Less Than Full Time, More Than a Surgeon

There was a time when I thought the solution to struggling in surgical training was simply to do more of it. More operating. More clinics. More on-calls. More courses. More reading. More hours. It seems perfectly logical when you say it like that. Surgery is a craft, and crafts require repetition. If you're not confident, surely you need more exposure. If you're behind, work harder. If someone else is progressing faster than you, speed up.

The problem is that sometimes the answer to being overwhelmed isn't more. Sometimes it's less.

For me, training Less Than Full Time became one of those counterintuitive decisions that made me a better surgeon. It gave me something that full-time training, at that particular point in my life, simply wasn't giving me enough of. Time. Not just time away from the hospital, but time to think, time to recover, time to be a father, and — perhaps most importantly — time to rebuild a confidence that had quietly gone missing.

It wasn't a decision I arrived at easily. Two worries sat over it before I made it, and neither of them went away just because I'd made up my mind.

The first was money. Surgical training doesn't pay enough for a percentage cut in salary to feel like a minor adjustment. There were mortgage repayments, childcare costs, the ordinary weight of running a household, all of it calculated against a salary that was already reduced by working less than full time and would take longer to become a consultant's salary as a result. I did the sums more than once, and more than once they made me hesitate. Choosing LTFT wasn't a lifestyle indulgence. It was a financial decision with a real cost attached, and I want to be honest about that rather than pretend the choice was purely about wellbeing.

The second worry was clinical exposure, and this one kept me awake more than the money did. Surgery has traditionally run on a fairly simple equation: time in hospital equals commitment, and commitment equals competence. The best trainee was often assumed to be the one who arrived first and left last. Reducing my hours meant reducing my case numbers, and in a specialty where confidence is built case by case, that felt like a genuine risk rather than an abstract one. Fewer lists. Fewer emergencies. Fewer chances to be in the room when something went wrong and someone more senior showed you how to fix it. I worried, quite reasonably, that I would fall behind not just in years but in ability.

I understood, too, why some of the older generation remained suspicious of it. They told stories about their own training that sounded almost mythical — one-in-two rotas, sleeping in the hospital, operating through the night and starting an elective list the following morning, knowing every patient on the ward better than they knew their own families. There is something admirable in that. There is also something slightly terrifying about it. And immersion does work. If you spend most of your waking life doing surgery, you see a great deal of surgery. You recognise patterns faster. You build relationships with the consultants who train you. You watch complications evolve from the first sign to the resolution. There is continuity in that kind of exposure that is genuinely difficult to replace.

But there is another variable in that equation that gets left out too often: the person receiving the experience. Ten exhausted hours are not the same as ten productive ones. Being physically present in a hospital doesn't automatically mean you are learning.

There were periods during my training when confidence simply didn't come naturally, and I don't think people always appreciate how non-linear that can be. The assumption is that confidence rises steadily with seniority — a little more each year, until by the final year you're practically a consultant already. If only. Confidence in surgical training behaves more like a stock market than a staircase. There are rallies. There are crashes. There are occasional events that make you wonder whether you should withdraw your investment completely. I had spells where I questioned everything. Was I good enough? Was I progressing quickly enough? Did my trainers think I was good enough?