PPUD syndrome (post PLAB unemployed doctor's syndrome)BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7536.283 (Published 02 February 2006) Cite this as: BMJ 2006;332:283
All rapid responses
Surinder Sareen’s piece on PPUD syndrome (post PLAB unemployed
doctor's syndrome) very courageously summarises through humour, a problem
of national if not international importance, which has been repeatedly
swept under the carpet.
At the BMA Junior conference in spring 2004 I had proposed a motion
to address the inequities being faced by IMGs in the UK through a national
working party with representation from all stakeholders. Although this was
voted for unanimously and the issue of IMGs seemed to be one which most
were unwilling to touch with a bargepole.
As a result my colleagues and I on the BMA Junior Doctors Committee
had landed ourselves an uphill task. Surprisingly, one group of doctors
who seemed less sympathetic to the problems being faced by IMGs new in the
UK, were indeed established doctors who were once IMGs themselves.
Since that time, we have been campaigning to raise awareness and
facilitate action to combat this issue. We have attempted to meet,
communicate and negotiate with various UK stakeholders and also the
governments of countries from which PLAB doctors have been originating.
Our aim has been to alleviate the problems being faced by both IMGs as
well as their UK counterparts in the wake of an unchecked influx of IMGs
lured by the almost daily availability of PLAB examination places, but
with absolutely no manpower plan to fall into. The statistics are alarming
with rumored thousands of junior doctors in this country who are currently
After what has been no smooth road, we have proposed a solution to
the problems of IMGs (1) seeking training posts in the UK through the
establishment of a number of international foundation posts (IFP).
Placements would be limited according to manpower demand and would target
shortage specialties. Doctors applying to the scheme would undertake a
package of assessments, including PLABs 1 and 2, the IELTS test as well as
an interview process, or assessment of employability. IMGs would only be
considered for an IFP once all the components of the assessment had been
completed. The assessment would be scored and IMGs could then apply for an
IFP through a matching process run by associate overseas deans through a
central clearing house. When applying, IMGs would declare their assessment
scores and give their ranked preferences for the specialties and UK
regions in which they would like to work. Once they have been successfully
matched to a particular IFP they would then be invited to undertake an
‘introduction to working in the NHS’ induction programme.
Ideally, the whole process would take place overseas allowing doctors
to remain in their home countries and continue to gain experience there
while applying for a placement. However, in reality one visit to the UK
might be necessary until the GMC was able to resolve the technicalities
and difficulties involved in safely conducting the exams overseas. The
assessment process would enable IMGs to complete the PLAB and/or IELTS
examinations as well as the other components of the assessment package.
Once they have completed the assessment package they can submit their
application for an IFP electronically, either from their country of origin
or the UK, return to their country of origin if applicable and wait to
hear if they have been successful.
They would continue to lead normal lives in their countries of origin
and then come, or return to the UK with a confirmed place on such a
programme and would be recommended for placement at the appropriate level
of training following completion of the programme. This would enable the
integration of doctors into appropriate levels in the NHS, commensurate
with their qualifications and experience, rather than the current
situation where everyone is queuing up at the bottom of the career ladder
creating an asphyxiating bottle neck. Needless to say, this will greatly
reduce the number of unemployed IMGs living in the UK in almost
Some may feel that the described processes for obtaining an IFP and a
training post in the UK are discriminatory. However, it is recognised that
covert discrimination on the grounds of race already exists in the NHS at
all levels when applying for junior or senior jobs and clinical excellence
awards. (1) IMGs face more difficulties in obtaining jobs than UK medical
graduates and this is exacerbated by the present excess of doctors
applying for each training post. All that this proposal does is to ensure
an explicit, hurdle which IMGs would need to go through, as a single point
entry system to the NHS. Once in the NHS, they can then compete with other
medical graduates on a level playing field. This proposal is designed to
be a win-win tool that will advantage both UK trained doctors and IMGs
We hope that as a result of our efforts, agencies such as the
Department of Health, Postgraduate Medical Deans and the GMC will help to
roll out the IFP proposal in a form that is acceptable to all. However, as
many as thousands of unemployed doctors, IMGs in particular, are currently
in suspended animation, time is of the essence. It is essential that we
absorb existing manpower before we invite any more doctors into this
country with false hopes of trainee level employment.
Dr Sareen’s piece may bring smiles to our lips on a lighter vein, but
in reality ought to be a source of shame to us all and policy makers in
particular. The time to act is now.
Dr Sumantra Ray (BMA JDC Lead on the issue of IMGs), Clinical
Research Fellow & Honorary Clinical Teacher, Ninewells Hospital &
Medical School, Dundee DD1 9SY.
1. International Medical Graduates – A Fairer Future:
Competing interests: No competing interests
Leave England and go to a place of high opportunity. You are wasting
in the UK. The sooner you realise the better. I felt really sad to read
letter,nothing has changed. What a complete waste of talent. To think
serious phsician shortages in England and yet thousands of unemployed
doctors-it is a complete joke. Don't end up being just another sad Staff
loser settling for second best.
You will also be happier if you get the heck out of Grantham!
Competing interests: No competing interests