Recruiting overseas doctors
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7359.290 (Published 10 August 2002) Cite this as: BMJ 2002;325:290All rapid responses
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This issue settles the old dilemma in public health, between
programmes and campaigns.
Programmes are plans well structured in time, which disclose the
causes and effects possibles in a situation and on this basis politics
are planned which confront all the phases of the problem.
Campaigns are spasmodic procedures which work in a specific
situation (for example, lowering the number of patients in a list) while
programmes are applied and cause a persistent effect.
A campaign alone won´t solve any situation and might cause more
problems than solutions.
A campaign if included in a programme which attacks all the causes and
consequencies of the issue will work as a contingent plan while the
most slow but secure programme gives results.
Taking overseas doctors it´s a campaign, while the re-
estructuring of the NHS is a programme. One should not necessarily be
opposed to the other.
Competing interests: No competing interests
An British born Indian, having fought for racial equality in the NHS
and patient rights, I often wonder why the NHS does not make the
conditions of work suitable for British trained doctors. By British
trained I do not just mean caucasians. Working in the NHS frustrates me
these days, I am in England to work with British trained doctors, yet
everyone seems to be from abroad post PLAB. Often I feel I am in India
because I cannot spot a British doctor anywhere. In the mess, I have
nothing in common, and the banter I am used to with British trained doctors
is now non-existent.
These days there is no community spirit in hospitals. Doctors work
individually and morale is low. Each person has his or her own agenda. Indians
usually admit they are here to complete their PLAB exams, get their MRCPs
and leave for India - to get a nice cushy job over there. The problem is
that in the interim, many overseas doctors whom I have come across in my
extensive work throughout the country, tend to place "the patient" last of
all. By the patient, I mean - patient welfare, consideration that all
their problems are solved, explanation to patients and actually caring
about what happens to them. Simple things like ensuring they have social
services support at home or contact with organisations that can assist
them post discharge.
I am sorry, I have come across too many foreign doctors who take the
short cut - easy job and MRCP then out.
There are many good Indian doctors but I often find that my British
training conflicts with the way they perceive things should be done. I
merely happened to be trained a certain way and yes, there is nothing
wrong with attempting to maintain a "patient first" practice.
First lesson - thou shalt not put patients at risk because of one's
ego!
Since the influx of foreign doctors, I do feel the standard of the
NHS has deteriorated. Foreign doctors are more likely to take the low
salary and the poor working conditions of the Trusts in question. It is
about the NHS attempting to find a cheap option while compromising patient
care. An example was the Trust accusing the consultant in London of racism
when he refused to work with people he could not understand the nurses.
Why should any doctor who expects high standards and criticises
justifiably have to compromise on patient care - because of the fear of
the race card?
My solution would be to train up doctors in this country, provide
them with respect, improve working conditions and ensure their pay is high
enough for them to remain in the NHS. The finances used for recruiting
initiatives abroad should be used for our doctors here. Perhaps then the
standards will be raised to the levels required to sustain a good
reputation for patient care. Unfortunately, the powers that be waste
resources and take the short cut at every opportunity. This is a surefire
way to increase the exodus of British trained doctors leaving a system
that deterioarates in standards because of the lack of training.
Kind regards
Dr Rita Pal
Competing interests: No competing interests
Long waiting lists will continue to exist regardless of active
recruitment of foreign trained physicians. The reason being that publicly
funded healthcare inevitably leads to market failures. The “invisible
hand of the market” is not allowed to find an equilibrium between
suppliers (physicians) and consumers (patients).
Similarly, the lack of incentive and absence of competitive market
forces results in equipment shortages (i.e. MRI machines), and
inefficiencies in service delivery.
Rosen writes of the “perverse incentive” of consultants to see
patients privately, who are on long waiting lists. Since when has it
become perverse for individuals to have the right to spend their money as
they see fit (1).
To address waiting lists, the fundamentals of healthcare delivery
need to be re-examined. To do otherwise is offering “band-aid” solutions.
