International Medical Graduates: What future in the NHS?
We were interested to read Dr Trewby and colleagues’ letter in the
recent BMJ1. While estimating that between one and ten thousand
International Medical Graduates (IMGs) may be affected by recent changes
in the employment rules relating to doctors, the true size of the problem
can only really be guessed. What is not in doubt is that the nature of
medical staffing in the NHS is about to undergo a huge change. Following a
local audit we highlight 2 matters:
We studied applications for our Basic Surgical Training (BST) scheme
which started in August 2005. Of 449 applications for 6 posts, 78%
graduated from non-European Union (EU) countries, 61% coming from India.
276 doctors from India therefore applied for a place on a BST scheme in a
district hospital. Anecdotal evidence suggests that only a small
proportion of these doctors ever actually gained positions on official
training programs (one to our rotation). Many of the rest will have
“settled” for trust grade or staff grade posts, while sadly many others
will have been trapped in financially unrewarding clinical assistantships.
Those in trust grade posts make a significant contribution to the overall
medical manpower in the NHS. It remains unclear how this gap will be
filled. There will not be sufficient numbers of UK garduates willing and
able to fill such service posts. In our study only 6% of applicants came
from non-UK EU countries. Is it assumed that this number will increase
once the IMG population has been eradicated? If so do we know if non-UK EU
graduates will be capable of fulfilling the roles formerly undertaken by
doctors from India and elsewhere outside the EU?
Secondly we are concerned by the ethics of what is happening. At this
time of crisis the General Medical Council (GMC) continues to hold
Professional Linguistic Assessments Board (PLAB) examinations in India,
Africa and other countries. This practice constitutes an indirect
invitation by the GMC to those doctors taking the exam to come and work in
the UK. Having taken the PLAB1 exam in their own country it would not seem
unreasonable for them to assume that there will be opportunities to work
as a doctor once they arrive in the UK. In the current climate, where the
possibility of gaining employment is now near zero, the situation has
become unethical and indeed quite unforgivable. Far from encouraging these
young doctors to come to the UK they should be fully appraised of the new
regulations and discouraged form coming, except in extraordinary
circumstances of specific manpower shortages.
The current system has developed over many years. There are many
failures in it but the recent regulation change is not the answer. It
certainly constitutes a very public response to the unemployment crisis
amongst home grown graduates, but the implications of the change run far
deeper than this. In the short term it seems likely that a large number of
posts will simply change from being filled by Indian doctors to being
filled by non-UK EU doctors. There has been no communication in the
medical press about anticipated outcomes resulting from this major
demographic change in the medical workforce. No doubt time will tell.
Meanwhile let’s hope the many thousands of doctors from Asia, Africa and
elsewhere can afford to get themselves home and then find employment to
help pay off the debts they incurred in our country.
Reference:
1 Peter Trewby, Gareth Williams, Peter Williamson, Edward Barnes, Peter
Carr, Jennifer Crilley, Alwyn Foden, Stephen Mitchell, and Jeremy Murphy
Non-European doctors and change in UK policy: Ten thousand international
medical graduates may be affected
BMJ 2006; 332: 913-c-914-c
Competing interests:
Dr Edema is an International Medical Graduate working in the NHS and Mr Richardson is a Consultant who regularly works with International Medical Graduates
Rapid Response:
International Medical Graduates: What future in the NHS?
We were interested to read Dr Trewby and colleagues’ letter in the
recent BMJ1. While estimating that between one and ten thousand
International Medical Graduates (IMGs) may be affected by recent changes
in the employment rules relating to doctors, the true size of the problem
can only really be guessed. What is not in doubt is that the nature of
medical staffing in the NHS is about to undergo a huge change. Following a
local audit we highlight 2 matters:
We studied applications for our Basic Surgical Training (BST) scheme
which started in August 2005. Of 449 applications for 6 posts, 78%
graduated from non-European Union (EU) countries, 61% coming from India.
276 doctors from India therefore applied for a place on a BST scheme in a
district hospital. Anecdotal evidence suggests that only a small
proportion of these doctors ever actually gained positions on official
training programs (one to our rotation). Many of the rest will have
“settled” for trust grade or staff grade posts, while sadly many others
will have been trapped in financially unrewarding clinical assistantships.
Those in trust grade posts make a significant contribution to the overall
medical manpower in the NHS. It remains unclear how this gap will be
filled. There will not be sufficient numbers of UK garduates willing and
able to fill such service posts. In our study only 6% of applicants came
from non-UK EU countries. Is it assumed that this number will increase
once the IMG population has been eradicated? If so do we know if non-UK EU
graduates will be capable of fulfilling the roles formerly undertaken by
doctors from India and elsewhere outside the EU?
Secondly we are concerned by the ethics of what is happening. At this
time of crisis the General Medical Council (GMC) continues to hold
Professional Linguistic Assessments Board (PLAB) examinations in India,
Africa and other countries. This practice constitutes an indirect
invitation by the GMC to those doctors taking the exam to come and work in
the UK. Having taken the PLAB1 exam in their own country it would not seem
unreasonable for them to assume that there will be opportunities to work
as a doctor once they arrive in the UK. In the current climate, where the
possibility of gaining employment is now near zero, the situation has
become unethical and indeed quite unforgivable. Far from encouraging these
young doctors to come to the UK they should be fully appraised of the new
regulations and discouraged form coming, except in extraordinary
circumstances of specific manpower shortages.
The current system has developed over many years. There are many
failures in it but the recent regulation change is not the answer. It
certainly constitutes a very public response to the unemployment crisis
amongst home grown graduates, but the implications of the change run far
deeper than this. In the short term it seems likely that a large number of
posts will simply change from being filled by Indian doctors to being
filled by non-UK EU doctors. There has been no communication in the
medical press about anticipated outcomes resulting from this major
demographic change in the medical workforce. No doubt time will tell.
Meanwhile let’s hope the many thousands of doctors from Asia, Africa and
elsewhere can afford to get themselves home and then find employment to
help pay off the debts they incurred in our country.
Reference:
1 Peter Trewby, Gareth Williams, Peter Williamson, Edward Barnes, Peter
Carr, Jennifer Crilley, Alwyn Foden, Stephen Mitchell, and Jeremy Murphy
Non-European doctors and change in UK policy: Ten thousand international
medical graduates may be affected
BMJ 2006; 332: 913-c-914-c
Competing interests:
Dr Edema is an International Medical Graduate working in the NHS and Mr Richardson is a Consultant who regularly works with International Medical Graduates
Competing interests: No competing interests