Career Focus

The overseas doctors training scheme

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7176.2 (Published 09 January 1999) Cite this as: BMJ 1999;318:S2-7176

Romesh Gupta and Sundara Lingham revisit the opportunities for training in the United Kingdom for overseas doctors

  1. Romesh C Gupta, chairman,
  2. Sundara Lingam, regional secretary
  1. Hospital Doctors Forum, Overseas Doctors Association


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    The overseas doctors training scheme (ODTS) was established in 1984 and the Overseas Doctors' Association was a major party in contributing to its conception. Overseas doctors are those who are not nationals of the European Economic Area (EEA) or do not hold a primary qualification obtained in the EEA. The scheme is run by the royal colleges, with support from the education department of the NHS Executive. We asked all the colleges in the United Kingdom about the scheme they administer, and the table shows the current position.

    The scheme has had a mixed reception since its inception: some have viewed it as useless and a backdoor entry to postgraduate medical training, while others regard it as a success with many fine achievements. Initially, the scheme was by a dual sponsorship programme run by individual consultants. The dual sponsorship scheme allowed a senior colleague (first sponsor) from overseas to arrange a training post with a consultant in Britain. The UK consultant becomes the second sponsor. With this recommendation the trainee doctor gets registration and a first training post in Britain. The colleges administered the scheme but usually did not place doctors in posts.

    Under the scheme each college assesses the applications of the overseas doctors who wish to come to Britain for further training. The doctors, who must still be abroad, apply directly to the relevant college. Most colleges have a waiting list. Doctors who have come to Britain for training or to sit the Professional and Linguistic Assessment Board (PLAB) test will usually not be allowed to enter the scheme. The same applies to doctors who have sat or have applied to sit the PLAB tests. On the recommendation of their referee (usually the consultant under whom they work) and on the basis of application and experience, doctors are accepted on the scheme. Once they are accepted, the colleges act as their UK sponsor and apply to the General Medical Council for them to be exempted from PLAB test. Previously, doctors entering for training under the scheme did not have to pass the English test, the international English language testing system, but this has now been made mandatory. All doctors applying for the scheme should obtain a score of seven marks or more in all four parts of the test.

    Departments or hospitals that wish to take a doctor from the scheme apply to the relevant royal college and can request the curricula vitae of the doctors waiting for placement. The consultants concerned select a doctor and can offer the post without interview or open competition. The time doctors wait on the scheme varies. Once they are on the waiting list for the scheme, it is generally a good idea for their referee to write to colleagues in Britain recommending them and highlighting their training requirements.

    Only doctors on the waiting list will be able to obtain a post in the UK without open competition or official interview. Most royal colleges accept applicants who have already achieved postgraduate qualifications in their home countries. The scheme can accept candidates at senior house officer or registrar level in NHS hospitals; however, most doctors are recommended to apply for senior house officer posts even though many might have had five years' experience in the specialty, including at registrar level (see table).

    State of overseas doctors training scheme in UK royal colleges*

    View this table:

    The scheme seems to have worked well for many years, with no major problems of equality with those who had passed the PLAB test. The scheme usually “fixed” the first appointment for ODTS doctors, and subsequent posts were usually obtained by open competition. Since there were vacancies in most specialties at senior house officer or registrar levels there was no problem getting the subsequent posts. However, it is fair to say that most doctors on the scheme worked in district hospitals, with only a few placed initially at teaching hospitals or in a subspecialty training programme. British hospitals have been dependent on overseas doctors at senior house officer and registrar grade to provide services in the NHS: consultants were happy to employ these doctors, who were experienced and worked hard. Many doctors on the scheme quickly obtained higher qualifications and were able to enter the higher specialist training programme. However, it seems that many are still working in district hospitals and are not having subspecialty training in teaching hospitals.

