Estimated read time: 6 mins
Eleven years ago, as a disillusioned SAS-grade urogynaecologist, I decided to take a master’s in healthcare law and ethics and then I joined Medical Protection as a medicolegal consultant. As such, I know the SAS grade better than most.
Historically, doctors’ grades have been grouped together into junior doctors, middle-grade doctors and consultants. However, one of the most important, often marginalised, and overlooked grades is the Specialty and Associate Specialist, commonly known as SAS.
The reason for the poor status of SAS doctors is institutional bias. They have always been seen as second class – even though they are an essential part of the healthcare system, providing high level care to patients across a range of different specialties. They also comprise 22% of the licensed GMC workforce.1
SAS doctors are typically senior doctors who have completed their basic medical training and have gained several years of experience in a particular specialty. They are not consultants, but highly skilled professionals who provide specialist care and support to consultants and other members of the medical team.
The role of SAS doctors is varied, and their responsibilities depend on their specialty and level of experience. Some SAS doctors work in emergency medicine, providing urgent care and support to patients in critical conditions. Others work within the surgical specialties, assisting consultants with complex procedures and surgeries. SAS doctors may also work in mental health, rehabilitation, or other specialties, providing specialist care to patients with specific medical conditions.
One of the main benefits of SAS doctors is their flexibility. They can work in different specialties and settings, adapting to the needs of the healthcare system. They may work in hospitals, clinics, or other healthcare facilities, providing support and care to patients across the whole healthcare spectrum.
In addition to their clinical responsibilities, SAS doctors contribute to the development of the healthcare system. They may participate in research studies, help to develop new treatment protocols and procedures, and provide feedback and suggestions on ways to improve patient care.
It is concerning that despite their essential role in the healthcare system, SAS doctors are often undervalued and continue to face challenges. One of the main challenges is the lack of career progression opportunities. SAS doctors are not consultants, and they may find it difficult to advance their careers beyond a certain point. This is in part due to the inability to be on the specialist register – except for a very protracted route called CESAR which is very complicated to get through. This can lead to frustration and a lack of motivation, which can ultimately affect the quality of care they provide.
Another challenge for SAS doctors is the lack of recognition and appreciation for their contribution and commitment to patient care. SAS doctors often work long hours, providing specialist care and support to patients across a range of areas. However, their work may not always be acknowledged or appreciated, leading to demotivation and burnout.
To address these challenges, there have been calls for greater recognition and support for SAS doctors. This includes providing more opportunities for career progression, improving working conditions, increasing the level of support and supervision provided to SAS doctors, and breaking down the hierarchy between consultants and SAS doctors. The GMC should consider making the CESAR process easier and less protracted so more SAS doctors can go onto the specialist register. By addressing these issues, the healthcare system can ensure that SAS doctors are motivated, engaged, and can continue to provide the highest quality of care to patients.
Some organisations such as the Academy of Medical Royal Colleges are also trying to engage, empower, and mentor the SAS workforce to ensure they are no longer treated as second-class doctors.3 Dr Laura Hipple, RCOG National SAS and LED Chair has done a lot of work on raising awareness about SAS doctors and this being a ‘viable, satisfying career pathway’.4 The SAS Collective are also doing excellent work to promote measures that would help to improve and protect the careers of SAS and locally employed doctors.
SAS doctors are a vital part of the healthcare system in the UK. They provide specialist care and support to patients across different specialties and play a crucial role in mentoring and training junior doctors and other healthcare professionals. Despite the challenges they face, SAS doctors are motivated and committed to providing the highest quality of care to patients. By recognising and supporting SAS doctors, the healthcare system can ensure it retains this important cohort of doctors.
Medical Protection is committed to supporting SAS doctors. We have actively sought advice and guidance from senior SAS doctors to improve our understanding of the grade and the challenges they face so we can adjust our products accordingly. We feel well equipped to talk to SAS doctors about adequate indemnity and to support them whatever difficulties their career brings, be that help with a report for an inquest, help with a patient complaint, an HSIB enquiry, a GMC investigation, or a disciplinary matter.
References
The state of medical education and practice: The workforce report London: General Medical Council; 2022.
GMC plans to enable ‘10,000 or more’ SAS doctors to enter general practice - Pulse Today
SAS Papers & Reports Archives - Academy of Medical Royal Colleges (aomrc.org.uk)
SAS and LED Committee | RCOG