SAS: a career with progression

Life is so full of choices, decisions that mould our future and when looking retrospectively can make a life look like it has lots of ‘sliding doors’ moments, alternative lives never travelled.  When it comes to career choices, I feel like the choices I made were my own, driven by what I wanted my career to look like even when what I wanted wasn’t an option.  I have, on occasion, felt like the external perspective of my grade is that it is a second choice, lesser option when really it was the most positive career choice I could have made for myself.  When I am presented with this external perspective, I find myself trying to explain or justify my path.  The gift being a SAS doctor has given me is the ability to provide continuity of care for patients due to geographical stability, placing me in a good position to recognise service needs and help provide service improvement while also offering a good life-work balance and the ability to achieve a portfolio career.

When I look back, I knew I wanted to be a staff grade (pre 2008 contract title for specialty doctor) from my first year on the surgical rotation even though I had never met a surgical staff grade.  I made multiple enquiries about how to follow this pathway to be met with lots of positive encouragement to continue in the rotation and get into a training programme. Local staff grade jobs were few and far between.  

In the early years I found my surgical specialty, ENT, but not the job I wanted.  I moved to London and found a permanent ENT staff grade job there, 18 months later a similar job was advertised in my home city, Belfast, in the hospital opposite my secondary school and a few miles away from my childhood home. The only problem was it being a locum job.  I was faced with a conundrum: job location versus stability.  I took the risk and went for location but found myself in the situation of many current locally employed doctors (including locum consultants).  I started with a 6-month temporary contract, at the time I thought reasonable as a trial period, to show that there was service improvement following my appointment.  Coming up to the end date of my contract I was reassured that the work I was doing was reducing patient waiting times and my contract would be extended and reviewed again in another 6 months. This process continued for 4 years without pay progression.  Being in this situation can be unsettling, secretly questioning my working worth.  To help ease my fears I audited my practice for evidence of improvement and presented it at departmental meetings.  I undertook compulsory, annual appraisal, the same system used for consultants, using this as an opportunity to evidence my training needs in my personal development plan.  With persistence and support of colleagues and management I did get a substantive post and my job title changed from staff grade to specialty doctor.  I continue to work as a specialty doctor with the aim of progressing to a specialist role (introduced in 2021), a national grade for senior SAS doctors who have a minimum of 12 years postgraduate experience with at least 6 years in a relevant specialty, I have 24 and 20 years respectively. 

I feel grateful to have always had a job plan.  A job plan may seem like a basic building block to any job but secondary to a contract I feel it is so important.  Having a clear layout of sessions that make up a working week creates stability and comfort in knowing what each day has in store and allows for planning life outside of work which in turn leads to an enhanced life-work balance as well as job satisfaction.  The joy in having this stability is that for years I have been confident in being a constant, reliable presence in my family’s life.  My husband is a consultant surgeon and we have three busy children. I can also devote time to my interest in athletics, both competing and more recently coaching.  In the absence of a job plan, the experience of some SAS and LEDs, the working week can be so variable being pulled to cover ad hoc sessions, which can make a work life feel erratic and leave no time for supporting professional activities.  

In contrast to a doctor in a dedicated training program, training for a SAS doctor often comes secondary to service needs, so identifying training opportunities within these areas is vital and can result in being well trained in a specialised area.  Like annual appraisal, my annual job plan review has been instrumental in helping me avail of opportunities to grow my skill set, building to an autonomous practitioner by making the most of supervised theatre sessions where there was no allocated trainee. This progressed to having my own list, operating without supervision.   

The Covid pandemic hit everyone’s ability to operate due to redeployment and staff absence. General anaesthetic lists were not running at full capacity.  During this downturn I found an opportunity to develop part of our service while maintaining my own surgical skills.  I worked with our management team, outpatient staff and theatre co-ordinator to create a local anaesthetic list we could do in our outpatient department, saving on inpatient bed admissions and offering a local anaesthetic alternative to some procedures listed for general anaesthetic.  This list is now a regular list for our unit with an agreed change to my job plan.

During my 20 years working as a SAS grade doctor, I have completed 5 Trust approved leadership courses including:

• CLIME – Clinicians Leading in Managing Effectively
• STRIDE – SAS Training in Driving Excellence
• SCIL- Scottish Improvement and Leadership
• Aspire – Leadership course run by a HSC leadership centre

I also recently acted as a team manager on several occasions for Athletics Northern Ireland at international athletics events; as a result, I have taken part in even more leadership training to help prepare for the possibility of being a team manager at future events like the Commonwealth Games in 2026. 

I understand that all this leadership training may seem excessive but let me explain using one of the feedback tools I learned from these courses, the SBI (Situation, Behaviour, Impact) feedback tool – 

Situation: I am a specialty doctor who wants a progressive career.

Behaviour: Management opportunities for a SAS grade doctors were not readily available.

Impact: Because these opportunities were not available, I felt overlooked.  I took on as much training as I could to present myself as a competitive candidate should an opportunity arise.

In years gone by positions like patient safety and clinical governance lead, clinical director, educational supervisor and clinical supervisor were only available to application for consultants.  The development of a SAS lead, introduced to my Trust in 2019, helped open a door for SAS career progression into these roles.  Having completed 2 QI, quality improvement, courses and presented QI projects at meetings I was in a good position to be appointed as a QI lead in my department.  Two of my projects were accepted at the BMJ IHI, International Health Improvement, forum in Gothenburg in 2022. My Trust supported me to be the individual representative of the Trust at the forum, in turn I was able to bring back any learning and present it locally and regionally.   Quality Improvement has brought with it a world of opportunities. Almost one year after being appointed as a QI lead I was successful in an interview to be part of my Trust’s QI faculty, I help alongside a consultant and 2 SAS colleagues to deliver a QI programme, spanning an academic year.  Around this same time, I was appointed as a member of the RCSEd SAS and LED committee. The college recognised how my experience in QI could be used for QI faculty in the RCESEd QI symposium as well as helping to provide a session on QI methodology to my SAS colleagues at our most recent RCSEd SAS development day in Birmingham.  

QI projects can be borne from adverse incidents, so when the position of patient safety and clinical governance (PSCG) lead in my unit was advertised I jumped at the chance to apply, using my experience and training to highlight why I should be considered suitable.  Although this is probably one of the more challenging parts of my job it has been an excellent learning experience.  

In 2023, the Northern Ireland Medical and Dental training association, NIMDTA, appointed the first Associate Dean for SAS career development in Northern Ireland, an exciting change to our local SAS community.  This role has helped build on previous SAS development programmes in NI by offering regional educational events and the opportunity to apply to a development fund, a fund to support SAS in developing new or improving existing clinical services or to extend their roles and skills.  Following another interview and agreed change to my job plan I feel fortunate to have been appointed to join the team at NIMDTA as the deputy associate dean for SAS career development.  I look forward to using my experiences and training throughout my career to help other SAS doctors identify opportunities that will help them develop their career portfolio.