    Increasing competition

    Recently, however, more overseas doctors seem to be seeking posts in Britain. This includes doctors who came to Britain on their own to sit the PLAB test as the route to getting a training post. In 1997 there were 3612 attempts at the PLAB test, of which 1,318 (36%) were successful. These doctors who passed the test and doctors from EEA countries, who are able to come to Britain and get posts without the PLAB test, are now competing for posts with the ODTS doctors. Doctors accepted on the scheme are now finding it difficult to get suitable training posts after their initial placement, which is usually six months. Almost all now enter at senior house officer level - some colleges have now changed the scheme to get overseas doctors at honorary registrar grade, but this is still rare. Many doctors on the scheme are unable to get posts in some specialties such as paediatrics, all medical subspecialties, surgery, gynaecology and obstetrics, and plastic surgery. Posts are available in histopathology, anaesthetics, and possibly psychiatry.

    In some colleges the waiting time to get a placement is two to three years, which may be why some doctors decide to come to Britain via the PLAB test. There is a shortage of training posts at senior house officer level in Britain. The number of applicants for each senior house officer post is presently about 50-100, and in some specialties, especially paediatrics and specialties in internal medicine, it is 100 or more. Doctors on the scheme have to compete with the influx of doctors from the EEA, making it harder for doctors from developing countries to find jobs.

    Another factor contributing to the increased competition is that the PLAB tests are now held more frequently. Fourteen tests were held in the United Kingdom in 1997, and the part 1 examination for the PLAB test is now held in many other countries. Many doctors who have passed the PLAB test are looking for the same jobs as the ODTS doctors, and both are experiencing delays in obtaining posts. In some specialties it is taking more than a year to find a post.

    Some ODTS doctors assume that the royal colleges will continue to arrange posts for them for the years needed to complete their training, but this is not so. In the past it was possible to recommend doctors who had done well in their first post to another, but this is no longer sufficient.

    Three years ago, deans agreed that doctors who passed the PLAB test and those on the scheme who are already in Britain should be treated the same way on the job market (that is, selection by interview on open competition). This was to give equality to all trainees. Philosophically this is correct, but it causes difficulties for doctors on the scheme. Many of them become unemployed as a result, and they and their families suffer.

    Consultants are less keen than they once were to take ODTS doctors as they have had no opportunity of interviewing them before they arrive in Britain. Some have never had a doctor on the scheme, and only a few offer at least one place every year for ODTS doctors.

    Possible solutions

    A quota system would address many of the problems created by increased competition. The scheme was funded by the government, but the money should be ring fenced for training overseas doctors (excluding EEA doctors). Coordination between the deaneries and royal colleges should be improved with the money allocated for the ODTS doctors who come for training. A small quota of all senior house officer posts should be reserved for ODTS doctors.

    The scheme should be introduced for higher specialist training (specialist registrar grade) in fixed term training appointments (type II), although a three month induction period would be necessary before a doctor could take up a post as specialist registrar.

    Some colleges charge candidates to enter the scheme (see table). Since the scheme is supported by the Department of Health, the charges should be abolished to reduce the financial burden on the overseas doctors.

    Interviews could be organised for ODTS candidates in their own home country before they join the scheme. This could be done either by a group of consultants going to cities and large towns overseas to interview en masse or by teleconferencing arranged by the British Council. British consultants visiting developing countries might also be able to organise interviews. Posts should be offered for a minimum of two years as a senior house officer or for one year as a specialist registrar or research registrar. Some colleges have encouraged consultants to take doctors on the scheme by advertising the scheme in their newsletter. We hope all colleges will follow this example and advertise the scheme regularly and publish the data annually in the newsletter.

    Conclusion

    The overseas doctors training scheme is good for both the doctor and the hospital, a win-win situation. Colleges must promote the scheme regularly among their members and publish a report annually. Overseas doctors have much to offer.

    Acknowledgments

    We thank the directors of the overseas doctors training scheme and their staff of the various royal colleges for providing the information needed to complete this article.