The BMJ Debate: Doctors and immigration
28 Feb, 08 | by BMJ Group
Deborah Cohen talks to Edwin Borman, Graham Winyard, and Ramesh Mehta
On February 29 the UK government is introducing an Australian-style points based immigration system for highly skilled workers. The BMJ’s Deborah Cohen has put your questions about these changes to Edwin Borman, former chair of the BMA’s International Committee, Graham Winyard, former postgraduate dean and former deputy chief medical officer, and Ramesh Mehta, president of BAPIO (the British Association of Physicians of Indian Origin). Topics covered in the debate include:
- What the immigration policy changes mean
- Balancing needs of UK and international graduates
- Representing international graduates
- Department of Health appeal in the House of Lords
- Movement of doctors
- Plight of students
Read the full transcript
Full transcript
Deborah Cohen: The BMJ: Helping doctors make better decisions. Hello, I’m Deborah Cohen, features editor of the BMJ. This week on the BMJ debate we will be discussing the UK government’s new immigration policy. Edwin Borman, from the BMA’s International Committee, Ramesh Mehta, president of the British Association of Physicians of Indian Origin or BAPIO as it’s known, and Graham Winyard, a former postgraduate dean and deputy chief medical officer, thank you for joining us. The government has announced new temporary immigration regulations that will bar doctors from beyond the EU from gaining postgraduate medical training places in the UK. The government said it will close the highly skilled migrant route. Instead, it’s going to be an Australian-style points based immigration system, and will take effect from the 29th February this year. Edwin, you’ve been in regular contact with the department of health since the announcement. Can you give us the latest information about what this all means?
Edwin Borman: For doctors who are currently in the country, they are temporarily protected. They still will be able to get training grade posts. For doctors who are new to the UK and haven’t got their applications in already, unfortunately the door is already closed. They’ll only be able to get jobs that do not involve a training content. This is a major setback. Any doctor in training will be able to apply to the Home Office as before. What is different is that the system has changed, and doctors who would otherwise have been coming for training will now find that they are barred from access to that.
DC: An Australian points system – how is that going to operate?
EB: The UK has been talking about introducing a points system for quite some time. They are now doing it. And what this will mean is in the case of doctors in training coming from abroad, they will find themselves shut out of training grade posts here in the UK. They will be eligible to apply for service posts though.
Ramesh Mehta: I just want to explain it in simple terms. Those who are on HSMP already in the country, when their visa expires they need to go on to the new system which is called Tier One instead of HSMP. Now these HSMP people, they got their visa based on a points system anyway. The points system is a little bit more refined and the name is changed to Tier One. So the present HSMP will be called Tier One. So it’s just about the same.
DC: So isn’t this all a big fudge? Is this just to grab headlines?
RM: I think the department of health unfortunately is trying to play games. Our case is in the House of Lords at the moment. The hearing actually is this Thursday. They would have waited very well to see the outcome of that and then decide what they want to do. We do accept that there are a limited number of training posts available in the country, and it is sensible that there has to be some regulation of the people coming from overseas to the UK. We need to ensure that our local graduates are looked after properly. There is absolutely no doubt about it. We do not want the situation which has happened at the moment, that there are 10,000 – approximately – doctors who are on HSMP. They could apply to the training posts. They should be treated equal to UK graduates. But there are no posts available. And it doesn’t make sense that we allow more doctors to come in to be struggling again. We need to remember that three or four years ago we had a situation when there was a huge number of what is called post PLAB doctors who were looking for jobs and applying probably to thousands of hospitals per week without finding a job. So we don’t want to get into that situation.
DC: But there has been an accusation that BAPIO is selling out by taking that line, that they’re looking after the people that are ok but ignoring the plight of people that want to come to the UK from other countries. What do you say to that?
RM: You see we need to be practical, and we need to use common sense. It’s no question of selling out because we are fighting the case against the department of health in the court. So it’s not a sell out. It is, as I said, common sense. There are nearly 10,000 unemployed doctors who have HSMP visas in the country at the moment who cannot get into the training posts. Ok? I’m sorry. I said unemployed. They’re not actually unemployed, but they cannot get into the training posts at the moment. Now it doesn’t make sense to invite more doctors who would still be struggling even more.
