Your career in Acute Medicine. Your way.
Specialty and Specialist (SAS) doctors are experienced, valued members of the acute medical workforce. Their clinical expertise, continuity, leadership and teaching make an essential contribution to patient care.
Whether you are beginning an SAS career, developing expertise in Acute Medicine, shaping a portfolio role or exploring further progression, SAM is here to help you find opportunities and support.
There is no single route to a successful medical career. SAS is a positive, established career choice in its own right.
Understanding SAS careers
SAS is the established collective term for Specialty, Associate Specialist and Specialist doctors. It describes a range of experienced career-grade doctors working outside formal specialty training programmes.
Specialty Doctor
A nationally recognised career grade for doctors with relevant postgraduate experience.
Under the 2021 England contract, entry normally requires four years of postgraduate training or equivalent experience, including two years relevant to the specialty.
Specialty Doctors can develop substantial expertise, take on senior responsibilities and build long-term careers within Acute Medicine.
Specialist Doctor
The Specialist grade was introduced in 2021 to recognise experienced doctors working at a high level of clinical responsibility and capability.
Entry under the England 2021 contract requires at least 12 years of medical work, including six years in a relevant specialty, or accepted equivalent experience.
Applicants must also meet the relevant Specialist grade capabilities framework.
Associate Specialist and older grades
Associate Specialist and former Staff Grade posts are closed to new appointments, but doctors may remain employed under these historic contracts.
Their contribution, experience and ongoing development remain important within the acute medical workforce.
Contractual conditions and opportunities to transfer to newer grades should be considered individually.
Specialist grade is not the same as specialist registration
Employment as a Specialist Doctor does not automatically confer entry to the GMC Specialist Register. These are separate processes with different requirements. Doctors seeking specialist registration outside an approved UK training programme may be eligible for the Portfolio Pathway.
GMC: understanding specialist registration →National contracts differ between England, Scotland, Wales and Northern Ireland. Locally Employed Doctors (LEDs), including many clinical fellows, may work alongside SAS colleagues but are not necessarily employed on national SAS contracts.
Why choose an SAS career in Acute Medicine?
Acute Medicine offers clinical variety, a fast-moving multidisciplinary environment and opportunities to develop interests that fit your skills and aspirations. An SAS career allows you to help shape how that professional life develops.
Clinical variety
Assess and manage acutely unwell adults across a broad range of medical presentations, developing experience in assessment, diagnosis and early specialist treatment.
Continuity and stability
Build long-term relationships with colleagues and local services, often without the repeated geographical rotations of formal training programmes.
Flexibility and balance
Explore flexible or less-than-full-time working, a sustainable job plan, and opportunities to balance clinical practice with other professional interests.
Develop specialist interests
Opportunities may include medical SDEC, Enhanced Care, point-of-care ultrasound, acute oncology, frailty, obstetric medicine or other interests relevant to local services.
Education and leadership
Shape undergraduate and postgraduate education, simulation, clinical supervision, governance, service development and multidisciplinary team learning.
Research and improvement
Lead quality improvement initiatives, contribute to clinical research, develop pathways and help improve the experience of patients and the acute medical workforce.
The right SAS post should recognise both your existing clinical contribution and your opportunity to develop. It is worth discussing your longer-term interests before accepting a job.
Discover more about the specialty of Acute Medicine →Making the most of your SAS role
A rewarding SAS career depends on more than clinical duties. Good job planning, professional development, appraisal and recognition should support your role throughout your career.
Job planning and SPA time
Your job plan should reflect your clinical responsibilities, professional development, service needs and agreed ambitions.
- Review your job plan regularly and ensure responsibilities are realistic.
- Identify sufficient supporting professional activity (SPA) time for appraisal, CPD and job planning.
- Discuss additional SPA for teaching, research, education, leadership, governance and other agreed roles.
- Consider clinical workload, on-call responsibilities and sustainable working.
- Ensure agreed development activity and objectives are documented.
Professional support and recognition
SAS doctors should have meaningful access to development and professional support throughout their careers.
- Annual appraisal and a personal development plan.
- Appropriate clinical supervision, mentorship and educational support.
- Access to study leave and CPD opportunities.
- Support from a local SAS Advocate, SAS Tutor or equivalent role, where available.
- Fair opportunities to lead, teach, contribute to governance and develop professional interests.
One SPA is a minimum, not necessarily enough
Under the relevant 2021 England SAS contracts, the minimum one SPA supports CPD, appraisal and job planning. Additional agreed roles and responsibilities may require additional SPA time.
Use annual job planning to agree the time needed for your individual role. Actual entitlement depends on the applicable national contract, working pattern and local agreement.
BMA: SPA guidance for SAS doctors →Develop your expertise in Acute Medicine
Your development can be broad, focused or built around several different interests. Formal specialty training is not the only route to developing advanced clinical, educational and leadership capabilities.
Developing a specialist skill
Some SAS doctors may wish to develop a defined specialist clinical capability, such as ultrasound, echocardiography, procedural skills or a related specialty interest.
The Acute Internal Medicine curriculum and its specialist skills can provide useful structure for personal development. SAS doctors are not required to undertake the entire curriculum unless pursuing a particular qualification or registration pathway.
Explore AIM training and capabilities →My SAS career-development checklist
Use these prompts to reflect on your current role, identify opportunities and prepare for discussions with your appraiser, clinical lead or mentor.
