Specialty and specialist doctors (SAS)
What is SAS?
SAS doctors (Specialty doctors) have been around for a long time. The term SAS is often used to include specialty doctors, associate specialists, staff grades and a number of other career grades.
The name SAS has now been replaced with 2 different groups ‘specialty doctor’ who can progress to become ‘Specialist doctors’. However, the term SAS is often still used.
If you become a specialty or a specialist doctor you should be employed a 2021 contract, these are national contracts. Health Education England alongside the BMA have done a lot of work to create these contracts and the charter that comes with it. This helps ensure job plans are fair and allow for development of specialty and specialist alongside their colleagues going through more traditional progression routes.
Being a specialty doctor is a positive career choice that is the right decision for lots of people. Many doctors now choose a speciality career from an early stage. Some doctors end up in specialty jobs following difficult life events that have made traditional training routes no longer appropriate for them. Other doctors may not be able to access traditional training programs. This does not mean they are inadequate doctors, they don’t work hard or they have not developed a high level of skill. These doctors just need a different way to have a successful and enjoyable career.
Over the coming years it is expected that the specialty career will grow as we have to develop a diverse and varied workforce.
All doctors appointed into new SAS posts are appointed as specialist doctors and specialty doctors. However, a number of doctors still remain on the terms and conditions for other grades that are now closed to new entrants.
Specialty doctor (from 1 April 2008) – To become a Specialty doctor, you need to have at least 4 years postgraduate training experience (or its equivalent gained on a part-time or flexible basis). Two of these years need to be relevant to your specialty. Specialty doctors are not in a formal training program. This does not mean they have not taken part in training and development.
Specialty doctors are often highly experienced in their speciality of choice, they have just trained (or are training) in a none traditional manor. Their skill set may be in line with a classical specialist curriculum or may be more specific or generalised.
Specialist doctor (from 1 April 2021) – In 2021 the new Specialist grade was created which has provided career progression for specialty doctors. You must have completed a minimum of 12 years’ medical work (either as a continuous period or in aggregate) since obtaining a primary medical qualification, of which a minimum of 6 years should have been in a relevant specialty, and meets the criteria set out in the generic capabilities framework for the specialist grade, which has been developed by AoMRC, BMA and NHS Employers.
Associate specialist (closed in 2008) – completed a minimum of 10 years’ medical work since obtaining primary medical qualification, of which a minimum of 4 years should have been in a relevant specialty.
Why become a Specialty doctor?
Being a Specialty or a Specialist doctor can have lots of advantages, you may be able to:
- Work more flexibly without having to meet the requirements of a formal training programme
- Work in a specific location without rotating
- Work in a subspecialty which suits you
- Spend more time on work on quality improvement and research
- Optimise your work-life balance by being involved in your job planning
- Gain experience to enhance your application for a Specialty training post
- Have more time to study for membership exams
- Achieve a portfolio career, with several distinct roles
- Develop your skills and competencies to apply to join the GMC Specialist Register via the CESR (Certificate of Eligibility for Specialist Registration) or CEGPR (Certificate of Eligibility for General Practice Registration
These are just some options to explore. The real advantage of a Specialty or Specialist role is you can create a job that works for you, your interests and your life.
There are disadvantages too. Specialty and Specialist roles are still not widely recognised as a career choice and this has its challenges. Currently they are in a minority in the senior workforce, however this is likely to change over the coming years with our changing workforce. You often have to be very organised to decide what training and development you want and need to do. You may have to seek these opportunities yourself.
SAS in Acute Medicine
Being a Specialty doctor in acute medicine is a fantastic role! Acute medicine is such an exciting and varied speciality where you can really create a job to suit you.
All the reasons to do acute medicine are the same as the more traditional training route - https://www.acutemedicine.org.uk/training-in-acute-medicine/
Here you will also find a link to a great BMJ article.
You need to have four years post graduate experience with at least two of these being in acute medicine. Usually a Specialty doctor will have completed Core medical training, Internal medicine training, ACCS AM or ACCS IM (but this is not mandatory). Alternatively, they may have experience outside of the UK.
As a Specialty doctor you do not need to follow the acute medicine training curriculum, though some Specialty doctors may use this to help identify their training and development needs. Every hospital will have a formal appraisal process and system for you to follow and use. However, if you want to, you can pay for and use the NHS portfolio with the acute medicine curriculum uploaded. You can complete your FAMUS if this is something you are interested in, and you can even develop a specialist skill. The Specialty contract encourages speciality doctors to develop and outlines how hospital trusts should support them. When applying for or discussing the creation of a Specialty job, you should think carefully about what you want to get out of the job to ensure you can create a job plan that works for you and your development needs, including SPA time.
