Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Reserve training places at your own risk
- Kapil Parakh (21 September 2007)
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Reserved training places for overseas graduates
- Jonathan N Allcock (21 September 2007)
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Whats wrong with UK graduates?
- Elliott J King (21 September 2007)
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The true Multinational Corporation
- M Dalvi, Nina Kapoor FY1 Basingstoke Hospital (22 September 2007)
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Should postgraduate training places be reserved for UK graduates?
- Thein H Oo (23 September 2007)
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nhs ethical recruitment policy is a joke
- edmund willis (25 September 2007)
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competition only
- ivy paul (17 December 2007)
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Kapil Parakh, Instructor, Johns Hopkins University School of Medicine
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There has been significant debate on how to deal with international medical graduates in the United States and United Kingdom. The recent article(1) fails to mention the contribution of international medical graduates to the healthcare system of their adopted countries. A recent report in the Lancet noted that the contribution of international medical graduates “is crucial for meeting the health needs of the UK and its diverse population."(2) Similarly, the United States "draws some of the world's most talented medical graduates who contribute enormously to the country's research endeavors" and are "overrepresented in the groups that care for the country's most isolated and vulnerable citizens."(3) The main criticism of international medical graduates is that they are crowding out UK graduates from training positions.(4) However, by increasing competition for postgraduate training positions, international medical graduates force UK graduates to acquire skills and work harder to remain competitive. As a result, the entire health care system, and society benefit. Conversely, shutting international graduates out of the training system would encourage this talented pool of candidates to move on to other countries with significant implications for research, medical education and the health of the citizens of the UK. 1. Borman E, Should postgraduate training places be reserved for UK graduates? No. BMJ 2007; 335: 591 2. Overseas doctors and the UK's National Health Service. Lancet. 2007 Jul 21;370(9583):194. 3. McMahon GT. Coming to America--international medical graduates in the United States. N Engl J Med. 2004 Jun 10;350(24):2435-7. 4. Bryne E, Should postgraduate training places be reserved for UK graduates? Yes. BMJ 2007; 335: 590 Competing interests: I completed medical school in Zambia and post-graduate training at Johns Hopkins. |
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Jonathan N Allcock, GP B10 0JL
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Dear Sir, Of course we should reserve training places.We have a moral duty to look after the doctors that have trained here.As a profession we should be furthering the cause of social justice within our society and we cannot do this if poor UK graduates are displaced from their careers by overseas doctors who, in my experience at least, come from wealthy families. There is another issue and that is to do with the governance of the UK. The first use of doctors from overseas within the NHS occurred when the UK was a waining imperial power and pulled in medical expertise from the countries of the Empire and those countries that had recently become independent. Today there is some of that aaproach still evident; a national government would seek to fill the medical labour markets with it's own graduates and not import them from overseas. To pile more misery on the injustice that our own graduates are suffering the Scottish Labour MPs in parliament voted in tuition fees for students in England. Clearly the current debacle in the UK is a consequence of a British Imperial Government treating England like one of it's former colonies. To provide just government for the people living in England we need an English parliament and we need it now. Competing interests: None declared |
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Elliott J King, 4th Year Medical Student Cardiff University
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I think both of the authors make very valid points. We should have an NHS that is open for anybody to work in regardless of their country of training. It seems that people view UK graduates as not able to meet the research and clinical expertise of International graduates. I believe this is not a prudent argument to make and UK graduates can and do match those skills of international graduates, while I acknolwedge the different skills they may being. What is evident is there has been an increase in the number of medical student places in the UK, logic must dictate that the has to be a reduction in the number of international graduates coming to the UK or there was no point in increasing the numbers in the first place. Furthurmore the government has a duty to protect tax payers money tied up in the training of UK students and I include in this international students training in the UK. Either the number of international graduates coming to the UK is reduced or the government must increase the number of training posts for a better workforce planning. Competing interests: None declared |
