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SAS doctor findings from the 2022 UK census of physicians

The RCP has today published the headline findings from the 2022 UK census of physicians relating to specialty and associate specialist (SAS) doctors, while in the latest issue of Commentary, RCP SAS lead Dr Jamie Read and RCP registrar Professor Cathryn Edwards discuss progress made on delivering the RCP’s 2022–24 SAS doctors strategy.

The UK royal colleges of physicians received 244 responses from SAS physicians to our annual workforce census. The General Medical Council (GMC) reports that there are around 50,000 doctors in the UK with a licence to practise who are not in training or on the specialist register or GP register.

‘Doctors in these broad groups are not on a formal training programme or working in a consultant or GP post [although they could be working as locum consultants]. They play an important role in service delivery … and they work across many specialties taking on roles in leadership, education and clinical governance.’Specialty, associate specialist and locally employed doctors workplace experiences survey: initial findings report, GMC, 2020

A growing number of SAS doctors are motivated by a more flexible career path, geographical stability or a better work–life balance. This is a skilled, diverse and motivated group of clinicians: 83% of them have 10 or more years of experience in medicine.

At a glance findings:

  • 49% of SAS respondents were between 40–54 years of age and most were women (66%).
  • 51% of respondents were White British.
  • 58% gained their primary medical qualification in the UK.
  • 81% are working autonomously in their organisation.
  • 82% are employed in the NHS.
  • 87% say they feel satisfied by working in their specialty always or often.
  • 44% say they feel in control of their workload most or all of the time.
  • Most SAS respondents were working in general internal medicine, sexual health / HIV, geriatrics and palliative care.

What did we learn?

It is important to remember that the number of SAS physicians who responded is a small number, comprising only a quarter of eligible members of the three royal colleges of physicians. However:

Compared with 41% of consultant physicians who are women, more than two-thirds (66%) of SAS physicians are women; and the percentage working less than full time or flexibly was higher among SAS physicians (50%) compared with consultant physicians (28%). This could be linked to people choosing an SAS career for work–life balance or to accommodate caring responsibilities. In addition, 64% of SAS physicians had taken their full annual leave entitlement compared with 58% of consultants. Where SAS doctors had not used all their leave, they said they were too busy or unable to find cover.

It was reassuring to note that three-quarters of SAS physicians said that they would recommend their organisation to colleagues, friends and family. They also reported feeling more in control of their workload than consultant physicians. SAS doctors (51%) told us that they would also be happier than consultants (35%) to continue with their current working pattern and number of sessions in the future. However, fewer SAS doctors (55%) undertook any work remotely compared with their consultant colleagues (83%).

One stark finding was that only 19% of respondents had an additional leadership role, eg educational or clinical lead – compared with 47% of consultants; very few (14%) felt that their employer had fully implemented the SAS charter; and only a third of respondents felt that their employer had a process to guide SAS doctors through the certificate of eligibility for specialist registration (CESR) process.

Discussing the findings, Dr Jamie Read, RCP SAS lead, said: 

‘An SAS job can be very rewarding, combining flexibility, stability and work–life balance with the opportunity to build a portfolio career. However, many SAS doctors say they feel isolated. Some struggle to have their workload formally recognised, or to work autonomously.

‘We want to support more SAS doctors to take up leadership roles in the future – this is an experienced and motivated group of physicians who contribute a huge amount to the training of future doctors, while in many cases working autonomously and running their own clinics.

‘Over the coming months, we’ll be working with SAS colleagues to make sure short-term goals in the 2022–24 strategy are achieved, as well as helping to develop and define a clear professional identity and offering meaningful educational support for our SAS fellows and members. Ultimately, we want to create a sense of belonging and community of practice that recognises the contribution and ambition of many SAS physicians who historically have not received recognition.’

To find out more about how the RCP is working to support SAS doctors, read our article in the August issue of Commentary