Intended for healthcare professionals


Medical immigration: the elephant in the room

BMJ 2007; 335 doi: (Published 20 September 2007) Cite this as: BMJ 2007;335:593
  1. Graham Winyard, retired postgraduate dean
  1. Winchester SO23 9TE
  1. gwinyard{at}

The threat of unemployment among UK graduates this year is being blamed on the new computerised recruitment system. But, argues Graham Winyard, the real problem is government policy on medical immigration

The effects of the collapse of the United Kingdom's electronic recruitment and selection system for junior doctors, the Medical Training Applications Service (MTAS), have shaken British medicine.1 Anxiety has been raised about the careers of thousands of young doctors along with questions about the fitness for purpose of some of medicine's key institutions.2 The government has ordered an independent review not only of the recruitment system but of the whole of the new pattern of postgraduate education, Modernising Medical Careers,3 and it is understandable that the system is being blamed for all current difficulties.

The reality, in respect of medical unemployment, is more complicated and more worrying. Even if MTAS had worked perfectly, we would have still faced major problems with medical unemployment because of the government's muddled approach to managing medical immigration. This has created a large surplus of applicants over available training places, making disappointment for thousands inevitable. The policy confusion has compounded a long standing failure to address the implications of the major expansion in UK medical school output for postgraduate education and career structures. These are vitally important issues for the future of medicine in this country. But because immigration is such a sensitive matter, they remain little discussed – the “elephant in the room.”

Implications of medical school expansion

In the late 1990s UK medical schools produced nearly 5000 graduates each year, considerably fewer than the NHS needed. This had two important consequences:

  • The NHS recruited large numbers of doctors from overseas, with more than one third of training posts occupied by international medical graduates

  • UK graduates, provided they were willing to be flexible about …

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