Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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A level playing field
- Michael Bates (21 April 2006)
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Unfair to all without prejudice
- Sandeep Kampani (21 April 2006)
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An alternative to work permits for non-EEA doctors
- Julianne S. Fransman (21 April 2006)
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Job crisis for overseas doctors
- Sath Nag (21 April 2006)
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Re: An alternative to work permits for non-EEA doctors
- Peeyush Kumar (22 April 2006)
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Talent wasted.
- Tarun Durga (22 April 2006)
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Clarifying HSMP - Not a level playing field nor it is the light at the end of the tunnel!
- sanjoo chengappa (22 April 2006)
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Tossed aside, nothing new
- A Joglekar (22 April 2006)
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Misinterpretation and twisting of new immigration law
- Sam Michel Ritroda, Ritroda SM (23 April 2006)
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Hope against Hopes
- A K Bhadra (23 April 2006)
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Surprising policy
- Erik T Walbeehm (23 April 2006)
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Hijacked careers
- Arun Natarajan (23 April 2006)
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Hidden Implications for Some UK Medical Graduates
- Elaine Leung, G12 9HZ (23 April 2006)
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Change of goal posts
- A Raghu Ram (23 April 2006)
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Shameful
- ini i. udo (24 April 2006)
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When are we going to Learn
- Najmul H Shah (24 April 2006)
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Legal advice?
- Philibert Kuuzume (24 April 2006)
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Home Student Perspective
- Hans Odd (25 April 2006)
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Locum doctors - nobody seems to remember
- Shahab A Syed (25 April 2006)
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Sentiments and facts
- Abhijit M Bal (26 April 2006)
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GMC Responsibility and the new regulations on work permit
- Assem Rostom (26 April 2006)
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Solutions
- Venkata Sreekanth Sampath (26 April 2006)
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Taking into account international medical students in UK Medical Schools
- Yi-Yen K Kee (26 April 2006)
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Back to Square One
- Dinesh K Sharma (26 April 2006)
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Re: Home Student Perspective
- Naresh G Pore (27 April 2006)
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Another white wash article
- Gopal Sheshappanavar (28 April 2006)
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Re: Locum doctors - nobody seems to remember
- Jibran Khan (28 April 2006)
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Re: Locum doctors - nobody seems to remember
- Ahmer S Hussain (28 April 2006)
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British National, British Trained, Unemployed
- Katrina Webster (28 April 2006)
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Re: Another white wash article
- Abhijit M Bal (28 April 2006)
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A balanced view is impossible!
- Shankar Kamath (1 May 2006)
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Why did I (and others) come to the UK?
- J T George (3 July 2006)
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Michael Bates, Consultant Psychiatrist Cardiff
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Whenever this country has succeeded over the centuries it has been by allowing the best person to do the job, regardless of his background. The British have always begged, stole or borrowed the best available talent. The new visa rules are plainly cruel, discriminatory and open to legal challenge. Are we really to employ a Latvian over an Indian, not on merit, but because the former is a 'European'? Competing interests: None declared |
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Sandeep Kampani, Staff Grade Community Paediatrics Wyre Forest PCT ,worcester
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The article by Lynn Eaton is a statement of the price of poor planning and vision of the health authorities which is reflecting in all ways whether financial or manpower planning. Sadly the price is being paid by the International Medical graduates who come here using most of their financial resources, some running into debt and also their invaluable time for doing IELTS and PLAB. Its a horror story from IELTS to PLAB and to apply for clinical atachment. Getting a job means you are good and sometimes lucky with the fact a few hundred applications down the post with lot of equal opportunity forms. Getting a training post means you are both lucky in the lottery draw and good in your field. To knockout doctors who have trained in U.K. and to send out people here after they have come here after alot of hardship says the whole story behind everything practised in the NHS. Competing interests: None declared |
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Julianne S. Fransman, solicitor Gherson & Co, 1 Great Cumberland Place, London W1H 7AL
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The article by Lynn Easton, "Tossed Aside" (22 April 2006), correctly makes the point that, "Any UK trust wishing to employ non-EEA medical staff will have to prove that no home grown doctors or EEA doctors are available to fill the post." This, of course, reflects that fact that in order to apply successfully for a work permit, the employer must first advertise the position in line with Home Office requirements so that any suitably qualified candidate who does not require a work permit may be identified. Unsurprisingly the Home Office's strict recruitment procedure requirements mean that unless the job in question falls within the list of shortage occupations, the non-EEA doctor stands dismally little chance of obtaining a work permit. There is, however, an alternative route to the conventional work permit, which was not referred to in the above article and which may be of considerable interest to many of the non-EEA doctors affected by the recent changes to the immigration provisions. The Highly Skilled Migrant Programme (HSMP) is a far newer UK immigration category that is related to, but significantly different from, the work permit. In respect of work permits, unless the position falls within a shortage category, the employer has to demonstrate that there is no available EEA doctor to take the position. Crucially, there is no such requirement with regard to the HSMP as it is a status that relates to the doctor personally and has nothing to do with an employer. If a doctor (or any other professional) applies successfully under the HSMP, he or she may seek or take whatever work they wish, provided that it is within their professional field. Unlike a work permit, which is highly restrictive and permits the holder to work only in one particular job for one particular employer and under certain conditions, the HSMP status is virtually totally flexible and allows the successfual applicant to change where and how he or she works at will. The highly skilled migrant may be employed, self employed or both. No application is required if he or she wishes to change employment and/or self employment. It is therefore obvious that the HSMP provides a far more desirable immigration status than the work permit and, in our view, should be particularly attractive to non-EEA doctors who are thinking about alternative routes to residence in the UK. As with the work permit scheme, the HSMP leads to indefinite leave to remain in the UK (commonly referred to as 'permanent residence') and, ultimately, naturalisation and British citizenship. Our understanding at the present time is that a doctor must hold full GMC registration if applying under the HSMP. We have sought clarification from the Home Office on this point and are awaiting further information; however to the best of our knowledge full registration is required. Competing interests: None declared |
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Sath Nag, Consultant James Cook University Hospital,Marton Road ,Middlesbrough TS4 3BW
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The PLAB exam ensured that overseas doctors(mainly from non-EU countries)were up to the mark in terms of clinical competence and communication skills.This valuable and qualified workforce is now being made redundant.It will be most interesting to see how the NHS copes with this change.In this age of clinical governance and accountability it's deplorable that Nationality has taken precedence over merit. Competing interests: None declared |
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Peeyush Kumar, SHO anaesthetics NG5 1PB
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Julianne S. Fransman has written about the HSMP visa.
