SAS Doctors (10 Oct 2025)

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Dr Marilena Giannoudi (MG): Hello everyone, and welcome to another episode of Career Conversations, brought to you by the Royal College of Physicians of Edinburgh Trainee and Members Committee. I am Doctor Marilena Giannoudi. I am a cardiology registrar and the co-chair of the Committee. I'm delighted to be joined by Doctor Libby Crawford and Doctor Sue Pound to give you a special episode on SAS doctors. Before we start, I'll introduce them both. So, Doctor Libby Crawford is a specialist in acute medicine and the clinical lead for same day emergency care at the Royal Victoria Infirmary in Newcastle. She is the lead doctor for the Royal College of Physicians of Edinburgh and has a keen interest in education and medical simulation and is a consultant geriatrician in Scotland and the vice president of the Royal College of Physicians of Edinburgh. So welcome both of you.

Dr Libby Crawford (LC): Thank you Marilena. It's good to be here.

Dr Sue Pound (SP): Good to join you too. Thank you.

MG: Thank you so much. This is a special episode for SAS week. So, the most important question that we must start with. And Libby, I'll address this to you is what is an SAS doctor.

LC: Thank you. I think it's a great place to start because the term SAS doctor, I think, often breeds confusion and misunderstanding of what the term is and who we are as a group. So, I think in its absolute form, SAS doctor encompasses a number of different grades, including specialty doctors, specialists, and also there's a few associate specialists still kicking around from where the previous grades have been closed. So, there's a huge breadth of different doctors at different stages in their career practicing under this umbrella term of SAS doctors. And I think the best or the most fundamental way of understanding it is probably to think of us as a range of clinical physicians working in a non-consultant grade in a non-training position.

MG: Thank you. That actually clears things up quite nicely. So how can we as more junior doctors in training. How do we join that career pathway? Or what does it typically look like when you're trying to figure out what training pathway to follow, or if the training pathway is the right thing for you to follow? Kind of. How do we consider that as a possible career option?

LC: And yeah, I think there's lots of different routes into a career for anyone in a training position or a non-training position, and certainly becoming a SAS doctor allows flexibility in terms of how you develop that career. And I think that's the most important part and one of the biggest pros to becoming a SAS doctor. There's lots of different points in your career where you can press pause and decide that there is actually a different route for you or a different opportunity for you as a developing doctor. And I think if I go back to the beginning of what you would need as an absolute to become an SAS doctor, because I think we all understand the training pathway very well, but perhaps this way is a little bit less understood. So, to become an SAS doctor, you need four years of postgraduate experience, two of which in the relevant specialty to wherever you are going to work. So, from that stage, you are post foundation training plus a couple of extra years, wherever that may be. Now, that experience doesn't necessarily need to be within a training pathway. It could be as a locally employed doctor; it could be as a post foundation. These F3 f4 roles that we hear about so much now, or in clinical fellows or actually abroad and in different experiences. So if you have those four years of postgraduate experience, you can become an SAS doctor. Then the pathway is a little bit up to you and how you see that developing as your career develops. You can remain an SAS doctor for your entire career, becoming more experienced, picking up different things along the way, and really developing your portfolio career essentially as to how you would like it to develop. Or it may be that you choose to go down an alternative pathway, and you want to try and progress into a more traditional route and either return to training or potentially pursue a qualification, which allows you then to enter the specialist register and become a consultant. So for some it may be a short period, and for others it may be a career decision to become a doctor rather than pursuing a traditional training route.

MG: Because you mentioned, you know, picking up experience and seeing where you go and obviously for those of us that are in training, we've got different grades and different milestones that we need to reach. How does that work? If you are an SAS doctor? Are there different levels within that or different milestones? How does that work?

