The Contribution of IMGs To The NHS PDF

The contribution of
international medical
graduate doctors to
the NHS
May 2015
BMA equality and inclusion unit British Medical Association

bma.org.uk
Contribution of IMG (international medical graduate) doctors to the NHS 1
Editorial board
A report from the BMA equality and inclusion unit.
BMA equality and inclusion committee chair Krishna Kasaraneni

Policy director Hilary Lloyd
Head of equality and inclusion unit Nicky Jayesinghe
BMA equality and inclusion unit Yasemin Dil

Darshna Gohil
Ciara Greene
Jonathan Longley
2 British Medical Association Contribution of IMG (international medical graduate) doctors to the NHS 3
Acknowledgements Foreword
The BMA would like to thank all the doctors who gave up their time to share their experiences for this The NHS is dependent on IMG doctors (international medical graduate) to provide a
resource. high quality, reliable and safe service to patients. They enrich the NHS with their skills,
enthusiasm and diverse perspectives and have become essential members of the UK’s
medical workforce. With over one in three doctors presently working in the NHS having
Abbreviations graduated outside of the UK, the BMA equality and inclusion unit has developed this
resource to celebrate the contributions of IMG doctors to British healthcare.
BMA British Medical Association
BME Black and minority ethnic This resource shares the experiences of 39 doctors who are working, or have worked in the
Mark Porter
BMJ British Medical Journal BMA council chair NHS, but originally trained all over the world, with contributors from as far afield as India,
CCG Clinical commissioning group Colombia, and Australia, and as close to home as Italy and Spain. They have shared their
CQC Care Quality Commission reasons for coming to the UK, what they have found difficult, what they have enjoyed, and
EEA European Economic Area importantly, what we can do better as an Association to help IMG doctors when they first
ENT Ear, nose, throat come to the UK and beyond.
F1/F2 Foundation year 1/2
FRCSEd Fellow of The Royal College of Surgeons Edinburgh IMG doctors are not a new addition to the NHS workforce – in fact a significant proportion of
FRCS Fellowship of The Royal College of Surgeons doctors working in the UK before the NHS was established had trained abroad. Thanks to the
FRCOG Fellow of The Royal College of Obstetricians & Gynaecologists excellent clinical and research teaching and the resources available here in the UK, doctors
GMC General Medical Council from all over the world continue to come to the UK to complete postgraduate training. Those
GP General practitioner who do so may stay here, and many contribute their entire working life to the NHS.
IMG International medical graduate
IELTS International English Language Testing System While the UK and the medical profession have come a long way in terms of equality since
MBA Master of Business Administration IMG doctors first came to work in the UK, as you will see from these stories, there is still some
MBBS Bachelor of Medicine, Bachelor of Surgery way to go to ensure equality for all.
MDU Medical Defence Union
MMC Modernising medical careers The BMA is committed to promoting equal opportunities for development and career
MSc Master of Science progression, and eliminating discrimination in all forms from the medical profession.
MTAS Medical Training Application Service Fairness, dignity and respect must be at the heart of healthcare. We hope that this resource
NHS National Health Service provides an insight into the working lives of IMG doctors and recognises their invaluable
PhD Doctorate of Philosophy contributions to the NHS.
PLAB Professional and Linguistic Assessments Board
PMQ Primary medical qualification
RCGP Royal College of GPs
PRHO Pre-registration house officer
SHO Senior house officer
UCLH University College London Hospitals
UK United Kingdom
UKG United Kingdom graduates
US United States Mark Porter
BMA council chair
Introduction Figure 1: Place of primary medical qualification of licensed doctors on the register in 2013.2
IMG doctors and the evolution of the NHS go hand in hand. Faced with workforce shortages,
100
the recruitment of health professionals from overseas began before the NHS was established 14 18 16 19
in 1948, and is a practice that has continued through to the present day. IMG doctors have 24 25
3.6 32 5.8
80 5.8 UK graduates
enhanced the UK health system over the years, improving the diversity of the profession to 18 56
17 11 EEA graduates*
reflect a changing population, providing a fresh approach to healthcare due to training in 9.6
different systems, and filling shortages in specialties which may otherwise remain empty. 60 IMGs‡
%
83 79 75
Over the past 60 years there has been a marked shift in the migration patterns of IMG doctors. 40
65 17 63
59
Historically, the majority of IMG doctors working in the UK came from the Indian subcontinent. 58
By 1960, following numerous mass recruitment drives by the NHS, 30-40 per cent of all junior 20
27
doctors in the UK were from India, Pakistan, Bangladesh, and Sri Lanka.1 Currently, a greater
number of graduates are arriving from within the EEA (European Economic Area), while the 0
<30 30-50 >50 30-50 >50 30-50 >50
number of doctors arriving from outside the EEA has in fact levelled off. 2013 saw increases in
the number of doctors from southern Europe such as Italy and Greece.2 Doctors in Doctors not on the Doctors on the Doctors on the
training GP/specialist register GP register specialist register
This shift may well be connected to the tougher challenges that non-EEA doctors now face and not in training
to settle and work in the UK. These doctors face stricter immigration laws and more complex Age (years)
registration requirements including completing the IELTS (International English Language
Testing System) test, which in June 2014 saw its minimum score for a pass increased, and the
PLAB (Professional and Linguistic Assessments Board) test – an examination of a doctor’s * EEA graduates are doctors who gained their primary medical qualification in the EEA, but outside of the UK, and who
are EEA nationals or who have European Community rights to be treated as EEA nationals.
medical competence and their ability to communicate in English. ‡ IMGs are doctors who gained their primary medical qualification outside of the UK, EEA and Switzerland, and who
do not have European Community rights to work in the UK.
Despite this, over a third of doctors on the medical register today gained their primary
medical qualification outside of the UK2 yet there is poor recognition of their importance
to the continued development of the NHS. IMG doctors come to the UK for a range of This resource shares the experiences of 39 IMG doctors from around the world (see Figure 2)
reasons including better working conditions and pay, higher standards of teaching, or to some of whom have been working in the NHS for many years and some of whom have
pursue postgraduate training. In reality however, IMG doctors often face barriers to career arrived more recently. Through their personal stories this resource aims to elucidate
progression within the NHS. Those who come to the UK with hopes of continuing their the reasons why they have come to the UK, the expectations they had and the very real
training can struggle to get places on programmes and the GMC reports that currently two challenges and barriers they have faced or continue to face. Importantly it provides an
thirds of doctors who are not on the GP or specialist register did not graduate in the UK (see opportunity to hear firsthand from these doctors how they think their transition to the UK
Figure 1).2 could have been improved and what support and guidance they continue to need. These
stories will provide a wealth of information and learning for doctors who have just arrived or
IMGs may face further difficulties integrating into a new country and a new health system. are considering coming to the UK. We hope this resource will raise the profile of IMG doctors
As seen throughout this resource, these can include communication and cultural across the UK and celebrate their successes in the NHS.
differences, lack of knowledge about the health system and regulatory frameworks,
poor induction and support, as well as complications in day to day tasks such as finding
somewhere to live or opening a bank account.
To ensure that the NHS can continue to deliver safe and effective care in the face of
increasing pressures, the skill and commitment of these doctors must be recognised and
valued. The NHS is home to one of the most diverse workforces in the world, reflective of the
society it serves, and something that should be celebrated. IMG doctors need to be treated
fairly and with compassion by the healthcare system and the public, and be given equal
opportunities to progress in their careers as they choose.
1 S Snow and E Jones. History and Policy (H&P). ‘Immigration and the National Health Service: putting history to
the forefront.’ 2011. Available online at www.historyandpolicy.org/policy-papers/papers/immigration-and-the-
national-health-service-putting-history-to-the-forefron
2 General Medical Council (GMC). ‘The state of medical education and practice in the UK report: 2014’. 2014.
Available online at www.gmc-uk.org/publications/25452.asp. (Accessed 17.02.15).
Figure 2. Countries of origin of doctors who contributed to this resource.
Russia
Netherlands
Poland
Hungary
Italy
Portugal Spain Greece
Iraq Iran
Pakistan Nepal
Egypt
India
United Arab
Sudan Emirates
Ethiopia
Colombia Sri Lanka
Brazil
Australia
We asked interviewees which three

words they would use to describe
their career in the NHS so far: Obstructive Valuable
Struggle
Interesting Fascinating
Insecurity
Exciting
Inspirational
Successful
Dynamic
Discrimination
Frustrating
Challenging
Worthwhile
Stressful
Fantastic
Rewarding Fulfilling
Unique Rollercoaster ride Satisfying Shocking
Supportive Difficult
Unusual Empowering
Intense
Varied
Enjoyable Enlightening
10 British Medical Association The contribution of IMG (international medical graduate) doctors to the NHS 11
Manish Adke
‘I came to have had to bite the bullet and keep quiet 12. What are the main contributions of IMG
doctors to healthcare in the UK?
the UK to get about not being allowed to progress in their
careers. This may have something to do with IMGs have worked to a senior specialist
better quality the drop in the number of IMGs. and consultant level, so have contributed
enormously to the safe provision of quality
1. What is your name?
of training 10. What information, advice, support, would healthcare throughout the NHS. On call
Manish Adke in intensive have made your entrance to the UK and the services are fantastically supported by IMGs,
NHS easier? levels of clinical governance and quality of care
2. What is your position and where do you work?
care and When I moved to the UK 20 years ago there are consistently supported, and branches of
Consultant anaesthetist, Betsi Cadwaladr University Health Board, Wales labour was no internet available – I only had the practice that do not attract UK graduates are
supported by IMGs.
3. Where were you born?
analgesia telephone and fax numbers of the hospital
where I was to go. I received no information on
Maharashtra, India and in order the training programme, the NHS system, the
13. Which 3 words would you use to
4. Where did you complete your medical training?
to gain a solid job description, or about career development.
There was also no information on visa describe your career in the NHS so far?
Shivaji University, India and King Edward Memorial Hospital, Mumbai, India and modern regulations, or forward travel once I arrived in Fantastic
Fascinating
5. When did you come to the UK?
understand- the UK. More information from NHS hospitals
and the immigration offi ce would have been Fulfi lling
1994 ing of very helpful.
14. What do you miss the most from home?
medicine.’ 11. What can the BMA do to help IMG doctors Friends and family.
working in the NHS?
6. Why did you decide to come to the UK? 8. What have been your best experiences 25–30 per cent of the NHS workforce are 15. What would you miss the most if you
What were your goals/ambitions? working in the NHS as an IMG doctor? IMGs, but the number of IMGs coming to the left the UK?
The principal reason I came to the UK was to The NHS is a phenomenal organisation where UK now has dropped signifi cantly. The BMA Professionally, my stable and regular 8am-
get better quality of training in intensive care everyone, both patients and staff , are treated should lobby to increase the number of IMGs 6pm job and the income it provides.
and labour analgesia and, in order to gain a equally. A motivating factor is that we are per hospital. A good way to do this would be
solid and modern understanding of medicine, providing care for all, rather than working through using NHS specifi c visas for new IMGs. Personally, the clear, clean summer days –
it was necessary to look abroad. My main goals within a system that is based on money, as perfect for playing cricket, which I do in a
were to get more experience in intensive care, with the private sector in India. The support It would also be better if all the information local league in Liverpool. I would also miss
labour, anaesthesia, and obstetrics. that the NHS provides for career development and links that an IMG might need before the friends and family that I have made
is fantastic, such as supporting training moving was located in one place on the BMA here.
7. In starting your work as a doctor in the NHS, programmes allowing you to update your website such as for NHS jobs, visas, and the
what did you find difficult? What did you find techniques as they evolve in medical practise. royal colleges. It would also only be fair to 16. What would you miss the least if you
helpful? There is also a good emphasis on education in provide new IMGs with realistic expectations left the UK?
The induction to my fi rst hospital near role development – I have found that you are concerning the longevity of their careers with The weather! Cold and rainy!
Cardiff was fantastic, and despite my prior developed as a teacher as well, although this is the NHS – currently aft er two years you are
experience, the controlled manner in which easier in university hospitals. on your own, and unsure whether you will be
I was introduced to the ward was handled staying or returning home. The BMA could also
very well. I lived 15 miles outside of Cardiff , so 9. What have been your worst experiences support IMGs who are two to four years into
there was little else to do apart from study. working in the NHS as an IMG doctor? their NHS career, as around this period they are
This also made it diffi cult to shop due to poor The struggle to get a post as a trainee or oft en found to be struggling psychologically
access to Cardiff , although I received support specialist can be particularly diffi
cult for IMG with the large workload and low pay. The BMA
from colleagues who would give me a lift doctors. Restrictions for IMG doctors have should also give new IMGs the same discount
once a week. I also struggled with the hospital increased over the last 10-15 years which have as their UK equivalents – this is only fair given
canteen! The food there was so bad it took made it more challenging for IMG doctors to the fact that IMGs oft en have families at home
me several weeks before I could even go in. In get consultant posts. Despite being able to to support.
terms of support however, I did feel supported prove yourself, the rewards are not adequate.
professionally and personally. There have been episodes where IMG doctors
Pouya Alaghband
11. What can the BMA do to help IMG

