As we move from the stone age to the new SAS age, I want to shine a spotlight on a group of often unsung heroes within our healthcare system – the SAS doctors – and the invaluable leadership role they play in delivering specialised care in various sub-specialties of medicine.
As a SAS doctor and a SAS advocate, I have the privilege of working closely with these dedicated professionals who are instrumental in ensuring that high-quality healthcare remains accessible to all. They play a pivotal role in providing specialised care in our hospitals, often working tirelessly behind the scenes to ensure patients receive the best possible treatment.
A vital part of our medical fraternity
SAS doctors play indispensable role in our community. They are not just colleagues but mentors, leaders, educators, and friends. They take up expanded roles as training programme directors (TPDs), SAS tutors, SAS advocates, appraisers, and researchers. Their commitment to our field ensures that we continue to make progress in the scientific and medical community, ultimately benefiting patients across the country.
So what are SAS doctors?
They are not consultants, junior doctors or trainees. Speciality (four+ years), associate specialist and specialty (12+ years) doctors are those working in the UK/Northern Ireland who are appointed on specific recognised contracts. International medical graduates and Black, Asian and minority ethnic people are over-represented in the cohort, and there is increasing recognition that SAS doctors constitute a marginalised group. This can however often lead to difficulties due to inequalities for the population.
Should we encourage our senior specialty (12+ years) to transfer and apply for a specialist post and take on different responsibilities? Yes, but this takes a strong leadership and consultant support to progress and we ask for your help with this.
The changing landscape
SAS and locally employed doctors grew by 40% from 2017 to 2021, four times the rate of growth of doctors on the specialist register in this period (11%), and about six times that of GPs (7%) as per the GMC workforce report 2022. They will be the largest group in the medical workforce by 2030, should the trend continue. The skills mix in this group of doctors is evident, some ranging from those with relatively little clinical experience to doctors who have held senior clinical leadership roles in non-UK healthcare systems.
They have different career trajectories, but the largest number of leavers. If we train and retain our SAS doctors, we can bring in an effective and positive change in our care for patients within the NHS.
So how do we motivate our biggest workforce in delivering the changes we want to see in the NHS?
We stop demotivating them and we encourage them to grow but in a supportive enriched environment.
The leadership role of SAS doctors
One of the noteworthy aspects of SAS doctors is their leadership position within our field. They bring years of experience and specialised knowledge to the team, thereby rendering them invaluable leaders and mentors for the junior members of the team. SAS doctors can serve as clinical leads, ensuring the effective functioning of services, and assuming responsibilities for training and development programmes. We have seen experiences of this in some units and hope to see this grow.
Research and service development
SAS doctors across many trusts can be actively engaged in research and service development in addition to their clinical responsibilities. They contribute to the advancement of their respective specialities through their involvement in studies, quality improvement projects, clinical audits, and the implementation of best practices. Their work has an everlasting impact on the quality of care.
‘I don’t belong anywhere’: Identity crisis among SAS doctors
The lived experience of many SAS doctors is often in contrast to formal policy on the range of roles that they are given to fulfil. They can often struggle to achieve the professional development that they desire, including using appraisal reviews. There are still practices where the SAS doctors are withheld from training, with contrasting professional development expectations compared to trainees. SAS doctors typically are considered as an outsider group, often being defined by what they are not, making it a perceived career failure, rather than a positive career choice.
‘As a SAS advocate I hope to encourage, boost pride in being an SAS and improving wellbeing’
The dedication, expertise, and leadership of the SAS doctors are the cornerstones of our healthcare system, touching thousands of lives. SAS doctors are the true unsung heroes of our NHS workforce. Their contributions are indispensable in ensuring high-quality patient care and the smooth functioning of our healthcare. There is scope to bring the professional development opportunities for SAS doctors more effectively in line with published policy, including the SAS Charter (AOMRC) and so much of untapped potential within this workforce.
It’s time we recognise and honour the hard work carried out daily by SAS doctors in roles pivotal to the provision of patient care.
We hope as a committee and community we can work together to improve the quality of our training and experiences moving forward for all our colleagues.
This article first appeared in the Summer 2024 issue of College News.