Some of the deaneries have come out with a new interpretation stating that they can only consider an HSMP holder for shortlisting if the HSMP visa covers the entire duration of the SHO or SpR rotation (ie 3 or 5 years). This is simply not possible as HSMP visa is issued only for initial 1 year (now 2 years) and then extended for 3 years. Birmingham and Yorkshire deaneries have refused GPVTS candidates that they cant be considered as their HSMP visa is not covered till August 2009. Some of these candidates would have been eligible for ILR before 2009. These deaneries say that the HSMP extension or conversion to ILR is not automatic and thus cant proceed with shortlisting. On contacting Work Permit UK, who issue HSMP, I was told that there has been no change in HSMP guidelines and this interpretation by deaneries is news to them. Competing interests: None declared |
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Tarun Durga, SHO Walsgrave Hospital,CV2 2DX
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The measure taken by the Government doesn't appear to be a knee jerk reaction rather a part of well thought out strategy by higher officials in the Health and Home department. It doesn't need a Newtonian brain to figure out that something of this sort would be done. 1.GMC made a quick buck from PLAB, so why should it stop it.It wasn't concerned about the welfare of International doctors! 2.The NHS needed Doctors desperately at around 1998-1999 when there was a media outcry of shortages.The department of health increased the intake of British Medical Graduates and knew that it needed doctors only for the interim period.So it was planned out strategy rather than a knee jerk reaction as made out in the BMJ.The international graduates have been used for the interim period and it would have been right if this was told at the very outset.The future of thousands of International graduates has been completely ruined.I believe that it fair for the internation graduates to feel cheated and be bitter about the system. 3.The International Medical Graduates simulated much needed competion in the NHS.NHS is a monolithic system and it desperately needs to opene up.This strategy of Department of Health and Home Office will backfire in long run. 4.Will it help the NHS or british medical system? I believe it would not.The kind of absolute job security which british medical graduates will enjoy will make them complacent.Why SHOULD ANYONE WORK HARD TO SAVE HIS JOB IF IT IS ASSURED THAT HE WILL BE THERE FOREVER? 5.It is a a difficult situation for the IMGs but they are floating talent.Talent which has desire to work hard and be focussed.Talent Knows no nationality,religion or region.It will flow to place which respect it.I believe sooner or later these IMGs will settle in good positions. However the reliability of British system will be in Question for times to come.Trust in the British system will be the biggest casualty of these decisions. Competing interests: None declared |
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sanjoo chengappa, SHO in Psychiatry Queen Marys Hospital, Roehampton, London SW15 5PN
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This is to clarify the issues around HSMP. After all the turmoil consequent to the quick fix policy changes in March by the Department of Health and Home Office it appeared for a while that overseas doctors who constitute a significant part of the NHS medical workforce had a level playing field and a fair chance to continue and finish their training through HSMP because this would have put them on par with UK and EU graduates when applying for jobs. For most overseas doctors like me who are currently in the middle of their training this would have been an way out of the mess they now find themselves in. HSMP visas until April were given for period of one year that could be extended for a further 3 years ( 1 + 3 years ) if the candidate could show that he had been economically active in that one year. After this period of time the person could apply for indefinite leave to remain. After April 2006 this has been changed to 2 + 3 years because of the policy change from 4 years to 5 years required in total to apply for indefinite leave to remain. All this was well and good, however the NHS trusts after consultation with the Home Office and Department of Health have been rejecting non-EU doctors with HSMP visas if they dont have a period of visa covering the length of the job ( ref 1). In most specialities SpR training schemes run for 5 years (except in Psychiatry where some schemes are for 3 years). This effectively excludes every non-EU doctor from taking up specialist training. You cannot apply for specialist training job in the first, second year of the HSMP nor can you do so after you get an extention of the HSMP because at any point in time you dont have enough years on your visa covering the length of the job. The argument that the HSMP visas would be renewed/extended if the candidates have been economically active (that is the only criteria that is required for extentions of HSMP visas) dont seem to be accepted by the NHS trusts on advice from the Home Office who say that they cannot automaticaly guarantee extentions of HSMP visas. This appears to be a part of the series of cruel jokes being played on non EU doctors who now face uncertain futures due to inconsiderate policy makers. Ref 1: follow the link and look at point 20 http://www.bma.org.uk/ap.nsf/Content/guidanceimmigrationapril2006 Competing interests: overseas doctor |
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A Joglekar, SpR St. Mary's Dept. of Child Psyhiatry, Loondon W2
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The action by Home Office and DOH basically stink of colonial attitudes. When the British first landed in India, she was contributing over 25% of world economy. 300 years later when they left after what they call ''the great british raj (rule)'' India was contributing less than 3% of the world economy. I have always called British presence in India as ''the great british loot''. They left when there was nothing left to loot. Now it's intellectual & educational collonisation. Invite overseas docs, use them when required and then discard them. Dadabhai Navoji, twice prsident of Indian National Congress when Indians were fighting for freedom calculated that if we take an under-estimate of £3.5 million being made PA (multiply that with 300 years) by the British out of India, with an interest of 7.5%, HM and her citizens actually owe India over a 100 trillion. And what happened to Commonwealth aspirations, sorry, goodbye commonwealth - welcome EU. Competing interests: None declared |
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Sam Michel Ritroda, Research Associate Cardiff,CF14 3BR, Ritroda SM