doctors working in the NHS?
One day seminars setting out how the
NHS is organised and how it works. And
a website that brings a lot of relevant
1. What is your name? information together into one place for
Pouya Alaghband IMGs.
2. What is your position and where do you work? 12. What are the main contributions of ‘IMGs bring a lot of
Specialty registrar year four in ophthalmology, Health Education Yorkshire and the Humber Deanery IMG doctors to healthcare in the UK?
IMGs bring a lot of valuable experience
valuable experience
3. Where were you born? and diff erent ways of working from their and different ways
Tehran, Iran country of origin. They bring diff erent
viewpoints and opinions that makes the
of working from
4. Where did you complete your medical training? NHS better and can help with patients their country of
Islamic Azad University, Tehran, Iran from diff erent countries.
origin. They bring
5. When did you come to the UK? different viewpoints
2009 13. Which 3 words would you use to
describe your career in the NHS
and opinions that
so far? makes the NHS
6. Why did you decide to come to the UK? 9. What have been your worst experiences
Entertaining
Fulfi lling
better and can help
What were your goals/ambitions? working in the NHS as an IMG doctor? Innovative with patients from
My wife was already living in the UK and it made
sense to join her here. I wanted to further my
Not knowing where to start and where to go
for help and advice. All the information that I 14. What do you miss the most from
different countries.’
career and gain postgraduate education. picked up from my colleagues was anecdotal home?
and ambiguous. My family.
7. In starting your work as a doctor in the NHS,
what did you find difficult? What did you find 10. What information, advice, support, would 15. What would you miss the most if
helpful? have made your entrance to the UK and the you left the UK?
I found the bureaucracy diffi cult to deal with. NHS easier? The culture of the UK and the
The culture was very diff erent. I found dealing A website or app highlighting important discipline and organisation that
with patients also a bit diffi
cult, especially when information for IMGs to help them get started applies to most things in the UK.
it came to breaking bad news to them and in the NHS would be helpful. I do know now
gaining informed consent from them. that there is information available but it is oft en 16. What would you miss the least if
diffi
cult to fi nd. So a simple website that clearly you left the UK?
8. What have been your best experiences sets out what IMGs need to do to start their The weather.
working in the NHS as an IMG doctor? career in the NHS, plus what the roles of the
The support that I received from my clinical BMA and the GMC are, would be helpful.
supervisor was very useful in helping me to get
ahead in my career and training.
Mohammed Al Haddad
10. What information, advice, support,

would have made your entrance to 13. Which 3 words would you use to
the UK and the NHS easier? describe your career in the NHS
I would have liked to have had an IMG so far?
mentor who was successful, who Interesting
1. What is your name? could tell me about the NHS and how it Challenging
Mohammed Al Haddad works. I don’t think the mentor would Frustrating
necessarily need to be from the same
2. What is your position and where do you work? country as the mentee. 14. What do you miss the most from
Consultant, anaesthesia and intensive care, Western Infi rmary, NHS Greater Glasgow and Clyde home?
11. What can the BMA do to help IMG The food.
3. Where were you born? doctors working in the NHS?
Basra, Iraq It would be helpful if the BMA had a 15. What would you miss the most if
pool of mentors that IMGs could access you left the UK?
4. Where did you complete your medical training? when they arrive in the UK. It would also Law and order, fi nancial security,
Al-Nahrain School of Medicine, Iraq be helpful to have talks from mentors the tolerance of society, freedom of
that have had positive experiences of speech and standards of living.
5. When did you come to the UK? working in the NHS. This way IMGs are
1996 not exposed to negativity as their fi rst 16. What would you miss the least if
introduction to working in the UK. you left the UK?
I have found that the British way
12. What are the main contributions of of communicating is not very
6. Why did you decide to come to the UK? 8. What have been your best experiences IMG doctors to healthcare in the UK? straightforward! Sometimes people
What were your goals/ambitions? working in the NHS as an IMG doctor? The UK has a very diverse population say things and you understand
I was keen to emigrate either to the UK or to I found the guidance and supervision of and IMG doctors bring variety and what the words are, but they mean
America to advance my medical training and consultants very helpful. I had a consultant richness to the environment that would something entirely diff erent and
for better career opportunities. My wife at the supervising me very early on in my career otherwise not be there. For an example nuanced.
time had a British passport so that made it who gave me good advice and recognised my coming from Iraq, I could understand
easier to move to the UK rather than anywhere potential. why Muslim patients would react in a
else. certain way with regard to issues such
9. What have been your worst experiences as end of life care or organ donation,
7. In starting your work as a doctor in the NHS, working in the NHS as an IMG doctor? whereas another doctor would react in
what did you find difficult? What did you find My experience of working in the NHS has a very diff erent way.
helpful? generally been a positive one. I have on the
In Iraq doctors are pretty much left on their odd occasion heard comments from other
own to get on with their work – there wasn’t colleagues that IMGs may not be as capable as
a strong sense of team working. When I came their UK colleagues, but I have always seen that
as their perceptions and their problem rather
to the UK it took me some time to realise that
here, healthcare professionals work in teams. than something to do with me. I don’t speak
‘I would have liked to have had an IMG mentor who
English with a foreign accent which may have was successful, who could tell me about the NHS
meant I was not as exposed to these sorts of
Further, the contribution from nursing staff
and other allied health professionals is more comments as the majority of people, as many
and how it works.’
valued in the UK; and learning to include them think I was brought up in the UK.
in the decision making with regards to the care
of patients took some time to get used to.
Anonymous
‘The NHS 9. What have been your worst 12. What are the main contributions of
experiences working in the NHS as an IMG doctors to healthcare in the UK?
still has a IMG doctor? The biggest contribution is undoubtedly
good image Aside from record-keeping being a the staffi
ng of the NHS. UK graduates do
not supply enough doctors for the NHS
abroad, one little behind, I am not happy with the
increasing amounts of responsibility to survive, so without IMGs the system
Not disclosed that seems to that consultants here are being would fall apart. This is quite rare for a
Western system – countries like the US
have formed burdened with. I am responsible for
approximately 15,000 patients a year, and Australia have systems in place that
Not disclosed about 30 but I may only see 3,000 of them. In signifi cantly limit the number of foreign
doctors that can work there.
years ago, some cases, locums I have never met
are seeing patients I don’t have contact
Adelaide, Australia whereas the with, and yet I am still responsible for
reality is not any complaints.
Adelaide University (undergraduate), Royal Adelaide Hospital (postgraduate), Australia as nice.’ 10. What information, advice, support, so far?
would have made your entrance to Satisfying
5. When did you come to the UK? the UK and the NHS easier? Frustrating
2000 I think that there needs to be much Professional
more human resources support for
incoming graduates, as the system 14. What do you miss the most from
seems very disorganised at the moment. home?
6. Why did you decide to come to the UK? What Australia to get paperwork completed, which I think that there should also be more In a professional respect, the level
were your goals/ambitions? came as a complete shock to my poor mother! I information supplied about job security of power that doctors have.
I was already qualifi ed as a general also found the NHS patient record and booking and visas. Given my own experiences I
ophthalmologist, but wanted to become a sub- systems diffi
cult to adjust to – I would estimate think that more information should be Also the food and weather!
specialist in vitreoretinal surgery. I came to the that when I arrived they were around 10–15 available regarding the sheer number
UK to do a fellowship in order to achieve this, years behind the Australian equivalents. of patients that IMGs will be responsible 15. What would you miss the most if
but ended up doing three fellowships in a row. for. The NHS still has a good image you left the UK?
Following this, as ophthalmic consultant jobs I found the larger departments very, very abroad, one that seems to have formed The idea of being in a highly
in the UK were very rare I returned to Australia useful. Bigger departments meant that there about 30 years ago, whereas the reality regarded country.
and worked in Melbourne in 2004. However, a were more colleagues around, which meant is not as nice.
position became available in Kent, and in 2005 that I could bounce ideas off them when I was 16. What would you miss the least if
I was back working in the UK on a permanent in need of assistance. 11. What can the BMA do to help IMG you left the UK?
basis. doctors working in the NHS? Health management.
8. What have been your best experiences I think that the BMA can try to help
7. In starting your work as a doctor in the NHS, working in the NHS as an IMG doctor? ensure that IMGs aren’t put into
what did you find difficult? What did you find I would say that the best thing is that Australian high-responsibility positions straight
helpful? graduates are highly regarded, so many NHS away, and be an intermediary between
The main problems I had when I started my doctors are happy to work with me as a result. managers and IMGs.
fi rst stint in the UK were always concerning The bigger departments also mean that I
my visa. Though I had sorted things out at always have access to sub-specialists, whereas
my end – it was my places of work that were in Australia smaller departments mean that
not completing their paperwork correctly. I this is not the case.
was once forced to immediately fl y back to
Elena Barquero
‘It seems like 10. What information, advice, support,

a lot of new the UK and the NHS easier? describe your career in the NHS
IMG doctors Information upon induction on how to so far?
Diffi
cult
get their get on to the performer list on the GMC
website would have been very useful, Challenging
Elena Barquero information especially as a GP. Information on the Exponential

