Making the most of non-training posts
On graduating from medical school,
most doctors expect to progress
through the golden gates of specialty
training to the holy grail of the
consultant post. Yet many will take
a more circuitous route, discovering
jewels they never knew existed.
Time out of formal training is more common than is advertised,
and there are many reasons for anaesthetists to relinquish their
training number. It may be woven into career goals, such as
working abroad, or moving into the SAS grade. Sometimes
it is unexpected and unplanned. Examination difficulty is a
common one, along with competition for registrar posts. Some
trainees may be released from the military and consequently
their training programme. Health issues may prompt a need for
a different focus, or interests outside anaesthesia might need
more attention.
A non-training post can be a real boost to you as a doctor,
anaesthetist and human – and help shape your career the way
you want it.
It can be a real positive
If stepping off the ‘ladder’ was not part of your game plan, it
is important to realise it is not the end of the world – or your
career. Many trainees will take time out at some point and still
have successful careers in anaesthesia. Two of them are writing
this article.
You may find these posts allow you to regain some of the spark and enthusiasm for the specialty that sometimes gets lost amongst the pressure-cooker of training.
It may feel like a disaster but there is always a need for
competent anaesthetists, and many departments have gaps on
rotas they would like you to fill.
A non-training post can also give you breathing space. There
are no workplace-based assessments, no exams unless you
choose to take them, and no ARCPs (we’ll get to appraisals
later). Without deadlines to progress to the next stage, you are
more in control of what you choose to do with your time. Service
development and quality improvement projects are easier to
complete if you are not rotating every few months!
You may have more choice over geographic location or work
schedule. As you are likely to be in one hospital you really get
to know your colleagues well, and feeling part of a department
should not be underestimated. Some of these posts are fixed
term, others substantive, which can allow time to decide on
career plans. You may find these posts allow you to regain some
of the spark and enthusiasm for the specialty that sometimes
gets lost amongst the pressure-cooker of training.
Getting the job
Non-training posts fall into two groups – Specialty Doctors
(SAS) or Locally-Employed Doctors (LED). SAS posts are
usually substantive and should comply with national terms
and conditions. There are specific entry specifications for the
role. LED jobs can have a variety of titles (Trust Grade, Clinical
Fellow etc) and terms and conditions are set entirely by the local
employer, not a nationally agreed contract. You will have to apply for the job like any other, so ensure your CV is up to date
and check the entry criteria. It is important to confirm details
such as pay, study leave, CPD time and so on. Don’t assume
you will be paid the same as when you were training; there is
no obligation for your employer to ensure this. Will you have
access to educational support and teaching? Is there a training
component to the job or is it predominantly service delivery?
Checking before you start will save awkwardness later.
Decide your aims
What is the purpose of this time? Do you wish to gain skills
in a specific area, improve your CV before applying again,
or pass exams? To get some headspace and relax? Knowing
this will help you get the most out of this time, but be realistic.
It’s unlikely you’ll get a complex research project done in a
year, but if you have specific aims then discuss them with the
department and see how they can support you. You may wish
to work less-than-full-time. If you are planning on applying
for a training number, then make sure you know the details
of the application timeline and criteria, and use this period to
enhance your application.
Sort out the specifics
Training by its nature is didactic; a non-training post is very
different and, in some respects, you are left to your own
devices when it comes to your education. Find out about
the study leave policies and teaching that you are eligible
to attend. Study leave will be arranged through the Trust or
Health Board rather than deanery, and you may have more
freedom as to how you use it.
In a non-training post it is important that you find out who
your designated body and responsible officer are, and
arrange your appraisal. You must have an appraisal annually as
mandated by the GMC. The process is different to ARCP, and
a bit bewildering if you haven’t done it before. The support of
someone who knows the system can be invaluable.
An alternative career path
The SAS grade can be a very rewarding career in anaesthesia,
and there are many great role models within the specialty.
Many of us have consciously chosen SAS roles; others use
the posts to work towards CESR and consultant jobs. A big
advantage of the SAS route is stability – not rotating round a
region and more control over working patterns. There are SAS
anaesthetists who have developed special clinical interests,
taken a role in education or management. It is certainly not the
‘dead-end’ job that once it may have been perceived.
Getting back into training
If you decide to reapply to training, make this time count. If you
need the exam, pass it: use this time to revise if you need to,
dropping clinical hours if necessary. Don’t underestimate your
experience out of training. This can often mean more solo (and
regular) lists, increased responsibility and increasing trust as you work with people more regularly. Improving non-technical
skills, running lists and increasing your knowledge of how
an anaesthetic department works are valuable skills for your
career, as well as great to talk about at interview.
Whatever you choose to do, we hope that you can use this
time wisely to make the best choice for you. Change can
be daunting, but it can also be stimulating and exciting and
can open your eyes to new possibilities. A mentor can be
invaluable as a companion through any period of change
or transition, and the Association of Anaesthetists provide a
scheme to all its members.
After all, a change is as good as a rest, right?
Thomas James
SAS Anaesthetist
Bradford Teaching Hospitals NHS Foundation Trust
Naomi Freeman
ST7 Anaesthetic Trainee
South East Scotland School of Anaesthesia