LC: That's an area that really is quite different to the traditional route, whereas there isn't any formal documentation or frameworks to guide that. And I think the progression and development of SAS doctor along, hitting those milestones, if you like, is very much set out on an individual basis. So rather than there being a recognised national framework, it's more focused to the individual. And that is developed on the ground at annual appraisal and job planning meetings with your heads of department clinical directors to really develop you as an individual clinician and think about what milestones you want to reach, because you are not working down a traditional pathway. Everyone's pathway down their career is different. So, I think creating a national framework which allows you to reach milestones is quite challenging. Depending on the area that you work in, what responsibilities you have and also what responsibilities you want to take on. Because I think that's a clear difference between the two pathways is, I think in some ways, the autonomy that an SAS doctor has over their career development versus a traditional training pathway.

MG: In terms of getting a job in that pathway, obviously, usually you apply via oral or, you know, something equivalent to that. How do you get a job? Do you have to approach a specific department? Are there standalone posts that you can then try and get an extension for? How does that aspect work?

LC: Yeah. So I think there's not a firm answer to that in my personal experience, for both my own job and also for those that I've spoken to both locally and nationally, it tends to be that you have had experience of working within these departments or with specific teams in an area that interests you, and a role is perhaps created with you in mind, rather than you applying to a blanket job that's out there on NHS jobs. I think there will be that case nationally, that there will be jobs advertised that you would apply for, as any of the other NHS jobs would be. But certainly, in my experience, the vast majority of these jobs are created with someone in mind. Now that might be because of a service need or a service development. It may be that it is because they have a specific person that they want to try and fit within a team and offer more stability and a long-term job too. But it tends to be that it is negotiated locally on the ground.

MG: Thanks so much. That actually helps clear things up quite a lot. Now on career conversations, we tend to ask individuals to maybe tell us a bit about their own kind of story and how they got to where they are. Would it be okay if you could maybe tell us a bit about your career path and what a typical week looks like for you.

LC: Mine is a story, a little bit like a lot of people who get to a senior position as an essayist doctor, that it winds a little bit and it isn't terribly straightforward. But I started with very traditional training. I did foundation training and then core medical training. After a year that I spent traveling in New Zealand and working abroad, and when I was doing cortical training, I had my first child, became less than full time and then sadly had a fairly difficult time with some family illness, which forced me to reconsider priorities and think about different ways in which I could continue to work in an effective way, but perhaps with a little bit more balance within my life. So, at that stage, I was a registrar working in acute medicine. I had two years of specialty training at registrar level under my belt and made a decision that actually traditional training at that point with rotational aspects and night shifts and portfolio requirements and lots of deadlines just didn't fit in with two small children. Family illness and the other strains on life. So I made a decision to come out of training and at that point was working within a very supportive team where I work now, and we had a discussion about whether or not there would be a possibility for me to come and work there full time. They were very keen and at that point snapped my hand off to create a substantive post for me within the hospital. So I took up a role in Newcastle working within acute medicine, initially just three days a week, nine to five, working predominantly in the same day emergency care unit and just trying to find my feet and perhaps take a moment and think about what I wanted and just consolidate both my clinical knowledge, my confidence within my role, and also just a bit of balance outside of working life. About two years into that role, I started to take on a bit more responsibility and started taking on some leadership roles and quite a lot of education and quite a bit of innovation around the department, and I think it was then recognised that I was working at a reasonably high level, and we started to negotiate a little bit about what that would look like and how that would be recognised. And as time went on, we had very open conversations, I think, within the department about my capabilities and where I was and what I wanted to achieve. And then, helpfully, the BMA negotiated the SAS contract in 2021, which reopened the possibility of a little bit of career progression and stability and recognition of seniority within the SAS role. And the term specialist was created essentially. So, it is a recognition of a senior SAS doctor working autonomously and taking on those other aspects of work outside the direct clinical delivery of service. So around leadership, management, education, and innovation, those sorts of things, and would give recognition to someone working at that level. Recognition and support and a little bit of backing from your department that you are working to a level that is equivalent to your consultant colleagues. So, I was appointed to a specialist position in 2021 and have been there ever since. And I think in addition to my clinical role as providing sort of day to day cover and working with the emergency, well, the assessment suite and same day emergency care, I have had lots of opportunity to take on additional roles, which I think have really broadened my career path, but in a controlled manner, at a staged fashion, in a way that I have been able to do that at a time in my career that I feel capable to take on additional things. So, I have become heavily involved in simulation and education support. I started becoming an instructor on ALS courses and then developed my interest from there. And I now lead with a colleague of mine in terms of medical simulation within the directorate, and I am head of department. I have been since the pandemic. Whether that's a blessing or a curse, I don't know. But it's something that I enjoy and allows me to use skills that I've picked up along the way and also push the department forward and think about the agenda of acute medicine within the unit. And that is really something that I do enjoy spending time doing. I also now am a clinical supervisor and an educational supervisor for resident doctors as they come through the department, and I think it's just given me the opportunity to achieve what I want to achieve and do the things that interest me and give me satisfaction at a time and a pace that suited my lifestyle at the time. So that's the sort of brief snapshot of my career to date in terms of what I do day to day and how my average week looks. It changes quite a bit depending on where we are and what we do. But I tend to work two clinical days a week, and then I have quite a bit of non-clinical time in that time where I do a lot of the supervision and my management roles, and I teach a lot of simulation. So, I work over four days a week and that suits me.