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1. We were shocked to learn that on occasions International Medical Graduates (IMG) working within NHS have been called by the personnel department of the trusts they have applied for and been told that they cannot be short listed for interview as they will not have a PFT visa from August. 2. For the Specialist Registrar post, which is for 5 years, there is no visa option to cover the period. In simple terms there is no SPR post for coloured skin and only on base of skin not on the base of merit interview will be done. Its good reminder of USA in 1060s and just 50 year of divide UK is still there. IMG are being rejected not on qualifications but immigration status. We strongly feel being part of a system that openly discriminates in this way. Overseas doctors will now be openly treated differently in the NHS. Some trusts have already gleefully started rejecting applications from them to decrease burden of workload. This is blatantly discriminatory and completely against the spirit and intention of the WP regulations and challengeable. 3. It need to be told in no uncertain terms it's very wrong to deny applications on this basis and people should be offered the interview and job so they have a chance for a visa-if their ability warrants it. Any stipulations regarding nationality or residency only apply at the stage of appointment -not the interview. Not short listing them is tantamount to denial of the right to compete - which is not the intent of the law. 4. Equal opportunities still apply. Unless you voluntary declare to come out from equal opportunity policy, denial for an interview on basis of immigration status means IMG is denied an opportunity to be appointed. 5. In all of theses guideline by DOH and Home Office, there is no mention that a foreign national will not be short-listed because there were EU/UK nationals available. Any decisions re suitability or unsuitability can only be taken after interviewing candidate’s .If it turns out that the EU/UK nationals favoured unsuitable then you will deal an autonomic and illegal status where you appoint anyone without any merit. 6. If you have interpreted guideline in that way you cannot answer the problem. IMG needs a job to get work permit visa. If he cannot get even a short-listing for job how he will arrange visa? He cannot get a visa, as personnel department are denying giving them a short-listing for job. 7. A law is a law. It has to be followed or obeyed. But: It can be open to interpretation. It can be ambiguous and unclear. It can be twisted out of context. It may contain many loopholes within it, knowingly or unknowingly. Therefore: Its interpretation is open to challenge unless very clear-cut and precise. Ergo, it would appear that putting a condition like "popular post" as an exclusion clause is not a LAW, but an INTERPRETATION of that law - which by the personnel department sounds downright ludicrous, not to say illegal. 8. The Guidelines says- "If you are advertising a popular post, you may wish to restrict applications to only those doctors who do not need a work permit to take up the contract. This should reduce the number of applications you have to deal with." But it also says- "Where a work permit is required, you, as the employer, need to apply for a work permit on behalf of the doctor/dentist. When this is issued, the doctor/dentist themselves will then need to apply for leave to remain as a work permit holder. If the doctor/dentist currently has leave under another category of the Immigration Rules (for example leave as a Postgraduate Doctor or Dentist) then they will not be able to take up the post until both the work permit has been issued and the doctor/dentist themselves has been granted leave to remain as a work permit holder." So in simple terms if some have PFT already given till Feb 2007 and job continue till same duration, one cannot refuse short listing for this IMG. 9. Fact is no one is asking for concessions, but for a PROPER reading and lawful implementation of the law is essential, so that a fair decision is made instead of a completely distorted one. Disqualifying him from competing is against the purpose of the European Work ethics. We are talking about COMPETING, not OBTAINING. It clearly mentions that protectionism starts only at the appointments stage, not with the interview process. 10. We are in also in process of demanding a grace period of at least a year for those rendered jobless in this manner - to give them a fighting chance to compete and get back on their feet. One suggested option will be to introduce this new rule to those who will start their career whilst those already having a foot in the ladder continue work permit but have no discrimination. The competition for the local graduates is not from existing overseas doctors in employment but by the 1000's that are waiting for their first job. 11. We also know that if IMG get a job, it will be at the expense of possibly better doctors than IMG due to their nationality. This Situation is shameful and short sighted. With one change in rules the government has succeeded in driving a wedge between colleagues. You cannot seriously expect IMG to up and leave in the middle of their medical carrier. But, I m not that optimistic to say that Government will have the courtesy to act in a civilised way because its question of different ethnic origin. What has just happened to IMG is akin to a barren woman adopting a baby and down the line when she eventually conceives and gets her own baby decides to drive away the adopted baby. How different is U.K from any uncivilised autocratic country it need to be ascertain in International forum. We are living in UK in 2006 or slave and race supremacy age of 1600 century it is evident the speed trusts responded in interviews We are not really sure the goal posts have not changed along with the rules of the game? 12. Remember the current overseas doctors already in employment have contributed (and also gained) from the NHS and in a way; their loss is just as much a loss to the state. PROPER reading and lawful implementation of the law is your accountability, so that a fair decision is made instead of a completely distorted one. Competing interests: Overseas Doctors Support group |
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A K Bhadra, Research Fellow Royal National Orthopaedic Hospital, HA7 4LP
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Its a long and extremely difficult journey from IELTS, PLAB, Clinical attachment to eventually being lucky enough to get a job. Majority of the Non-EEA graduates start with a heavy burden of debt and with an average wait of 12 months or more before securing a job in the NHS that burden only becomes heavier. But they still survive with a slim chance but a big fat hope. After all these, when they manage to get into the system with their merit, excellence and hard work, they like to smile with bigger hopes of progressing smoothly to a better career.There comes the new rule that they are no longer wanted in the system, because they do not belong to the EEA. Nobody surrounding these hopeful bunch clearly know about this new rule. Different deaneries are interpreting and trying to implement the new rule in different ways. Some deanery is mentioning that the Specialist traing is primarily for EEA members only, some deanery is saying that doctors with HSMP will be considered as par EEA members whereas some other deanery is saying that Non-EEA without HSMP for the whole length of training cannot be considered. Even after all that we are still surviving with hopes, spending hundreds of hours and sending hundreds of applications to every corner of the country and hoping we might get a lucky break. This is very sad that the criteria for being a part of the NHS and serving the British people is not the merit, skills, excellence, hard work or honesty, it is - who you are, how you look like, where you are from. But the neverending hope for a lucky bright day will always be there till the end. I would like to remind the rule makers that outside the walls of their offices they are also normal human beings. It is unfair to play with your fellow human beings' lives. Moreover I think the British people deserve to be in the safer hands than being sorry. Competing interests: None declared |
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Erik T Walbeehm, Clinical Hand Fellow Wythenshawe Hospital, Manchester, M23 9LT
