In our specialty of emergency medicine, staff and associate specialist (SAS) doctors make up a considerable proportion of the senior clinical workforce at the present time. No exact figures exist as to how many SAS doctors work in the specialty, but latest figures would suggest that there are currently >800 SAS doctors working in emergency medicine in the UK.

SAS doctors face many disadvantages, including relatively poor levels of remuneration and an outdated contract, which does not compare favourably with either the new consultant contract or the “new deal” arrangements for junior medical staff.

To compound the disadvantage caused by poor remuneration and an out-of-date contract, many SAS doctors find themselves being educationally disadvantaged as well.

HISTORY OF STAFF AND ASSOCIATE SPECIALIST POSTS

The associate specialist grade (initially entitled medical assistant grade) was introduced as a permanent career grade in 1964, following recommendations made in the Platt Report (1961). The title of associate specialist was introduced later (1981). Associate specialists are senior clinicians responsible to named consultants. Being a career grade position, appointments are without fixed term (subject to a year’s probationary period), and may be held until retirement.¹

The staff grade was introduced in November 1988 as one of the many measures implemented to help resolve the problems of the existing hospital medical staff career structure. At the time of its introduction, the intention was that staff grades would be doctors who helped meet service requirements, while bridging the gap between consultant-level staff and junior doctors in training. Staff grade posts were intended to provide a secure, well-remunerated and well-supported option …