MG: I'm not within the acute medicine specialty, but I think that sounds really quite similar to what a consultant role would be like. And the clinical to non-clinical split, which is great. The one question that I had kind of following on from that is that you mentioned before about the portfolio. So, the portfolio that you had to keep to get to where you are, is that what other trainees following the acute medicine route would have, or is it something different?

LC: So, there isn't actually a formal portfolio for SAS doctors. It's something that I think would be really beneficial going forward for doctors if they had access to that. Because if you wish to or want to pursue, gaining access to the specialist register and becoming a consultant. Then you have to follow a certain path that allows you to get there. Then I mentioned a little bit confusing because it's actually now known as the portfolio pathway, and it sounds very similar to perhaps what trainees may use. But I think having access to a portfolio and being able to record and keep evidence that supports your career development and your educational commitments as you go through your training or your non-training period is really helpful, because then you do decide to pursue that as an option to become a consultant and go down a different path. You have that evidence available to you. What I have done over the last few years is maintain my appraisal every year I've had job planning, we have local platforms and things that we do that with, as I'm sure most trusts have available, and you still are able to document and demonstrate all of your CPD and your development and things as you move forward. And I think it's really important to do that. We have to as part of revalidation, but also in terms of showing your development and also your progression, then you've got lots of evidence to be able to document where you are working, to what level you are working to, and that can support a claim for perhaps progression on different aspects of this career ladder as you say.

MG: Great, and obviously it sounds like there are so many different ways to follow this career route. If there was one piece of advice that you could give to somebody considering it, what would it be?

LC: I think it would be to make sure you put yourself first, I think. Think about what you want and think about where you want to be in the next five years, and then perhaps think about how you get there now, whether that is through a traditional or a non-traditional route. I think the opportunities are open, but you need to really concentrate and think about where you want to be and what you want from your career, because I think then that gives you the ability to be able to sit back and think about how you're going to achieve that goal.

MG: And one myth that you'd like to dispel of what it is like to be an SAS doctor, what would that be?

LC: I think the biggest myth that I would like to dispel is that it is a career by default rather than choice. I think many, many people still have very old fashioned and outdated views that perhaps SAS doctors are the graveyard of failed exams, or an inability to progress on to a training role, or, you know, less than full time women, for instance, or people with caring responsibilities. And I think that is just not the case anymore. I think many people are choosing flexibility and geographic stability for lots of different reasons outwith immediate caring responsibilities. So, I think people are making a decision that SAS is a route that they wish to go down by choice rather than force. And I think that is certainly the biggest myth that I would like to stand and shout about.

MG: Thank you so much for that, Libby. I think that's been an excellent overview as to what an SAS doctor is, how, you know, we can consider it as a potential career option. But obviously this is SAS week. We are the Royal College of Physicians of Edinburgh, and we have Sue here with us. So, I think now is probably the time for me to direct some questions to her. And maybe if you could both give your input on this. So, I guess the first question is how can the college support SAS doctors and what opportunities are there within the college for SAS doctors?

