Tossed aside
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7547.932 (Published 20 April 2006) Cite this as: BMJ 2006;332:932All rapid responses
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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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests:
None declared
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
Why did I (and others) come to the UK?
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
Competing interests: No competing interests