DC: Graham, for the audience that can’t actually see you nodding along to some of what Ramesh was saying there, is there anything you would like to add about this?
Graham Winyard: Yes I would, because I think the discussion so far illustrates the whole problem that there has been about this issue. There has been a lot of attention paid – and quite rightly so – to the plight of overseas doctors who came over here on one set of expectations and then saw the department change the rules over their heads. But there has been almost no discussion about the plight of the UK graduates, and I think that is equally dire. What has happened is because the government as a whole has failed to adjust its immigration policies to reflect the carefully planned, implemented slowly over the years – so the problem has been very clearly coming; it hasn’t surprised anyone – they’ve failed to adjust immigration policies to reflect the expanded output of our medical schools, and at the moment thousands of UK graduates are facing the end of their career in medicine unless they go and practice overseas. And I think their problem is just as important and needs to be balanced with the problems of the international medical graduates.
DC: Do you think the department of health have jumped on the immigration bandwagon after the whole MTAS debacle?
GW: This issue doesn’t have anything to do with MTAS. The main effect of MTAS and MMC has been to distract attention from this other problem which would have happened anyway. It’s just a failure of planning the workforce in the broadest sense to reflect the investment that’s gone in the new medical schools, the expansion of existing medical schools that was set out by this government – the same government – in the pursuit of self reliance on doctors. I think that’s a very laudable aim that still stands good. But there is no point in training lots and lots more doctors if their careers are then terminated after two or three years in medicine. And that’s the situation at the moment because there aren’t enough specialist training places to deal with the numbers of doctors coming out of our medical schools, supplemented by the 10,000 doctors that Ramesh refers to who we’ve let in already in the expectation of being eligible for specialist training.
DC: Edwin, you wanted to come back and say something there.
EB: Yes, I disagree with two things that Graham has just said. I think that there is quite a lot of overlap between this immigration chaos and MTAS, and I also believe that this is a problem that could have been addressed, should have been addressed, and is not being addressed appropriately now. With regard to the MTAS issue, the difficulty has been that we are seeing UK graduates displaced by overseas graduates partly because the MTAS system was developed in a way that didn’t always pick out who on paper would have been the best applicant for the job. Sometimes the criteria set were set in ways that, in response to Graham, might not have been conducive to a UK graduate, for example on experience. The second area where I would disagree is that there has been much going on trying to address the needs of UK graduates. I seem to remember a whole lot of demonstrations out on the streets – the harnessing of some of the national dailies. There has been much lobbying of ministers, questions asked in parliament. Because of that, in the last round we did have an increase in the number of training posts available specifically to make sure that UK graduates were going to be able to find jobs.
DC: So how does the BMA reconcile the different needs between the international medical graduates and the UK medical graduates?
EB: The BMA’s approach is by firstly saying, this is not a problem of the BMA’s making. Indeed this is a problem despite the BMA’s repeated drawing to the attention of the department of health the need for proper workforce planning. Secondly, the need to be absolutely fair to everyone as far as is possible who is already in the system – a recognition that there could be different rules for people coming in at a later stage. But for doctors from abroad who are in the country, they have a reasonable expectation to be able to proceed with their careers. Unfortunately we just haven’t had sufficient movement on that from the department of health.
DC: Ramesh, what’s your take on all this?
RM: Thanks, Edwin, I think it makes sense that everybody is looking after all the graduates, whether overseas or local graduates. I think the medical profession is unanimous in saying that there should be fairness and justice for everybody. So those overseas graduates, for example, who are already in the country, who came under the old regulation, cannot be neglected. But I have a little problem with what Edwin is saying about what BMA has been doing. Edwin said “in spite of” BMA. Now to a point he’s right, that in spite of what our BMA has been saying, the department of health’s medical manpower planning has been catastrophic. It is hopeless. However, I must say that BMA could have been much stronger in its presentation than what it has done so far. BMA has a big clout. BMA is the only trade union for doctors representing all the doctors, and they should have been much more forceful than they have been on the department of health as well as the Home Office.
DC: And Edwin, do you have any response to that?
