Specialty, Associate Specialist and Specialist (SAS) doctors and Locally Employed Doctors (LEDs) make up a significant proportion of the obstetrics and gynaecology (O&G) workforce.
They are highly valuable doctors with a wide range of backgrounds, skills and experiences.
It is important to understand the differences between SAS and LEDs.
What is an SAS doctor?
SAS doctors are employed on nationally agreed contracts in permanent posts and have the same appraisal and revalidation requirements as consultants. SAS doctors can also undertake locum posts.
A new senior SAS doctor post called specialist doctor was recently introduced to give career progression for specialty doctors. ‘SAS’ now covers: specialty doctor, associate specialists and specialist doctors).
A specialty doctor post on either the new or old contract requires a minimum of four years post-graduate experience, at least two of which must be in the relevant specialty.
You can apply at any level of experience, and should negotiate to enter the grade at a level appropriate for your experience.
Jobs are advertised nationally, but if you have a specific unit in mind, it is always worth making local enquiries.
There is a wide range of experience, competency and autonomous practice amongst specialty doctors.
Some specialty doctors are new to post, but many are very experienced senior clinicians who have not progressed due to closure of the associate specialist grade in 2008.
You don't need to be on the Specialist Register or have MRCOG to be a SAS doctor, although many do.
Specialist doctors (new contract) must have at least 12 years’ post-graduate experience in England, Wales and Northern Ireland, and 10 years’ experience in Scotland, at least six of which must be in the relevant specialty.
They must meet the criteria set out in the generic capabilities framework for specialist grade developed by the AoMRC, BMA and NHS employers.
Specialist doctor posts are created in response to local service needs, and individual specifications.Job plans are created accordingly. Posts are usually advertised externally and appointed through open competitions.
Associate specialists are senior SAS doctors who regraded before 2008. They had to have at least 10 years’ post-graduate experience, at least four of which were in the relevant specialty. Similar to the new specialist doctor, associate specialists practise autonomously within areas defined by their job plan.
For more information on SAS contracts, please see the BMA website here and NHS Employers here.
What is a Locally Employed Doctor (LED)?
Locally Employed Doctors (LEDs) are employed by trusts on local terms and conditions, so they are usually non-permanent posts and do not have nationally agreed terms and conditions (unlike SAS doctors).
There is also no nationally recognised career or pay progression thresholds for these posts.
There are a large variety of LED names: Clinical Fellow, Teaching Fellow, Trust Doctor, Trust Registrar, Trust SHO, Foundation Year 3 (FY3) etc.
Doctors can enter a junior trust doctor post without a minimum of two years in the specialty.
Like SAS doctors and Consultants, LE doctors need to have an annual appraisal and five-yearly revalidations.
The Trust is under no obligation to provide specialty training unless it is agreed in the job plan.
Some Trusts have created local “CESR training” programmes for LEDs and SAS doctors, but this is very much under control/discretion of the local employing Trust/department.
You don’t need to be on the Specialist Register or have MRCOG to be a LE doctor.
Please see the BMA for further information on their LED checklist and contract checking service.
Why consider a career as a SAS doctor?
- Advantages include geographical stability at an earlier stage in your career and possibility of regular hours and sessions.
- Assuming you have the appropriate experience and proven ability to work safely alone, then there is the possibility of autonomous practice.
- SAS doctors are employed on nationally agreed contracts (rather than locally agreed) in permanent posts.
- SAS doctors can also train to become educators (educational supervisors of foundation doctors and/or GP or RCOG doctors in training), be involved in research as local Principle Investigators for national trials, or leaders in their departments or hospitals. Please see here for further information and resources on SAS doctors as educators.
Please see here for further information and resources on SAS doctors as educators
- Career development in these posts is about opportunity and ability, not job title. Please see here for further information on career development for SAS doctors.
- You do not need to be on the Specialist Register or have MRCOG to be a senior SAS doctor, although some of these doctors are.
Please see here for further information on career development for SAS doctors
- Find out more about starting your career in O&G here.