Change for the better

Change makes for interesting and exciting times and this has certainly been the case in recent years for the trauma and orthopaedic specialty and associate specialist surgeons.

A real area of progress has been linking specialty and associate specialist (SAS) doctors with colleagues and counterparts across the country. Last year the BOA (British Orthopaedic Association) launched its SAS/LED T&O Network (STONe), an online community where SAS/locally employed doctors (LEDs), and those who strive to support them, can share training opportunities, encouragement and career progression information. 

It’s free to join the WhatsApp group and it’s also open to those who aren’t BOA members (details on the BOA website). It’s great to see this peer-to-peer support, especially as across the UK there are many excellent SAS surgeons who act as fantastic role models to those starting out on similar roads. 

The BOA and RCSEd offer support and advice in various settings. In 2023, the BOA Congress had a dedicated SAS session, and the RCSEd SAS Development Day addressed several key current topics, including the specialist grade, autonomous coding and the Portfolio Pathway. Both conferences were excellent. Several well-attended webinars from the BOA and RCSEd have also provided information on these issues and on topics for the Fellowship of the Royal College of Surgeons examination, accessible from the comfort of home. Alternatively, for SAS surgeons wanting to go further afield to increase their expertise, the BOA offers funding for travelling fellowships. The BOA and RCSEd also provide a Future Leaders Programme, where SAS surgeons are encouraged to make the most of their abilities and the opportunities that are available to the SAS community.

In late 2023, the new Portfolio Pathway, replacing the Certificate of Eligibility for Specialist Registration (CESR), updated the process for entry to the specialist register. It aims to reduce the burden of documentation without reducing the standard of successful applicants. In particular, it moves the focus on to evidence of achieving competencies rather than demonstrating a learning course similar to that of a specialty trainee. As I like to say: ‘You don’t have to show that you used to be a caterpillar, you just have to show that you’re a butterfly now.’

The T&O Portfolio Pathway has ignited much discussion. Earlier this year, STONe connected dozens of T&O surgeons with others interested in the Pathway, either as future applicants or CESR veterans, in ‘TOPP partnerships’, because ‘if you want to travel far, travel together’.

The introduction of the specialist grade in 2021 has also been welcomed, creating a new nationally recognised autonomous grade – but for many it hasn’t been easy to attain. There are many stories of this being a long, awkward path, too often with insurmountable barricades. There are calls for the process of creating these posts to be driven forward. 

Times of change can also be times of frustration. Alexis de Tocqueville wrote of the French revolution that when conditions and opportunities began to improve, social frustrations also grew quickly. The ‘Tocqueville paradox’ highlights how a taste of improvement drives enthusiasm for yet more improvement, coupled with frustration when the speed of change lags aspirations. However, among SAS surgeons, this impatience is also fuelled by the knowledge that experienced SAS surgeons are already contributing to the surgical workforce at a high level and could do so much more. Calls for recognition and the ability to progress are loud, and based on real ability, workload and passion. 

The eagerness of senior SAS surgeons to be recognised is not unrealistic but reflects their skill and enthusiasm. The role and potential of SAS doctors are being noticed as never before. The zeitgeist is to recognise the value and strengths of SAS doctors in many arenas and positive changes mount as the months pass. Change indeed makes for interesting and exciting times, especially when it’s change for the better.