Working in another country

Authors: Carol Seymour 

Publication date:  22 Oct 2009

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Carol Seymour, medicolegal adviser for the Medical Protection Society, looks at everything you need to know to work in the rest of Europe

Many people come to the United Kingdom from all over the world to achieve undergraduate and postgraduate qualifications in medicine. A medical qualification is regarded as your passport to the world, but what are the things that you need to consider if you want to work abroad? And how easy is it to return to work in the UK?[1]

The number of health professionals working in different countries and jurisdictions is now a significant consideration in global health policy, particularly in Europe because of the freedom of movement of doctors. Recent publicity has highlighted the difficulties faced by non-UK trained doctors carrying out work in the UK out of hours system; it begs the question of whether UK doctors working in other countries could face similar hurdles. Other issues that are never far from the political agenda are the consequences of poaching doctors trained in low income countries as a short term solution to the shortage of health professionals in some European Union (EU) countries, including the UK.[2]

This article will explore what you should do if you are planning to work in other countries, with a specific focus on the rest of Europe, so that you are in a position to compete in the job market outside the UK.

Where to start

Before considering a temporary or permanent move abroad, you should find out as much information as you can about the healthcare system in the country you choose to work in. Particular issues to consider are:

• Your current registration status and how to register in another country

• The training requirements in other countries and how to keep your training up to date

• Professional indemnity requirements

• Language skills

• Your eventual return to the UK.

Information can be obtained from a range of sources, such as the appropriate high commissions or embassies and medical councils or associations. In some countries a restricted work visa may be required, so it is important to check with the relevant embassy. The BMA’s international department has produced an excellent monograph to assist people who want to work in Europe.[3] There is also useful information on the Foreign and Commonwealth Office’s website (www.fco.gov.uk).

Registration

In the UK, all doctors must be registered with the General Medical Council. In addition, the General Medical Council regulates all aspects of medical education and sets the standard for higher specialty medical training, through the Postgraduate Medical Education and Training Board. Before going to work in another country, it is essential to obtain a certificate of good standing from the General Medical Council, and also to inform the General Medical Council of any change in your correspondence address.

Working in the European Economic Area

The European Economic Area (EEA) consists of the countries of the EU and the European Free Trade Association, except for Switzerland. Since 1975, a series of EU directives has entitled doctors from EEA countries to practise and obtain full registration as a doctor in another EEA country provided they fulfil two criteria. Firstly, they must be citizens of an EEA country; and secondly, they must have completed basic medical training in an EEA member state and hold a recognised medical qualification.[4] In 2005, a directive on the mutual recognition of medical qualifications was accepted, which further facilitated the movement of doctors to work anywhere in the EU.[5]

Although the migration of health workers in Europe has been studied, the precise number of outgoing or incoming doctors from and to the UK is unknown.[6] An Oxford study on the views of a cohort of doctors qualifying in British medical schools indicates that most doctors who left the UK for a time returned to practise in the NHS.[7]

Registration in EEA countries

Before going to work in an EEA country, you should contact the competent authority for information on the registration process. The equivalent of the General Medical Council and the Postgraduate Medical Education and Training Board are the “competent authorities” in EEA countries. The BMA provides a list of competent authorities and equivalents. European Commission law sets out that these applications should be dealt with within three months; it is important to plan this early, so that registration is completed before travel.

If you have completed specialist training, a certificate of completion of training will need to be provided, or an equivalent certificate issued by the Postgraduate Medical Education and Training Board. It may be necessary to have these relevant documents translated into the language of the EEA country; embassies in the UK have lists of translators who could assist in this process.

Training and professional codes

You must abide by the professional and ethical codes of conduct of the country in which you plan to work. Although guidelines in the General Medical Council’s Good Medical Practice are likely to be reflected in the code of any EEA country, there may be differences that relate to cultural and political matters, which may affect patient expectations and attitudes. As in the UK, being aware of the code of practice is essential to maintain good practice and to avoid misunderstandings between patients and colleagues, which could lead to complaints and subsequent disciplinary proceedings. Information on this can be obtained through the BMA, the medical authority of the relevant country, and through colleagues practising there.

Information on the medical education and training system within that country should be obtained before you leave the UK. Each country will be different and may not follow UK training or the specialist training programme. You may be required to undergo health screening before being accepted to a new post in another country.

If you are in a training grade, it is important to discuss with the appropriate deanery whether or not you can retain your national training number, so that you can come back into the UK system on your return, and to be clear how this may affect the date for your certificate of completion of training.

If you are a specialist, ensure that you have continued registration with the General Medical Council and discuss with your deanery, royal college, or faculty whether experience obtained abroad would be recognised in the UK, particularly if you intend to return. This will avoid disappointment and a delay in taking up a UK post. All doctors, trainees, and specialists should keep up to date with continuing professional development and appraisals—consider maintaining a logbook of your experience and training. This will be particularly important in the future with revalidation looming. If you are a general practitioner who is taking time out to work overseas, you should discuss with the primary care trust about remaining on, or returning to, the performer’s list.[8]

Professional indemnity

Adequate professional indemnity must be in place to cover you for clinical negligence claims. This may be provided by the employer or the state—in a similar way to NHS indemnity—but if not you should arrange your own.

You should notify your current medical defence organisation about any change of employment; tell them that you plan to work in another country, and check whether they can provide indemnity in that country or can advise about local providers.

Language

Doctors who speak only English may find language a barrier if they want to work in a non-English speaking country. It is essential to have effective communication with patients and other health professionals, so being proficient in the language of the country, or having access to translators, will be necessary for safe autonomous practice.

Working in the developing world

Working in the developing world is personally and professionally satisfying, and there are many programmes that support this. Many of the agencies that employ doctors in the developing world, for example, Médicins Sans Frontières and Voluntary Service Overseas, will be able to provide specific information on the healthcare system, registration, and working in other countries. The BMA international department gives excellent advice on the requirements and refers to “People in Aid,” which has produced a code of best practice for working in such countries. The use of translators in clinical practice may be more readily accepted in the developing world than in EEA countries.

Returning to the UK

When planning to work abroad it is important to include preparations for your return to work in the UK by getting in touch with your deanery, royal college, faculty, and the General Medical Council. It is advisable for UK medical graduates to have completed foundation training before doing a period of training abroad, and to ensure that any national training number can be retained on return to the UK.

Approval from the appropriate deaneries and royal colleges is important for time out of a programme for approved clinical training, or time out of a programme for clinical experience. Time spent working outside the UK will be regarded as a break in NHS service; advice on the implications of such a break, including pension, should be sought from the deanery or the BMA.

Conclusion

Many doctors want to work abroad to enhance their skills and see the world. Much planning and preparation is required, however, to ensure that this is professionally and personally rewarding. If you intend to return to the UK, you should plan your route back to a UK post before leaving. Consider how you would come back into NHS service and the implications that working overseas will have on the recognition of the training and experience you received abroad, and on your salary and pension.

A medical qualification may be a passport to the world, but careful planning and consultation with the appropriate organisations outside and inside the UK will make the experience enjoyable and successful and will make sure that you have a viable career route back home again—assuming that you want to come back and do not find that the grass is greener elsewhere.

Competing interests: None declared.

Carol Seymour medicolegal adviser Medical Protection Society

Correspondence to Stella Zegge  stella.zegge@mps.org.uk