Progression
You can be a Speciality doctor forever, if you are happy in your role you do not have to move into a different role and there is a pay scale to recognise your experience. https://www.bma.org.uk/pay-and-contracts/pay/specialist-associate-specialist-and-specialty-doctors-pay-scales/pay-scales-for-sas-doctors-in-england
Lots of people choose to stay as a speciality doctor and this leads to very skilled speciality doctors.
Some people will want to change their role and take on more responsibility. You have 2 options for this. Becoming a Specialist or the Portfolio pathway (previously called CESR) route.
Laura Jones, SAM SAS Lead Bio
My Name is Laura Jones and I am an Acute Medicine Specialty Doctor at the Queen Elizabeth Hospital Gateshead. Working with SAM I hope to develop the role and recognition of Speciality doctors in acute medicine.
Like many Speciality doctors I ended up here after some life challenges leading to a change in how I work. I started in a role as a senior clinical fellow and I quickly found my love for acute medicine again! After six months I recognised that a career as a speciality doctor could offer me excellent training, job satisfaction, and an opportunity to develop my interests within acute medicine, all alongside an improved work-life balance. I approached the department to discuss a move to become a speciality doctor and was fortunate many months later to interview for, and be appointed to, a permanent role.
There are many benefits to being a Specialty doctor, but there are a lot of challenges too. As speciality doctors we are still finding our voice. Locally people often struggle to understand the role and recognise our skills (and that's before we think on a national level). I am lucky to have found a job in a forward-thinking department that has excellent management support. I work in a trust where speciality doctors work in very senior managerial roles. However, I know this is not the case for all speciality doctors. Lots of people remain on short term 'non-speciality’ contracts, spend years in fellow posts with no options for progression and lack of recognition for the fantastic work they do. Many people don't even know that there are alternative routes for development. I love my training colleagues and find we can learn lots from each other, there is a place in acute medicine for us all and the future workforce needs to be a diverse mix. One size does not fit all for development as a doctor and we need to make sure that we are not losing excellent doctors to the 'one size for all' traditional training model.
I look forward to working with SAM to promote speciality doctors within acute medicine.
Ross Palmer, SAS Doctor in Acute Medicine & Medical Education
I have recently started a post as a Specialty Doctor in Acute Medicine. Prior to this I had completed ACCS acute medicine training with subsequent time as a senior teaching fellow while I decided whether or not to pursue higher training.
I am lucky to work across two very supportive departments (acute medicine and medical education) and I was able to develop a bespoke job plan with a 50/50 clinical/education split. This clearly affords me much greater time to teach and to develop my interest in undergraduate medical education compared with the traditional training route.
Another consideration for me was the appeal of not having to rotate for training. As a late entrant to medicine with young children and no wider family support I felt a return to the rigors of a full on-call rota and potential long commute was just not feasible.
While this is a new role I am excited about the possibilities of how it may evolve over the coming years and anticipate that I will have a higher degree of autonomy in terms of my professional development than I would have in a training programme.
Chris Tuplin, Consultant
I started at Hinchingbrooke Hospital 10 years ago as a trust grade SHO. I was in this role for 2 years. Following this I was then appointed onto a Specialty Doctor contract. As a Specialty Doctor I was primarily employed to staff the Ambulatory Care Unit. However I also covered gaps in the on call rotas for medicine (firstly as a SHO then latterly as a SpR). I worked my way through the MRCP with the support of my Consultant colleagues. I then worked towards CCT via the CESR pathway. I achieved CESR in General Internal Medicine in August 2022. I was then employed as a substantive Consultant in Acute Medicine in December 2022. I was well supported by colleagues in my trust in working towards CESR.
Please do make contact if I can be of help in giving further information on this and / or supporting others working towards CESR with Acute Medicine.
Portfolio Pathway (CESR) Acute Medicine
The Acute Internal Medicine (AIM) curriculum was published in July 2022. For a transition period, you can make a CESR application against either the new curriculum or the previous version.
This option is available until the transition deadline of 31 March 2024.
Below are guidance documents for each version of the curriculum with the Joint Royal Colleges of Physicians Training Board.
CESR / CEGPR will soon become the Portfolio pathway. If you want to apply under the CESR / CEGPR Equivalence requirements, you will find your Specialty Specific Guidance below this message.
Please note, the CESR / CEGPR pathway expires at 23:59 on 29 November. From that point onwards, if you want to apply under the new Portfolio pathway, please view the GMC CESR updated Specialty Specific Guidance page.
For specific guidance for applying for CESR in Acute Medicine from the GMC see below.
Membership
Stay on top of the most cutting-edge acute medical research, discuss challenges and triumphs with colleagues, and influence the future of this exciting young speciality.