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More doctors than ever are now taking time out of training after their Foundation Year 2 (F2), to experience what’s commonly known as an F3 year. The majority of people who take an F3 year tend to work as locum doctors for some – or all – of that time period. However, most doctors return to training shortly after their F3, with 93% of doctors taking F3s back in a training programme within five years.

The main reason for this trend is the fear of missing out on career progression. A comment we often hear is, “I don’t want to be an SHO locum doctor when I’m 50.”

If you’re in a similar position, you may think you only have two options for your career path:

    💡 Either choose locuming for the flexibility, higher salary, and autonomy, but accept you’ll be stuck working at the same grade forever.

    💡 Or, sacrifice all those benefits and go back into training so you can move up the grades.

Thankfully, this is a common misconception that’s actually incorrect. You don’t have to choose between the two, and you can still achieve good career progression while working as a locum doctor.

In fact, we’re seeing the decision to work indefinitely as a ‘career locum’ become far more popular these days. That’s because locum doctors can still progress into more senior roles, moving from SHO to registrar, and eventually even consultant.

It’s worth mentioning, though, that if you take this career path you’ll be going it alone, and the opportunities for progression certainly aren’t as clear as they are for a trainee.

In this article, we’ll help you understand what routes are available to you as a locum SHO to progress to a specialist registrar (SpR) role. We’ll also provide you with a clear roadmap for how to achieve this, as well as comparing the pros and cons.

The Benefits of Working as a Locum Registrar

While working as a locum doctor, stepping up regularly from SHO to SpR will provide you with some benefits, especially if you’ve been working in this role for a while. These include:

⬆️  Career progression

Once you have some experience of locuming as an SpR, you’ll be able to start doing this more regularly and naturally take steps forward on your career path.

💰  Higher rates of pay

Working a locum shift as an SpR will entitle you to be paid accordingly. As an example, a locum SpR working in the emergency department in the east of England will earn between £63.09 to £72.70 per hour, depending on the type of shift. As an SHO, that would only earn you £42.98 to £48.37 per hour.

You can learn more about the rates you could earn based on your grade, specialty, and region by using our Locum Salary Calculator.

👍  More opportunities to pick up shifts

If you’re able to work on both the SHO and SpR rotas, that will increase the number of job opportunities available to you.

📚  Opportunities for learning and personal development

Working at SpR level, you’ll handle more complex cases and have the opportunity to develop greater competencies. This can be especially useful if you’re looking to skip Core Training and apply for a specialist trainee year three (ST3) post later on in your career, or even if you’re planning on locuming all the way to consultancy by getting a certificate of eligibility for specialist registration (CESR).

🚦  Don’t move too fast

On the flip side of all this, there have been plenty of cases where some departments put pressure on SHOs to step up to SpR level even if they’re not necessarily ready. With that in mind, you should only take on work that you’re comfortably doing. If you’re not ready to step up as an SpR, you’re feel fully entitled to say no.

Unfortunately, this situation tends to happen in departments that are deeply under-staffed and have big gaps in the rota they urgently need to fill. That means the chance of having support from other registrars during that shift is also lower.

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Progression to a More Senior Grade

As a locum, there’s no fixed milestone to signify the difference between when a doctor is an SHO when they’re considered a registrar or SpR. This is a fluid boundary, often dependent on the department’s view of your readiness to work at the higher grade.

To start picking up locum work as a registrar, you’ll need to demonstrate sufficient experience and capabilities in your specialty. Ultimately, that’s what will convince the consultants in your department you’re ready to make the step up.

To do this, you need to show that:

    👉  Your experience allows you to meet the competencies of a trainee in that specialty.

    👉  You’ve done the same exams that a trainee would do.

    👉  You’re building a bank of evidence in your portfolio and your CV that demonstrate why you’re ready for SpR positions.

Your Roadmap to Working as a Locum Registrar

To achieve the above task of demonstrating that you’re ready and capable to take on locum work as an SpR, here are some specific steps and actions you can take:

1️⃣  Do your research

Spend time researching the training competencies required to work in a training grade ST3 post. This will usually mean completing your annual review of competency progression (ARCP) requirements of a core trainee year two (CT2) or equivalent.

You can find examples of specialty-specific ARCP checklists posted by Health Education England, individual deaneries, or the Royal Colleges, such as: 

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Use these as a guide to set yourself learning goals and do your best to consistently reach them whilst you’re locuming. Although you won’t need to complete everything to start working as a locum SpR, it’s important to know what’s required of you and proactively work towards it.

2️⃣  Make your ambition clear to the necessary people

Tell your locum agencies, staff banks, and the appropriate people in the departments you work in that you want to progress. They won’t know unless you make them aware that you’re actively looking for opportunities to work as an SpR. Once they know, they’ll be happy to help you.

3️⃣  Keep a great portfolio

It’s always important to keep a strong portfolio as a locum. Within this, map out your experience and provide as much evidence as possible to align with the training competencies, keeping a checklist of how you’re progressing. You can also use this to identify gaps and make an effort to fill them as quickly as possible.

4️⃣  Update your CV every few months

As a locum, your CV should primarily consist of your skills and competencies, rather than your audit and research work.

This is to show prospective employers that you have all the necessary requirements to work at your desired level. That will become even more important if you’re looking to step up to a locum SpR role.