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Following the article "Tossed aside" by Lynn Eaton and all that has been on the news, I am amazed that the NHS has taken to such drastic measures. As a european national (dutch nationality) I can understand the notion that protection of one's own people is important. In quite a few countries there has been debate about opening up the borders to eastern european workmen, who are going to be working at far cheaper rates then the local workers, outpricing them and interfering with local economics. Those people are banned at the entrance, if needed, but the debate is still continuing, because of political and ethical issues. However, the NHS has been relying on foreign doctors for a long time, in order to get the work done. It is not that those doctors have come in and taken over jobs from local doctors. If there is a shortage now, a notion that Eaton challenges because the conclusions drawn from the poll might be flawed because a small number of doctors interviewed and a badly chosen timepoint for the interview, that is a planning problem. The necessary number of students entering at medical schools has been miscalculated, and possibly the number of foreign doctors allowed entrance, also. Is the way to deal with this to discontinue doctors that are already working here, and doing responsible, busy jobs?? They are punished for a planning problem which was probably misjudged by somebody sitting behind a desk working from nine to five in an utterly secure job?? I can agree with protecting one's own, but it is unethical to bar people from finishing what they have been allowed to start, for other reasons than malpractice or faults. Shouldn't this be approached in phases? The doctors that are here should be allowed to finish and less people should be allowed to enter the country. That way nobody is promised anything under false pretences. It is surprising that an organisation like the NHS, where political correctness is getting to an almost absurd level, allows a policy like this. It is also inconceivable to think that this policy would actually hold up in a european court of law, and I can understand the indignation of all foreign, non-eu, doctors in this country. Hopefully, somebody with sufficient political and managerial power will come to his or her senses and think about this problem rationally and responsibly. Competing interests: None declared |
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Arun Natarajan, DRWF Clinical Research Fellow University of Newcastle
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Dear Editor, What will happen to overseas doctors who are pursuing research in order to compete for specialist training numbers? I have spent nearly seven years in the UK and have been plugging away at research since two years (without a salary for the initial 6 months) hoping to embellish my credentials and somehow, anyhow, gain entry into a cardiology training program. And one fine morning, the Department of Health springs this nasty surprise. Suddenly, I find myself incapable of competing in the job market because of my nationality despite having several ‘extras’ on my CV. Even if one does hold an appropriate visa, it apparently needs to cover the full duration of the post applied for. And no visas are granted for 5 years. So the trap is indeed well laid. The chances of being offered a 5 year rotation are bleak, especially in an oversubscribed speciality like cardiology. I realise that I chose this path myself. Then again, one plans such things in life in good faith. One does not walk out of the house each morning expecting to be struck by lightning. Have seven years have gone down the drain. I find it difficult to accept this. Where and what next? Hundreds of others probably face a similar impasse. But then, who cares about such trivialities. Arun.Natarajan1@newcastle.ac.uk Competing interests: I am an International Medical Graduate |
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Elaine Leung, International medical student Glasgow University, G12 9HZ
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UK MEDICAL GRADUATES WITHOUT AN EEA PASSPORT As an international medical student, I have been following news on the rule changes for days. I am so glad to see that this cruel reality has finally made known to the public (instead of being broadcasted only on More4). However, most people are still not aware of the fact that international students graduated from UK medical schools will ALL be affected too, if he/ she does not hold an EEA passport. With the SAME medical degree and training, we will not be able to proceed for specialist training after our foundation years simply because we have different passports. Many international medical students come from countries with no infrastructures for further medical training. Not being able to be trained in the UK leaves these international medical students and their countries in a desparate position. On the other hand, it is also a loss for patients in the UK. The quality of patient care is no longer the top priority when the type of passport is used to determine who takes care of the patients. P.S. It does give you a bizarre feeling when you hear that some medical students are thinking about the possibility of repeating a couple of years during their undergraduate training (by failing their exams, and with a price tag of about 19000 pounds per year) in order to be here long enough to apply for a different residential status. Competing interests: One of the many international students who will be affected. |
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A Raghu Ram, Consultatnt Ophthalmic Surgeon Royal Glamorgan Hospital CF72 8XR
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Dear Sir I have keenly following the debate over overseas doctors in the medical and lay press over the last few weeks. As a trainor for many of the overseas doctors, I can see the frustrations of many of our trainees who have been abandoned midway by the new home office regulation. These doctors who have invested their valuable time and money for training have been suddenly told that they are no longer needed. It is like disqqualifying your team at half time in a football match!!. Moreover it is astonishing that GMC continues to conduct PLAB exam and justify holding them ( letters BMA news 22nd April) on the grounds that it is seeking to demonstrate medical knowledge and skills in IMG's.( International Medical Graduates). I am not sure what purpose it serves when most of the IMG's are not able to enter training schemes due to new regulation. I thinks it is time the the government takes responsibility for the completion of training of overseas doctors who are already here and the best way to stop oversupply of IMG's is to put to a stop to PLAB test which is being held in many overseas centres. Yours sicerely Mr A.R.Raghu Ram, MD,FRCS,FRCOpht. Consultant Ophthalmic Surgeon Competing interests: None declared |
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ini i. udo, SHO medicine Nobles Hospital,Isle of Man
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A look at all the furore surrounding this article shows the impact this issue is having on the medical polity. I am an african, a nigerian,we have known the British to be gentlemen. It is indeed very sad that the Home office/DoH will conive to suddenly spring out such a new and devious visa regulation to affect 'gentlemanly' people of the society. How can you wake up one day and make such an announcement in one fell swoop?Threatening THOUSANDS of families with dislocation within a couple of months!This is looking to make the Late Fieldmarshal Idi-Amin of Uganda a saint,or tell me what difference is there in this to Robert Mugabe seizing farmlands from 'foreigners' in Zimbabwe. All through medical Schools in Nigeria over the years there has been the crop of distinguished British trained Consultants who have taught us,Consultants we hold in the highest of regards because of the knowledge they have shown and imparted over the years, hence it is not difficult to make the UK a destination to obtain the golden fleece when a young doctor is looking at the future. But now those of us who made our way over here are now a laughing stock.We are returning home with nothing,our