EB: Well, I have repeatedly invited Ramesh to join in on the times that we go clobbering the department of health, to join in on the committees where we would agree how to clobber the department of health. And much to my regret, Ramesh has declined to do so. I will readily acknowledge that Ramesh has launched legal action. Initially that was unsuccessful. It has since been successful, and we’ll be finding out very soon whether in the long run BAPIO has been successful. All I can say is that working with the BMA would be a much more constructive way of taking on the department of health rather than us dividing our forces. And I’d be more than happy to work with Ramesh to achieve that.
DC: Ok, moving on slightly, you mentioned the department of health’s appeal in the House of Lords. Now what will happen if that appeal is upheld?
EB: If the House of Lords rules against the department of health, and says that the secretary of state is not allowed to issue guidance on immigration related matters, the department of health is in two big holes. The first one is, what is the secretary of state going to do on further related guidance that they may need to send out? That’s a separate matter. As it applies to the medical profession, the department of health is in a huge hole too – the second deep hole – because they now have a whole lot of doctors in the country who will argue that they are eligible to be treated equally, and the department of health is not able to provide guidance that potentially could close them out of an appointment system. So clearly the department of health is hoping that they get away with this one and that the House of Lords rules in their favour.
GW: Now Edwin has talked about the department of health being in a hole. The people who are really in the hole are the 10,000 international medical graduates and the annual outputs of cohorts of UK graduates who haven’t got enough training places, and this problem isn’t going to go away. I think medical organisations generally, if I can say so, I think are slightly ducking out of this. It’s easy to blame the department of health or government as a whole, and there are lots of grounds for doing it. But that doesn’t solve the problem of what do we do about the situation we are in now where we’ve got too many doctors who need specialist training posts. That’s all they can do, really, particularly the younger ones. They can’t work in career posts. They’re not yet sufficiently experienced and trained. We’ve got too many of them. And what do we do? Who has the priority for the jobs there are? The department of health are taking one view, and are trying with their guidance to say priority will be to UK graduates. That undoubtedly is unfair to the IMGs who are over here.
DC: Ramesh, as someone with the inside track of being involved with the appeal, do you have any indication about how the department of health fighting the decision are trying to get the decision overturned?
RM: Yes. First of all what Edwin was talking about, if the department of health lost, how the ministers’ position is crucial there: you see, the minister of health is not normally allowed to interfere in the working of the Home Office. The regulations about HSMP were devised by the Home Office which was very clear in saying that any individual who has HSMP – and it doesn’t have to be a doctor, but any skilled migrant – will be treated as equal to a UK citizen, because these people in principle have come to the UK to settle down in the UK. Now what the minister of health did was overrule the minister at the Home Office to bring in this new regulation by saying, ok, everybody else is fine, but the doctors on HSMP will be treated differently. And that’s why they lost the case. That’s why we believe they are going to lose in the House of Lords, because it is illegal. So that’s the point there. Now you’re other point as to what is going to happen to the doctors who are already here, I think it is mismanagement by the department of health. There is no doubt. I think all of us have agreed about it. I think we need to find a solution for these doctors and the local doctors, and the only possible solution for the time being is to increase the number of training posts.
DC: Ok, Edwin.
EB: And here Ramesh and I absolutely agree that there is a temporary problem for which a temporary solution is required. All sorts of changes can go on outside of that but until all three of us, I would suggest, are in agreement, there is a cohort of doctors – some UK based and qualified and some who have come from abroad – who need to be treated fairly. And the fair way of dealing with this group is to make sure that if there is a shortfall of places available, the department of health, as they did last time, should provide additional places for these doctors. It should only be for a short period. Roughly 60% of international medical graduates will go home of their own accord within a five year period, and we should find that we understand the manpower structures of the UK as we move to self sufficiency much more clearly in a couple of years’ time. The difficulty that this is for the department of health is that it costs. It costs plenty. And it also means greater stresses on the training system, so it will cost in consultant time to teach these doctors. And the department of health currently is balking because of those reasons.
DC: Don’t you think there’s a fear it might be reported in the press that the taxpayer will be footing the bill for increasing the number of posts for people from outside the EU?
EB: The taxpayer can complain about footing the bill for a whole range of profligate things. Need I mention NHS IT? Northern Rock? How far do you want me to go? This is relatively small amounts of money, but it is a huge investment in the future of the NHS’s provision of medical staffing.
