EDITOR, - I wish that Tessa Richards had reconsidered the title of her article, “The Overseas Doctors Training Scheme: failing expectations.”1 In the article she correctly identifies that the faults lie not so much in the scheme but in the constraints within which it operates.

Why can we not meet the demand for posts? The royal colleges have no power to make appointments. We have to compete with a large pool of experienced, overseas trained, doctors based in Britain who have local referees and are available for interview. British surgeons prefer to select from these rather than appoint someone arriving from abroad “sight unseen.” If a single trainee from the scheme disappoints them they determine never again to employ a trainee offered by the college.

Why are expectations often unfulfilled? I recently visited southern India and met enough excellent trainees to fill all our requirements for a year. Unfortunately, Britain has a limited capacity to offer training to all the trainees who wish to come. This is not the fault of the scheme. We should be proud that our standards and training are still prized.

How can we improve matters? I believe that the Department of Health and the General Medical Council should cooperate to reduce the floating pool of overseas graduates who are merely filling service needs and no longer receiving training. Some of those with rights of residence deserve staff grade posts to give them stability, which would free more training posts. I believe that awarding full registration and rights of residence to doctors who have not been in approved career training posts raises expectations that cannot be fulfilled as these doctors are condemned to second class status.

All overseas doctors who come for training should be placed under the aegis of a royal college so that …