How Autonomy Manifests for SAS Doctors in Clinical Decision-Making, Leadership Opportunities, and Day-to-Day Responsibilities

Dr Naeem Aziz FRCP ( October, 2024)

RCP London SAS Lead & Council member

SAS Advocate, Clinical Director, Aneurin Bevan University Health Board

Introduction

For SAS doctors, professional autonomy can significantly enhance both their job satisfaction and career progression. Autonomy enables one to take greater control over various aspects of one’s role, from making independent clinical decisions to leading teams, and influencing the direction of healthcare services. How autonomy manifests in three key areas of professional life:

1. Clinical Decision-Making

Greater Responsibility for Patient Care.

• As an SAS doctor, autonomy in clinical decision making allows the management of patient care with minimal supervision. This means taking the lead in diagnosing, treating, and developing care plans for patients, without requiring constant input from a consultant.

Independent Management of Complex Cases

• Over time, SAS doctors may become recognized for their expertise in certain areas, allowing them to independently handle complex cases. This autonomy allows one to make timely decisions, improve patient outcomes, and manage challenging cases.

Leading specialist Clinics

• Autonomy also manifests itself when you are trusted to run specialist clinics or services within your department. This could involve conducting clinics for specific patient groups, performing procedures, or leading multidisciplinary teams (MDTs) in your area of expertise. Operating these clinics provides full control over patient management in a focused area.

Clinical Protocol Development

• With increased autonomy, you may have the opportunity to contribute to the development of clinical guidelines and protocols. This allows one to influence the way care is delivered in one’s specialty, shaping practices to improve patient safety and outcomes.

2. Leadership Opportunities

Team Leadership and Management

• Autonomy often goes hand in hand with leadership. As you gain experience, you may take on formal leadership roles such as leading a clinical team, managing a department, or heading specific initiatives (e.g., quality improvement projects). Leading a team gives you the freedom to influence decision-making and departmental strategies.

Service Development and Innovation

• SAS doctors with leadership autonomy often play a key role in the development and improvement of healthcare services. One may be tasked with redesigning patient pathways, implementing new treatment protocols, or introducing innovative technologies. These projects give you the autonomy to drive improvements that directly benefit patients and improve the efficiency of your department.

Clinical Governance Roles

• Another manifestation of autonomy is the involvement in clinical governance. This includes leading patient safety initiatives, overseeing audits, and ensuring that the department meets NHS standards. Autonomy in this area allows one to influence how care is delivered and ensure that it meets the highest quality standards.

Representation in Committees and Decision-Making Bodies

• With greater autonomy, SAS doctors can represent their departments or specialties at trust-wide or regional meetings. By sitting on clinical committees or advisory boards, you can have a say in broader healthcare policies and decisions that affect both your department and patient care across trust.

3. Day-to-Day Responsibilities

Designing Your Job Plan:

• In your day-to-day role, autonomy provides you the ability to influence your job plan, allowing for a more balanced and fulfilling work schedule. By negotiating your job plan, you can secure dedicated time for non-clinical responsibilities, such as teaching, research, or leadership activities, ensuring that your role aligns with your career goals.

Junior doctors’ mentoring and supervision

• As a senior SAS doctor, autonomy allows you to assume mentoring and supervisory responsibilities. You may oversee junior doctors, trainees, or other healthcare professionals, guiding their development and contributing to the training programs. This not only gives you a greater influence over how your team functions but also supports the professional growth of those around you.

Managing Your Clinical Time

• Autonomy in your day-to-day responsibilities means having more control over how you manage your clinical time. For example, you may be able to adjust your workload, manage your clinical schedules, or prioritize certain patient cases based on your expertise. This freedom enables you to optimize your time and focus on areas that matter the most to you and your department.

Flexibility in Career Development Activities

• With increased autonomy, you have more control over your professional development. You can choose to dedicate time to specific interests such as participating in research, attending conferences, or engaging in further education. By having autonomy over these activities, one can tailor one’s career path in a way that supports long-term goals.

Conclusion

For SAS doctors, autonomy manifests in various ways across clinical decision making, leadership, and day-to-day responsibilities. It allows you to take full ownership of your clinical practice, lead teams, and services, and actively shape your career. By gaining greater independence, one can improve both patient outcomes and job satisfaction, while positioning themselves for further career progression, such as moving into a Specialist Grade post or other senior roles. Autonomy is key to creating a fulfilling and impactful professional life within the NHS.