When I became a SAS doctor more than 13 years ago, I did not see it as a clear career pathway. As I often say, I did not land on the SAS pathway. The SAS pathway landed on me.
At the time, SAS roles were often seen as temporary posts for doctors on their way to consultancy. Anyone who did not take that route could be seen as having fallen short.
That perception has not fully disappeared, but the SAS pathway has changed. It is now a career in its own right, giving doctors flexibility to build working lives around their skills, interests and priorities.
For me, that flexibility has been one of its greatest strengths.
A career shaped by experience
My career has taken me across services and settings in England and Wales, including the public, private and charity sectors. I have worked in drug and alcohol services, rehabilitation, older adult and general adult psychiatry, and now forensic psychiatry.
Each role has shaped the doctor I am today, giving me knowledge and perspectives I bring into my current work.
I describe a SAS career as building with Lego: choosing the blocks that suit you and creating your own mix of clinical work, education, management and leadership.
That freedom matters, because success should not have only one definition.
Some SAS doctors want to focus solely on patient care. Others want to teach, lead services, gain further qualifications or pursue senior roles. Both are valid and possible choices.
Choosing family and medicine
My decision to remain on the SAS pathway was also shaped by my family.
At one point, I felt I had to choose between career progression and being present for my family and two young children. I chose my family, and I do not regret it.
I have been able to be present for concerts, birthdays and ordinary moments that matter more to me than a consultant title.
Medicine matters, but it is not a person’s whole life. The SAS pathway has let me protect life outside work while continuing to grow as a doctor.
Leadership built through experience
Flexibility does not mean a lack of ambition. Over my career, I have built clinical expertise and developed skills in education, management and leadership, including a master’s in healthcare management and a postgraduate certificate in medical education.
That development happened gradually, at a pace that worked for me.
Leadership is not learnt from a short course alone. It comes through experience, judgement, supporting colleagues and understanding services over time.
SAS doctors often have this practical experience, but still have to prove their leadership credentials in ways not always expected of colleagues with a consultant title.
Our ability should be judged on our experience, skills and qualifications, not simply on the name of our post.
Overcoming barriers
I saw this when a clinical director role in my field was advertised for consultants only.
When I saw a clinical director role in my field was advertised for consultants only, I questioned whether consultancy was genuinely required. I sought advice from the BMA and professional bodies, and raised it with my employer. After review, the restriction was removed and I received an apology.
For me, the point was not that I should automatically get the position. It was that I should be allowed to apply and be assessed on merit.
Things are changing, but visibility still matters. SAS doctors already hold senior responsibilities; employers need to recognise leadership beyond consultant roles.
When organisations restrict opportunities to consultants, they may overlook experienced SAS doctors with the qualifications, knowledge and practical skills to contribute.
The stability SAS doctors provide
SAS doctors provide vital continuity and stability within NHS services.
Many stay in departments for years, building knowledge of services, patients and staff that helps teams through change and pressure.
We also bring ideas from different specialties, organisations and settings.
SAS doctors are a stabilising force within the NHS, supporting services under pressure and providing continuity for patients and colleagues.
That contribution deserves to be recognised.
Opportunities must be visible
Support for SAS doctors has improved, but opportunities only help if doctors know they exist. Communication must improve.
Employers, professional bodies, education organisations and the BMA could make information on funding, training and leadership easier to find and allow SAS doctors to be aware of the additional benefits available.
BMA representatives can also play an important part by understanding what is available locally and helping SAS doctors navigate those opportunities.
Better communication would support doctors, retain experienced clinicians and make fuller use of skills already in the workforce.
See us for what we contribute
My wish for the future is simple: SAS doctors should be seen and respected for their own merit.
Some SAS doctors will focus on a clinical niche; others will teach, manage or lead. All should have fair opportunities to choose and progress.
To medical students and doctors considering their next step, I would say: do not dismiss the SAS pathway because it has unique benefits and rewards.
Look into it properly. It can be challenging, but it offers autonomy, variety and room to develop as yourself.
The SAS pathway has let me build a fulfilling medical career, be present for the people who matter, and grow without following someone else’s definition of success.
It is not a second-choice career. It is a career built on your own terms.
Antonino Curatola is a senior specialty and associate specialist doctor in forensic psychiatry.