from other necessary vaccinations, and paperwork,
such as criminal records bureau checks, 14. What do you miss the most
GP, Lambeth CCG, London and clinical teaching fellow, Imperial Medical School, London. I am also IMGs who would have made my arrival much from home?
I fi nd it easier to understand
the facilitator for the monthly peer-support meeting for the Induction & Refresher Scheme.
have already easier. Clearer guidelines on the level of
English language required would also patients there, and also the
3. Where were you born? been through have been useful, but I understand that teamwork from my old practice.
I also miss my family, friends,
Barcelona, Spain
the system.’ this has now changed.
weather, and food.
4. Where did you complete your medical training? 11. What can the BMA do to help IMG
Universitat Autonoma de Barcelona, Spain doctors working in the NHS? 15. What would you miss the most
As an overseas doctor I didn’t really if you left the UK?
5. When did you come to the UK? understand what the BMA was for quite I would miss the options that are
2009 some time, so some information about open to GPs, I am a GP educator
it on the GMC website would be nice. for example. I would miss the
With all of the exams that IMG doctors community and organisation of
need to take I think that free courses the UK.
6. Why did you decide to come to the UK? 8. What have been your best experiences to prepare for them would help. Help
What were your goals/ambitions? working in the NHS as an IMG doctor? on the pathway to the performers list 16. What would you miss the least
It was for personal reasons – my partner was My communication skills have improved a lot, would also be nice. It seems like a lot of if you left the UK?
leaving Spain to go to the UK, so I left with and I can now follow guidelines a lot better. new IMG doctors get their information The paperwork, long hours and how
him. I wanted to improve my English, and my I also think that I have matured far quicker from other IMGs who have already been lonely the practice can be.
understanding of British culture and the NHS. as a doctor. through the system. I think that the
BMA should also be providing more
7. In starting your work as a doctor in the NHS, 9. What have been your worst experiences legal advice for IMG doctors – I had to
what did you find difficult? What did you find working in the NHS as an IMG doctor? spend a lot of money on exams that I
helpful? As a GP I found it very diffi
cult to get on to the did not need to take and would have
I found it helpful that the patients did not performer list, which is important to me. There appreciated advice on this.
object to me, and that in certain areas there were also lots of exams, and it is not clear at all
was not strict guidance. where to get information on how to prepare 12. What are the main contributions of
for them. IMG doctors to healthcare in the UK?
The NHS deals with patients from
diff erent cultures, and from all over the
world – IMG doctors have an advantage
here with how they can deal with
these patients. I can help with Spanish
and Portuguese patients, such as in
translation, which improves patient
access.
Grecy Bell
‘The BMA graduates. Partly because the doctor- from diff erent countries, there is a wide
variety of interests and overlap.
should have centred approach of my schooling
in Colombia it was very diffi
cult and
a guide challenging at the beginning until I 12. What are the main contributions of
IMG doctors to healthcare in the UK?
solely for realised the diff erence in approach.
There is a cultural aspect as well, there I am not sure about this question
Grecy Bell IMG doctors are things you need to learn about the because all doctors do their best. Three
out of ten doctors are IMGs, so really
that covers new culture. Some people feel outside
the group because they have diff erent IMG doctors are the backbone of the
GP partner, Green Croft Medical Centre South, Scotland everything beliefs and so on. NHS. Furthermore they bring diff erent
cultures, views and experiences that
like how to As human beings, we all have prejudice, enrich the experience of the NHS.
Cartagena, Colombia look for a job, but we need to adapt when entering a

house, also new culture. At times IMGs do less well
because they come over and want to 13. Which 3 words would you use to
Cartagena University, Colombia immigration act in the same way that they did at describe your career in the NHS
so far?
advice and home, but they have to adapt. There is a
culture shock sometimes because IMGs Satisfying
2002 so on.’ don’t talk about it or make an eff ort to Rewarding
become involved in the culture. Challenging
10. What information, advice, support, 14. What do you miss the most
6. Why did you decide to come to the UK? What staff . I am more comfortable with the set up would have made your entrance to from home?
were your goals/ambitions? here. We work in teams here and everyone can the UK and the NHS easier? Food, weather, people, music. I now
My main reasons for coming here were contribute equally. In Colombia medical staff I found that the GMC now has general call Scotland my home. I do miss
my family, my husband is Scottish and we don’t question their seniors. In terms of what is information about coming to the UK on Colombia, but every day that passes
relocated but the standard of medical training helpful, all the people were very helpful to me, their website, but this didn’t exist ten Scotland feels more like home.
is good here too. I like that here I have the especially in my clinical attachment course. years ago when I moved here. The BMA
opportunity to practice in a free-for-all medical Shadowing people was great and it really felt has some good resources too. I found 15. What would you miss the most if
set-up. My goals in life are to be happy and like I was part of a team. the BMA junior doctors guide very useful you left the UK?
practise medicine. when I came over. The BMA should Professionally, I would miss having
8. What have been your good experiences have a guide solely for IMG doctors that the ability to treat anyone who
7. In starting your work as a doctor in the NHS, working in the NHS as an IMG doctor? covers everything like how to look for comes through the door, nothing
what did you find difficult? What did you find I have had all good experiences. NHS staff are a job, house, also immigration advice to do with insurance or money.
helpful? very supportive to IMG doctors. Every day I and so on. The NHS experience is unique. In
There were many challenges in my work. feel supported. I feel very welcome and like a Colombia, I couldn’t treat a patient
My primary degree was in Spanish. I went to member of the NHS family. 11. What can the BMA do to help IMG if they didn’t have insurance, which I
Queens University Belfast and did a six month doctors working in the NHS? always felt bad about.
course in English to improve my English. 9. What have been your worst experiences I was pleased that the BMA got involved
Abbreviations and things like that took a long working in the NHS as an IMG doctor? in the GMC and RCGP examinations I would also miss haggis and
time. I also had to adapt to moving from a I would like to rephrase the question and talk issue. I always have been a member shortbread.
doctor-centred system to a patient-centred about the diffi
culties I have encountered. To of the BMA, I was very pleased with
system. The way things are done here is start with, you’re not sure because of the lack the level of involvement and hope this 16. What would you miss the least if
very diff erent to the way they are done in of insight, you think you are doing everything expands to more involvement. I think you left the UK?
Colombia where doctors have a higher level you need to but as an IMG you need to work the BMA should have an IMG committee (no answer)
of authority and are not questioned by other extra hard to get to a similar point as the British or forum as well. Although we are all
Gusztav Belteki
‘It was trainee at home in Hungary and was not used not function without IMG doctors. They
bring in diversity and diff erent backgrounds.
hard at the to it. I think all IMGs are initially vulnerable.
From my perspective it changed long ago, I am The population they serve is diverse, so it is
beginning to more senior now and I know the system and so better to have a diverse group to serve that
population.
find my role on. In addition, there are now more European
doctors in the NHS than 10 years ago and there
Gusztav Belteki and place is an increasing understanding of diff erences
within the between the systems.
describe your career in the NHS so far?
Consultant neonatologist, Cambridge University Hospitals NHS Foundation Trust team. Most 10. What information, advice, support, would Rewarding – it is very rewarding to work
have made your entrance to the UK and the in the NHS and to serve people who really
people did, NHS easier? need help, it would not be so rewarding in
Szekesfehervar, Hungary however, keep Some sort of induction to the NHS system. A a private system.