contemporaries back home have even left us behind. You can only imagine what service Britsh trained consultants have offered humanity over the years in my country.I feel ashamed, i can't quite decide if i am ashamed of my self or of the British. I am very sad that inspite of all the trouble and hurdles- PLAB I and II,selling my possessions,searching for clinical observership posts,countless job application forms(not just CVs,yes thousands of pages of filled Job Application forms, Permit free Visa etc then suddenly this...it is certainly most unkind,and will certainly have repercussions in future. By the way,let me make very clear at this point that i am not an economic migrant, i tell you and i invite anyone anywhere to disprove the fact that the Consultant Practising in Nigeria gets more respect and lives a more comfortable life in terms of his wordly possessions vis-a-vis the society he lives in than the one living in Britain. I am totally in support of UK gradautes being infront of the queue when it comes to job offers,if this so then why tamper with PFT visa, what has this got to do with the Permit free Visa? If there are so many so so numbers of British gradutes coming through the system then surely humanity requires that we discontinue the PLAB tests and not put poor young enthusiatics but hapless chaps into a hopeless situation by deceit.The PLAB and the Royal college Exams centres overseas have to cease. Let people not be desuaded from going to study in America or Australia by deceit. Lastly,this problem only proves to me the more how out of touch the DoH is with facts on the ground.If anyone sits down to consider the day to day function of Hospitals, he will realise that there will be crisis come August, but by then many of the foreign doctors would have been gone, i hope our dignity holds out and we never return.But i pray that for the sake of the helpless patients that the ?incoming doctors from ALL OVER EUROPE quickly get their english right less a disaster portends. Competing interests: None declared |
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Najmul H Shah, consultant gastroenterologist Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham B9 5SS
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When are we going to learn? All our previous attempts to eliminate overseas doctors from the NHS have failed miserably in the past and I can guarantee that this latest initiative also is going to end up with a similar fate. We tried this before while unfolding the Callman scheme, with the “Orange Book” only finding a very small paragraph for the provision of training opportunities for overseas doctors.You know the out come!. Despite our utmost efforts and desires, we could not do it with out overseas doctors and ended up filling up to 50% posts for SpRs by the same group. We again attempted this by trapping hundreds and thousands of energetic, knowledgeable and competent overseas doctors in the useless cul -de-sacs of “NON Career Grade”. When we miserable failed to fill up our consultant grade posts from other sources, we ultimately have to come up with a new legislation to provide a way out for the same doctors stuck in these Cul-de Sacs to now get out of this mess to be placed on the specialist register via the new route. Overseas doctors were again used as guinea pigs to experiment with the recently launched Foundation program and then dumped.From the feed back i can see, It will remain to be seen how soon they will be needed again to come to our rescue. I only wish we truly recognise a definitive role for overseas graduates in the NHS. We need a policy of INCLUSION rather than EXCLUSION when it comes to making provisions for overseas doctors in any of your new schemes. We, perhaps, can be guilty of compromising the quality of care in the NHS by breeding a group of physicians by default, who are going to be less confident and inadequately trained, due to gaps in their training while struggling to stay in non training posts in the interim period of uncertainty due to our failed schemes. For the present, I can only ask the overseas doctors to be patient and around. This scheme is also going to fail shortly and you will be wanted very soon. Don’t go away as yet Competing interests: None declared |
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Philibert Kuuzume, Clinical Attachee Bedford Hospital
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I am particularly not surprised at the final decision reached by this government as regards non-EU medical graduates. The way the mood of the Trust medical application forms gradually changed over the period, associated with stringent visa issuance policies said it all. The advice to my fellow colleagues of the noble profession is not dispair but to have a deeper reflection about the next decisisve step because we still have a lot of years ahead of us. Even if they succumb to pressure now on the surface, the situation may be what they want to do at the various trust levels. The home office has had it wrong on many occasions and their judgements ridiculed by the courts. Why dont we start talking to the legal arm of the system so that we can have home office come to explain why they would not consider/compensate all those of us who have successfully completed the plab exams and are already in the system. Good Luck to us all. Competing interests: None declared |
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Hans Odd, Medical Student St Georges London University SW17 0RE
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It is instructive that the majority of respondents are those affected directly by this new ruling, so I'd like to offer a perspective from those who might directly benefit from the outcomes most people believe might stem from it. I understand the pesonal sense of loss that people who have incurred financial losses coming to this country to gain specialist training - the professional implications for the individuals concerned are also very profound. Here though is where I must add the first of several BUTs. There are several large issues involved here: the affect of drawing in so many able individuals from overseas is having great health care implications for the countries of origin. Since many of the replies so far have mentioned that the ultimate end is leave to remain or permanent residence, the idea that many Doctors train to return to practice in their home countries seems a specious argument, as very few foreign doctors seem to return (or can someone provide hard figures for those that do so, in order to spread the benefit of their training in their home countries? It would be most instructive). On one hand this practice is either intellectual asset stripping of developing countries' intellectual resources, or human capital flight, where high achievers can earn the most money - neither help the countries of origin, but obviously do benefit the NHS and the individuals directly. My second 'but' is apart from citing personal financial loss, how can IMG justify British tax payers money to pursue their own professional and personal development, if the increased number of medical students currently in training, 56% increase across the UK and 67% increase in England (of which I am one), will make the numbers from abroad surplus to those actually required by the NHS? This is a hard-nosed question, but if it comes to a question of merit, it might seem a slur on the UK medical schools if they aren't seen as being capable of providing adequate care for patients upon graduation. There needs to be a greater level of honesty from both government and IMG's about the reasons and purpose of specialist training here in the UK. If the idea of training is to allow the dissemination of techniques to countries without the ability to train indigenous doctors insitu, then this can be seen as a function of