Karen Ellison, Medicolegal Consultant at Medical Protection, talks from their own experience as working as a SAS-grade urogynecologist, about the continued undervaluing of specialty doctors and specialist grade doctors in the medical workforce.
11 years ago, as a disillusioned SAS grade urogynecologist, I decided to study a master's in healthcare law and ethics and joined Medical Protection as Medicolegal Consultant. As such, I know the SAS grade better than most.
As you know, in the UK, there are different grades of doctors that are categorised based on their level of experience and qualifications. Historically, these have been grouped together into junior doctors, middle grade doctors and consultants. However, one of the most important, often marginalised and looked over grades is the Specialty and Associate Specialist, commonly known as SAS doctors.
The reason for the poor status of SAS doctors is institutional bias – they have always been seen as second class – even if 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 they are highly skilled professionals who provide specialist care and support to consultants and other members of the medical team.
The roles of SAS doctors are 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.
SAS doctors play a crucial role in supporting consultants, junior doctors, and other members of the medical team. They are often responsible for mentoring and training junior doctors, helping them to develop their skills and knowledge. SAS doctors may also provide supervision and support to medical students and other healthcare professionals, helping them to gain valuable experience in their chosen field.
In addition to their clinical responsibilities, SAS doctors also 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.
In recent months, SAS doctors have been considered part of the solution of GP shortages with the GMC announcing that they had plans to enable over 10,000 doctors to enter general practice.2
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 difficult to navigate. This can lead to frustration and a lack of motivation, which may 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 feelings of 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 so more SAS doctors can get 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 have also worked on different papers and reports trying to engage, empower and mentor the SAS workforce ensuring that they are no longer treated as “second-class doctors”.3 Dr Laura Hipple, RCOG National SAS & LED Chair has also done a lot of work on raising awareness about SAD doctors and this being a “viable, satisfying career pathway”.
In conclusion, 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 they 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 continue 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, a HSIB enquiry, a GMC investigation or a disciplinary matter, amongst other things.