Summary of responsesBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7454.s274 (Published 19 June 2004) Cite this as: BMJ 2004;328:s274
The recent article by Sharon Alcock on the difficulties of overseas doctors coming to the United Kingdom for part 2 of the professional and linguistic assessments board (PLAB) examination, in the hope of finding a position in the NHS afterwards, has predictably resulted in a huge number of responses—well in excess of 50.1 Judging by the names, most of these were from South Asian doctors; one correspondent was of African origin. The many, strangely similar, stories of their awful plight do not make for comfortable reading, although some even try to put a positive spin on their experiences and seem all too willing to take responsibility for their problems.
What is staggering throughout is the vast number of applications that correspondents report having to submit, mostly to no avail whatsoever, which is clearly a big cost issue in terms of their money and time.
It also causes major frustration, as applicants have found that capping of numbers and random picking of candidates influence the selection process.
The advice given in the many examples and career histories ranges from applying to every single hospital and for any job going to targeting the application very carefully, which further highlights the confusion that characterises overseas doctors' predicament.
The space is not sufficient to go into details of all the individual stories, but what is striking is the similarities they share.
Most correspondents submitted an astute analysis of the reasons for the hopeless situation and share out responsibility for what has caused this. Some are clearly disillusioned and put the blame on the involved institutions' drive to increase their profits continually. Some examine the reasons why overseas doctors might come to the United Kingdom in the first place; and some call for improved communication worldwide about what type of doctor is so desperately needed in the NHS, so that people do not travel here with false hopes and expectations.
As one correspondent, Raman Sharma, a South Asian, British born and trained junior doctor from Burnley says: “I was shocked to see the pounding these experienced doctors received from the NHS.” Whereas another British trained doctor returning from Australia shares his own experiences, namely that doctors who have trained in the United Kingdom and are returning to work here, are faced with similar problems of finding positions.
Profiteering or misinformation?
A considerable number of correspondents list the bodies and institutions that they suspect of using the PLAB system and the overseas doctors for the purpose of increasing their business profits. Mostly the General Medical Council, but also the British government, the Home Office and immigration authorities, the Department of Health, hospital trusts, postal services (which profit from the hundreds of applications that individual doctors report sending), and deaneries all come in for strong criticism.⇓
Role of the media?
Several also mention the part the media play in possibly conveying entirely the wrong impression to people on the Indian subcontinent about life and work in the United Kingdom, and some explicitly challenge their fellow country people to be more suspicious and gain greater awareness of the real situation before embarking—with no definite place to go—on an indefinite journey into a different work and life culture, which entails huge financial sacrifices and risks.
One, presumably unemployed, doctor, Samir Kulkani, actually says: “Although one other website tried to give us an advance warning about the job situation in UK [sic], I and my friends refused to believe what is presumably the harsh reality now.” Disgruntlement and frustration also became obvious in the repeated question why overseas doctors were thought qualified enough to work in trust grade positions or other nonstandard jobs but not to be appointed to a training position.
Racism or preference for British or European trained staff?
Numerous correspondents expressed concerns at what seems like an obvious preference for doctors from the United Kingdom or Europe, in the latter case even if their linguistic proficiency and clinical skills may leave much to be desired.
In this extremely competitive environment, one correspondent detected a slight preference for women doctors and others concluded that racism within the NHS hindered their chances—a clear issue of equal opportunities, as one correspondent finds. Raja Sejhar Gajula, “a doctor,” in a sharp and witty response, categorises candidates from A to G, lists their characteristics, and concludes on the basis of these characteristics who gets the jobs. Several correspondents warn of the immense brain drain that the PLAB system constitutes for developing countries.
Some correspondents are, perhaps surprisingly, quite critical of their fellow overseas doctors, who are admonished to realise that they are responsible for their condition and to stop blaming others. The issue of loyalty to their own countries, at whose taxpayers' expense the overseas doctors trained, is mentioned, and the assumption is made that the real incentive for their coming to the United Kingdom is financial gain through high salaries—not the much proclaimed pursuit of academic excellence. The fact that the GMC mentions in its literature that it is not responsible for helping doctors to find jobs is also brought up. Are some doctors just more realistic than others, or does fear of alienating their host country play a part in this?
Although many of the correspondents criticise the GMC, a consensus seems to emerge that the GMC is not the only body to carry responsibility for the sad state of affairs. Among the solutions proffered are the following.
The GMC needs to make it absolutely clear that it is senior doctors who are needed, not junior ones.
PLAB 1 should not run every week, or maybe not at all for some time.
The GMC should allow doctors to register as soon as they have passed their PLAB, regardless of whether or not they have a job, as this would help them with housing problems.
The GMC should not run so many exams as it knows it hasn't got a job for every doctor who passes them. This gives them false hope.
Recruitment should be centralised and all applications go to the same body.
Career counselling and practical help and advice should be given to those who have passed PLAB part 2.
The limited numbers of doctors needed should be publicised widely, so that overseas doctors know what they are letting themselves in for.
To conclude with Umesh Prabhu, consultant paediatrician in the United Kingdom: “There is an acute shortage of trained doctors in UK [sic] but there is no shortage of doctors who want to be trained.” This message needs to be communicated very clearly to overseas doctors, to enable them to make an informed choice.