During both my foundation years and early stages of emergency medicine training, I was fortunate enough to gain a substantial amount of experience in the intensive care setting and it became clear I wanted to work in that specialty.
Simultaneously, it became apparent I did not want to enter the traditional training route. I saw the many challenges training rotations come with. Consistently being faced with novel environments alongside short rotations that can inhibit one’s ability to integrate with a team.
Also, the schedule of training appeared very fixed, with little flexibility in either coverage or chronology.
Choosing the SAS pathway
It dawned on me that, as I watched trainees come and go, as well as my lived experience of the same, that the colleagues who appeared most content, highly respected and key pillars in their departments were a grade of doctor I had not learned much about – staff, associate specialist and specialty doctors.
This sparked my interest in the grade, and it did not take long for me to be convinced that this was the option for me. I had been inspired by some amazing doctors, none of whom had trodden the typical path.
I am so grateful I saw the huge benefits SAS doctors can bring to a department; not just outstanding clinical practice, but also their influence in departmental leadership – a benefit brought by avoiding the regular rotations of training.
Since becoming an SAS doctor I, like many others, have had the privilege of cultivating somewhat of a portfolio career. This career direction for me has been one that brought me joy, personal and professional development, the opportunity to feel like I belonged and the chance to take ownership of projects.
Role as SAS doctor in intensive care
As an SAS doctor in ICU I provide regular daytime and out-of-hours clinical care to patients in the Regional Intensive Care Unit. I get to assess and treat patients with a huge array of pathologies as well as care for them when they are at their very sickest, something I find very rewarding.
Aside from providing direct clinical care, I am involved in the provision of bedside teaching to medical and nursing colleagues as well as involved in the delivery of multi-disciplinary courses such as SCREAM (Standardised Critical Care Resus Emergency Airway Management).
Other non-clinical components of my work involve being a rota coordinator for the clinical fellows, a regular contributor in the senior medical management team. I also lead and participate in quality-improvement projects that have helped deliver substantial change, including the transition to electronic medical documentation in ICU.
Role as a clinical supervisor
After being supported through training, I received GMC trainer recognition and in the last year was successfully appointed as a clinical supervisor.
This has given me the privilege of providing clinical supervision to a variety of trainees from several specialties which has been really rewarding; allowing me to be able to mentor junior medical colleagues as they embark on their specialty training programmes.
I find it exciting to hear about their career plans and learning needs during their attachments, identifying ways which I can help support their development.
Role as a cruise ship doctor
Since becoming an SAS doctor, I have been able to avail of a flexible working model known as annualisation; essentially compressing my shifts and allowing me to enjoy four consecutive months of annual leave.
This allows me a great flexibility without compromising my full-time status. This flexibility has enabled me to regularly return to practice maritime medicine as a cruise ship physician.
On board I am faced with the same array of pathology as is seen in primary and emergency care settings, albeit in a more resource-limited and remote environment.
It is always interesting, sometimes exhilarating and occasionally terrifying. Healthcare onboard comes with the added complexity of not just caring for the acutely unwell patient but considering where in the world the ship is located and what resources may be available to you should they need med-evacuated.
When it is my day off, this role furnishes me with the opportunity to explore the culture, architecture and culinary delights of whichever beautiful port the ship has docked in.
This work has enabled me to visit countless cities around the world, sail beneath the Golden Gate Bridge, cross oceans, awaken every fortnight docked between Sydney’s Opera House and Harbour Bridge and swim in Norwegian Fjords, to name just a few of my amazing experiences.
Ignore the negative perceptions
The most rewarding part of the SAS role? I highly value the ownership of my own career that being a SAS doctor has granted me. From the day I started I have been able to shape my job plan, formulate a personalised development strategy and integrate into the departmental team. I feel a valued contributor to the facility and by being a SAS doctor I feel established in the trust.
My advice for anyone considering the SAS pathway is to ignore the negative perceptions SAS roles can sadly and inappropriately carry. Instead, take time to speak with those already in the role, see what huge achievements they make in the care of their patients but also in shaping the departments they work in.
It was conversations with inspirational and highly respected SAS doctors which led me to make this career choice and I cannot thank them enough.
Andrew Clarey is a specialty doctor in critical care medicine at Belfast Health and Social care Trust and a cruise ship physician