an open mind book or an induction course which explained
job roles, seniority, on call systems and so on, Challenging – sometimes the workload is
Semmelweis University, Budapest, Hungary and helped would have been very helpful. For example excessive, the resources are limited and
communication can be diffi cult particularly
me to learn an important thing for people to understand
is levels of seniority and the roles and duties with other specialties and the hospital
2003 the system.’ attached to them. There is no role or duty management.
equivalent to the NHS consultant in many
other European countries. Career progression 14. What do you miss the most from home?
is in general more gradual with more steps You would think that I would say family
6. Why did you decide to come to the UK? What initially puzzled by me not knowing some things. than in the essentially two-tiered (trainee/ but my small family is with me and I can
were your goals/ambitions? Most people did, however, keep an open mind consultant) UK system. Many European fl y home to see my parents in fi ve hours
I am also a molecular biologist. I came to the and helped me to learn the system. doctors fi nd it diffi
cult to place themselves door to door. I think it is the language. I
UK initially to pursue a research career in within the UK system. am fl uent in English but I will never get to
2003 but aft er two years I decided to apply for 8. What have been your best experiences the level of being able to communicate to
a clinical job. I undertook my core paediatric working in the NHS as an IMG doctor? In my opinion, if the UK wants to continue to the same level as I can in Hungarian! The
training in Budapest, completed my neonatal For me, the single best thing about the NHS attract IMG doctors who don’t want to start second thing is that I lived for the fi rst 30
training here and then became a consultant is that services and resources are prioritised from the beginning of training here – it needs years of my life in Hungary – it is diffi
cult to
in 2010. I don’t have an academic post at the for those who need them most, not for those a better way of translating competences and explain but it has its own colours, climate
moment, but I do have an honorary contract who can pay for them or who demand them job levels into this system. – I don’t know what it is, and I only realised
with Cambridge University. most. From a moral and ethical perspective, it when I left but then you do miss it.
is better to prioritise those in need. In addition, 11. What can the BMA do to help IMG doctors
7. In starting your work as a doctor in the NHS, it ensures good outcomes and the best return working in the NHS? 15. What would you miss the most if you
what did you find difficult? What did you find for the money spent, at least in my specialty, I found a lot of information in BMJ Careers – left the UK?
helpful? neonatology. I would be really sad if that I had to teach myself a lot and many things Most people are very polite and tolerant
There are many IMG doctors coming to work changed as, in my opinion, this is the single were initially completely unfamiliar to me. here, it is not necessarily the same in other
in the NHS and many of them face signifi cant most important asset. Also, the high morale For example, I hadn’t heard of what clinical countries and I would really miss that. Here,
diffi
culties initially. I think it is easier for graduates and dedication of front-line staff is really governance was before, and the laws of the UK they don’t skip you in a queue, they don’t
from Australia, India or from other previous important. Most doctors and nurses are really were new to me and so on. I found interesting drive aggressively, and it is really nice.
British colonies, places with a similar system dedicated even though most nurses are not articles about these in BMJ Careers – they
to the UK, unlike other European countries paid particularly well. should publish all the articles about the UK 16. What would you miss the least if you
with very diff erent systems. On-calls, seniority, system together, perhaps in a book. left the UK?
organisation, ethics, and legalities – they all can 9. What have been your worst experiences This is a very hard question but if I had to
be very diff erent. It was hard at the beginning working in the NHS as an IMG doctor? 12. What are the main contributions of IMG say something it would probably be UKIP
to fi nd my role and place within the team. I was A small number of people were initially doctors to healthcare in the UK? and the other nationalist parties.
the fi rst European on the unit, there were many dismissive and quite critical of me. I found it There are large numbers of IMG doctors
doctors from India, Asia and so on, and they were diffi
cult to take, as I had been a high-fl ying working in the NHS. Currently, the NHS would
Bimal Bhowmick
10. What information, advice, support, 12. What are the main contributions of
would have made your entrance to IMG doctors to healthcare in the UK?
the UK and the NHS easier? Without IMGs the NHS would not
Having a two day acclimatisation course exist. IMGs are the work horses of the
that highlights practical information for NHS, but have been systematically
1. What is your name? new doctors for example how to speak disadvantaged on what specialties they
Bimal Bhowmick with patients, nurses, other doctors, have been able to get on to. When I was
and how to write a prescription. As an training in the 60s and 70s, we were
2. What is your position and where do you work? associate postgraduate dean for IMGs only allowed to go onto training posts of
Locum consultant physician for the elderly in community care, North Powys I used to arrange such courses for IMGs unglamorous specialties or were stuck
and I would invite other organisations in non-progression jobs. This gave many
3. Where were you born? including the GMC and the BMA to give IMGs a complex of being failures.
East Bengal, India presentations. The BMA should consider
holding these courses as they are a
4. Where did you complete your medical training? good recruitment opportunity. 13. Which 3 words would you use to
Calcutta Medical College, India describe your career in the NHS
11. What can the BMA do to help IMG so far?
5. When did you come to the UK? doctors working in the NHS? Compassionate
1969 I think that the BMA should run Caring
induction courses for IMGs that should Committed
involve patient input as well. The BMA
should support IMGs to be safe and 14. What do you miss the most from
6. Why did you decide to come to the UK? At that time I found the support and guidance eff ective doctors. They should be home?
What were your goals/ambitions? of the nurses that I worked with was invaluable. informed about the implications of I miss the variety of food that you
My main goal in coming to the UK was to gain training schedules and revalidation. can get back home but not in the UK.
further qualifi cations which added kudos 8. What have been your best experiences The BMA should play a big role in
to practising as a specialist in India. The working in the NHS as an IMG doctor? helping IMGs to settle into the NHS. 15. What would you miss the most if
medical school that I went to in Calcutta was I learnt how to respect the patient and be you left the UK?
established by the British and many of the empathic. The chance to learn new techniques I would miss the people, over the
professors that were teaching there had been and to use technology that I was not exposed years I have made many friends and
to the UK for further specialty training. to in India. I did not fi nd anything particularly acquaintances, and I would also
diffi
cult and have found the whole experience miss the NHS.
7. In starting your work as a doctor in the NHS, great.
‘IMGs are the work horses
what did you find difficult? What did you find of the NHS, but have been 16. What would you miss the least if
helpful? 9. What have been your worst experiences you left the UK?
There was no system of induction to the NHS working in the NHS as an IMG doctor?
systematically disadvantaged I would not miss the British food! I
or acclimatisation for doctors that had come I didn’t have any negative experiences on what specialties they have fi nd it very bland.
that I want to highlight. I have always been
to the UK from another country. It felt as if you
were thrown into the deep end and had to fend hardworking and committed and I believe you
been able to get on to.’
for yourself. There was not much support from get back as much as you give from patients,
the senior consultants that you were supposed carers and colleagues.
to be working under. Further, medical
techniques and technologies were far more
advanced in the UK than back home, and there
was no support provided on how to use them.
Anonymous
‘I felt that I 9. What have been your worst 12. What are the main contributions of
experiences working in the NHS as an IMG doctors to healthcare in the UK?
had to prove IMG doctor? We are very well qualifi ed, our work
myself to The feeling that you have to try ethic is exemplary and doctors of Indian
origin are recognised as some of the
be a good twice as hard to get any results in an
environment that was alien to me, was best in the world. We bring a diff erent
Not disclosed doctor to a really hard. I felt that I had to prove perspective and innovative ways to
work. I regard empathy as one of the
much greater myself to be a good doctor to a much
greater extent before my colleagues essential qualifi cations of being a doctor
Consultant endocrinologist extent accepted me as such. and this is something that I feel needs
more emphasis.
before my 10. What information, advice, support,
Calicut, India colleagues would have made your entrance to
the UK and the NHS easier? 13. Which 3 words would you use to
accepted me Not sure, my staying here was describe your career in the NHS
Calicut Medical College, India as such.’ serendipitous and it is diffi cult to make so far?
a judgement now that the climate Varied
5. When did you come to the UK? is diff erent and training routes for Intriguing
2003 overseas graduates have been closed Fulfi lling
off . The climate within the NHS has
changed as well and generally my advice 14. What do you miss the most from
to overseas graduates has refl ected home?
6. Why did you decide to come to the UK? understand why, but still frustrating. What I this; do not come here if you are aft er Family and parents. Arts and
What were your goals/ambitions? found helpful was colleagues who were friendly training. If you have suffi cient level literature and the intangible feeling
Serendipity – I actually only came to the UK to and helpful. of training and qualifi cations and you of connectedness.
do my membership exam for The Royal College need sub-specialist experience, make
of Physicians as I was between training posts. It was really helpful talking to friends and sure that you have the right job sorted 15. What would you miss the most if
Unfortunately the start date of the training relatives that have been in the same situation. prior to coming here and understand you left the UK?
post I had secured in India was brought forward A lot of the information that I got to help me the constraints. Had I known about the I love the fact that the NHS is free
so I could not get back to India in time and through was from them. diffi
culties in fi nding training posts, the and that it off ers universal coverage
ended up losing it. Following this I decided to subtle barriers to career progression and here in the UK. I’d also miss my
try and make a go of it in the UK working in the 8. What have been your best experiences the constant changes to the training friends.
NHS. working in the NHS as an IMG doctor? and systems, I would have thought
I like the fact that the care that people receive twice. 16. What would you miss the least if
7. In starting your work as a doctor in the NHS, is of a high standard here in the UK and it is you left the UK?
what did you find difficult? What did you find free. I fi nd most people to be helpful – both 11. What can the BMA do to help IMG The bureaucracy, guidelines that
helpful? clinicians and patients. I feel proud that I work doctors working in the NHS? are sometimes too rigidly adhered
Given that I did not intend to fi nd work here, for an organisation that helps people when Ensure fairer environment especially to, and the commute to and from
I had not done any research on it. The offi cial they are vulnerable and in need. around complaints and sanctions, I work.
advice on getting into a training rotation was understand the GMC has looked at this
not very helpful. There seemed to be a bit of a previously; perhaps the BMA could lend
glass ceiling. What I found frustrating was that its infl uence in this matter. Additionally,
experience and knowledge prior to coming the BMA can work to ensure that there is
here was not much taken into account. I can a degree of fairness in the recruitment
process, and to try and combat the
subtle bias that exists.
Marco Burattin
‘There are Secondly, you can defi nitely tell that 12. What are the main contributions of
a number the relationship between IMG doctors
and local doctors can be challenging. At the start, any IMG doctor is extremely
of different You try to integrate and to be part of dedicated. IMG doctors all have
experience of working outside the
components the team but it can be diffi cult. The
environment can be highly charged and NHS and all have experience of working
Marco Burattin to life in the stressful, essentially making it a perfect with diff erent diseases that
are uncommon here.
NHS that situation for confl ict. There is a divide,
quite deep at fi rst but it does vanish over
Specialist registrar, acute medicine, Leicester Royal Infi rmary, University Hospitals of Leicester you need to time as you get used to the system. I It also enriches the NHS in terms of
diversity in background, religion and
NHS Trust
adjust to, think experiences can be quite diff erent
depending on your colleagues. culture.
3. Where were you born? from simple
Rome, Italy
tests, to the would have made your entrance to 13. Which 3 words would you use to
4. Where did you complete your medical training? structure the UK and the NHS easier? describe your career in the NHS
so far?
Sapienza, University of Rome, Italy
of medical I specifi cally wanted to know about
the training system. It would have Exciting (I couldn’t sit still on the
5. When did you come to the UK? teams been good to have had a better plane when I was on my way over)
Dynamic (and it still is)
2007
looking after understanding of the system before I
started. I was extremely keen to do my Empowering
the wards, absolute best as a junior doctor and I
14. What do you miss the most from
6. Why did you decide to come to the UK? I did an attachment placement before I started
and every could have benefi ted from having advice
on how to balance work and personal life home?
What were your goals/ambitions? in my fi rst post and that was very helpful specific job which at times was diffi cult. Now I have Family and food. Most of my time
spent with my family is around a
I wanted to pursue a career in hospital
medicine and develop my career with further
in understanding the framework, such as
diff erent roles and the way the systems work,
role.’ learnt how to switch off . In 2007, I was
constantly in the hospital in my mind. I table, so we spend a lot of our time
training. I didn’t have any specifi c goals. I was as well as practicalities like note writing. BMA didn’t have friends and family around. All talking and eating.
just attracted by the training opportunities that publications were very useful. I had a junior I cared about was getting my job done.
the UK healthcare system off ered. My then doctors publication which had all you needed 15. What would you miss the most if
girlfriend, now wife, was also in the UK. to know in one booklet. I think I still have it There is a lot of support out there from you left the UK?
somewhere. Courses like advanced life support the UK institutions. I was eager to meet Education, training opportunities
7. In starting your work as a doctor in the NHS, and intermediate life support were helpful too. other Italians working in the NHS, to are really precious, I doubt other
what did you find difficult? What did you find learn from each other, but there doesn’t countries could off er the same.
helpful? 8. What have been your best experiences seem to be many of us here. Some sort
First and foremost the biggest obstacle was working in the NHS as an IMG doctor? of support in networking would have 16. What would you miss the least if
the language barrier, with the system coming I certainly appreciate the multicultural been useful too. you left the UK?
alongside it. There are a number of diff erent environment of the NHS. I also like the training I want to be original and not say the
components to life in the NHS that you need and work structure of each placement, 11. What can the BMA do to help IMG weather! Lunch: there is never time
to adjust to, from simple tests, to the structure especially in the early years of training. doctors working in the NHS? to sit down and eat here.
of medical teams looking aft er the wards, and Induction is really precious at the
every specifi c job role. These are all diff erent 9. What have been your worst experiences beginning of any placement: online, face-
to the Italian system. You really need to adjust working in the NHS as an IMG doctor? to-face, even a podcast would be very
to the new system or you end up asking the Firstly, I would say that some patients are very helpful. It could include information about
wrong questions to the wrong people, and end demanding which can put a lot of pressure on how things are done here and specifi cs
up interpreting things in the wrong way leading you, especially when wards are short staff ed. such as how to interact with patients.
to incorrect results.
Kovoor Elias Cheriyan

Back in those days there was absolutely so far?
no advice provided in advance. We were Rewarding
1. What is your name? thrown straight into the deep end with Struggle
Kovoor Elias Cheriyan no induction and expected to learn the Learning
ropes. What we provide for IMGs these
2. What is your position and where do you work? days is very good, medical personnel 14. What do you miss the most from
Part time consultant paediatrician, Kent Community Health NHS Trust were not spoon-fed back then as they home?
are now. The weather, the food, and some
3. Where were you born? of my college mates.
Kerala, South India 11. What can the BMA do to help IMG
doctors working in the NHS? 15. What would you miss the most
4. Where did you complete your medical training? The BMA should be more sensitive to if you left the UK?
Government Medical College, India the needs of IMG doctors. To gauge Everything! Radio 4, The Times, and
their needs they should survey all IMG the ordered way of life in particular.
5. When did you come to the UK? doctors, which will tell them more than I
1975 can, and inform their work. 16. What would you miss the least if
you left the UK?
12. What are the main contributions of The bitter winter – it is the only time
IMG doctors to healthcare in the UK? that I want to escape these shores!
6. Why did you decide to come to the UK? work. I also struggled with my surroundings IMG doctors have provided the
What were your goals/ambitions? outside of the hospital, such as the weather, backbone of the NHS, particularly in
I came to pursue higher medical qualifi cations. the food, and the loneliness. I worked with less attractive but just as necessary
Britain has a better system of postgraduate very supportive teams though, who were specialties.
qualifi cations, and a more appealing way of life. very helpful.
My father served with the British armed forces,
so I was a big fan of everything British. 8. What have been your best experiences
working in the NHS as an IMG doctor?
I originally only came for a two month clinical I like the stability that a consultant post
attachment, but at the end of the fi rst week provides – once you have achieved one, the
the consultant was so pleased with me that NHS is a good employer providing continuity ‘Some people – not patients – find it difficult to
and good pension arrangements. I have been
he off ered me a job, and I have been here ever
since. a part of good teams and have enjoyed taking
accept you as an IMG doctor. They can take their
on each of the challenges that has been put in time to get to know and understand you.’
7. In starting your work as a doctor in the NHS, front of us.
what did you find difficult? What did you find
helpful? 9. What have been your worst experiences
I had to familiarise myself with a diff erent sort working in the NHS as an IMG doctor?
of patient, but generally the NHS was easy Some people – not patients – fi nd it diffi
cult
to adapt to. Getting the work done was not a to accept you as an IMG doctor. They can take
problem, but getting a job was – for some time their time to get to know and understand you.
I had to keep changing job and doing locum Once they do, however, then things are ok.
Pedro Cunha