DC: But is it good use of the taxpayers’ money? Graham.
GW: Not a terribly good use, and I think there are other difficulties about creating new jobs on the scale that would be necessary to solve this problem. Last year 1,200 extra jobs were created, and even then 1,300 – department of health figures – UK graduates, who in all previous years would have expected to flow through into training, couldn’t get jobs. If you think there are 10,000 plus – the surplus of the UK – you can’t create thousands and thousands of training jobs even if you had the money. There isn’t the training capacity. There aren’t the service opportunities. It could solve part of the problem, but I think we’ve still got a big surplus of doctors on our hands.
EB: But there is an overwhelming case for this for other reasons as well. We’re coming very close to the deadline for the implementation of the working time directive. The UK will have difficulties implementing that. Why aren’t we using this as a constructive opportunity to increase rotas at a training grade level to make sure that we are able to implement the working time directive? The UK is under-doctored. It’s been known to be that for at least 20 to 30 years when compared to the rest of Europe. Why aren’t we attempting to catch up in terms of medical staffing as well? Why do we find that we’re anomalous in Europe for relying on nurses, paramedics, other groups to pick up work which correctly is being done by doctors in other countries? We are attempting to create a health service on the cheap. Here is an opportunity to correct that.
DC: Ramesh, you wanted to come in.
RM: We’ve been talking about common sense. Now money I don’t think is a problem at all here. The reason is this: that all these approximately 10,000 overseas doctors are already in service non-training jobs. So they are already in the jobs. The only thing the department of health has to do is to convert these service jobs into training jobs. I will give you an example. What are these service jobs? At the essential level, these doctors in service jobs have got different names, for example clinical fellow or senior clinical fellow or a trust doctor. They are doing exactly the same as the doctor in training. They are doing the same job. They are getting the same money. They are being paid. Now the only thing the department of health has to do is to say, ok, these are training jobs as well. They would be recognised for training. Hardly any money is involved there.
DC: Do you think that for overseas doctors, knowing that they’re not eligible for a training post will stop them from wanting to come to the UK?
RM: They have stopped already. For example in 2003 there were nearly 14,000 who came and passed PLAB tests and were applying for jobs. In 2004 there were nearly 10,000. 2005 and 2006: also approximately 10,000 doctors coming in. I know that in 2007 from India only 300 doctors took the PLAB 1 test. So the number of doctors coming from, especially the Indian subcontinent, has gone down drastically. We also need to remember it’s the world that is getting smaller. Globalisation is moving fast. Developing countries are developing very fast as well. I mean, I was in India recently and I can see the huge amount of development there, and there are a lot more opportunities. Already the reverse brain drain is happening. So a lot of the doctors who are here are finding better opportunities in the Indian subcontinent. This is going to happen. So the department of health has to think of the future of a quality health service for patients in this country for which they have to have collaboration with other countries as well.
DC: Graham, do you think then there is a risk that maybe the UK will fail to attract the best doctors? They will be put off coming?
GW: Well I’m not sure we’ve been very good at that anyway. I think some of the other countries that have treated people better have been more attractive to doctors from the Indian subcontinent – America is a very good example – because there have always been huge uncertainties almost at every stage in post PLAB. Will you get a job? If you get one job, will you be discriminated again and fail to get another job? Will you be diverted? This is all well trodden territory but I don’t think we can claim a very good record in dealing with international medical graduates. I would like to see us do a lot better in a proper, planned, structured way. And allowing just a flow of individuals into all sorts of jobs isn’t the best way to do it.
DC: Edwin.
EB: I’m not going to get into a debate with Graham as to whether we have attracted the best or not. What I do know is that the NHS wouldn’t have survived without the contribution of doctors who have come from abroad, and that when you think about it there must have been an implicit policy in the department of health to rely on doctors coming from abroad. In current money terms, the UK saves £250,000 for every doctor that brings a medical qualification to the UK for free. We’re training doctors on the understanding that many of them will return home and contribute to their home countries’ healthcare system. We’re retaining many of these doctors and many of them are lost from their home country. They’ll never get that £250,000 back. So actually the UK has done damn well out of all of this.