My current role
My professional development
My future direction
What could I do next?
You do not need to tick every box. Choose two or three priorities that would make the greatest difference to your professional development or working life.
Consider discussing these with your clinical supervisor, SAS Advocate, SAS Tutor, appraiser or clinical lead. Your agreed actions can then be incorporated into your usual professional development processes.
This is an optional self-reflection tool, not a formal appraisal, assessment, competency framework or GMC portfolio. Your selections remain in this browser session only and are not submitted to SAM.
Your career, your progression
Progression does not mean the same thing for everyone. Developing deeper expertise, leading services, moving to the Specialist grade or gaining specialist registration can all be valid ambitions.
Develop within the Specialty Doctor grade
A long-term Specialty Doctor career can offer professional satisfaction, continuity, increasing experience and opportunities to develop particular areas of expertise.
- Deepen clinical expertise and autonomy within your agreed scope of practice.
- Develop teaching, leadership, improvement and research roles.
- Build specialist interests within Acute Medicine.
- Review pay progression and professional development with your employer.
Progress to the Specialist grade
The Specialist grade recognises experienced doctors with the capabilities to undertake substantial clinical responsibility within a defined role.
- Review the Specialist grade entry requirements and capabilities.
- Identify relevant experience, leadership and evidence of capability.
- Discuss potential opportunities with your employer.
- Apply for a suitably established Specialist grade post.
Pursue GMC specialist registration
Doctors who have not completed an approved UK specialty training programme may be able to demonstrate the required knowledge, skills and experience through the GMC Portfolio Pathway.
- Review the requirements for Acute Internal Medicine.
- Identify evidence and areas needing further development.
- Agree relevant training and supervision arrangements.
- Plan and prepare an application using current GMC guidance.
These pathways do not have to be linear
Becoming a Specialist Doctor is not a prerequisite for applying to the GMC Portfolio Pathway. Equally, doctors can build fulfilling senior SAS careers without pursuing specialist registration.
The right choice depends on your interests, circumstances, experience and professional ambitions.
GMC: specialty-specific Portfolio Pathway guidance →SAS voices: different careers, shared purpose
There is no single route through a career in Acute Medicine. These experiences show how doctors have developed roles around clinical interests, education, personal circumstances and career progression.
LJ Laura Jones Specialty Doctor in Acute Medicine and former SAM SAS Lead
Laura describes finding a renewed enthusiasm for Acute Medicine after personal circumstances led her to reconsider her previous career route.
Experience as a senior clinical fellow helped her recognise the benefits of a permanent Specialty Doctor role, combining clinical development, job satisfaction and work-life balance.
Her experience also highlights the need for better recognition of SAS expertise, permanent career opportunities and a more inclusive approach to medical development.
RP Ross Palmer SAS Doctor in Acute Medicine and Medical Education
Ross moved into a Specialty Doctor post following ACCS Acute Medicine training and a senior teaching fellowship.
His bespoke job plan divided time between clinical Acute Medicine and undergraduate medical education. This allowed him to develop teaching interests while retaining clinical practice.
Avoiding further rotations was also important to his family life. His experience illustrates how SAS careers can accommodate professional interests and personal circumstances.
CT Chris Tuplin Consultant with previous Specialty Doctor experience
Chris began in a Trust Grade post, subsequently becoming a Specialty Doctor with a major role in Ambulatory Care.
With support from consultant colleagues, he completed MRCP and developed the evidence required for specialist registration through the former CESR process.
He gained specialist registration in General Internal Medicine in 2022 and subsequently took up a substantive consultant appointment in Acute Medicine.
Could your experience help someone else?
SAM would welcome further accounts from SAS doctors working in Acute Medicine: from those building long-term Specialty Doctor careers to colleagues working at Specialist grade, in education, clinical leadership or research.
We would particularly like to reflect the diversity of SAS experiences across the four UK nations.
Contact SAM about sharing your story →SAS professional guidance and resources
National professional guidance can help SAS doctors and their employers develop fair contracts, effective job plans, high-quality educational support and clear career opportunities.
RCP SAS priorities 2026–2030
The Royal College of Physicians sets out five priorities for better recognition, career development, workplace culture, representation and flexible career routes for SAS doctors across the UK.
Read the RCP priorities →NHS Employers: SAS leadership pathways
Published October 2026, this guidance helps employers identify, develop and embed SAS leadership opportunities, including approaches to Specialist grade roles, mentoring and job planning.
Explore leadership guidance →Working across the four nations
SAS career structures and professional development principles are relevant across the UK. However, pay, contractual terms, study leave, employment policies and some support arrangements vary between England, Scotland, Wales and Northern Ireland.
Check the contract that applies to your employment and the relevant nation-specific guidance from your employer, professional association or medical Royal College.
Your SAS community within SAM
SAS doctors are an integral part of Acute Medicine. Your experience, professional interests and perspectives are important to the future development of the specialty.
Be part of the future of Acute Medicine
SAM brings together clinicians from across the acute medical multidisciplinary team. SAS doctors have a vital role in shaping our clinical practice, education, leadership and advocacy.
Your experience matters. Your contribution deserves recognition. Your career belongs in Acute Medicine.
Connect with SAM
Discover membership, take part in our events and professional networks, or get in touch about SAS priorities and support.