Answers to frequently asked questions (FAQs) about Specialty, Associate Specialist and Specialist (SAS) doctors and Locally Employed Doctors (LEDs)
SAS doctors are employed on nationally agreed contracts (rather than locally agreed) in permanent posts and have the same appraisal and revalidation requirements as consultants.
The term ‘SAS doctor’ was originally derived from the job titles ‘staff grade’ and ‘associate specialist’.
The UK have recently introduced a new specialty doctor contract. A new senior SAS doctor post called Specialist doctor was introduced to afford career progression for specialty doctors. ‘SAS’ now covers all these job titles (specialty doctors, associate specialists and specialist doctors).
A specialty doctor post on either the new or old contract requires a minimum of four years post-graduate experience, at least two of which must be in the relevant specialty.
Some specialty doctors are new to post but many are very senior clinicians with significant levels of experience who have not had the opportunity to progress due to closure of the associate specialist grade in 2008. There is a wide range of experience, competency and autonomous practice amongst specialty doctors.
Specialist doctors (new contract) must have at least 12 years’ post-graduate experience in England, Wales and Northern Ireland, and 10 years’ experience in Scotland, at least six of which must be in the relevant specialty). They need to meet the criteria set out in the generic capabilities framework for specialist grade developed by the AoMRC, BMA and NHS employers.
Specialist doctor posts are created by employers in response to local service needs, and individual person specifications and job plans are created accordingly. Posts are usually advertised externally and appointed through open competitions.
Associate specialists are senior SAS doctors who successfully regraded before 2008. They had to have at least 10 years’ post-graduate experience, at least four of which were in the relevant specialty. Similar to the new specialist doctor, associate specialists practise autonomously within areas defined by their job plan.
It is possible to have a full and satisfying career as a SAS doctor, and it can be seen as an alternative to a consultant career in our specialty.
- Advantages include geographical stability at an earlier stage in your career and possibility of regular hours and sessions.
- Assuming you have the appropriate experience and proven ability to work safely alone, then there is the possibility of autonomous practice.
- SAS doctors can also train to become educators (Educational supervisors of foundation doctors and/or GP or RCOG doctors in training), be involved in research as local Principle Investigators for national trials, or leaders in their departments or hospitals.
- Career development in these posts is about opportunity and ability, not job title.
- You do not need to be on the Specialist Register to be a senior SAS doctor, although some of these doctors are (see below for information on Specialist Register).
You need at least two years' full-time experience in the specialty before you apply (see above), but you can apply at any level of experience, and should negotiate to enter the grade at a level appropriate to your previous experience.
Jobs are advertised nationally, but if you have a specific unit in mind, it is always worth making local enquiries as to what might be possible.
Locally Employed Doctors (LEDs) are employed by trusts on local terms and conditions, so they are usually non-permanent posts and do not have nationally agreed terms and conditions (unlike SAS doctors).
There is also no nationally recognised career or pay progression thresholds for these posts.
There are a large variety of LED names: Clinical Fellow, Teaching Fellow, Trust Doctor, Trust Registrar, Trust SHO, Foundation Year 3 (FY3) etc.
Doctors can enter a junior trust doctor post without a minimum of two years in the specialty.
Like SAS doctors and Consultants, LE doctors need to have an annual appraisal and five-yearly revalidations.
The Trust is under no obligation to provide specialty training unless it is agreed in the job plan.
Some Trusts have created local “CESR training” programmes for LEDs and SAS doctors, but this is very much under control/discretion of the local employing Trust/department.
Be alert to opportunities that arise and any gaps in local service provision that you could develop yourself to fill and offer to help do this.
These posts are essentially service provision posts, so the employing trust is under no obligation to provide additional paid time for specialty training unless this is an agreed part of the job plan.
- This may be able to be negotiated locally if such training will enable the SAS doctor to provide a local service that is currently lacking or needs improvement, for example.
- Generic developmental needs (leadership, teaching etc.) can often be provided by SAS Development funding, available through local SAS Tutors and/or Health Education regional centres. See here for information on the Scottish Government’s SAS Development Fund Application Process.
- Provision of these funds currently varies around the country but in England there are plans to make access to these funds more equitable in future.
Ensure your Clinical Director (CD) and other senior colleagues are aware that you are keen to develop your role.
Discuss with your CD if there are any departmental leadership roles you could take on – audit, guidelines, maternity day unit etc. Could you manage the rota or organise the departmental teaching?
- Find out if you have a local SAS Tutor, and through your SAS Tutor/Director of Medical Education (DME) find out what is being provided in your region to help develop SAS Doctors
- If there isn’t an SAS Tutor at your trust, consider asking your local Director of Medical Education about becoming one
- Look out for generic courses in becoming an educational supervisor, trainer, examiner, leader, mentor, coach
- Contact your local research department to see what research projects there are presently that you could get involved with or could be a principle investigator for in future, and update your GCP eLearning
- Ask about local appraiser training (SAS doctor appraisers can appraise consultants as well as other SAS Doctors)
- Consider taking part in formal education of undergraduate medical students or allied health professionals; train to sit on interview panels; get involved in hospital induction of SAS doctors. See SAS doctors as educators.
- Please see the information on specialist roles for further resources to support your career development
It is often a case of being alert and proactive and willing to work for what you want to achieve, as well as letting others know you are interested in developing yourself, so they think of you when new opportunities arise.
We are keen to help develop some regional networks of O&G SAS / LE Doctors.
If you are interested in helping with this then a good place to start is with your local SAS Tutor if you have one, who should have links with SAS Tutors in other parts of your region.
Also try contacting your local College Tutor or Head of School who may be willing to contact regional College Tutors on your behalf.
LE Doctors can be harder to locate as often these jobs are not permanent and because the posts have so many different job titles.
The RCOG SAS and LED Committee represent SAS and LEDs across the UK. See the SAS and LED Committee page to discover your regional RCOG representative.