overseas development and should administered as such. If it was really an interim policy to make do and mend until the UK became self-suffient in doctors to meet politic targets, this too should be admitted. I and many other current students were anxious over the stories of the failure of UK students to find jobs, as was widely reported at the time in the popular and trade press. We stand directly to lose out if the market is saturated by capable and motivated students from abroad. The point has been raised that this will lead to complacency and lowering of standards amongst home students, who might be lead to believe they have a life long sinecure in the NHS due to little other than being lucky in which part of the globe they were born in. I don't beleive this will happen - why? Simply the competition here at home is rigourous enough - for each student selected by St Georges on the Graduate Entry Programme 20 did not receive a place. Competition too for places on Specialist training, further down the professional road will also ensure that standards do not slip. I and my colleagues have embarked on a medical career for many of the same reasons as IMGs - to have an intellectually rewarding job serving our community. The fact that doctors in the UK are now the best paid in Europe - and presumeably better paid than many if not all developing countries - has nothing to do with it.....surely? Or am I being naive? Ensuring patient care of the highest order is too important to be elided with personal arguments for IMG Sprecialist training as it currently is. Competing interests: Ist Year Medical Student (Graduate Entry Scheme) |
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Shahab A Syed, Consultant Surgeon Multan-Pakistan
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The current changes in NHS for non EEC doctors demands reviewing by all the concerned and responsible authorities. (Home Office, GMC, BMA, Royal Colleges, Hospital Trusts, Health Department and Social Services) as this is a mistake which will have drastic implications on NHS and training of overseas doctors which we are all proud of. It is astonishing that one big taskforce of the locum doctors filling short term posts of NHS from non EEA countries has been completely forgotten. A number of specialist doctors who neither hold, nor intend to apply for British Nationality but have been trained in UK, achieved necessary qualifications, hold full GMC registration regularly come to work in UK for short term periods and contribute significantly to NHS. Their expert services to NHS are very well recognized by their colleagues as the safety of patients is not jeopardized. Home office should have a visa category for them as well, so that NHS does not lose on that. This can be very easily accomplished by simply taking an oath from these doctors that they will neither avail public funds, nor apply for British Nationality. I am sure all NHS consultants can foresee that by giving these short term posts to doctors not familiar with UK health system not only places hospital trusts in danger but also is a great risk to the patients well being. Competing interests: Overseas Surgical Locum Regstrar/Staff Grade /Consultant |
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Abhijit M Bal, Specialist Registrar Department of Medical Microbiology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN
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It must be said that any change does affect people in the short term. However, I feel the international medical graduates affected by the present ruling have gone overboard in their criticisms. Unfortunately, I find that expresson of sentiments has taken precedence over statement of facts. More than the ruling, the rapid responses have ended up dividing the doctors club. Competing interests: I am an international medical graduate from India |
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Assem Rostom, Consultant Clinical Oncologist The Royal Marsden Hospital, Downs Road SM2 5PT
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Now with the new regulations on work permit, I assume the GMC will stop the overseas part one PLAB examination and the UK part two which is a good source of revenue. The Answer is not. They are continuing to hold this. Why go on if the chance of getting a job for the non-EU gradates is impossible? Its beyond me! Competing interests: NONE |
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Venkata Sreekanth Sampath, Specialist Registrar Haematology Cardiff
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Non UK/EEA medical graduates have been given a raw deal because of the new policy. The UK government can continue to have the policy of considering an UK/EEA graduate above others and make the following additions. 1. All non UK graduates( including EEA) should give evidence of their competency in English by passing the IELTS test. After all , for many EEA graduates English is not the native language and in the best interests of the healthcare of UK people, they should prove themselves to be as competent as non EEA graduates as far as English goes. 2. The PLAB exam should also be passed by all EEA candidates and possibly all UK candidates( similar to how all US candidates also have to pass the USMLE). Once an EEA candidate has passed the IELTS and the PLAB exam, let him be considered above non EEA graduates; the current rules can continue to apply. Otherwise there is every chance that a UK citizen might have to undergo treatment by incompetent doctors who have neither passed the PLAB nor shown ability to communicate well in the English language. Competing interests: I am an IMG |
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Yi-Yen K Kee, SpR Geriatric Medicine St Helier Hospital, SM5 1AA
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Dear Editor, I am writing regarding the recent change to the visas for non-EEA doctors. I am a graduate from a London medical school and am fortunate that I have not been affected by the recent changes. One of the main reasons for me choosing London over Sydney when I was making my decision of where to do my medical training was the ability to continue working in the country that I will train in. At the time of my application to medical schools, Australian medical schools clearly indicated that due to their over supply of doctors, foreign students will not be guaranteed training jobs upon graduation. Therefore, seeing that I would have have the chance of completing my postgraduate training in the UK, I elected to come to London rather than sunny Australia! I do not regret that decision and have had an educational and fruitful postgraduate training. It is very sad that future generations of locally trained doctors but who do not hold a EEA/British passport will have to leave the country even though they have spent 5/6 years in medical school in the UK learning about the workings of the NHS! Tuition fees for overseas students are expensive, especially for medical students. I am sure that many foreign students will reconsider the UK as a country of choice to study medicine if they are unable to continue their postgraduate training as well. The universities will have to start counting the cost of losing these students! The UK has always been welcoming of foreigners and many have chosen to stay in the country. Some have taken up British citizenship and continue to make a positive contribution to the field of medicine. I hope that the Home Office will make an exception for non-EEA doctors who have trained in this country to remain and complete their postgraduate training in the UK. Competing interests: None declared |
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Dinesh K Sharma, SMO ESI Hospital, Amritsar-143001
