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A SAS perspective

What makes a good department? A SAS perspective

After being asked to describe a ‘good department’ from the perspective of a specialty doctor, it struck me that every department is different, just as the needs of every anaesthetist are different. What follows therefore, are general observations and suggestions that apply to all departments. If there is a theme to be had, it is that meeting the individual needs of individual doctors makes them happier and more productive. It is also usually the right thing to do.

In the typical department nationally, specialty doctors and associate specialists (SAS doctors) make up around one fifth of the permanent anaesthetic team. Some SAS doctors may be relatively inexperienced, requiring supervision and support to develop their own practice. Other SAS doctors may have experience and autonomy on a par with their consultant colleagues, with corresponding needs. Some SAS doctors will work with some supervision through their careers, while many will develop greater autonomy. This autonomy should be appropriately recognised, with work attributed and coded to the doctor that carried it out. Some SAS doctors will choose to seek entry to the specialist register via a Certificate of Eligibility for Specialist Registration (CESR), and this too should be facilitated.

The good department recognises the value of individuals at all stages of their careers, supports them and treats them with respect. 

As valued members of the department, SAS doctors should be involved in departmental planning, recruitment and service development. Inclusivity is important and too often forgotten. Does your department have ‘consultant meetings’? Are your SAS doctors welcome at these meetings? If so, shouldn’t these meetings be called something different?

All SAS doctors have the same rights to job planning and requirements for appraisal and revalidation as consultants. There is no reason why the process for job planning SAS doctors, or the resulting job plans, should differ greatly from consultants in the same department. Such job plans should contain a mutually-agreed balance between fixed sessions and flexibility, as well as between daytime working and out-of-hours activity. Any arrangements for reducing out-of-hours commitments on the grounds of advancing age should apply equally to SAS doctors and consultants alike. Paraphrasing Animal Farm, in the good department all anaesthetists are equal, with no group more equal than others.

Appropriate paid SPA time should be included in the contract for Continuing Professional Development to support appraisal and revalidation, with a minimum 1 PA. If additional ‘core’ SPA time is the norm for consultants in a department, it should also be the norm for that department’s SAS doctors. Additional roles should carry additional SPA time. Access to office facilities, appropriate IT and administrative support should likewise be the same. These things should be true of every department, not just the good ones.

The good department must create ways of working that allow each anaesthetist to flourish and carve out an individual niche, based on their individual talents and expertise. 

SAS doctors can play valuable roles in both clinical and non-clinical settings, and in the good department, they are encouraged to do so. Nationally, SAS doctors are subspecialty leads, educational supervisors, appraisers and mentors. Extended roles involving leadership, education or research for anyone with the aptitude should be the norm, not the exception. Failure to recognise this results in frustration from all quarters, and prevents even the good department becoming the best it can be.

Robert James Fleming
Specialty Doctor and elected board / council member at the Association of Anaesthetists

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