Most of us were told that moving from specialty doctor to specialist is about putting in the years, building a solid appraisal portfolio and waiting for someone to notice. But what if the work that proves you’re ready is already happening, and it’s invisible to your trust? What if the “business need” you’re asked to prove has existed for years, in the autonomous work you’re doing now? And what if a system that relies on that work without recognising it isn’t just slow, but exploitative? Recorded during SAS Week, this conversation is with Dr Shashi Madhapura, SAS Development Programme lead and Associate Dean for SAS in the North West, and one of the country’s best-known advocates for SAS doctors. He goes further than the usual career-progression talk. Shashi moved to Manchester in 1998 with ten years of intensive care experience behind him. He quit a London post when he was refused even the chance to apply for regrading. He later helped 11 of Stockport’s 45 staff grade doctors become associate specialists in two years.