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Dear Editor, As the full impact of decision made by UK government unfolds over the next few months, a large number of Indian Medical Graduates would realise the futility of their sojourn to UK in search of greener pastures. When they return to their homeland they would find that their peers who were left behind are now busy pursuing postgraduate studies, running their own clinics or working with public and private sector hospitals. They would have to struggle find a suitable niche for them in a changed scenario. The UK government rashly recruited doctors from a poor economy when it needed them and has now dropped them like hot potatos. It serves us well too! We now have to make our young medical graduates understand that best place for them is their own land.India is waging a grim battle against disease and poverty. It needs more hands in this struggle. Next time UK needs comes begging for doctors in India, the Indian government must negotiate a secure and honourable deal. Until then you live happily in UK and we are happy on our own soil. Bye Bye UK and wishing you a prosperous EU and EEA! Competing interests: None declared |
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Naresh G Pore, Research Fellow Colchester General hospital, CO4 5JL
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Firstly I wish to make it clear that although I am also concerned regards my career like my fellow IMG's, I feel that if The DOH was pursuing this new policy to protect British Medical Graduates then I would have had no complaints about the same. However can you tell us how an European doctor (Non english speaking) is any better than a Non EU doctor who is already undergone some training in this country or comes from a country which follows the British Medical system. Now coming to the issue that you raised regards British tax payer being burdened, I would like to point out to you that The British Government does not issue visas free of charge to us to come to this country. The GMC charges fees for the PLAB exams and also for the Registrations. The Royal Colleges also charge their appropriate fees accordingly for their Memberships. Also we pay a tax at 40% to the Inland Revenue and still it is mentioned on our Visas that we have no recourse to Public Funds. Also when we register to local Universities for Post graduate degrees our fees are atleast 5 times higher than for the local graduates. So you can see that rather than burdening the British tax payer we do contribute to the system including the NHS. Inspite of all this we have been following the rules since we know that working in the NHS has benefits for us and not necessarily financial. Is it too much to ask for a fair playing ground on basis of merit and not nationality? Competing interests: None declared |
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Gopal Sheshappanavar, Orthopaedics Stanmore
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The article in the BMJ does not seek to address the real problem. It is used as an opportunity just for the sake of publishing an article. Those who read the article know most of the issues already mentioned in this article. It would have been worth the paper if the real issues were addressed. And the real issues are 1. What would happen to thousands of bright overseas doctors who are not in SpR or other rotations who have given time and effort to contribute and learn from the british health system. They are left high and dry with very uncertain future before they got into so called 'proper training programme'. 2. What about those doctors who had HSMP visa and had promised at the time of application for Visa to make 'UK my main home'. Does their promise not have any value? 3. What about those doctors who have yet to start working in NHS after spending lots of time and money taking PLAB? These are the real issues and should have been addressed in the article. Competing interests: None declared |
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Jibran Khan, Medical Consultant USA
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I agree. We are a special group of doctors making significant contributions as highly trained professionals who ask for nothing in return except the immediate monetary benefits, placing no extraneous demand on the government and not competing with any vested group for permanent positions. We deserve special recognition and treatment. Competing interests: None declared |
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Ahmer S Hussain, Consultant Ophthalmologist Nishtar Hospital, Multan
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I agree with Mr Syed regarding policy changes in rules affecting the training and work of non EU doctors should have been made after joint consultation of the concerned authorities (Home Office, GMC, BMA, Royal Colleges, Hospital Trusts, Health Department and Social Services) and not by an individual department. NHS will certainly face problems regarding patient care and safety on short term locum appointments. Till now non EU, UK trained doctors who have returned to their respective countries without applying for British nationality occasionally come to UK to provide specialist services to NHS and also gain from the recent advances in their respective fields. PFT visa enabled them to work on these short term posts but with the recent changes in rules, practically it would be very difficult for a trust to do that on a short notice to DHSS. A British or EU doctor may not always be available or interested in taking these short term work commitments. Therefore, a visa category particularly aiming on such specialist services to NHS should be introduced by the home office. syedahmerpk@yahoo.com Competing interests: None declared |
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Katrina Webster, Unemployed SHO N/A
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I have read the many responses to Eaton's article with great interest but was disappointed to see just one letter, from a British medical student (Home Student Perspective, Hans Odd), giving an alternative perspective. I am a British national who trained in Britain but have been unemployed for 4 months. I contribute this in part to the unbelievable competition for posts due to the huge influx of foreign doctors into the UK. We do not have priority for jobs over IMGs and even with the new regulations will still be competing against the whole of Europe. I keep hearing the arguement that "hospitals will have to give a post to a UK or EEA national even if there is someone better from elsewhere". I find this suggestion offensive. This country trains good quality doctors in the health system which they will work. Growing up and training in this country gives a unique appreciation of its culture and hopefully great communications skills (you would never succeed at medical school without them!). Unfortunately these qualities are apparently overlooked, despite them being a requirement by MMC, in the immense competition for posts. I do feel that IMGs are being treated unfairly but I believe the only fair solution would be for all doctors trained outside of the UK to require a work permit, as is the case in Australia and New Zealand. If this does not happen the UK will continue to lose its home grown medics, who it should hold in high regard & that it paid £250 000 to train. I hope this goes some way to explain to IMGs that the situation of the UK being apparently saturated by doctors is affecting everyone no matter what passport you hold. Competing interests: None declared |
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Abhijit M Bal, Specialist Registrar Dept of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN
