56% feel worn out at the end of the day [3]

The approach should be two-fold: increasing how much time away from work people can have, but also improving the conditions at work. Simply focusing on letting more doctors work reduced hours isn’t addressing the root of why they feel working full time is unsustainable.

I disagree with the premise underlying LTFT as it currently stands — it can only be granted if there is a ‘well founded reason’, often caring for others or ill-health. A key way of increasing flexibility in NHS training is to broaden the scope of a ‘well founded reason’ to enable doctors to pursue other interests, medical-related or not. Doctors should not feel burdened by their job in the NHS, or that it is a limiting factor to their other interests.

Foundation doctors going directly into specialty training is at a record low. In 2018, only 37.7% of trainees completed their foundation programme to go straight into training, compared to 71.3% in 2011 [4]. Is this a reflex response of burnt-out doctors, only two years into training and taking time out, creating the flexibility for themselves that the current system lacks?

To improve conditions at work, there is much to be done around filling rota gaps and better workforce planning. Nearly three quarters of all specialties were underfilled in 2016 [5] and 67% of doctors experienced rota gaps at work [6]. We also need to foster a culture of positive feedback in the NHS. Having just returned from a year of training in Australia, the difference in culture to the NHS was very apparent. My trust would be fined if we didn’t have a break within 6 hours of our shift or if we worked more than nine consecutive days. On my first induction day I was told about free counselling services for health care professionals and the personal study budget for each doctor. Throughout the year I saw the amount of positive feedback received by all healthcare professionals in regular informal appraisals.

The issue of burnout within the NHS is multifaceted, but improving access to LTFT training is only part of the solution. The solution needs to be multidimensional to match the complexity of the problem. This includes changing the culture around why trainees can become LTFT.

[1] Rimmer Abi. Allowing more doctors to work less than full time could reduce burnout, says royal college BMJ 2019; 366 :l5778

[2] Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach burnout inventory manual (3rd ed.). Palo Alto, CA: Consulting Psychologists Press.

[3] GMC National Training Survey 2019 Report

[4] UK Foundation Programme. F2 career destinations report 2018.

[5] BMA. The state of pre and post graduate medical recruitment in England. 2017.

[6] BMA. Quarterly BMA Survey: Current views across the medical profession. Quarter 2: June 2017.

Competing interests: No competing interests

01 October 2019
Sujitha Selvarajah
Croydon University Hospital