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Where are UK trained doctors? The migrant care law and its implications for the NHS–an essay by Julian M Simpson

BMJ 2018; 361 doi: (Published 31 May 2018) Cite this as: BMJ 2018;361:k2336

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Re: Where are UK trained doctors? The migrant care law and its implications for the NHS–an essay by Julian M Simpson

Julian Simpson's narrative on the role played by International Medical Graduates is a surreal biography of my own personal life and medical career.

During the late 1960s, an acute shortage of doctors in certain specialties across England led to the recruitment of doctors who had qualified outside Europe; most were from the Asian sub-continent [1]. As the son of two such doctors, the harsh reality of how they were treated is deeply ingrained in my earliest memories. Being unable to secure consultant posts, both my parents worked in specialties to which it had been difficult to recruit UK qualified doctors, namely geriatrics and learning disability (then going by the not outdated term "mental handicap") as non-training Associate Specialists. Such posts represented the equivalent of a career "dead end". This was compounded by securing jobs in areas with greater socio-economic deprivation, where my father was once met with the statements from a patient "I don't want to be treated by that black doctor". Strange then that his spoken English was once remarked by his secretary as being "better than many English people". It was not until he obtained a locum consultant post in his early 50s that he felt empowered and valued.

Perhaps the greatest irony is that, having seen two doctors who were widely regarded as part of the "backbone of the NHS" [2] being treated like second class medical citizens, I took it upon myself to choose what remains not just a shortage specialty, but the even more unpopular sub-speciality within psychiatry-old age psychiatry. My parents tried to persuade me to pursue something more "respectable" but I continued undeterred, now find myself in a sub-speciality to which there remains a tremendous need for recruitment if it is to meet the challenges of an ageing population.

My whole career has been founded on creating a level playing field to improve the career prospects of International Medical Graduates (IMGs), particularly for non-training doctors [3]. Having also been Training Programme Director for one of the largest training schemes in psychiatry, where more than 80% of doctors qualified outside Europe, I introduced a fair an objective and transparent interview process where IMGs could compete on an level playing field [4]. This model was later used as the basis for national recruitment at The Royal College of Psychiatrists. Many trainees from the GKT scheme in psychiatry have had successful careers.

As a medical student, it would have been unheard of for an IMG become a consultant in a London teaching hospital. I cannot recall even one while growing up in Cambridge in 1970s and 1980s. Times have changed, but perhaps not fast enough.

If the NHS is to survive, it needs to address the inequality in medical staffing across certain parts of the country. Until the vision of like minded individuals seeking to extol the many virtues of psychiatry, geriatrics and general practice is realised, we remain back in the 1960s. History has a strange way of repeating itself.


[1] Esmail A. Asian doctors in the NHS: service and betrayal. The British Journal of General Practice. 2007;57(543):827-834.
[2] Rao, R. "Continuing professional development for staff and associate specialist grade doctors: the final frontier?." The Psychiatrist 34.12 (2010): 533-536.
[3] Rao, Tony. "The SAS grade in the 21st century." BMJ 344 (2012): e2836.
[4] Rao, R. "The Structured Clinically Relevant Interview for Psychiatrists in Training (SCRIPT): a new standardized assessment tool for recruitment in the UK." Academic Psychiatry 31.6 (2007): 443-446.

Competing interests: No competing interests

06 June 2018
Rahul Tony Rao
Consultant Old Age Psychiatrist
South London and Maudsley NHS Foundation Trust
Marina House, 63-65 Denmark Hill, London SE5 8RS