A helping hand for international medical graduates
Authors: Irene Valero-Sanchez, Judy McKimm, Ruth Green
Publication date: 24 Nov 2017
More needs to be done to help overseas doctors adapt to their new working life, say Irene Valero-Sanchez and colleagues
International medical graduates (IMGs) account for a significant proportion of the NHS workforce. According to the figures in the last General Medical Council registration statistics report, nearly a third of the current registered medical practitioners in the UK qualified overseas.
Despite health secretary Jeremy Hunt’s announcement last year2 that he will end the UK’s reliance on overseas doctors, it is likely that, for the short to medium term at least, NHS trusts and health boards will still have to recruit from abroad. After Brexit, Hunt said that he expects NHS England to reach the target of training sufficient “home grown” doctors by 2025.
However, it takes between six and 16 years to train new doctors and this, coupled with unpredictable international medical migration patterns, means that it’s currently not feasible to produce enough home grown doctors to fill existing recruitment gaps.
A recent freedom of information request revealed that nearly 70% of NHS trusts are actively recruiting from overseas, with around a 7% vacancy rate for doctors. This rate could increase if, after Brexit negotiations, staff from the EU are forced to leave the UK. Currently their status is unclear.
Starting a new job in the UK is a challenging experience for most IMGs. They face many difficulties that can hinder their performance and career progression—they have to learn new medicolegal frameworks, training systems, duties and skills, guidelines, and negotiate working relationships with other professionals. A doctor’s role can differ between countries: for example, in Portugal and the Czech Republic cannulation is routinely performed by nurses while doctors are barely trained in that skill. Also, in countries such as Spain, professional medical indemnity for training doctors is largely assumed by the employing organisations, as claims are less frequent. Non-UK qualified doctors may also face language barriers and cultural differences.   Evidence from the GMC shows that doctors who qualified outside the UK and doctors from black and minority ethnic (BME) groups do not perform as well in examinations and are more likely to face fitness to practise proceedings than their white or UK trained colleagues. 
IMGs also face challenges related to career progression. A GMC study of a cohort of 7423 foundation year 2 doctors found that those with an undergraduate degree from outside the UK were less likely to be offered a specialty or GP training place than those who attended a UK medical school. Also, doctors not in a UK training programme but with a UK licence to practise were less likely than their UK trained counterparts to pass postgraduate exams.
Acknowledging the lack of standardised induction programmes for overseas doctors, and hoping to tackle staff recruitment and retention difficulties, the emergency medicine department at University Hospitals of Leicester NHS Trust developed the LEAD-it project.
The programme begins with a three month supernumerary tailored induction. The programme team provides pastoral care, including help with practicalities such as opening a bank account and registering with a GP, as well as regular, ongoing review and development of doctors’ clinical practice to ensure patient safety and staff satisfaction. There are regular educational supervisor meetings, completion of work based assessments and 360 degree multi-source feedback, competency sign off, and three monthly feedback meetings with the international consultant lead.
The scheme also includes a “buddy system” where an allocated peer, normally a colleague who has been through a similar situation, answers questions about the doctor’s adaptation to the new environment. All IMGs who participated in the project reported a very positive experience overall.  This was reflected in IMG retention rates rising from 0% (2013-14) to 60% (2014-15) in the emergency department.
Given the NHS’s reliance on IMGs, we suggest that a model of structured, tailored induction and support (similar to the LEAD-it strategy) should be widely applied in a standardised, mandatory way for all international medical graduates taking their first post in the UK.
Competing interests: We have read and understood BMJ’s policy on declaration of interests and declare we have no competing interests
- General Medical Council. List of registered medical practitioners. [Link] .
- Torjesen I. Hunt aims for fully home grown doctor workforce. 2016. [Link] .
- Hughes D, Clarke V. Thousands of NHS nursing and doctor posts lie vacant. 2016. [Link] .
- General Medical Council. Interactive reports to investigate factors that affect progression of doctors in training. 2015. [Link] .
- McKimm J, Wilkinson T. “Doctors on the move”: Exploring professionalism in the light of cultural transitions. Med Teach 2015;37:837-43. [Link] [Link] .
- NatCen. Fairness and the GMC: doctors’ views. 2014. [Link] .
- Humphrey C, Hickman S, Gulliford MC. Place of medical qualification and outcomes of UK General Medical Council “fitness to practise” process: cohort study. BMJ 2011;342:d1817. [Link] [Link] .
- Bhat M, Ajaz A, Zama N. Difficulties for international medical graduates working in the NHS. BMJ Careers. 2014. [Link] .
- Williams R. LEAD-it Leicester emergency advancement and development of international training. 2016. [Link] .
- Williams R. The experience of international medical graduates. 2016. [Link] .
Irene Valero-Sanchez locum consultant chest physician
Papworth Hospital NHS Foundation Trust
Judy McKimm professor of medical education anddirector of strategic educational development Swansea University Medical School
Ruth Green consultant chest physician University Hospitals of Leicester NHS Trust