If you’re interested in learning how to write a great medical CV for locuming, check out our helpful guide here.

5️⃣  Make time for exams

We appreciate that making time for exams is easier said than done, but they will serve as valuable evidence of your qualifications, and your departments will put a lot of stock in that.

This may require you to work ad-hoc shift for a period of time to ensure you can study, but having the flexibility to do that is one of the benefits of locuming.

6️⃣  Use feedback as a guide  

Ask your consultants for feedback on a regular basis, and use that as a measurement for where you stand. They’ll be able to provide guidance, and will also let you know how close they feel you are to being ready to take the next step up the ladder.

If they don’t feel you’re quite ready to work as an SpR yet, ask them why. Try to take away some actionable things to work on that will help you progress.  

7️⃣  Consider long-term locum posts

Working in long-term locum posts will give you the opportunity to build more relationships in the department, which will be beneficial for your progression.

There will also be more incentive for your department to help you tick off your training competencies if they know you’ll be around in future an able to help fill middle-grade gaps in the rota.

8️⃣  Be prepared to move around

If you’re struggling to get the experience you need in your existing roles, try moving to a new department where progression might become easier.

Alternatively, another option is to consider clinical fellowships. That will give you the opportunity to gain experience first as you jump in and out of locum work.

Should Your Approach Vary Based on Specialty?

As mentioned earlier, there are no set requirements to move up from SHO to a locum SpR besides completing your F2 of course. If you can demonstrate enough knowledge, and both you and your consultants feel you’re up for the challenge, you can work at that grade as a locum doctor.

Because of this, no specialties should be off-limits to you. However, getting the necessary competencies can be more difficult in some specialties compared to others.

With specialties like emergency or general medicine, and psychiatry, it’s often easier to gain the required competencies. This is mainly because the competencies and their settings are usually very accessible to locum doctors.

For example, to work as locum SpR in the emergency department, most consultants will want to know you have a strong clinical acumen, as well as enough experience of working in majors, minors, resuscitation, paediatric emergencies, and, less often, urgent care. Fortunately, these areas are all accessible from a standard emergency department SHO locum role.

In more competitive or niche specialities, such as surgery and anaesthetics, the competencies are more theatre or procedural based, which can make it harder to gain experience in competitive areas. For instance, getting the opportunity to attend theatre and get enough experience in certain surgical procedures as a locum doctor can be nearly impossible when there are four core surgical trainees competing to attend themselves.

Another factor to consider is whether it’s possible to find SHO locum work in more niche areas to build up the competencies (i.e. for oncology, anaesthetics, and paediatrics roles). Critical care units and neonatal intensive care units are examples where locum work is much harder to come by. For these specialties, you may be better off applying for a clinical fellowship that has attachments within the departments you’re looking to build up your experience and competencies.

However, many department heads will allow you to step up to SpR level, providing you’ve completed the required exams and attended courses like basic surgical skills and advanced trauma life support, even if there are gaps in these competencies. Just be aware that you might have restrictions on what SpR shifts you can apply for in situations like these.

The Possibility of Returning to Training

You may wonder what this would mean regarding your ability to pivot and return to training later in your career.

If you want to work as a locum doctor for a while, then enter training later, it’s important to note that you’ll need to be careful with how much work you do in certain areas. There’s actually is a maximum limit to the amount of experience you’re allowed to have when applying to ST1, CT1, or equivalent training posts.

For the majority of specialties, this is 18 months, with the exception of neurosurgery and obstetrics and gynaecology, which are limited at 24 months.

While there doesn’t appear to be the same limit for ST3 posts, there is a stated “maximum desired” amount of experience. Depending on the individual specialty, this ranges from 48 to 60 months. Going over this limit can count negatively towards your application in certain specialties, particularly surgical.

In Summary

To recap, you can work as a locum SpR after completing your F2 training. But you’ll need to demonstrate to your consultant that you’re ready to make that step up, which is a lot easier to do if you’ve been working at the same hospital for a while.

To help make this as easy as possible for you, here’s a summary of our top tips for progressing to SpR while working as a locum SHO:

��������✅  Research the specialty-specific ARCP requirements for that of a CT2 or equivalent doctor.

��������✅  Be proactive in sharing your ambitions with your consultants and ask for their feedback on your progress regularly.

��������✅  Check out our guide to writing the perfect CV for locuming and keep updating your CV as you gain more experience.

��������✅  Make time for exams and clinical courses.

��������✅  Consider a clinical fellowship if you’re struggling to get enough experience through your locum position.

Working hard to move forward in these areas will help you make the step up to begin working as an SpR locum. Once you’re ready to do that, our last piece of advice would be to try to get a gentle start and ease yourself in. We suggest starting with shifts where there will be other SpRs or consultants to support you. For example, don’t take up a night shift as the medical registrar until you’re comfortable working in that role with minimal support.

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Your Ultimate Guide to Succeeding as a Locum Doctor

This article is part of a wider series of resources and guides that are designed to support you as a locum doctor, covering areas such as getting your first job, managing your finances, understanding your rights, and many more. Visit our Locum Doctor Hub for everything you need to know about locuming today.

Additionally, if you're considering an F3 year, you might also find it useful to look through the selection of resources we've put together in our F3 Resource Hub.

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