DC: So that begs the question, why expand the number of places at medical school and produce more UK graduates?
EB: Because ethically, as a developed country if that’s correct, it’s inappropriate in a globalised world. And we do have to recognise that the movement, the flux, of doctors between countries is increasing. We, the UK, are embarrassed within developed countries – other than of course the United States that has no sense of embarrassment at all – in recruiting doctors, whether passively or actively, to come to the UK. It’s correct that we pay for the number of doctors and nurses that we need, and that we don’t find that there are pressures on doctors and nurses to leave countries that have healthcare problems that far, far, far outstrip our own.
DC: Ramesh, you wanted to come in.
RM: I would like to mention another point about why overseas doctors like to come to the UK. One of the very important reasons for that is the medical training in the UK is supposed to be one of the best in the world. Especially for doctors in the Indian subcontinent, UK medical training is like mecca: the final best training. However, with times things are changing very fast, and I mentioned globalisation and I mentioned collaboration. I think we need to think about this in context with changing public health in this country. The medical students who are learning medicine get hardly to see pathology in this day and age. For example, looking for spleens and livers and diseases that they read in the books, they hardly see here. One of the important reasons we need to collaborate with developing countries and perhaps think of a sort of exchange of students – whether they send a graduate or postgraduate student at that level – exchange of these students and have a collaborative training arrangement.
DC: Graham, that brings us on to long term solutions. The current department of health measures are only temporary and, as someone that has been involved in workforce planning, do you have any strong feelings about future solutions to workforce planning?
GW: If we can find our way through this temporary surplus of doctors, there shouldn’t be a problem. We have enough training places to accommodate the increased output of our own medical schools, plus taking significant numbers of doctors from overseas, whether from Europe or further afar. So it’s a matter of smoothing things out and getting back into the right sort of balance. It should be a temporary problem.
DC: Edwin, do you have any thoughts on future long term solutions?
EB: There’s another factor that I’d like to add into this. The BMA has been speaking to the department of health, trying to find solutions to what everyone recognises is a really tragic situation for the doctors themselves. One group that doesn’t get mentioned sufficiently often but certainly has been a focus of our lobbying has been the group of students who fund their way through medical school. They are citizens of another country but pay to be trained here in the United Kingdom for the reasons that Ramesh has mentioned. Medical training in the UK is seen as high quality.
DC: Do you have any word on what’s going to be the situation for them?
EB: The good news is that following the lobbying, the department of health has confirmed that these students will now be able to complete their specialist training. Under the previous rules they were restricted to only foundation training. They will now be able to go the full course, which is obviously great news for them but also great news for the United Kingdom because many of these students go on to stay here.
DC: Ramesh.
RM: I have to take a point with Graham who thinks that this situation is temporary. You know if you look at the history of the National Health Service, the flood and drought situation has happened time and again, and time and again. It is going to happen again unless the department of health understands that they have to discuss the solutions with everybody, whether it’s BMA or BAPIO or lots of other organisations. There has to be a proper consultation and we need to find the right way and the right long term solution. If the department of health is going to just change the immigration rules on a short term basis, it isn’t going to help. And I think the department of health has to start consulting with all different sorts of organisations and all the stakeholders.
DC: Graham Winyard, Ramesh Mehta, and Edwin Borman, thank you for joining us.
[music]
DC: The BMJ - helping doctors make better decisions.
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I am a IMG who came to the UK in 2003. I did my SHO training, got my MRCP and then realised that the UK actually only wants IMGs to fill up staff grade / trust grade posts. All through my career in the UK - wether applying for my first PRHO job, or applying for my SHO rotation or applying for SPR posts (which I did not get), I always felt treated second rate to British graduates. No matter how good I was or how ever long I train in Britain, I was a second class doctor in the eyes of the NHS establishment - and I bet the large majority of IMGs in UK will agree with this.
Finally,in 2007, I left the country for good and emigrated to the United States. Now I read all this news about the pathetic situation of junior docs and man - how glad I am to have left in time. Looking back at my time there and comparing how doctors train and work in the USA, I have a few points to make
1. The fundamental problem in the UK is oversupply of junior doctors as pointed out in this debate - MTAS or not, this disaster would have occurred.