Pavi S. Kundhal
Medical Student, University of Toronto
1. Rosen R. Recruiting overseas doctors. BMJ 2002;325(7359):290-1
(August 10)
Competing interests: No competing interests
Rebecca Rosen’s excellent editorial makes a number of important
points(1). We have been informed by the Avon Gloucestershire and
Wiltshire Strategic Health Authority that a large number of cataract
patients from Bristol Eye Hospital will have surgery carried out at a
local district general hospital by a European team. Our nursing staff
were asked to provide information about the number of ‘straight forward’
cataract cases on our waiting list. We expressed a willingness to carry
out this work ourselves and were told by the Department of Health that
bids to carry out surgery in order to reduce numbers on the waiting list
would be favourably received. Our highly competitive bid was however
turned down, without having ever been looked at, despite having the
obvious advantages of audit, appraisal and continuity of care.
Bristol Eye Hospital has consistently been at the forefront of
innovation in ophthalmology and cataract surgery in particular(2,3). We
have met all our "Action on Cataract" targets and increased our annual
cataract throughput by 60% in the past 18 months. We have repeatedly
applied to do more cataract surgery but have been unable to do so because
funding has not been available.
It is difficult to maintain staff morale and motivation when our
local surgical teams see funds that we have repeatedly requested being
spent on European surgeons carrying out surgery at highly inflated rates,
in the knowledge that we shall be expected to look after their
complications and to maintain our own low complication rates, while
operating on the remaining complex cases and teaching junior doctors. A
small amount of extra funding to employ optometrists in the outpatient
clinics to see suitable patients could free surgeons to go to theatre and
carry out surgery to reduce the numbers on the waiting list(4). This
would cost a fraction of the money that is earmarked for European surgeons
but it lacks the dramatic impact and headline grabbing potential.
Many of the staff working at our hospital are from overseas and some
are from other European countries. Given appropriate funding we could
also advertise for medical staff who could work as fully integrated
members of a team here at the Bristol Eye Hospital and thereby invest in
and develop the local service for years to come and not just the short
term.
1. Rosen R . Recruiting Overseas Doctors. BMJ.2002.325.290-291.
2. Laidlaw DAH, Harrad RA, Hopper CD, Whitaker A, Donovan JL, Brookes ST,
Marsh GW, Peters TJ, Sparrow JM, Frankel SJ. Randomised trial of the
effectiveness of second eye cataract surgery. Lancet 1998;352:925-929.
3. Frost NA, Hopper CD, Frankel SJ, Peters TJ, Durant JS, Sparrow JM. The
population requirement for cataract extraction: a cross sectional study.
Eye 2001; 15:745-752.
4. Gray SF, Spry PG, Spencer IC, Brookes ST, Baker IA, Peters TJ, Sparrow
JM, Easty DL. The Bristol shared care glaucoma study: Outcome at follow-up
at 2 years.
British Journal Ophthalmology 2000;84:456-63.
Competing interests: The Bristol Eye Hospital wishes to be considered
in open competition for delivering this work.
Competing interests: No competing interests
Dear Editor,
I find it quite amusing to see how the Labour government is labouring so
hard to keep its election promises especially the one related to health of
the people of the UK. They have apparently found the solution in
recruiting overseas doctors.
I have been trained in the UK for 4-5 years in my specialty and had the
intention to find a suitable job in the NHS then because I thought that
was the only way through which both the parties (ie. me the trainee and
the NHS the trainer) could benefit from such prolonged and expensive
exercise. But then I did not find one and I came back to India.
If you are serious to hire us who have been trained in UK and proved
ourselves by clearing the various exams of the Royal Colleges we are still
interested (you can find our details in the GMC register).
Giving preferences exclusively to the candidates from EU countries should
be exercised with due caution.
There are too many at home near you to help you out. Find them and use
them who are qualified and properly trained irrespective of their country
of origin.