would have made your entrance to 13. Which 3 words would you use
the UK and the NHS easier? to describe your career in the
Having a two day acclimatisation course NHS so far?
that highlights practical information for Challenging
1. What is your name? new doctors would be helpful. It should ‘Sweet and sour’
Pedro Cunha include what the diff erent training levels Stuck
actually entail. It would also be helpful
2. What is your position and where do you work? to have a repeat session of this training, 14. What do you miss the most
Clinical fellow in general surgery, Homerton University Hospital NHS Foundation Trust, London so that these doctors can feedback on from home?
their experience. My family and the friends I have
3. Where were you born? left behind.
Rio de Janeiro, Brazil 11. What can the BMA do to help IMG
doctors working in the NHS? 15. What would you miss the most
4. Where did you complete your medical training? I think that the BMA should reach out if you left the UK?
Universidade Federal do Rio de Janeiro, Brazil to foreign doctors prior to their entry The NHS – general interest
to the UK. Many IMG doctors do not opportunities that come up
5. When did you come to the UK? understand what the role of the BMA is and opportunities for medical
2009 and the breadth of the services that are research, continued professional
off ered to members. development, medical education
and the professional culture.
12. What are the main contributions of
6. Why did you decide to come to the UK? 8. What have been your best experiences IMG doctors to healthcare in the UK? 16. What would you miss the least
What were your goals/ambitions? working in the NHS as an IMG doctor? They enable the UK to have the if you left the UK?
The healthcare system in Brazil is very similar I feel I have a lot that I can provide as a doctor workforce it needs. Without IMGs the The administrative work of the NHS
to the NHS. I wanted to work in a system that here as I have a wealth of knowledge from NHS would not be able to meet the – it really is overly bureaucratic.
is more organised and a society that is less outside of the UK. needs of the population.
violent. I came for personal and professional
reasons. 9. What have been your worst experiences
7. In starting your work as a doctor in I have found that British doctors can think that
the NHS, what did you find difficult? their way is best, and not be open to new ideas.
What did you find helpful? Sometimes they can be dismissive and are not
I found it very diffi
cult to understand the interested in listening to your point. If your
‘Having a two day acclimatisation course that
diff erent job titles and what they meant, such specialty training took place outside the UK, highlights practical information for new doctors
then what you have learnt from your country
as where each position is within the training
cycle. I found the framework of jobs was very does not count for anything here. I feel IMG
would be helpful. It should include what the
diffi
cult to understand. The culture of work in doctors are not utilised to their full potential. different training levels actually entail.’
the UK is also very diff erent to what I am used
to but generally I found that British people
are accepting of foreign people and do make
concessions for the fact that someone is new
to the UK.
Ramy Daoud
‘I think the 9. What have been your worst 12. What are the main contributions of
experiences working in the NHS IMG doctors to healthcare in the UK?
greatest as an IMG doctor? We all bring our own perspectives and a
difficulty is There haven’t been many really. As a diverse range of cultures to the NHS. I
think sometimes it can be an advantage
the clinical psychiatrist there is a stigma attached
generally – sometimes psychiatrists to be an IMG here, as you might be
Ramy Daoud parts of the aren’t treated that well by other doctors able to bring a diff erent perspective
to solving problems which need to be

royal college but actually I haven’t experienced this.
approached sensitively. If we use driving
Consultant psychiatrist, Devon Partnership NHS Trust membership Personally I never felt discriminated as an analogy, where I am from there are
rules, but these aren’t really considered

examinations. against as an IMG doctor – perhaps this
is because my English is good. The only binding. Here in the UK people are very
Nigeria, but I am Egyptian I didn’t pass problem with that is that people think rule bound. It is the same in the NHS,
there are written and unwritten rules.
the first time that I’m on the same wavelength and
that I understand all the nuances in I know a lot of IMGs struggle with this
Cairo University, Egypt and I couldn’t conversations but in reality I don’t! I do and can do things diff erently – I actually
think their experiences can and does

work out have to work extra hard and pay close
attention. add to the NHS.
2004 why. I figured

out it was I think the greatest diffi
culty is the
clinical parts of the royal college 13. Which 3 words would you use to
nothing to membership examinations. I didn’t pass describe your career in the NHS
6. Why did you decide to come to the UK? so far?
What were your goals/ambitions?
I found my supervisor/boss – herself an IMG
– to be very understanding and patient which
do with my the fi rst time and I couldn’t work out
why. I fi gured out it was nothing to do Fulfi lling
When I was working in Egypt between 1998 was extremely helpful. I was in a catch 22 knowledge, with my knowledge, but more about my Challenging
situation with my GMC registration. When I did style and approach. The exams are very Rollercoaster ride
and 2004 my experience of medical life there
became very unpleasant and I wanted to leave. fi nally get a job I alerted the GMC but they were
but more culturally specifi c – which I agree with
Professionally the work wasn’t very satisfying slow with my application so that for two weeks I about my – we need to be culturally profi cient but 14. What do you miss the most from
couldn’t work with patients and had two weeks this is a really big hurdle for a lot of IMG home?
and on a wider scale I wasn’t getting along with
Egyptian culture. Coming to the UK seemed paid observation in the hospital. I was lucky to
style and doctors. My friends and the very laid back
like the best option for me. have a very understanding supervisor. approach.’ culture.
7. In starting your work as a doctor in the NHS, 8. What have been your best experiences would have made your entrance to 15. What would you miss the most if
what did you find difficult? What did you find working in the NHS as an IMG doctor? the UK and the NHS easier? you left the UK?
helpful? The best thing, and this was partly one of I think some sort of tailored training for I consider the UK to be my home
It was a culture shock! I think it was probably my goals for coming here, is the quality of IMGs which focuses on aspects of the now. If I left I suppose I would miss
easier for me than for other IMG doctors but it training. The work ethic here in the NHS is culture and the language could be very the peace and quiet.
was still a shock. I remember on one of my fi rst very good – in Egypt the work is mostly private helpful.
days working I had a strange exchange with the which actually complicates the doctor-patient 16. What would you miss the least if
head nurse in my department. She was very relationship. The quality of care in the NHS is 11. What can the BMA do to help IMG you left the UK?
lovely and polite and was telling me quite a long really good. doctors working in the NHS? Nothing signifi cant I can think of!
story about a patient. At the end of the story I have had an up and down relationship
she looked at me expectantly – apparently, in with the BMA but from my personal
there somewhere, was a request for me to do experience the BMA did help me with a
something! It is still diffi
cult and things do get dispute I was having so I do recognise
lost between the lines. that the BMA has an important role to
play. For IMGs, the BMA should run some
induction and training days.
Ashish Dave

1. What is your name? would have made your entrance to 13. Which 3 words would you use to
Ashish Dave the UK and the NHS easier? describe your career in the NHS
When I came to the UK I found out so far?
2. What is your position and where do you work? about an induction programme. I went Satisfying
Specialty and associate specialist doctor, cardiology, Mid Cheshire NHS Foundation Trust along to it and it was useful but I was Well recognised
not entirely sure who was running it and Progressive
3. Where were you born? whether it was a recognised course.
Born in Derbyshire, UK but grew up in India It would have been helpful for me to 14. What do you miss the most
attend a course that was arranged by from home?
4. Where did you complete your medical training? the BMA or the GMC so that I could Family, friends and the weather.
Santosh Medical School, Chaudhary Charan Singh University, India be sure that it was from a reputable
organisation and recognised. 15. What would you miss the most
5. When did you come to the UK? if you left the UK?
2012 11. What can the BMA do to help IMG Quality of life, social life, support of
doctors working in the NHS? a stable government.
I think that the BMA should run
induction courses for IMGs about 16. What would you miss the least if
working in the NHS and maybe give you left the UK?
6. Why did you decide to come to the UK? What I found really helpful however was that I
attendees a certifi cate at the end of the Revalidation and appraisals.
What were your goals/ambitions? was in a supervised role for the fi rst four weeks
course. These can then be shown to
I wanted to relocate to the UK because while I learnt the ropes before being able to see
employers.
economically and strategically this country patients myself.
is more secure. I also wanted to pursue a
profession in cardiology and my wife was 8. What have been your best experiences
doing an MBA in Cambridge. So a mixture of working in the NHS as an IMG doctor?
IMGs bring a wealth of experience to the
professional and personal reasons. I like the idea of the holistic approach of the
NHS. Oft en IMG doctors come to the
NHS and being able to see a patient throughout
UK as experienced and senior doctors
7. In starting your work as a doctor in the NHS, their journey from beginning to end.
but work in the NHS as junior doctors.
So the NHS doesn’t have the expense of
helpful? 9. What have been your worst experiences
training these doctors either.
It was a bit of a culture shock and I found working in the NHS as an IMG doctor?
the concept of integrated medicine hard to I have not really had any bad experiences.
grasp. In my country you did not necessarily
see the patient through their journey. They
came to you when it was absolutely necessary ‘I think that the BMA should run induction
and sometimes they would come back and
sometimes they would not. I found the
courses for IMGs about working in the NHS.’
complexities of the NHS diffi cult to understand.
Dev Gupta

1. What is your name? would have made your entrance to 13. Which 3 words would you use
Dev Gupta the UK and the NHS easier? to describe your career in the
Information on the weather conditions, NHS so far?
2. What is your position and where do you work? transport information, where you could Enjoyable
Specialty doctor and locum, accident and emergency, West Midlands get your next job, and mentoring. My Part of the country
entrance to the UK was admittedly Good life with little ups and downs
3. Where were you born? very easy, as my uncle used to work in
Punjab, India the UK, so already had contacts, and 14. What do you miss the most
through this I was able to source a job from home?
4. Where did you complete your medical training? before I arrived. I am socially cut off – I miss my
University of Nagpur, India family.
11. What can the BMA do to help IMG
5. When did you come to the UK? doctors working in the NHS? 15. What would you miss the most
1978 Things have improved a lot in the if you left the UK?
last ten to fi ft een years. If doctors are I have spent over half my life
discriminated against, the BMA should here, and feel like I am part of the
help out. Diaspora organisations country, so would miss that.
should be supported. Work should be
6. Why did you decide to come to the UK? 8. What have been your best experiences
done on clinical examinations, help 16. What would you miss the least
What were your goals/ambitions? working in the NHS as an IMG doctor?
should be provided for IMG doctors if you left the UK?
There were several reasons why I chose to I have managed to stay in the job I wanted. It is
taking interviews, and the BMA should I cannot think of an answer.
come to the UK – it was a career opportunity, very diffi
cult to get the job that you really want,
also look into why patients are more
I could undertake postgraduate research, and so doing that was an achievement. I also fi nd it
likely to complain about IMGs than UK
it was also benefi cial from a fi nancial point a pleasure how friendly my colleagues are.
graduates.
of view. Aft er four years here I married in
India, and then my wife joined me in the UK. 9. What have been your worst experiences
It was soon aft er this point that I gained the working in the NHS as an IMG doctor?
FRCS, I was getting a large amount of surgical I experienced discrimination, but only to some
IMG doctors play a substantial role in
experience, and had a child here, so I stayed. extent. When I was unable to get a job, I would
healthcare in the UK – we form part of
oft en compete against UK graduates who had
the whole team, and we also bring our
7. In starting your work as a doctor in the NHS, less experience, and they would normally get
own knowledge and expertise.
what did you find difficult? What did you find the jobs. This happened every six months,
helpful? although it happens less now as jobs are
I was working to the best of my ability, and my longer-term, and much has changed in the
seniors were able to step in and help when last ten to fi ft een years. Consultants used to
possible. Everyone was very helpful, and be very powerful in the decision of whether or ‘I experienced discrimination, but only to some
not you got the job, but this is diff erent now,
tried to teach me. I had no problem with the
working conditions. I found it diffi
cult to have as there are panels of doctors deciding. I only
extent. When I was unable to get a job, I would
to constantly be worrying about what my next experienced discrimination from a patient often compete against UK graduates who had less
once. They wanted to see a white doctor, but
job was going to be as most jobs were only six
months in duration. Accommodation went with this wasn’t possible.
experience, and they would normally get the jobs.’
this – it was all very fl uid.
Karl Hattotuwa

