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Indian Journal of Surgery
Medknow Publications on behalf of Association of Surgeons of India
ISSN: 0972-2068
Vol. 68, Num. 6, 2006, pp. 336-337

Indian Journal of Surgery, Vol. 68, No. 6, November-December, 2006, pp. 336-337

Letter To Editor

Training for overseas doctors in the UK

Academic Surgical Unit, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, HU16 5JQ
Correspondence Address:Academic Surgical Unit, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, HU16 5JQ Email:,

Code Number: is06100

Related Article: is04069


We read with interest the article by Raghu et al[1] and have been following the correspondence till date. The system of education and training in the UK is going through a metamorphosis, though not much of an emphasis is being given to the overseas doctors to be a part of it. In the midst of this, the sudden change in the immigration policies for the overseas doctors is a shock. The articles in Minerva section of the British Medical Journal (2006)[2] and Press Release from the Department of Health UK[3] are sensational shocking news for the thousands of overseas doctors among whom Indians form a major chunk. Currently, there are well over 115,000[3] doctors practicing in the NHS. Of these, 45% are overseas-qualified doctors. This compares with 40% who have qualified in the UK and 15% within the European economic area.[4],[5]

There are pros and cons associated with the sudden, unexpected, uncautioned change in the immigration policies. Loss of health professionals from underdeveloped and the developing countries would decrease,[6] which would benefit their healthcare system. The unemployment rate of the homegrown graduates in the UK would decrease.[7] On par the extent of impact, it would have on the finance, education/training, and psychology on a section of the doctors who are already in the UK is well beyond one's imagination. Training in the UK is popular amongst overseas trainees, because it is perceived to be good and well-thought of abroad.[8] The financial stability it brings makes overseas doctors to dream about UK.

Many doctors who have passed PLAB test wait for several months and in some instances ranging from six months to a year before they can find a job.[9],[10],[11],[12],[13] There are doctors at various stages of their career; beginning from somebody who is looking for an observer post to gain some local experience to the ones who are on honorary contract. Some are on locum appointment, hunting for a substantiate post and some, half way through their training awaiting eligibility for their exams. There are good few who have passed their exams and are applying for research posts and higher specialist training.

The competition to get onto a structured higher specialist training programme is fierce. In the surgical specialty alone on an average, there are about 200-250 basic surgical trainees competing for 1-2 slots on a higher surgical training programme.[14],[15],[16] There are a couple of bottlenecks in the career pathway where the trainees do struggle and the new immigration policy is an add-on.

The British Medical Association (BMA) in its response to immigration proposals, UK said - Treat Unemployed Overseas Doctors Fairly.[17] They acknowledge the fact that the sudden change in the immigration policy has hit overseas doctors the hardest. The BMA has expressed its concern for the thousands of overseas-unemployed doctors who are already in the UK, having made enormous personal and financial sacrifices to work in the NHS.

The new system came into force from July 2006.[3] The logistics of the transitional process will be a hardship given the significant number of doctors waiting to get a job after their PLAB exam.[17] These changes should not be implemented in such a way that their welfare is harmed. They are now faced with a hurdle of suddenly having to get a work permit. The highly skilled migrant programme[18] services can be of help in this situation at least for those who are already working in the NHS. Considering the changes in training and immigration rules, the impact on overseas doctors is significant. If we could hope for an extended time period for a gradual transition, it would be a breather for thousands of overseas doctors.

It will be very difficult for the fresh overseas graduates to train in the UK. The abolition of permit free training, the need for a work permit, the fact that government policies prefer UK and European graduates - all these would not make the career pathway rosy for the overseas graduates.


1.Ram PR. Surgical training for overseas doctors in the UK. Indian J Surg 2005;67:58.  Back to cited text no. 1    
2.Br Med J. Minerva. 2006;332:616. 11 MARCH 2006.  Back to cited text no. 2    
3.Department of Health. Press Release 2006/0093. Extra investment and increase in home-grown medical recruits eases UK reliance on overseas doctors. [cited on 2006 Mar 7]. Available from: And Statistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4131255andchk=TadpQg.  Back to cited text no. 3    
4.General Medical Council [homepage on the Internet]. Available from:  Back to cited text no. 4    
5.General Medical Council. Changing times and changing cultures: A review of the work of the GMC since 1995. General Medical Council: UK; 2000 Available from:  Back to cited text no. 5    
6.Chipwete J, Ramaiah S. Migration of health professionals. Lancet 2005;366:200.  Back to cited text no. 6    
7.'3,000 doctors out of work' claim. News on BBC, 09:39 GMT 10:39 UK. [cited on 2005 Sep 20]. Available from:  Back to cited text no. 7    
8.Raghu RP. Surgical training for overseas doctors in the UK - Facts, realities and solutions. Indian J Surg 2004;66:265-9.  Back to cited text no. 8    
9.Shah E, Dasgupta P. Training overseas doctors in the United Kingdom. Frequency of PLAB tests should match available jobs. BMJ 2001;322:110.  Back to cited text no. 9    
10.Welsh C. Training overseas doctors in the United Kingdom. They must be given accurate information about their job prospects. BMJ 2000;321:253-4.   Back to cited text no. 10    
11.BMA News. July 26, 2003:9.  Back to cited text no. 11    
12.Too few posts for Overseas Juniors. Hospital Doctor: UK; 2001.   Back to cited text no. 12    
13.Sridhar MK. UK encourages unrealistic expectations among overseas applicants for training. BMJ 1998;316:473.  Back to cited text no. 13  [PUBMED] Cossart L, Kirk RM. Surgical training for overseas doctors: An historical review and proposals for the future. Ann R Coll Surg Eng 1999;81:180-1.   Back to cited text no. 14  [PUBMED]  
15.Unfinished business - Proposals for reform of SHO grade', Department of Health Publication. [cited on 2002 Aug 21]. Available from:  Back to cited text no. 15    
16.Galasko CS, Smith K. Ratio of basic surgical trainees to type 1 specialist registrar programmes 1999/2000/2001/2002. Ann R Coll Surg Eng 1999;81:124-8.   Back to cited text no. 16  [PUBMED]  
17.Treat Unemployed Overseas Doctors Fairly - BMA Responds To Immigration Proposals, UK. Public Health News. [cited on 2006 Mar 8]. Available from: http:/ medicalnews.php?newsid= 39050.  Back to cited text no. 17    
18.Working in the UK as an Highly skilled immigrant. Available from: .  Back to cited text no. 18    

Copyright 2006 - Indian Journal of Surgery

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