2. The UK tries to get doctors on the cheap - sure it gets them on the cheap but so is the care given to patients many times. Consider this - the NHS employs a consultant for 100,000 pounds and under him, we have a staff grade, a nurse specialist, a SHO, a trust grade junior doctor, a Clinical fellow and 2 PRHOs. Each of these individuals are paid 30-40,000 pounds. And collectively, they do as much work as 5 consultants can do. In the US, it works very differently. You train intensively for 3-4 years - where you work 80 hours a week but where you are taught personally and hands-on by a dedicated team of consultants whose main job is to teach. Once you are trained, you have your “MD license” and you are automatically a consultant. And then, every patient in a US hospital must be treated by a consultant every day. A trainee cannot treat a patient on his own without the consultant seeing the patient every day. Contrast this with the UK - The consultant rounds on Monday, SHO on Tuesday, Staff grade on Wednesday, SPR on Thursday and finally, the Consultant again on Friday. Are patients really getting a good care when most of the care is being given by non-consultants ? Technically these personnel are under supervision - but that is not equivalent to giving actual care.
3. Consultants must realize that by ignoring the plight of junior doctors and by not controlling their numbers, the status and prestige of the whole medical profession has been damaged. Doctors are held in such high status in the US - but in the UK, that is far from the truth. Plumbers and electricians make more money than many doctors.
4. There should be a fundamental change in the UK training system. There should be a clear demarcation of training and service posts. Training posts should be intensive and co-ordinated and flow-through. The US trains endocrinologists and geriatricians in 1 year and all other sub- specialists in 3 years because of their focussed, intensive training. Why should the UK take 5-8 years to train there specialists - so that the NHS can extract the maximum work at sub-consultant pays for as long as it can ? All service posts should be “Consultant” equivalent. There should not be a privileged club of consultants who abuse an under-privileged club of staff grades. Inherently, this system discriminates against doctors.
5. A fair system of training is where entry is strictly regulated. But once you enter, you are treated on par with everybody else. There should not be parallel pathways like trust grades which perpetuate the abuse of trainee doctors.
And finall, IMGs - best of luck this year. But in case you dont succeed, pack your bags and move on. After all, this is not your country and dont expect the British government to dump its own citizens and go out to support you. You are in the wrong place in the wrong time but it is a big world out there. If you are really good and competent, you will succeed where ever you go.
Senthil Ramaiyah
March 2nd, 2008 at 11:43 am
First of all I believe in fairness… The best systems in the world are fair systems which makes a very strong basis for development. I think it is unfair to give preference to doctors based on country of qualification.
(I believe that Merits are the only fair way of selecting doctors).
Yes, you have the right to protect your own graduates, but if you really wanted to protect your own graduates, you should have planned properly and wisely in advance. Sudden changes in the rules would only make you fall out of favor as a country of destination for many overseas doctors, which will make it so difficult to attract them again when the need arises, and the latter is a quite possible scenario, especially with the increasing number of female doctors who are liable to career breaks, and the lack of funding to convert all the service posts into training ones, hence the need for overseas doctors cover. A better way of protecting your local graduates’ rights, could have been achieved, by limiting the number of overseas doctors entering the UK earlier, or by simply implementing the current restrictions on training earlier, when such consequences could have easily been predicted, but suddenly denying overseas doctors -that are already in the UK and that have already come under the promise of equal opportunities - of training posts, or treating them as second class doctors, is quite unfair. Having said that some overseas doctors are happy to work as service doctors, having finished their training in their home countries, but the idea of denying the aspiring young doctors who are still untrained, and who are already here, from training, and indirectly channeling them towards service posts, is surely unfair.
I agree with Mr Winyard that there are enough training places to accommodate the increased output of UK medical schools, but this is only when service posts, are covered by overseas doctors, as the situation stands right now. In the future when overseas doctors are no longer attracted to the UK (being denied of training), you either convert the service posts into training posts and further increase the number of UK graduates to fill them, which would require a huge funding, or continue to depend on overseas doctors to fill service posts, which would be much more difficult task to fulfill, as many overseas doctors in the future, would opt for countries that offer proper training, and the results of the latter are starting to show up now, as we recently read on the BBC about national unprecedented difficulties in attracting locum doctors.