1. What is your name? would have made your entrance to 13. Which 3 words would you use to
Karl Hattotuwa the UK and the NHS easier? describe your career in the NHS
Information on the roles of the BMA so far?
2. What is your position and where do you work? and GMC, how the NHS works, advice Enjoyable
Consultant, obstetrics and gynaecology, Bedford Hospital NHS Trust on medico-legal challenges one might Enlightening
face, and advice on the diff erent roles Fulfi lling
3. Where were you born? of healthcare professionals who work
Colombo, Sri Lanka within the team such as the importance 14. What do you miss the most from
of nurses within the team. home?
4. Where did you complete your medical training? The laid back way of life, my friends
Faculty of Medicine, University of Colombo, Sri Lanka 11. What can the BMA do to help IMG and family, and the respect that
doctors working in the NHS? doctors in Sri Lanka receive.
5. When did you come to the UK? If there was a way for IMG doctors to be
Spent my fi rst 10 years in the UK, returned in 1991 identifi ed before they actually came 15. What would you miss the most if
to the UK that would be helpful. They you left the UK?
should specifi cally be given information British pubs that serve really good
on the role of the BMA and the GMC, and local ale and rib eye steak!
the importance of being a member of
6. Why did you decide to come to the UK? 8. What have been your best experiences either the BMA or the MDU. 16. What would you miss the least if
What were your goals/ambitions? working in the NHS as an IMG doctor? you left the UK?
The main reason for coming to the UK was to Listening and talking to patients, which we 12. What are the main contributions of General administration and
further my education and gain postgraduate didn’t really do in Sri Lanka. IMG doctors to healthcare in the UK? bureaucracy.
training, which now includes MBBS, MS, In my view 60 per cent of doctors are
FRCSEd, FRCOG, and FSLCOG. I had previously 9. What have been your worst experiences IMG and therefore if you take away IMG
intended to return to Sri Lanka once this had working in the NHS as an IMG doctor? doctors, the NHS would collapse.
been completed. When I decided to stay and work in the NHS I
had a lot of issues with the Home Offi ce even
7. In starting your work as a doctor in the NHS, though I had the right to stay here. Once I had
what did you find difficult? What did you find resolved those, I had many issues with my
helpful? national training number and which part of the
I was already at senior registrar level by country I was meant to be training in. During
‘Once I had completed my training I was
the time I came to the UK. I found all the my training, the goal posts were constantly encouraged to take a staff grade rather than
changing and once I had completed my
paperwork and administration that the doctors
have to do here quite diffi
cult to adjust to. training I was encouraged to take a staff grade
go for a consultant post.’
Also, adjusting to the British way of life and rather than go for a consultant post. I was also
understanding how British people work. encouraged not to work in certain areas as they
were predominantly white areas and told that I
would not fi t in. This all felt discriminatory to me.
Jawad Husain
‘My to the system, I was provided with good Something around expectations would also
be useful, I think doctors come here thinking
experiences support from my programme directors and
senior management in the deanery and NHS. they’ll earn a lot of money, be very comfortable
have been My experiences have been very positive and I etc. In reality there are no training jobs for
IMGs, in fact we don’t have enough training
very positive have been able to acquire the skills I’ve needed
and in return contribute to the health system jobs for our own trainees. These are the
Jawad Husain and I have and country that has trusted in me. realities and unfortunately they are the true
facts. IMGs can have good careers as mid-
been able to 9. What have been your worst experiences grade doctors in this country but it is diffi
cult
Consultant urologist, divisional medical director of surgery, Wrightington, Wigan and Leigh NHS acquire the working in the NHS as an IMG doctor? to become a consultant. We need more middle
grade doctors and this needs to be clear to the
Foundation Trust
skills I’ve I think the lack of structure and uncertainty
in how to progress in careers. Though I medical fraternity.
3. Where were you born? needed and personally didn’t feel this, I knew of colleagues
Of course, all the usual information about
Lahore, Pakistan
in return that had lots of enthusiasm for the work but
unfortunately were moving from one job to examinations and processes is vital too.
4. Where did you complete your medical training? contribute another without progressing. When I was in
12. What are the main contributions of IMG
King Edward Medical University, Pakistan
to the health Ireland, at the beginning I was moving job
every six months and this can be so frustrating. doctors to healthcare in the UK?
5. When did you come to the UK? system and I knew a lot of colleagues also had struggled If IMGs weren’t here I think the health system
would collapse. In most district general
1994
country that with getting their visas to stay in the UK.
hospitals 70 to 80 per cent of the workforce are
has trusted 10. What information, advice, support, would consultants and mid-grade IMG doctors. The
have made your entrance to the UK and the health system is predominately relying on the
6. Why did you decide to come to the UK? out how to acquire the experience I needed for
in me.’ NHS easier? service commitment of IMG doctors – in reality
What were your goals/ambitions? my own career progression. I think clear information on expectations would they are the backbone of the system.
The King Edward Medical University is one What I found really helpful was the support have been useful – what you can do in the
of the oldest medical schools in the Indian that I received from my consultant – I am UK and where you could be in the future as
subcontinent and most of my teachers and really indebted to the consultants who took a doctor in UK. This information needs to be
professors, including at the Mayo Hospital an interest in my development. As an SHO in clear, easily available and visible so that one 13. Which 3 words would you use to
in Lahore, were either British trained or had a urology unit, the consultant I was working is able to plan their career and have realistic describe your career in the NHS so far?
completed their postgraduate degrees in the for advised and guided me, and helped me expectations. In my time the information we Excellent
UK. For me the standard was set very high and get a registrar position within six months of received was either through word of mouth Rewarding
having heard about their experiences, I aspired joining the NHS – I knew of many doctors or what we learnt from our own experiences. Satisfying
to complete my postgraduate training in the working in SHO positions for much longer and Having an organisation or forum that you could
UK from one of the surgical royal colleges. who were unable to progress. I think it is vital go to for advice and information would have 14. What do you miss the most from home?
that consultants can pick up on potential and been very helpful – there may have been some Home comforts and luxuries.
7. In starting your work as a doctor in the NHS, recognise talent in doctors and help them in my time but this could be quite hit and miss.
what did you find difficult? What did you find along their journey. 15. What would you miss the most if you
helpful? 11. What can the BMA do to help IMG doctors left the UK?
In 1994, there was no established structure 8. What have been your best experiences working in the NHS? Equality – respect of human beings.
in the system of how an IMG doctor would working in the NHS as an IMG doctor? Something dynamic – it can’t just be a document
progress from SHO to registrar to consultant. The recognition of talent by medical and on the website. The medical system, workforce 16. What would you miss the least if you
Which part of the country you ended up operational managers. I think in general this and political environment are changing rapidly left the UK?
working in, the type of hospital (district is a great credit to the system. If you have the in this country. The advice that we provide to The weather! It is the winter and rain that
general/teaching) you worked in and how you correct attributes you will be guided in the IMGs coming to the UK or who have recently I would certainly not miss.
moved around the country from job to job right direction and most of the time will be started should refl ect the future projection of the
was random and essentially ‘pot luck’. It was supported. I wasn’t a British national but once workforce in this country which can help doctors
diffi
cult to get to know the system and fi gure I decided to stay in the UK, work and contribute make decisions about their future career paths.
Amer Jafar
‘What I found 9. What have been your worst It would be good to have some meetings
experiences working in the NHS where IMG doctors who are not BMA
helpful as an IMG doctor? members can meet IMG BMA members.
was the Sometimes you fi nd yourself with so This would be useful as they can talk to
much paper work! There are so many each other, show their enthusiasm and
support from forms and so much paper work. This give them examples of where the BMA
Amer Jafar supervisors, takes away time that you could be has been essential. Doctor to doctor
spending with your patients. In my view communication is really important and
managers we need more support for this. The useful in situations like these. Perhaps
Associate specialist in care of the elderly, Royal Gwent Hospital and heads of interaction and engagement with the the BMA could give the IMG BMA
nursing team and junior doctors is also members some incentives for this.
departments.’ important. There can sometimes be a
Baghdad, Iraq lack of understanding that there are 12. What are the main contributions of
cultural diff erences in communications. IMG doctors to healthcare in the UK?
4. Where did you complete your medical training? Everybody has to help and support each They fi ll many vacancies that we have.
Baghdad Medical School, Iraq other on this. Bring new experiences to the country.
From a cultural point of view it is good to
5. When did you come to the UK? Also, career progression sometimes have a good mix for cultural enrichment.
1990 is not that easy. I personally haven’t
faced any problems but I know it can be
diffi
cult to become a consultant as an 13. Which 3 words would you use to
IMG doctor in the UK. describe your career in the NHS
6. Why did you decide to come to the UK? What I found helpful was the support so far?
What were your goals/ambitions? from supervisors, managers and heads of 10. What information, advice, support, Challenging
The medical syllabus in Baghdad is almost the departments. I felt that they looked out for me, would have made your entrance to Rewarding
same as in Britain so when I considered where if I was stuck on an application, or had failed the UK and the NHS easier? Interesting
I might go to undertake my postgraduate an exam a few times they looked aft er me. Not Information was diffi cult to fi nd but I did
studies, the UK was the fi rst place I thought of. only professionally but also in my day to day manage to gather everything I needed 14. What do you miss the most
I had an ambition to continue my studies but life, like how to register as a foreigner in the UK to actually get here. When I started from home?
to be honest when I came to the UK I wasn’t and stay here. Of course this all depends also working in the NHS there was a lot that The night life! Back home all the
planning on staying here. When I fi nished my on your skills, engagement and demonstration I didn’t know about, especially around shops stay open in the evenings!
PhD in 1993 there were political problems in of competencies. employment rights. Oft en you can
Iraq and I was advised not to go back home, so end up with a contract that you don’t 15. What would you miss the most
in 1994 I started working in the NHS in Wales. 8. What have been your best experiences understand the terms and conditions if you left the UK?
working in the NHS as an IMG doctor? of. It would be really useful to have I have become very attached to
7. In starting your work as a doctor in the NHS, For me the system itself is a good experience. information in one place about both the Cardiff , I feel like it is my city now –
what did you find difficult? What did you find There is a systematic approach to things practical issues of coming to the UK and so I would miss the place and all
helpful? here, for example how to see patients, there about working in the NHS. my friends here.
I initially came to the UK for academic reasons, are guidelines, regulations, evidence-based
so to start working in a hospital again was very medicine and respect. In my country as a 11. What can the BMA do to help IMG 16. What would you miss the least
diff erent. The switch from academic to clinical doctor you are very busy, people talk about doctors working in the NHS? if you left the UK?
work was diffi cult. Coming from Iraq the main doctors being very busy in the NHS but really I think that the BMA provides so many Paying council tax, it is expensive.
adjustment was to try and adapt to life here, I can cope. Also here you can have better and important services for IMG doctors such
it is a complete lifestyle change. It is especially more productive discussions with patients – as helping with your contract, but the
challenging when you have a family here as well. back in Iraq it was very diffi
cult to convince problem is nobody is aware of it and
patients to, for example, take their medication, people don’t know what the role of the
or listen to you. BMA is.
Farah Jameel
I have found the NHS a positive work a lot of useful advice and support
environment and I think this helps us but can also act as a useful network 13. Which 3 words would you use
to do the absolute most we can for of contacts when contemplating to describe your career in the
patients within the limited resources relocation. A mentoring scheme that NHS so far?
is daunting and overcoming this is a we have. I have seen excellent is specifi cally tailored to IMG doctors Fulfi lling
1. What is your name? challenge. evidence based care being delivered would have been quite useful. It would Successful
Farah Jameel uniformly all across the country and help guide IMGs through how the UK Enlightening
Starting out as an F1 doctor this is something other countries can medical system works, the relevant
meant that I had a very thorough only aspire to. linguistic nuances, the cultural You can be whoever you want to
Sessional GP, London
introduction to the NHS, which diff erences, and so on. be in this country in both your
3. Where were you born? when you’re new to the system is 9. What have been your worst home life and medical career.
Abu Dhabi, United Arab Emirates something I would recommend. I did experiences working in the NHS 11. What can the BMA do to help IMG
a period of shadowing which helped as an IMG doctor? doctors working in the NHS? 14. What do you miss the most
ease me into the job and outlined Following my excellent F1 year at The BMA could and needs to do more. from home?
Gulf Medical University, United Arab Emirates
basic duties and expectations. I am a teaching hospital, I rotated to a It should more strongly stand up Family and sunshine.
5. When did you come to the UK? certain that my easy going nature district general hospital for F2 in a for IMG doctors. In the recent past,
2007 and relatively modern outlook on life much smaller town. I struggled to fi nd there has been lots of doctor bashing, 15. What would you miss the most
eased my transition from one country the same supportive social network especially of IMG doctors, and I think if you left the UK?
to the next. I had little to adapt to and, without a way to debrief aft er the BMA could have come out earlier At the outset I would say nothing;
6. Why did you decide to come to consultation is very doctor centred when it came to dress sense and work, the year quickly became a or stronger in their defence. In terms my partner is here so I am stuck
the UK? What were your goals/ with a lot of emphasis and respect general conversation style. struggle. I got to a point where I began of what actions can be taken, this to him here for as long as he
ambitions? being placed on the words of the to question medicine as a career and could include creating supportive decides to stay put in the UK.
I always knew I wanted to come to doctor. Coming from a country where 8. What have been your good my decision to relocate to the UK. This networks, mentoring, and producing
the UK for postgraduate training the doctor is practically worshipped experiences working in the NHS was the lowest point in my NHS career guidance that can be distributed to Having spent some time
because of the high standards and I initially struggled with the general as an IMG doctor? and is certainly something that I wish all trusts around the country. The refl ecting on this question, I am
opportunities here. I didn’t have a lack of public respect for doctors. My F1 year was excellent. I was in a I’d been prepared for as I would handle BMA would also benefi t from a wider reminded about all the wonderful
clear idea of how long I was coming large teaching hospital but it was things diff erently now. I suspect there range of IMG role models. Through things about the UK. I came
for; I just wanted to see how things British use of language and English manageable because I was part of are many who have similar stories. the BMA’s networks, it should exert, to the UK for more than just
went. It could have been long term or nuances remain hard work, even a supportive team that regularly When family and friends are far away, and be seen to exert, pressure within training. I came here because
short term. I thought I would come now. Simple examples would include socialised together. Everyone work becomes the central point of the NHS to improve numbers of I value free expression and the
over at the end of my PRHO year (F1 the use of words like knackered, looked out for one another and the one’s life and when work itself isn’t IMG’s applying competitively for NHS human rights that are fostered
equivalent) in the UAE (United Arab wee, dinner (for lunch), tea meaning traditional medical camaraderie enjoyable, it can all start to fall apart management and leadership roles. in the UK, where the shared aim
Emirates), but was lucky enough to aft ernoon tea with sandwiches or helped break down the hierarchy, very quickly. is always for a fairer society with
meet a registrar who had trained in lunch, pants for underwear, and with the consultants and registrars 12. What are the main contributions equal opportunities for all. I get
the UK who suggested that joining trousers being what I had previously regularly checking in with the The irony of my situation was being of IMG doctors to healthcare in to contribute to that through
the UK system as early as possible referred to as pants. I am now just trainees. Similarly as a GP registrar, in an environment that was socially the UK? healthcare. I am a strong believer
would make the transition easier. beginning to understand and value everyone in my training practice was quite heavily dominated by religious IMG doctors work as hard as those in the principles and founding
Ultimately, I left my UAE PRHO year the subtlety of the English language very friendly and always did absolutely following, although having roots in from the UK across the health sector. values of the NHS. The concept of
midway through to make a new start both written and spoken in the UK. It everything they could for their the same religion I was an outcast Each of their contributions is as accessible healthcare, free at the
in the foundation programme and this certainly can knock one’s confi dence patients and me. as I wasn’t a practicing member of valuable as that of any other doctor. point of need, is one that should
has served me well. and make you question your language that religion. In essence I didn’t fi t in They do bring experience that can be adopted by more countries.
skills. All the bad press IMG doctors Finding the BMA and becoming amongst what one would deem my help break down cultural barriers
7. In starting your work as a doctor in receive only makes this worse. involved made me more confi dent own. to healthcare that may exist in our 16. What would you miss the least
the NHS, what did you find difficult? in taking on challenges when faced multicultural society and also greater if you left the UK?
What did you find helpful Unlike many British doctors who with uncomfortable situations or 10. What information, advice, support, familiarity with diseases that may be The weather.
Cultural norms can be very diff erent have been born and brought up in discussions. This empowered me to would have made your entrance to more common overseas.
between ethnic groups within the this country with their friends and positively infl uence my experience in the UK and the NHS easier?
UK and in a similar fashion across family at hand, relocating from a many of my jobs. When I fi rst came over, I wasn’t aware
diff erent countries, for example diff erent country can leave one feeling of organisations like the BMA and
in many countries the style of isolated and lonely. Experiencing this other IMG organisations that off er
B Nirmal Kumar
‘The BMA to a consultant post. At the end of the resources, combined with ongoing
support. I can say that the BMA has
can help day, I have always found that merit
is rewarded even if you come from a helped me in the past as well when I had
to identify diff erent system. some issues with my salary scale.

