Editorials

Training overseas doctors in the United Kingdom

They must be given accurate information about their job prospects

Personal view p 307

The United Kingdom has a long tradition of training overseas doctorsthat is, doctors who gained their primary qualification outside the European Economic Area. In this week's BMJ, Sridhar argues that the United Kingdom should radically revise its practices in relation to overseas doctors seeking training posts (p 307).¹ Similar issues were raised in 1994.²

Doctors have travelled to other countries for training for many years. Doctors who travel overseas for postgraduate training represent only one feature of "medical migration," which can be temporary or permanent and is a phenomenon that occurs worldwide for a variety of reasons. This migration is influenced by a number of factors, including a lack of training facilities and opportunities in the doctor's home country, high unemployment among health professionals in the home country, the shortage of doctors in some developed countries where there may be many posts that are hard to fill, and the availability of training placements in developed countries.³ "Medical migrants" make up a considerable proportion of the medical workforce in many developed countries, accounting for 30% of NHS staff. The number of overseas doctors in the training grades has been increasing over the past 10 years; in England, 29% (4257) of senior house officers and 27% (3208) of specialist registrars are from overseas. ^{2 4} The number of medical graduates from the European Economic Area who did not qualify in the United Kingdom but are being trained in the NHS is increasing slowly and accounts for 9% (1335) of senior house officers and 7% (795) of specialist registrars.⁴ The NHS is providing training to and benefiting from the services provided by a substantial number of overseas doctors.

The finite number of training posts for senior house officers and specialist registrars are filled by open competition, although a small number of doctors from overseas are placed directly into posts through the sponsorship of the Overseas Doctors Training Scheme, which is run by the medical royal colleges. Direct placement causes particular concern since it reduces the number of posts that are available through open competition. The NHS Executive has recently established a panel to make recommendations on this issue. It will take into account the service contribution provided by the doctors within structured training programmes, guidance from the Department of Health on the recruitment of doctors, equal opportunities legislation and policy, the arrangements for registration with the General Medical Council, and current immigration regulations. Options to be considered by the panel include a wholesale revision of the Overseas Doctors Training Scheme and the criteria for direct placement and possibly limiting direct placement to certain specific training placements or stopping it completely.

There is anecdotal evidence that a number of overseas doctors successfully complete the examination of the professional and linguistic assessment board but find it difficult to get training grade posts afterwards. In some cases doctors have waited for more than a year despite applying for many jobs. The supply of training placements for overseas doctors has been outstripped by the demand. Training opportunities in the NHS can meet the needs of overseas doctors, which include basic and higher specialist training and preparation for examinations. Improvements in managing and delivering training are needed to maximise the training opportunities; these improvements could include offering an induction course about the NHS and specific training placements and assessing the doctor's training needs and agreeing objectives. Immigration regulations allow overseas doctors to stay in the United Kingdom to complete postgraduate training to the standard of the Certificate of Completion of Satisfactory Training. This certificate is granted by the Specialist Training Authority of the Medical Royal Colleges and confirms that the doctor has completed specialist training.

While we await the recommendations of the review panel, overseas doctors who are considering travelling to the United Kingdom for training must be given appropriate information from British embassies and consulates, from the British Council, and from the GMC. The information must clearly state that success in the professional and linguistic assessment board examination does not guarantee employment in the NHS, and that there is competition for placements in training grades. Overseas doctors should be warned, as those who train in the United Kingdom should also be, that in certain specialties gaining a training post at a higher specialist level is intensely competitive.

Christopher Welsh, regional postgraduate dean. 

NHS Executive Trent, Sheffield S10 3TH (chris.welsh{at}doh.gsi.gov.uk)