Reflections of a "Non-Training" Specialty Doctor in Dermatology: Why Traditional Training Isn’t Always Better

This week marks SAS Week across the UK: a time to recognise the Specialty, Associate Specialist and Specialist doctors who play a crucial but often undervalued role in healthcare. For me, it’s a time to share reflections as a "non-training" Specialty Doctor working in dermatology, and to consider how the system is still stacked against those in “non-training” roles, how training programmes take too much credit, and how SAS doctors constantly have to prove themselves more than trainees.

There’s a deep-rooted bias in medicine that assumes anything outside formal training is lesser. You still hear phrases like “I'm so excited to take some time out of training,” said with the implication that this means a quieter, easier life. It always makes me raise my eyebrows because I’ve never worked harder or developed faster than I have as an SAS doctor.

When I was a medical student, specialty doctors were almost invisible. Occasionally we’d meet associate specialists, often doctors from other countries whose consultant status wasn’t recognised by the GMC. That’s a whole other issue for another day, but it speaks to how rigidly hierarchical our system remains.

The training that didn’t train

I did my Foundation Training in Aberdeen. I’ve always been driven, so I sat my MRCP exams far earlier than most, completing all three parts, including PACES, while still an FY2. I had to get special permission to do it, and was told repeatedly that I’d fail because I was too junior. I studied entirely on my own, without any support from a deanery or training body, and passed with the highest mark in my Aberdeen cohort.

After foundation training, I entered Core Medical Training, but quickly realised that very little of it actually felt like training; most of it was service provision. I found a clause that allowed early completion if all competencies were met and finished in 18 months instead of two years. I didn’t want to coast through a system that wasn’t helping me grow, and ironically, I’ve learned far more in non-training posts than I ever did within formal training.

Even then, I could see that the so-called “non-training” doctors were doing exactly the same work as traditional trainees. The only real difference was the mandatory teaching sessions, which were often more about ticking boxes off the curriculum than grounded in true pedagogical theory. Most of my real education came from individual clinicians who cared about teaching and created psychologically safe environments. Alongside that, I went looking for opportunities far beyond what was expected of the training programme. Alongside my MRCP, I completed a Postgraduate Diploma in Medical Education and began a formal lecturership during FY2 and CMT.

Which raises a question: if so much learning and progress happens outside the official system, why do training programmes get all the credit?

The year that wasn’t “time out”

Eventually, I took time out of training. Everyone said it would be "easier", due to the lack of imposed learning activities. However, I started locuming, and within weeks, my learning and opportunities had exploded. I found myself working across different hospitals, building networks, and being trusted with responsibility that genuinely helped me grow.

Sure, any job, locuming included, can be easy if you want it to be. Think of the “borderline” principle: it’s always possible to coast if that’s what you choose. But if you want your job as a doctor to be a doss, you’re probably in the wrong job. Medicine demands continuous learning, reflection and adaptability. For doctors who need heavy support, training programmes can be helpful. But I’m not convinced they always produce doctors who are better prepared for the evolving reality of modern medicine.

At first, I was apprehensive about locuming, particularly because of the stigma. People would say things like “you’re such a good locum” or “why do you care so much?” as if commitment was unusual. Occasionally I was overlooked for things until people realised my qualifications or level of experience. It was strange to see how much perception still drives inclusion.

Reflections: Becoming a non-training specialty doctor in dermatology

After a year of locuming, I moved into a Clinical Fellow post in Dermatology, again "non-training", and quickly realised that my role was identical to that of the trainees: same clinics, same patients, same responsibilities. The only difference was the contract length - mine was for 1 year whereas the trainees were contracted for 4 - and initially, the level of support.

The department's support in my education wasn’t automatic. I had to establish myself, to show that I was equally invested in the team and the work. It was not uncommon to hear disheartening rebuttals to my requests for feedback, like “I need to prioritise assessments for the trainees.” There’s an old saying that women have to work twice as hard to be taken seriously; I’d argue the same applies to SAS or "non-training" doctors.

Supervision for trainees is, or should be, structured and consistent. For SAS doctors, the rules are different. Many are very senior and need no oversight, which is fair. But for those who are early in their career and/or pursuing consultancy through the CESR/Portfolio Pathway (PP), structured support is limited. The CESR/PP route doesn’t require an educational supervisor, so "non-trainees" are generally self-sufficient, managing every detail themselves. There’s little in the way of hand-holding, in stark contrast to training programmes.

To put the workload in perspective: dermatology trainees are expected to complete about 18 workplace-based assessments per year, each reflecting that stage of training. For my CESR/PP submission, I submitted 53 assessments at consultant level and more than 100 in total across 3.5 years. CESR/PP applicants must also demonstrate up-to-date evidence of general medical competencies, even after completing core medical training, meaning additional work in acute medical settings alongside dermatology. Yet despite all this, we’re still described as “non-training.”

Rejection and irony

During my first year as a Clinical Fellow, people encouraged me to apply for a dermatology training number, so I did. I didn’t even get an interview, largely because, that particular year, the process placed unusually high value on additional degrees, which I didn’t have. My MRCP and clinical experience weren’t even considered, though they would have been in other years. Less than two years later, I was invited to sit on the national interview panel for dermatology trainees, which made me laugh at the irony.

Reflections: looking beyond titles

Over the past few years, I’ve come to appreciate how broad and impactful the SAS workforce is. Alongside many of my SAS colleagues, I’ve served on national committees, government working groups and international advocacy projects. I sit on the board of examiners for the Royal College of Physicians, I am an educational supervisor for resident doctors, and have been contracted by OpenAI for the past 2 years. Many SAS colleagues take on similar roles, leading services, driving innovation and influencing policy.

Yet SAS doctors are still too often defined by what we are not. Non-training, non-consultant: all words that focus on what’s missing rather than what’s brought to the table.

We should be held to high standards, absolutely. But we should never be dismissed simply because we don’t hold a consultant title. Ironically, once you secure a training number, it’s quite difficult not to complete it and become a consultant. As long as you turn up, complete a relatively modest number of assessments, and pass your exams, you’ll get your title. The road for SAS doctors is harder and lonelier, but it can certainly produce clinicians who are often more independent, more adaptable and, I would argue, more reflective.

Changing the narrative

I’ll admit that, as a student, I once fell into the same trap. I remember hearing people say, “Make sure you do your training, don’t become a specialty doctor,” and I’m sure I repeated it myself. I cringe thinking about that now.

One of the greatest advantages of being a specialty doctor is flexibility. When I was applying for training, I didn’t want to uproot my life in Glasgow. For many, it’s families, partners or simply a sense of belonging. It feels outdated to expect people to move across the country purely for a label when they’re already performing at the same standard.

SAS doctors are not “taking time out of training.” We are doctors who teach, lead, innovate and deliver. We are part of the future of medicine, and it’s time the system recognised that.