those that 9. What have been your worst 12. What are the main contributions of
B Nirmal Kumar need support experiences working in the NHS IMG doctors to healthcare in the UK?
as an IMG doctor? It is enormous. There is no doubt that
adjusting to To be honest I’ve not really had any bad IMGs have propped up the health
Consultant ENT (ear, nose and throat) surgeon and director of medical education, the culture, experiences. I feel like there are many fair services to a large extent. A few can get
into leadership roles but many haven’t.
Wrightington, Wigan and Leigh NHS Foundation Trust, honorary professor, Edge Hill University,
training programme director for ENT, Health Education North West, honorary secretary,
communica- minded people in this system. Of course
I am not denying that there might be However, this system is based on
ENT UK and editor-in-chief, Biomed Central Ear, Nose, Throat Disorders tions and an element of discrimination but if you meritocracy. People need to work extra
hard and make a large contribution.
so on, and work hard and get into the top percentile
everything is open to you. If you are in
Chennai, India give them the bottom 20 per cent I do know that
support the support mechanisms are perhaps
not as strong for those who come from describe your career in the NHS
Stanley Medical College, University of Madras, India through abroad and are not doing so well. so far?
Rewarding
inductions 10. What information, advice, support, Opportunity (research and
1995 and would have made your entrance to education)
the UK and the NHS easier? Quality
resources, My entry was easy but for people whose
combined English isn’t so good they may need 14. What do you miss the most
6. Why did you decide to come to the UK? from home?
I was in Ireland (from 1991 to 1995) before I
moved to the UK my consultant was British
with ongoing some help in learning the cultural
norms, communications etc. For me the Not much really – my home is
My professor was a fellow of the Royal College and my registrar was a Spaniard, so we were all support.’ nurses were my ‘best friends’ and they here now.
of Surgeons and aft er I got the university gold really foreigners in a foreign country – Ireland! can and do really help you if you are kind
medal in ENT he persuaded me that experience and respectful to them. However, I do 15. What would you miss the most
in a new environment would be very useful to 8. What have been your best experiences see a lot of foreign doctors who speak if you left the UK?
me. He really inspired and motivated me to working in the NHS as an IMG doctor? to the nurses very rudely. People aren’t The NHS combines the best
come here. For me the most impressive thing has always inherently racist – if as an IMG you are teaching, training and research that
been that if you put in the extra eff ort and work pleasant, polite and kind, and do your you get – this combination really
7. In starting your work as a doctor in the NHS, you can really achieve a lot in this system, which job well, you will be fi ne isn’t available elsewhere. This is the
what did you find difficult? What did you find is truly meritocratic. I have been very lucky and essence of what the NHS stands for.
helpful? fortunate. If you show you can do something, An induction to the language and This is the most enjoyable part of
I didn’t really have many diffi
culties. The I have always felt you will be rewarded. I had to culture would be very helpful I think. my career.
system seemed very similar and there wasn’t learn to work as the system required – I couldn’t
such a large diff erence in background, really expect it to adapt to me. 11. What can the BMA do to help IMG 16. What would you miss the least if
communication and culture for me. I was doctors working in the NHS? you left the UK?
educated both at school and at university in Early on I realised that education and research The BMA can help to identify those that Nothing.
English. I was working with people that were were very important and I undertook both need support adjusting to the culture,
fully aware of my situation and background so I a higher research degree at university and communications and so on, and give
easily assimilated into the environment. When higher surgical training, and eventually got them support through inductions and
Purvesh Madhani
‘To have 9. What have been your worst 12. What are the main contributions of
experiences working in the NHS IMG doctors to healthcare in the UK?
crossed half as an IMG doctor? I have begun to believe in a value-based
the world I’m sure some of my other colleagues system. We bring diff erent values here
and have a very strong work ethic.
to get here will agree with me on this; the MTAS.
This was the worst experience I had We live in a multi-cultural society so
Purvesh Madhani and work in whilst working for the NHS. There were it is important to have doctors from
diff erent places.
a completely professional and personal costs in that
year for me. I had to move away from
Specialty trainee 6 in forensic psychiatry, Fieldhead Hospital, Southwest Yorkshire NHS different home and take a break in my career.
Foundation Trust
system was 10. What information, advice, support, describe your career in the NHS
3. Where were you born? made much would have made your entrance to so far?
the UK and the NHS easier? Valuable
Mumbai, India
easier by An IMG specifi c induction pack would Valued
4. Where did you complete your medical training? the fact that have been much appreciated. This could Challenging
University of Mumbai, India
I felt I was have highlighted the cultural diff erences
and expectations in terms of working in 14. What do you miss the most
5. When did you come to the UK? valued for the UK. It could have included general from home?
The food.
2003
my skills and information about the structure of the
NHS but also focussed on the specifi cs
that made of working in a certain hospital or trust. 15. What would you miss the most
if you left the UK?
6. Why did you decide to come to the UK? My fi rst supervisor made my transition
working here My experiences were from 11 years
ago; I have heard from my junior IMG Value for meritocracy and the
What were your goals/ambitions? very smooth and I built on that. I found the valuable. colleagues that the GMC does have a inherent fairness in the workplace
here. This view is based on my
Two reasons really. The basic training in India
is similar to that in the UK and I consequently
management structures in my trust (eg
medical staffi ng) very supportive in helping
In terms of good induction system now so things
will have improved. personal experience. I think
anticipated the transition to working here me when needed. my career the NHS is an inherently fair
In hindsight it would also have been organisation.
would be relatively smooth. It also helped
that the UK is an English speaking country. 8. What have been your best experiences
I couldn’t useful for me to observe or shadow a
I would have been lost in France! My goals working in the NHS as an IMG doctor? have asked colleague for a few weeks when I fi rst 16. What would you miss the least if
In India a lot depended on the ability of started. you left the UK?
were to progress in my career and gain
specialist training in psychiatry. patients to pay for care unlike here in the UK.
for anything Apart from the weather, it is diffi
cult
Being free at point of use ensures that you more.’ 11. What can the BMA do to help IMG to generalise but I have found
7. In starting your work as a doctor in the NHS, focus on delivering the best quality care you doctors working in the NHS? wading through the sometimes
what did you find difficult? What did you can for your patients without the pressure of It would be useful if on a regular basis rigid and hierarchical NHS
find helpful? thinking about payment. the BMA could highlight the positive structures would be something I
Even though the training system was similar to impact that IMG doctors (who are almost wouldn’t miss much.
that in India there were important diff erences, To have crossed half the world to get here and a third of the medical workforce) have
which I had to grasp quickly. Other basic things work in a completely diff erent system was made to the NHS. It might be also useful
like setting up a bank account, credit history made much easier by the fact that I felt I was if the BMA could lobby the government
checks for renting a house, getting appropriate valued for my skills and that made working to keep our visa rules consistent, as
visas were all diffi
cult in the beginning. here valuable. In terms of my career I couldn’t currently they change for IMGs on what
have asked for anything more. seems like a yearly basis!
In terms of working however, I had a very
supportive supervisor and colleagues so
starting work wasn’t too much of a problem.
Christopher Magier
‘When I 9. What have been your worst cases diff erently, with more logic and
experiences working in the NHS common sense. UK-based doctors tend
employ as an IMG doctor? not to think as independently, and rely
doctors I had a very nasty experience with on guidelines more.