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I wish people could set their emotions aside and then look at the problem. Jobs are not a guarantee now. Jobs were never a guarantee anytime. What has changed is the recruitment process that make it more difficult for IMGs to get selected. HSMP visa does need people to sign the said declaration but all of it is subject to being economic resourceful. In any case, you sign the declaration but the Home Office does not promise you a job and does not give you a sovereign right to stay. You are also free to change your stance and leave the UK. If the Home Office must ensure a job because you have the HSMP visa, then you must stay in the UK no matter what happens and no matter how your career progresses. And now the PLAB. PLAB is set at the SHO level and the candidates who qualify are free to choose the speciality they want to pursue. There may still be openings in certain disciplines (such as psychiatry or microbiology) and to deny a person the right to prove his or her capability is not correct. It is upto the individual to sort out the job. Also, there are places in the UK where local graduates are reluctant to go and such positions could still be filled by IMGs. Yes, people need to be made aware of the difficulties and this has been made very clear by various bodies such as the GMC and the Royal Colleges. The arguments against PLAB, the NHS or the Home Office and the visa process could have been made even prior to the new regulations. If the best person should be selected for a trainee position irrespective of nationality, why should the best person not be choosen for a consultant appointment? But any employment is based on the ability to be eligible for a work permit and this situation is not unique to the UK. There is no doubt that the influx of IMGs has contributed to this job crisis and has eventually led to this ruling. Most IMGs must have been aware of the difficulties but were nevertheless prepared to give things a go. Sagacious assessment on their part could have predicted this eventuality. In fact, it was easy to foresee this. After all, successful people are those who are able to stay a step ahead and not those who are caught napping. Indeed, the globe is by no means homogeneous. We would wish every part of the world to be similar in terms of economy, health, and resources. But that is not the case unfortunately. The responsibility to reach this goal lies with both- the developed and the developing. It is a two way traffic. Competing interests: I am an international medical graduate. |
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Shankar Kamath, Associate Specialist, Psychiatry Walsall
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I read with interest the arguments that have ensued in the rapid response section, and want to voice my views. The visa changes were imminent in light of local graduates who are jobless. These graduates face relentless competition from overseas doctors-this group is heterogeneous- some are seeking basic training anew, while some are clearly overqualified for the posts-having completed their post graduate training back home, and having migrated for economic reasons rather than core training. This may be healthy for competition, but at the cost of losing home grown talent, and there is no place for fairness in this argument-a country wants to keep its own. I dont see these rules as any more oppositional to open competition than say the proposed reservation changes in India to include private sector employment. The situation is full of perverse catch 22s. The GMC is labelled a regulatory body, and oversees the working of doctors; What non political reasons can it give for allowing EU doctors to practice without their language/communication skills being validated via IELTS? If local graduates are jobless due to competition, then policy makers should have addressed EU doctors too, thus allowing british graduates access to jobs which are rightfully theirs. The exponential increase in the number of PLAB places when employment bottlenecks were apparent early on, reeks of a commercial venture. PLAB validates overseas training, so I fail to see how it can be considered disparately from employment prospects! It is the stealthy manner in which the rules were imposed that angers and dismays most IMGs. These rules were first tabled in parliament atleast as far back as February 2005. They were sketched in a political climate where overseas doctors (who are economic migrants) were sadly lumped with asylum seekers as "immigrants". Why were these rules not made public at that point, to enable folks to plan contingencies for their next year? Why were they announced a few weeks before they came into effect? Indeed, the debates/discussions between various affected stakeholders like the BMA, NHS trusts, Training bodies etc and the Home office should have occurred BEFORE the changes came in, if there was any genuine sensitivity to the difficulties of these doctors. The GMC in its crucial role of managing the influx of doctors should have been consulted too. It feels as though these various organisations chose to work in complete ignorance of each other. It is a market place, and apparently the only drivers are supply and demand. Competing interests: I am an international medical graduate |
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J T George, Specialist Registrar York District Hsopital, York, YO31 8HE
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I have read the many responses to Eaton's article with great interest especially those from a British medical student and an unemployed doctor giving alternative perspectives. There is little doubt that the influx of overseas doctors have contributed at least in part, to saturation of the job market. It is also true that 'home grown' doctors have a better understanding of the local health system and therefore may have inherent advantages in communication. However, the NHS has prided itself in equality of opportunities and this is one of the reasons I chose UK as my destination for postgraduate training. I secured my medical school seat in India through tough competition (at least 300 candidates compete for each seat)and had a choice to continue training in US, India, Austallasia or the UK. I invested time, money and effort to demonstrate my language (IELTS), skills (PLAB) and basic medical training (MRCP) and earning potential (HSMP)- all of which I sailed though. I have also convinced a panel of specialists and laymen, through open competition, that I am good enough to be accepted into a specialist training program. It defies logic that someone else like me should now be denied an opportunity to compete for such positions. No one is asking for a promise of employment - only an opportunity for those already in the UK to compete on equal footing. Increase in medical school intake and MMC have all been planned over many years. If UK authorities had hinted that a level playing field would soon be abolished, that anyone with a European Citizenship would be employed even before my application was even considered, I wouldn't have come to this island. Many others I know wouldn't done this either....which would have made the New Deal for junior doctors and the European Working Time Directive difficult to implement! I do agree that UK has to look after its own. However, this is no excuse to derail training plans of young doctors who have demonstrated their mettle. If international doctors were not allowed to compete for posts in the NHS, Parveen Kumar, BMA leader and co-author of the much loved 'Kumar and Clark' would have been practicing medicine elsewhere! The concept that you can discard trainees of proven mettle to accomodate someone else is morally and ethically unsound. It is surprising that an organisation like the NHS would not want to employ the very best in the world, but would rather support artificial barriers to competition. Competing interests: None declared |
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