SP: The first thing is to get involved with the college, and there are many ways in which you can become involved. There are three different types of membership that are relevant. So, if you are an SAS doctor who holds MRCP, then you are eligible for collegiate membership. If you are an SAS doctor who does not hold MRCP, then you are eligible for associate membership and both of those give you really huge opportunities to access our education, our education portal, join committees and we would really strongly encourage you to use those opportunities now for specialist doctors. So those are the more senior doctors that Libby was talking about. Our fellowship committee has fairly recently revised the guidelines for people being nominated for fellowship to encourage specialist doctors who have a lot of clinical experience to apply for fellowship. A lot of our SAS colleagues have a huge range of experience in teaching and training, for example, in particular, and we would value you as fellows of our college that, in addition, would open up opportunities, for example, in examining other college committees and many other opportunities to another benefit to being a fellow or a member of the College is that you also have free access to the Federation CPD diary, which allows you to record all of your CPD activities in one easy place, useful for appraisal. Libby, who you've been hearing from is our SAS lead. She's fairly recently appointed to this role, and she needs some help. So, it would be great if we could have some of you expressing interest in joining her to look at how we perhaps could better support SAS doctors in the college, what things are important to SAS doctors? How can we respond to that? So, I would really encourage you, if you have any interest in joining a small working group with Libby, then please do contact her.

MG: Thank you so much for that. Libby, do you have anything to add?

LC: I would just echo Sue's remarks. Please do get involved. I think there's a lot to be gained from being either a member of the college or as a fellow of the college. And if we can build together a network of SAS doctors who are affiliated through the college, then I think we can start to really look at what are the priorities and what are important to us as a group, because there is a little bit of a niche around SAS doctors that we are not training or resident doctors, and we are not consultants. We are a group in our own right, with our own needs, our own priorities, and our own voice. I think the best way to get that heard is for us to be able to speak forward for ourselves. With the backing of something like the Royal College of Physicians of Edinburgh, which is fantastic. Please do get involved and get in touch and let's see what we can build together to try and create a stronger feeling and a stronger presence within the College.

MG: That shows just how important unity is, both within the SAS community, but also within the wider MDT. And for us to all kind of look at each other and help each other, and ultimately everyone just wants the best for their patients. It doesn't really matter what everyone's individual route has been. We're all working in the same hospital buildings trying to do the same work, so we may as well help each other out and highlight the opportunities that there are. Because we all want to train, we all want to learn. It doesn't matter which route you follow; the end result is ultimately the same. Any closing remarks from either of you? Anything that you feel our listeners need to hear? Before I do my final thank yous.

LC: I think for me, all I would say is thank you to the college, to sue to you, Marilena, for highlighting SAS careers and giving us the opportunity to talk about it and really to make it a career choice and celebrate that. Rather than thinking about it as an alternative route for different reasons but really thinking about SAS by choice and really just giving an opportunity to celebrate, as I say, and lift each other up and think about what opportunity lies in the future. So, thank you.

SP: Thanks, Libby, and I would concur with that. I think celebrating SAS doctors, as we've heard, a very diverse group, a very important group as part of our wider physician team. So, I think if we can do more as a college to increase people's understanding of what an SAS doctor is and what that role has to offer, to increase our understanding as a college about how we can help and support you. We're in SAS week, and I think this is just an ideal opportunity for us to open some conversations and really encourage some new thinking and new ways of working together.

MG: Perfect. Thank you both. And a final plug from me. If you are a doctor in training or a doctor that's just finished medical school, or even a medical student, and you still don't know what the best career path for you is, then feel free to listen to more Career conversations episodes. We have tried to cover as many specialties as possible. And for our other listeners, also, please feel free to listen to clinical conversations in which we try and dissect investigations and management of common things that we tend to see on the ward. So, I'd like to take the opportunity to thank you both again for joining me and wish everyone a very happy SAS week. Thank you.