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M Dalvi, SpR in Psychiatry& Honorary Research Fellow Chelsea &Westminster Hospital SW10 9NG, Nina Kapoor FY1 Basingstoke Hospital
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The NHS was a creation of Clement Atlee Prime-Minster in post war Britian and is looked upon worldwide as a best example of socialism in Medicine. I fully agree with Edwin Borman that closing doors to international medical graduates will be a travesty of fate for a country known to be the home of democracy and will defeat the very nature of socialism. The move I think is more political than medical due to the E.U Treaty. Great Britian has hugely benefited from international doctors mainly from the Indian subcontinent, where the British created a very English medical education system before 1947, although old fashioned but very effective. This produced a large pool of highly trained doctors with great hardware, which strangely benefited the NHS due to seeds planted long back during the British Raj. It has been a true case of "give and take" although many have described it as simply poaching doctors from elsewhere. There have been benefits on both sides although largely to the NHS. With globalisation, the boundaries between healthcare systems have diminished and doctors like anyone else have the right to move freely and work where they like. These rigid boundaries created by Governments against migration go against socialism. Medical migration is a highly debatable issue although a relevant one, and managed migration may be an answer, not simply cutting off ties abruptly with former colonies from which Britian has derived colossal wealth. Competing interests: None declared |
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Thein H Oo, Attending Physician & Assistant Professor of Medicine Caritas St Elizabeth's Medical Center of Boston, Tufts University School of Medicine, Boston, USA
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I was reading this topic with great interest. I fully concur with Dr Parakh's comment. The world has become a global village. Shutting the NHS doors to talented foreign medical graduates will impoverish British medicine in the future. I was a loyal trainee in NHS between November 1993 to June 1997, achieving a Registrar status . Due to Calman Specialist training chaos, I was forced to go to USA where I eventually prosper professionally. There are a lot of things for UK to learn from USA. USA has an fairly open door policy for truly talented medical immigrants. It is not an open door for people who are just mediocre. Each institution openly embraces and welcomes talent from anywhere on earth. Obviously, it is a very competitive society. UK has some options: (1) Create more Consultant positions in NHS. (2) Welcome limited number of truly talented trainees from overseas. (3) Create competitive training programmes and choose the trainees carefully. There should be no centralized selection system. Let the hospitals choose their own candidates. (4) Create Consultant-led service. That means Consultants may have to sleep in hospital on-call room while on-call. (5) Let the junior doctors work 100-120 hours a week, enabling the trainees to gain necessary skills and educational environment. This will also shorten training duration and the government will have to spend less money on trainees ( Yes, residency training is very stressful but determined trainees will sail through. Some trainees will drop out from training programmes naturally ). (6) Let Consultants teach junior doctors 10-12 hours of teaching a week. (7) Provide good ancillary services (e.g. round-the-clock phlebotomists, ECG technicians ). Junior doctors are not supposed to do these jobs. Competing interests: I was a trainee in UK and USA. |
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edmund willis, GP Brigg n lincs dn20 8nt
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Borman states that it is 'to the uk's credit that .. the nhs does not allow doctors to be actively recruited from developing countries'. The facts are that the GMC arranges PLAB tests in several developing countries, and the Highly skilled migrant programme encourages doctors from poor countries to move to the uk with a likely promise of permanent residency. The poorer the country the more points they get. But of course our 'ethical policy doesnt allow us to 'actively recruit' - so thats alright then. !?? Competing interests: None declared |
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ivy paul, doctor A&E
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Should training posts be reserved for UK graduates? Why all these arguments, anyway? why the worry? Non-UK graduates are not discouraged when they take their PLAB exams, but there is already significant impediment in various steps from then onwards. Medical graduates from non-EU,non-UK countries are first compelled to prove their proficiency in the English language through an IELTS test. Then they have to sit the two parts of the PLAB exam, which has no specified syllabus; it is anything and everything in medicine. Once this is over, there are no clinical attachments for them.If they do acquire an observer-ship they often have to pay for it. They may or not qualify for jobs because their previous post-graduate training, if any, may not be worth anything in the UK. To qualify for any training post they have to work harder and really prove their worth. The percentage of non-UK doctors who finally do get into training is small and if they do get in they must have something in them. They are not a 'big' threat. All they do offer is a healthy competition. Why run away from competition? Competing interests: None declared |
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