My Brilliant Career…as an SAS doctor

Dr Ros Ring has been an Associate Specialist in Scotland since 2009. She works in a small community hospital, caring for the frailest and most complex patients: this involves a lot of palliative and end-of-life care, including care of end-stage dementia.

Even as a medical student I was drawn to elderly patients, but as a Senior House Officer (SHO) in a busy London hospital I soon found that I did not thrive on the acute ward. Some get a buzz from all that System 1 thinking – not me. In those days you could get 6-month stand-alone SHO posts: I wanted as much experience as possible before starting specialty training. As well as a medical rotation and the MRCP, I meandered in London and Scotland through old age psychiatry, A&E, palliative medicine, oncology and even a year as a GP registrar.

I was open to being converted to the world of general practice; I enjoyed my GP year and learnt a huge amount. But I found that the older patients only wanted to see the besuited male senior partner; as a young female GP, it was the younger women who wanted to come and see me. That year taught me the deepest respect for my GP colleagues, but I missed the elderly patients, and by the end I understood where I wanted my career to go.

I wasn’t sure what to do next. I had done all the six-month SHO jobs I could justify to gain experience: it was time to move on to the next phase. But to become a consultant in geriatric medicine, you have to train in acute medicine also, and probably serve your time on the acute take for years as a consultant afterwards. This was not appealing. Fortuitously, two staff grade posts came up at the local acute hospital just as I finished my GP year in 2002. I started in one of them, middle-grade on the acute MoE wards, and became pregnant almost immediately afterwards. I worked full time in the last months of the crumbling old hospital, and in my final heavy weeks I got in the way while the department moved to a shiny new hospital.

I came back to work when my son was 6 months old, part-time and informally job-sharing with the various part-time registrars that came through the department. The job on the acute MoE wards wasn’t the same as the full-on Acute Medical Admissions Unit, although I often did liaison there, but it was busy enough. I wished that our patients were with us longer, so that the System 2 thinking had time to kick in and I could get to know them better. One day one of my consultant colleagues mentioned going off to do her weekly ward round at the NHS long term care ward at the local community hospital. I thought that sounded interesting, so I asked if I could accompany her. As soon as I walked into the place and saw some of the patients, I knew I had found my niche.

Shortly afterwards, in 2006, I applied successfully for a new staff grade post covering two of these units. I replaced a ‘pop-in’ service from some local GPs who were struggling to fit their visits around emergency surgeries: an ‘in-house’ doctor made a real difference, and further posts were created to cover more of the long term care, boarding and respite beds around the city. By then I was firmly anchored in the service in which I work to this day, the longest serving SAS doctor in it, although it has changed around me almost beyond recognition. To my surprise, during the ‘window of opportunity’ in 2008-9 for staff grade doctors to apply to become associate specialists before the grade closed for good, I discovered I had indeed accrued enough experience to qualify. In 2009, off on maternity leave with a three-month-old baby, I was appointed Associate Specialist.

When I was invited to write this piece, it made me ask myself what suits me about the SAS grade, and why I have no plans to apply for Certificate of Eligibility for Specialist Registration (CESR) and become a consultant after all. And the answer is that one word: niche. My consultant colleagues are expected to turn their hands to many things during their working week – acute assessment, rehab ward rounds, day hospital, clinics, community work – overseeing, supervising, advising, and moving on to the next thing after their allocated session. I can see how this variety inspires and energises them. But for me, working in one place, knowing the team and the system thoroughly, accompanying patients and their families on their journey (which is often their last) – that’s what energises me. And the flexibility to work in this way, outside the training grades or a typical consultant job plan, is only really possible in the SAS grade. If there is a niche, an SAS doctor like me can fill it.