What these roles involve, how they differ, and how to decide which is right for you
Specialty, Associate Specialist, and Specialist (SAS) doctors, along with Locally Employed Doctors (LE doctors or LEDs), make up a significant and growing part of the obstetrics and gynaecology workforce. They bring highly valuable skills, experience, and expertise.
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Who are SAS doctors?
SAS stands for Specialty, Associate Specialist, and Specialist doctor. These are experienced clinicians working in permanent posts who are not in formal training and are not consultants. SAS doctors are employed on nationally agreed contracts and have the same appraisal and revalidation requirements as consultants.
For more detail on SAS contracts and employment terms, see guidance from the British Medical Association (BMA) and NHS Employers. You can also read the Academy of Medical Royal Colleges’ guidance for patients and the public on the role of SAS doctors.
There are several types of SAS roles, each with different entry requirements and responsibilities. The table below outlines the main differences between these roles:
Types of SAS roles
| Role | Eligibility/Entry requirements | Experience in post | Recruitment |
|---|---|---|---|
| Specialty doctor | At least 4 years postgraduate experience, including 2+ in the relevant specialty | Wide range – from early-career to senior clinicians working autonomously. Some may not have recognised career progressions due to the closure of the Associate Specialist grade. | Posts are advertised nationally. Local enquiries encouraged. Doctors should negotiate entry at a level appropriate to their experience. |
| Specialist doctor |
|
Senior SAS doctors working autonomously, within locally agreed clinical governance frameworks, meeting the GMC’s Generic Capabilities Framework. | Individual person specifications and job plans are created to meet local service needs. Competitive recruitment process. There is no automatic regrading process for specialty doctors. |
| Associate Specialist | Grade closed to new entrants in 2008; current Associate Specialists will have over 15 years experience in these roles | Senior SAS doctors working autonomously within areas defined by their job plan | Grade closed to new entrants in 2008. Only doctors already in post remain. |
Note: Many SAS doctors hold MRCOG or are on the Specialist Register, but these are not essential requirements for SAS roles.
Who are Locally Employed (LE) doctors?
LE doctors are employed by NHS trusts on local terms and conditions, usually in non-permanent posts. Unlike SAS doctors, their contracts are not nationally agreed. They are the fastest-growing part of the UK medical workforce.
There are a variety of job titles that are included under the umbrella term LED. These include: Clinical Fellow, Teaching Fellow, Trust Doctor, Trust Registrar, Trust SHO, Foundation Year 3 (FY3) etc.
Because LED contracts are determined locally, there is no nationally recognised career or pay progression thresholds for these posts. These contracts may not include study leave and there is no guarantee that those employed in these posts will have access to training or an educational supervisor.
Some trusts offer local “CESR training” programmes for LE and SAS and doctors, but this is entirely at the discretion of the local employing trust/department.
You can take up an LED post without a minimum of two years in the specialty. You are also not required to be on the Specialist Register or hold the MRCOG.
Like SAS doctors and Consultants, LE doctors need to have an annual appraisal and five-yearly revalidations.
We recommend using the BMA LED checklist and contract checking service before accepting a post.
Shared requirements
Like consultants and trainees, SAS and LE doctors are required to complete annual appraisals and undergo revalidation every five years. Many also take on leadership and education responsibilities or contribute to service development and research.
Why choose a SAS career
Choosing the right role depends on your career goals and experience The comparison below outlines important differences to support your decision-making:
| Aspect | SAS roles | LED roles |
|---|---|---|
| Contract type | Nationally agreed | Locally agreed (varies by trust) |
| Job security | Permanent roles | Usually fixed-term or temporary roles |
| Training and development | Structured job planning and opportunities for career development | Opportunities vary. Some trusts provide limited support |
| Eligibility | Typically 4 or more years postgraduate experience, with 2 in the specialty | More flexible. Often suitable for doctors seeking to gain additional NHS experience in the specialty. |
| Career progression | Pathways to specialist roles and SAS doctors can train to become educators, take on leadership roles and fulfil additional responsibilities at a local and national level. | Progression is not structured nor guaraunteed |
SAS roles offer greater stability and structure. The introduction of the specialist grade has provided a career progression pathway and recognition for senior speciality doctors. An LED post can provide a useful entry point to the NHS, or an opportunity to gain further experience in a region or area of expertise, but it is important to be aware of the differences in support, contract terms and career progression before making a decision.
You can read our SAS doctor case studies to learn more about how choosing a SAS career can be a positive career choice as well as to discover the benefits and opportunities a career as a SAS doctor can offer.
Further guidance and support
If you have any questions or need further support, please contact workforce@rcog.org.uk.