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How do foreign doctors find working in the NHS?

BMJ 2023; 382 doi: (Published 19 July 2023) Cite this as: BMJ 2023;382:p1618

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How can I make international trainees feel welcome?

  1. Richard Hurley, collections editor
  1. The BMJ
  2. rhurley{at}

Despite the warm welcome, foreign doctors experience specific challenges that could hinder retention. Richard Hurley speaks to some of the international medical graduates who help keep the NHS running

The NHS has long relied on professionals from abroad. Last year, a third of the 136 322 doctors working in NHS hospital and community services in England reported a non-British nationality—representing 168 other counties,1 including Egypt, India, Ireland, Nigeria, and Pakistan.

Although employers, colleagues, and patients are mostly welcoming, insufficient initial and ongoing support, social isolation, arduous visa and exam requirements, and racism can lead to demoralisation, anxiety, and burnout. Attention to these challenges could help improve recruitment and retention of the international medical graduates (IMGs), crucial to tackling chronic NHS understaffing to the tune of 12 000 hospital doctors.2

Ashwin Pandey, senior fellow in infectious diseases, London

From India

In the UK since 2016

IMGs coming for fellowships expect to get accredited training. But soon you realise that you have been recruited to fill rota gaps. Often there’s no formal curriculum, and supervisors may not understand training needs.

New IMGs need time to adapt to the NHS. As in my current hospital, each hospital should have a team to improve induction and wellbeing. IMGs also need help with employment rights. Clerical errors meant I didn’t get paid for 26 days when I arrived. Then I was underpaid for 1.5 years. I didn’t know to ask for days off in lieu of bank holidays or how study leave worked.

IMGs were more vulnerable during the pandemic, and I helped form the Association of Overseas Doctors in the UK ( and work with Team Soft-Landing ( for paediatricians.

Warkaa Shamkhani, specialty trainee year 7 interventional cardiology, Stoke-on-Trent

From Iraq

In the UK since 2015

I came here from Dubai, and my experience has been positive. It depends on how much effort you put in, and how badly you want to succeed. I came through a recruitment company.

I worked at a lower grade for three months to get to know the NHS system and structure. Applying for specialty training is competitive; interview preparation courses were really useful. In between my training I took a research degree. If you want to be a capable, knowledgeable, skilful doctor, then the UK is the best place to learn and practise. The pay is not the same as in Canada, New Zealand, and the US, but it’s not that bad.

Puskar Bura, specialty trainee year 6 cardiology, Exeter

From Nepal

In the UK since 2011

Initially, I felt lost. I didn’t know how things worked and struggled to ask for help. Employers should provide ongoing one-on-one support as well as induction. I led a scheme that paired IMGs with a senior buddy. And I contributed to recent national guidance for IMGs and employers.3

I’ve experienced subtle racism. People ask where I’m from, and sometimes it’s clear that they don’t like my answer. Stay positive and be proud of your identity and journey. Politely challenge bias. Ask for help: join the BMA, the British International Doctors Association, the British Association of Physicians of Indian Origin, and local groups.

Ahmed Swealem, senior house officer, orthopaedics and trauma, Kettering

From Egypt

In the UK since 2022

I’ve had a good experience overall. Consultants realised my capabilities once they got to know me. I’m far from home, away from friends and family. The UK has a lot of diversity, which is good. But you can still connect to your own culture: I have Egyptian friends here. Being able to make more frequent visits home would be good, especially for single IMGs.

I still struggle sometimes to know how the NHS works. Shadowing helped, but there needs to be enough time before starting work. A formal induction programme covering terminology and how the NHS works would help. A senior guide in the first month or two is a good idea.

Pushpo Babul Hossain, clinical teaching fellow, Cambridgeshire

From Bangladesh

In the UK since 2020

I’m IMG lead at the Doctors Association UK. In the pandemic, IMGs faced burn out and demoralisation. France gave IMGs citizenship; other countries offered permanent visas or bonuses. The UK offered nothing, so I founded the annual “overseas NHS workers day” to celebrate our contribution (

Many IMGs don’t have indefinite leave to remain and cannot access benefits. Visa renewals are expensive, and Home Office delays are common. Without a permit you cannot work at all. There’s no way to find out what’s going on. It creates anxiety. To apply for indefinite leave to remain is about £2400; they could reduce these costs. Many IMGs cannot bring their parents here, except as visitors who would have to pay NHS patient charges. All this demoralises IMGs and makes us consider going to other countries.


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