May God save the NHS-- the most beautiful health care delivery system in
the world!
Competing interests: No competing interests
Dear Colleague,
as much as I can understand that you are trying to foster the appointmant
of fellow middle easterners, I am afraid that your polemics against german
doctors are entirely unacceptable. the language problem you quote is
simply not existant - at least not with the germans who do speak excellent
english due to the fact that basically all of them have started reading
international publications since the beginning of their medical studies.
yes, there should be a focus on the recruitment of doctors from europe -
that is what the eu is all about!
Competing interests: No competing interests
Sir
The article "Recruiting overseas doctors" is interesting. Clearly,
government is aiming for a "quick-fix" solution to tackle the waiting-list
problem. It knows it has limited time to show results; before the next
election. And "showing" results is its first priority, no matter how
sincere it is. This obviously has brought it under pressure and so it
wants to play safe. It wants to get the job first, and work hard later.
It's target is the people, not the profession; because the latter is a
very small number compared to the former.
It is difficult to say what would most doctors think about the
government's move to recruit doctors from overseas (perhaps you could
launch an opinion poll on this topic), but I am sure quite a few would
have concerns about this. Its not only expensive to recruit overseas
doctors, but it is also unwise. It reflects this era of consumerism where
we simply replace anything that doesn't work, instead of bothering to mend
it, not realizing that by doing that we are becoming slaves to market
forces.
We have seen nurses being upgraded as practitioners, and we hear
about opticians being involved in the management of chronic eye diseases.
Now we hear of overseas(European) doctors coming to save the NHS. What is
puzzling here is that why is the government blind to the talents already
in the NHS? There are so many skilled middle grade doctors who could be
easily put to use for reducing waiting lists. You don't haved to give them
big incentives also. Some of them might even be more talented and
experienced than a junior Consultant from some European country. And using
their skills would make little change in the current practise, compared to
the one involving recruiting overseas doctors. So many theatre-lists of
Consultants are being run by these middle-grade doctors.
The only trouble in using their services is that government can't
"show" that it is doing "so much" to improve the NHS. Long live laziness
and consumerism!
Competing interests: No competing interests
i was given the impression that there are many vacancies for junior
doctor posts in the uk but having come down here from india i see it is
far from the truth.the reality is that these doctors are forced to accept
nontraining posts for their mere survival in this country.the gmc is doing
no favors to anyone by conducting plab tests 15 days in a month thereby
producing a sudden influx of overseas doctors who end up struggling for
jobs.when will this mayhem and confusion if at all end .if there is a need
for doctors let there be an increase in jobs in the market or let the gmc
conduct exams according to local needs so that all of us can hope to find
a job
Competing interests: No competing interests
I have been hearing talk about reducing waiting lists, and incentives
for the same.
Two incidences you have mentioned lack of extra pay for existing staff for
extra work, and resistance from Cardiac surgeons are just the tip of
iceberg.
I am of the opinion that the intiatives are just window dressing by the
bureaucracy.
A recent advertisement in Times of India gave an email address to apply
at - and it was non existent.
I am keen on coming down to UK and work with endoscopic surgery to finish
the waiting lists for Laparascopic Tubectomies and Infertility
investigations - tell me whom to approach.
Competing interests: No competing interests
Re: NHS AND PATIENT SAFETY
Dr. Rita Pal's letter smacks of the worst kind of racial profiling.
She pines for "British doctors" in the hospital mess and derides Indian
doctors for "not putting the interests of the patients first" and blames
the "influx of overseas doctors" for causing "standards to drop in the
NHS". Had the comments been made by a white British person, the furore
would have been huge. The fact that she has an Indian name does not make
her comments any less offensive. The BMJ would be well served by not
publishing the kind of language better suited to the seedier rightwing
tabloids. Or is this the institutionally racist system using Dr. Pal's
confused sense of identity to create and perpetuate racial sterotypes?
Dr. Rajiv Mohanraj
Competing interests: No competing interests