When I was going through my training posts, I discovered that I enjoyed working in ‘casualty’. It was a specialty that didn’t limit you to a specialty. I worked with a group of female doctors who showed me how to value, educate and encourage more junior doctors. They taught me the essential skills of multitasking and problem solving.
When the time came to move on from this job, I didn’t want to leave. It was then I was introduced to ‘staff grade’ and if I applied for a post at this grade I could remain in my casualty job. I went for it and was successful.
The structure of the grade suited me. I could have relatively fixed hours which allowed me to have a routine in my life. As I gained more experience in emergency medicine I became involved in the induction and formal teaching of junior doctors. I developed special skills and worked independently, running hand clinics and fracture clinics. I was encouraged to attend conferences and was asked to become an instructor on life support courses.
After eight years as a staff grade doctor, my consultant asked if I would apply to become an associate specialist. I readily agreed as I felt ready to step up to new challenges. I was given more and more responsibility in the department – clinical and managerial responsibility – and I was very happy to take this on. I started doing on-call and organising all rotas for the department. I got involved in leadership programmes and became governance lead in our department.
I was the Northern Ireland representative on the negotiating committee for the new UK SAS contracts in 2020. We had many priorities going into the negotiations: opening a senior SAS role to provide career progression for SAS doctors; increasing basic pay; a flatter pay scale to improve career average pension and improve the gender pay gap; new contractual safeguards to preserve work/life balance; review how unsocial hours are remunerated, and; increasing opportunities for career development.
We negotiated the contracts virtually which I found very helpful as travelling to London for these meetings would have been very disruptive to my family life and my clinical responsibilities. In December 2020 we finalised the best offer achievable and then contracts were put out to referendum early 2021. Thankfully Northern Ireland accepted with an impressive majority.
I hope to be able to help now with the implementation of the new contracts across all the Northern Ireland health trusts. It remains to be seen how many specialist posts will be created and how many specialty doctors will be appointed to them.
Speaking up in the workplace
I see a lot of discontented SAS doctors in varying specialties, across all trusts. This is a group of doctors who are often overlooked and undervalued. It is always really important that any discontent among a group pf doctors is brought to attention of the clinical director but unfortunately many SAS doctors feel reluctant or unable to speak up for themselves.
I know it can be difficult situation to be in when you feel disempowered, but there are ways to approach this: Having meetings with your clinical director, where you speak as a collective, can be helpful; talking to other SAS doctors and find out how they resolved difficulties will help also; I have found that bringing solutions to the problems rather than just a list of complaints makes resolution easier.
It is also important that SAS doctors make sure they are working to their terms and conditions. I know some SAS doctors do not get even the minimum supporting professional activity time. Start with that and look out for development and leadership courses. Become involved in management meetings, QIP and workforce groups.
When I started as a staff grade doctor I felt highly valued. I worked in a department where I had started training as a senior house officer and progressed to my appointment as a SAS doctor.
The staff knew me, and I was the ‘go-to’ person to help solve problems, look after a sick child or manage any emergency – clinical or otherwise. It was very satisfying to feel you were part of a team who could make a difference to patients, staff and all grades of doctors.
Rewards and challenges
I would advise medical students and doctors in training to consider very carefully the SAS grade as a career pathway. There is an opportunity to have a good work/life balance, but you must weigh this up against all the challenges you will face as a SAS doctor.
It is often difficult to access training and development programmes. It can feel like you are constantly having to challenge perceptions of SAS doctors and the role is too dependent on the opinions and prejudices of individual consultants and managers. It is because of this that I will continue to speak up for SAS doctors and highlight SAS as a career choice. So be prepared to have many mountains to climb.