In USA, all overseas doctors are treated fairly, and trained exactly the same as American doctors, the training is continuous, and all doctors become consultants, provided they progress satisfactorily, in a relatively short period of time. But in order to get into the system you have to pass some tough exams, and marks play an important role when applying for posts. In France, the number of overseas doctors accepted into specialist training is tailored through a competition based on an exam’s results, where the top candidates only get the training posts, depending on the need. Although it might sound tough but the system is very clear, from the start, you either get a proper training position like your French counterparts, or you get nothing.
And as always, Fairness is the secret for success. I hope no one finds my comments offensive.
Antoine Kass-Iliyya
March 3rd, 2008 at 11:43 am
I came to the UK in 2004 from India planning to train and specialise in Internal Medicine and complete MRCP which used to be (?still is) considered a prestigious qualification.
Though the UK does place quite a lot of emphasis on good communication skills which is entirely appropriate, I have found that this system lacks a clear structured training program atleast during SHO and HO years. The only benefit that I can see is the better pay compared to the US or even the rest of the world when you start off as a doctor in the NHS.
As a trainee I feel there is a need to learn everyday on the job and not just immerse yourself in the day to day service provision needs of the NHS and get taught for an hour once or twice a week!
I am about to complete MRCP but have no doubts that an Indian or American MD is a much desirable qualification. Added to this fact the yearly visa troubles and retrospective changes brought in by the DoH openly to prevent Non-Europeans from getting into traning posts is just insulting to say the least.
In these difficult times do IMGs like me stand a chance of getting into a competitive specialty like Cardiology or Gastroenterology on merit and furthering our careers? Or do we take up service/staff grade posts to prop up the NHS?Your guess is as good as mine.
Santos P D'Souza
March 6th, 2008 at 11:44 am
Senthil,
I cannot but agree with most of your views. Not many doctors get paid 100,000 pounds in the UK. And not everybody can come to USA for various reasons, including family commitments. Even US medical system has many inherent flaws. Nothing is perfect, my friend!
Neha
Neha Chote
March 6th, 2008 at 11:44 am
The issue of professional migration is emotive, as it affects many on a very personal level. It is most desirable that an individual aspires to get the best in terms of training and employment. The Home Office, Department of Health and indeed the General Medical Council have all received a fair degree of blame for the continuing plight of the International Medical Graduates.
This issue has been at the heart of ‘Bhavishya- The future’, a film I produced that explores medical migration*.
While I researched the characters for the film and took soundings from various interested parties I was impressed that a vast number of IMGs were actually quite complimentary to the NHS and other bodies to have given them the opportunity to try their luck here.
The real downside of the problems facing the young IMGs is that some of them may actually be wasting the most valuable time of their lives while waiting to strike it lucky on the NHS job market. It is best if well meaning organisation such as British Association of Physicians of Indian Origin (BAPIO) looked at this issue with a non political perspective, and helps those in difficulty here to find employment in other countries and in emerging economies such as India. BAPIO should pressurise the Indian government to offer opportunities and jobs for such talented doctors over there, rather than engaging them in legal battles here in the UK, which they may win but to no real long term advantage.
As one young doctor who remained in the UK for two years and managed to do no more that a couple of short term clinical attachments remarked, “…I wish I could stick to my original plans to give it no more than three months, but I kept my hopes alive on BAPIOs action, and am now two year out of touch with medicine and with substantial financial loss!”
http://www.bmj.com/cgi/content/full/333/7558/101
http://www.gmc- uk.org/publications/gmc_today/gmc_today_archive/gmctoday0703.pdf (Page 6-7)
http://news.bbc.co.uk/2/hi/uk_news/wales/north_east/5348102.stm
http://www.britfilms.com/britishfilms/catalogue/browse/?id=ACCEF7E1031a31B9E1tJu3C103DE
http://us.imdb.com/title/tt0963159/
Competing interests: Produced a film ‘Bhavishya- The Future’ exploring medical migration. http://www.bhavishya-thefuture.com
Nikhil C Kaushik
March 13th, 2008 at 11:45 am