From June to September 2018 the RCP conducted a UK-wide survey to assess the conditions and working practice of SAS physicians.
The RCP sent 820 SAS physicians in the UK a unique link to an online survey, and received 252 responses (30% response rate). Of the respondents:
- 61% were women
- 79% worked in England
- 79% were UK citizens
- 73% were aged between 40 and 59 years of age
- 51% graduated in the UK.
82% of respondents worked solely for the NHS, accounting for three quarters of all women and 91% of men. 89% did at least some work for the NHS, including 84% of all women and 97% of all men.
Almost two thirds (63%) were a specialty doctor, and 36% were an associate specialist. Of that 36%, three quarters were on the 2008 contract. 18% worked in geriatrics, 15% palliative care, 9% cardiology and 9% acute medicine.
89% were not on the specialty register, and only 1% had applied for a certificate of eligibility for specialist registration (CESR). 42% said they planned to apply, but of them only half were working towards it.
We found that job satisfaction was higher among associate specialists, with 78% always or often enjoying their job, compared with 69% of other grades. They were more likely to be working autonomously (75% compared to 45% of other grades), and twice as likely to be regularly asked to cover gaps in the consultant rota (35% compared to 17% of other grades).
But only 39% of associate specialists and 36% of other grades said they would recommend the role to a junior doctor. And only 56% of associate specialists and 45% of other grades would still become an SAS doctor if they could turn back time. The most often cited reasons were a lack of recognition, in terms of pay and progression.
Only 13% said their hospital had fully implemented the SAS Charter and only 16% the SAS development guide. Almost three times that number were clear it had not been implemented at all. And almost three fifths said their hospital had no established process for them to develop autonomous practice.
Half were contracted for one SPA or less in their job plan, and some had to sacrifice even that to direct clinical care. Yet their revalidation and CPD needs are the same as the trainees and consultants.
Almost three quarters (71%) always or often enjoyed their job. It was true of 80% of associate specialists on the 2008 contract, 71% of associate specialists on the pre-2008 contract, and 69% of specialty doctors.
17% did say their job always or often got them down, but 27% said it rarely or never did. And while 31% said they always or often worked under excessive pressure, this included a quarter of those who said they always or often enjoyed their job.
Over half (53%) said they wouldn’t recommend the role to a junior doctor, and 43% said they wouldn’t be an SAS doctor if they could turn back time. The most often cited reasons were a lack of recognition, in terms of pay and progression.
Almost a fifth (19%) said they had been the victim of bullying, harassment or victimisation in the workplace in the previous year. These SAS doctors were more likely to be women (60%), overseas graduates (60%) and aged 50 or older (64%). Only 25% made a formal report.
Only 13% of respondents said their hospital had fully implemented the SAS Charter, and another 32% that it had been implemented partially. 37% were clear that it had not been implemented at all.
Just 16% of respondents said their hospital had fully implemented SAS doctor development, with another 37% saying it had been partially implemented. 31% were clear that it had not been implemented at all.
Over half (54%) were already working autonomously. Another 18% said they were capable of working autonomously but weren’t due to a lack of support, and 15% said they needed support and a development plan to work autonomously. 58% said their hospital didn’t have an established process to develop autonomous practice.
Regarding external continuing professional development (CPD), 12% had been denied leave and 20% had been denied funding. When asked about appraisal, most (87%) had an appraisal in the last year. But almost a quarter (23%) said their hospital didn’t provide the data required as part of the supporting information, and a similar number (24%) didn’t have sufficient time to plan. Only 12% were themselves appraisers. Only 27% had a mentor.
Regarding involvement in training, 19% were a clinical supervisor, 11% were an educational supervisor and 6% held a formal academic position (clinical lecturer or clinical senior lecturer).
71% of respondents had no intention to move location, change their contract or retire in the next year, and 62% hadn’t changed jobs since their first appointment. But there was a marked difference between the grades: while half of associate specialists on the pre-2008 contract and 44% of those on the 2008 contract were still in their first job, two thirds of specialty doctors had moved.
The most concerning findings were that 28% hadn’t had a job planning meeting in the past year, and 10% in the last 3 years. While almost three quarters (72%) of associate specialists had had a meeting, only 63% of other grades had.
Over a third (35%) of respondents worked fewer than 10 programmed activities (PAs) per week. The vast majority (86%) were women, accounting for 50% of all women. In contrast, only 16% of men worked part-time.
Just over half (52%) of those working part-time were contracted to work between five and seven PAs on direct clinical care (DCC), and 15% more than seven. In reality, 49% worked between five and seven DCC PAs, and 23% worked more than seven.
The difference between contracts and reality was reversed when it came to supporting professional activities (SPA). 47% were contracted for one PA, 14% for less than one and 20% more than one. But in reality, 36% did one PA, 11% less than one, and 23% more than one.
Of those who worked full-time, 65% were contracted to work eight to 10 PAs on DCC, with 11% fewer and 10% more. In reality, only 56% worked eight to 10 PAs, and 13% worked more.
5% were contracted for no PAs for SPA, 40% for one and 63% for one or two. In reality, 8% worked no PAs for SPA, 35% worked one and 52% one or two.
We also asked about academic programmed activities (APA). The responses rates to this question were low, but almost two thirds (65%) of those who did respond said they were not contracted for any PAs for APA, and 57% said they didn’t work any.
Over a third (37%) of respondents did on-call. Of them, a third (32%) were on a senior rota alongside consultants. 22% were regularly asked to cover gaps in the consultant rota, and 23% the trainee rota.