What does a good SAS job look like?

SAS doctors are sought after to provide elective and emergency services. They are involved in on call rotas at every level and, in many hospitals, are vital to ensure 24 hour anaesthetic cover. Surveys of Clinical Directors suggest that many departments struggle to recruit SAS anaesthetists.

The diversity within the grade inevitably leads to a wide range of development needs for individuals. Some may wish to return to training at some point. Others may be working towards joining the Specialist Register through the Portfolio Pathway (CESR) route. Many will be happy to remain in SAS grades but seek opportunities to develop their practice and careers.

Job planning

SAS anaesthetists often choose their role to optimise their work life balance. Job plans may be personalised to the individual or may mirror that of the anaesthetists in training working on the same tier of the rota. Not all SAS doctors work out of hours.

There should be an appropriate balance between elective and out of hours work. Minimum staffing levels to cover a full shift rota should be the same as for anaesthetists in training. Otherwise there will be an excess of out of hours work.

Elective work gives opportunities for professional development and SAS doctors should have some choice in regular lists to suit their interests and expertise. Supervised lists for training purposes may be appropriate and enable SAS doctors to learn new skills. Daytime work means doctors can feel properly part of the department rather than spending lots of nights and weekends working when most people are not. SAS doctors who are accredited clinical supervisors can have trainees to work with them.

SAS doctors should be able to attend clinical governance meetings in the same manner as consultants and anaesthetists in training. Cover for any emergency lists running at the time should be shared equitably.

The Specialty Doctor contract mandates a minimum of 1.0 SPA session. The Academy of Medical Royal Colleges and British Medical Association recommend 1.5 SPA. There is widespread inequality between consultant and SAS members of staff in the allocation of SPA time. The basic SPA allocation should be the same for consultants and SAS doctors.

The basic SPA allocation is to enable doctors to meet the minimum requirements for appraisal and revalidation. These requirements are exactly the same for consultants and SAS doctors. Additional responsibilities should be recognised with appropriate additional SPA time, as for consultants.

Job planning meetings should take place annually and be separate from the appraisal meeting. Guidance on job planning is the same for SAS doctors and consultants. It should be a consensual process balancing the needs of the department and the individual and should be linked to appraisal and personal development plan. Diary monitoring may be useful if there are disagreements about the actual work being done.

Induction

A comprehensive induction package should be routine for SAS anaesthetists joining a new department. Time must be available for Trust induction and any necessary mandatory training before commencing clinical work.

Orientation within the workplace should be followed by a shadowing period. This may vary in duration depending on the experience of the new starter. It can be helpful to employ any documentation or checklists already available for rotating doctors in training.

Many SAS doctors join the NHS from abroad. The NHS is very different from most other healthcare systems. Cultural differences with respect to hierarchy and relations with other health professionals can make the transition to UK practice very challenging. The RCoA offers an annual ‘New to the NHS’ meeting and attendance is recommended for international doctors.

Moving to a foreign country is enormously stressful. Departments should consider pastoral support with buddying and/or mentoring.

Supervision and mentorship should be offered to a new SAS starter, whether informal or more structured. It may be appropriate to have an educational supervisor. This can be discussed during the induction period. Departments should consider having a designated lead to support SAS anaesthetists. Many hospitals have an SAS Tutor with responsibility for all SAS doctors in the organisation.

Professional development

The personal development plan should be agreed at the annual appraisal meeting. This should be used to discuss how to develop the career of the SAS doctor in such a way that the department and the individual benefit in the longer term.

Training can be supported to facilitate sitting the Fellowship examination or collecting evidence for a CESR application. In Trusts that are struggling to recruit, this may be a way to bring on SAS doctors to consultant practice internally. SAS doctors may become expert in some areas of practice and become subspecialty leads.

SAS doctors should have access to the same study leave entitlement and study leave budget as consultant colleagues. They should have equitable access to leave slots.

As permanent members of staff, SAS doctors should be included in departmental business meetings. They are important stakeholders in proposed service developments. These meetings are an opportunity to gain an understanding of how the department fits into the wider organisation.

SAS doctors can be educational supervisors and appraisers with appropriate training. There are many other hospital roles for which they might have suitable knowledge and experience.

SAS doctors should be encouraged to attend leadership and management courses. The Association runs seminars and webinars specifically for SAS doctors to support their development needs.

Fatigue and the aging anaesthetist

All anaesthetists should have access to rest facilities at night and before driving home after a night shift. There is an extensive suite of resources from the Association and the College on how best to manage working patterns and fatigue. Job plans should try to minimise the effects of fatigue, particularly for those working resident nights.

Many SAS anaesthetists continue to work resident on call with a higher intensity of work than similarly aged consultant colleagues. There is extensive evidence of the greater impact of sleep deprivation on function at work with increasing age. Any arrangements for coming off the on call rota must treat all staff equitably.

Summary

A good job for a SAS anaesthetist may look very similar to a good job for a consultant. A fair allocation of lists with a chance to do things one enjoys is likely to result in an engaged and productive colleague.

There may be fears that investing in development of SAS doctors will just encourage them to leave at some point in the future. Most will stay if they are happy. If not, the department may find it easier to recruit because they can demonstrate that they are committed to career opportunities for their SAS doctors.

Conversely, a job with too much out of hours work that regularly allocates the least popular lists to the SAS anaesthetists will result in a disengaged and unhappy workforce who are more likely to try their luck elsewhere.