now, I always a coroner’s inquest in my fi rst year
here. My team were accused of errors
Christopher Magier give them that were not our fault, which came 13. Which 3 words would you use to
two weeks as a shock aft er a very supportive
six months. We were found not to be so far?
Substantive consultant paediatrician, St Mary’s Hospital, Isle of Wight NHS Trust of unpaid responsible, but it was a very unpleasant Pleasant
Successful
board with experience.
Promising
Kedzierzyn-Kozle, Poland their clinical 10. What information, advice, support,
would have made your entrance to 14. What do you miss the most
attachment, the UK and the NHS easier? from home?
Wroclaw Medical University, Poland and then two On refl ection I was very lucky. Some For quite some time it was Polish
food, but now that there is a Polish
weeks paid of my friends arrived in the UK to fi nd
themselves on call from their fi rst day. shop on the Isle of Wight I’m not
2004 shadowing When I employ doctors now, I always sure that there is anything! With
technological advances I can now
for safety give them two weeks of unpaid board
with their clinical attachment, and read a Polish newspaper, visit Polish
reasons. then two weeks paid shadowing for websites, watch Polish television,
6. Why did you decide to come to the UK? and my friends are able to visit on a
the accents. One small diffi
culty that I did come
across was having to do my own intravenous
This gives safety reasons. This gives them a better
chance to tune their ears and adjust to regular basis.
It happened kind of accidentally. I had been at cannulations – in Poland nurses perform these. them a better the guidelines.
15. What would you miss the most if
Wroclaw University for 10 years, and I started to
think about changing jobs around 2003. Poland I had a very benefi cial shadowing period with a
chance to 11. What can the BMA do to help IMG you left the UK?
was due to join the European Union at the very helpful consultant. He assessed me, and tune their doctors working in the NHS? The public services here, such as
placed me according to my experience. I think that the BMA can inform the tax offi
ce, the driver and vehicle
start of 2004, and as a result there was a heavy
recruitment drive by the NHS in Poland. I had
ears and prospective IMGs better about licensing agency, and gas services,
done one month as a student at Great Ormond 8. What have been your best experiences adjust to the employment rights in the UK. I was are much better and easier to use
working in the NHS as an IMG doctor? underpaid during my fi rst year of here than in Poland. I would also
Street Hospital, and remembered it fondly. I
also applied for a position in South London, The support from the consultant during my
guidelines.’ employment here, as my employment miss the sea, and sailing.
with one year at Greenwich Hospital, and one shadowing period was a very good experience. history from Poland had been ignored.
year at St Thomas’ Hospital. Someone came Aft er my fi rst year I was completely competent It was only picked up towards the end of 16. What would you miss the least if
to Warsaw to conduct the interview, and I was and up to speed, and was able to make a very that year that I should have been on the you left the UK?
successful. good impression at my second hospital. I also highest pay for my scale. That is diffi
cult to say – you are
thought that it was good that there was a well- basically asking me in a polite way
7. In starting your work as a doctor in the structured approach to problems ie structures 12. What are the main contributions of what annoys me the most about the
NHS, what did you find difficult? What did and guidelines. IMG doctors to healthcare in the UK? UK! Call centres and helplines. They
you find helpful? IMG doctors bring a fresh mind to are incredibly infuriating, but aren’t
I struggled with the language barrier. I was I very much liked the system, I was making healthcare in the UK, and knowledge of as bad elsewhere.
adept at the written form, but this is of course good money, and had a good quality of life, other systems from around the world
diff erent to spoken language, especially in whereas in Poland I would have been stuck – the NHS is good, but it is not optimal.
the medical arena. British colloquialisms and at the university. I was also enjoying working Doctors from abroad tend to approach
abbreviations are very confusing – it took me more, and this inspired me to stay in the UK.
several weeks to get used to them, as well as
Joan Melendez
‘For me these diffi

culties and not everybody
adapting to sympathises with you for going through
a tough time. describe your career in the NHS
the system so far?
10. What information, advice, support, Challenging
and the would have made your entrance to Achieving
Joan Melendez language the UK and the NHS easier? Rewarding

was difficult. Going through the working system
and explaining it in detail, what you are 14. What do you miss the most
Senior specialist registrar, obstetrics and gynaecology, Royal Free Hospital The medical supposed to do and what is expected of from home?
I would say family and friends but I
English, the you. It would need to be very specifi c,
and not assume anything from the IMG am only two hours away on a plane
Girona, Spain abbreviations doctors. so in my particular case, it is not
diffi
cult to see them fairly regularly!
and the 11. What can the BMA do to help IMG
Universitat Autonoma de Barcelona, Spain jargon were doctors working in the NHS? 15. What would you miss the most
if you left the UK?
completely I participated in a workshop for F1
doctors from abroad who started I am used to the system now,
2006 new.’ working in the UK. I felt they found it so I guess I would miss being
really helpful, to get together and share comfortable with how things are
experiences from other doctors who organised. Also, here I feel there is
have been through the same process. always something else, a next step.
6. Why did you decide to come to the UK? needed to settle. You can feel lost and helpless For example during interviews, local Whether it is doing a fellowship,
What were your goals/ambitions? and that nobody cares at times. When you graduates have a clear idea of what being going into research for a while,
I wanted to move abroad, experience living in start, you are always one or two steps behind yourself means in an interview, but it can joining committees and scientifi c
London and work in medicine in a new system. local graduates so it is very helpful when mean something completely diff erent groups, there is always something
It was for new experiences and new challenges, someone can see through your diffi culties and to someone from Eastern Europe or to aim for and always people
not for economic reasons at that time. gives you a hand because they think you can Africa. A proper system of tutorials and pushing you to get there. In other
potentially be a good doctor. workshops to go through the specifi cs for countries, I feel they let you settle
7. In starting your work as a doctor in the NHS, new IMGs would be helpful. too easily.
what did you find difficult? What did you find 8. What have been your best experiences
helpful? working in the NHS as an IMG doctor? 12. What are the main contributions of 16. What would you miss the least
For me adapting to the system and the The challenges are very exciting. Every IMG doctors to healthcare in the UK? if you left the UK?
language was diffi cult. The medical English, the achievement (getting your training number, Most (not all) of IMGs come very well Bureaucracy and how the
abbreviations and the jargon were completely passing the exams, presenting or publishing prepared, with excellent knowledge managerial staff have lost sight of
new. I had to learn the oft en subtle diff erences studies and so on) makes you feel the work you and good clinical skills. However things what is really important. It feels as
when talking to other doctors compared to put in was worth it. That is very rewarding. may not be so smooth in terms of if they do not care about doctors,
patients. The organisational structure of the communication and language. IMG patients or people in general, they
hospital and its departments was also diff erent 9. What have been your worst experiences doctors are a good workforce to fi ll the only care about short term numbers
and that took time to learn and understand. working in the NHS as an IMG doctor? gaps in the otherwise short rotas. You will and fi gures. Doctors are stretched
Simple things like being on call, job roles, who At the beginning there is a language barrier oft en fi nd specialists (consultants in their and bullied, and that aff ects morale
is meant to do what – it is all very diff erent and which could make it diffi
cult for people to country of origin) happy to take middle which inevitably translates into
confusing at fi rst. see who you really are, sometimes you may grade jobs for the experience, to learn how patients feel when they see a
feel a bit ignorant and brainless. It is hard the system, develop certain skills and doctor. I think doctors used to be
It was helpful to fi nd someone who understood to communicate, you don’t understand spend a couple of years here. I also think more respected and appreciated for
your situation and was willing to help you, everything they tell you, you don’t know that most of them plan to return to their the work they do.
to guide you and act as your mentor. My how the system works and you don’t know country eventually, therefore they would
supervisor was very helpful, he was patient exactly what you are supposed to be doing. not be competing for consultant jobs.
and he was willing to give me the extra time I Local graduates are generally unaware of
Anonymous
2006: a fairer future. I wanted to leave

a bit of a legacy so that other people 13. Which 3 words would you use to
could build on it. On the back of this describe your career in the NHS
policy work I undertook a plethora of so far?
work on infl uencing various key policy Well, my career isn’t mainly in the
1. What is your name? fi gures and that had a big eff ect. Aft er NHS, so I will answer about my
Not disclosed 2006 partly due to our lobbying, the career in general:
crisis died down and better workforce
2. What is your position and where do you work? planning is more the norm now. Successful beyond expectation
Senior clinical academic position, Cambridge Unique
11. What can the BMA do to help IMG Impactful
3. Where were you born? doctors working in the NHS?
UK, but moved to Southeast Asia when I was 10 years old Help to crackdown on unfair 14. What do you miss the most
discrimination due to racism or other from home?
4. Where did you complete your medical training? issues. And recognising equality and Food – Indian food in Britain is
Kathmandu University College of Medical Sciences, Nepal diversity. horrible.
5. When did you come to the UK? 12. What are the main contributions of 15. What would you miss the most if
2003 IMG doctors to healthcare in the UK? you left the UK?
Their contribution is invaluable, since Systematic approach to medicine
the 1940s over 20 per cent of medical and associated research and
workers in the UK on and off have teaching.
6. Why did you decide to come to the UK? 9. What have been your worst experiences been IMGs, with the majority from the
What were your goals/ambitions? working in the NHS as an IMG doctor? Indian subcontinent. Without IMGs, the 16. What would you miss the least if
I was born here and spent the fi rst 10 years of Explaining myself to people. I feel that I healthcare system would be severely you left the UK?
my life here. I always planned on coming back am in a community by myself – IMGs don’t handicapped. IMGs are undervalued Bureaucracy, the number of
at some point. relate to me fully and neither do European and discrimination is defi nitely there, committees and the approval
medical graduates. The fi rst few years I had although it is oft en covert. needed is too much.
7. In starting your work as a doctor in the NHS, to explain myself a lot. People are obsessed
what did you find difficult? What did you find with putting people into boxes, and having
helpful? to explain my life’s history to people when it
Since being back in the UK, I have worked was irrelevant was diffi cult. I have undertaken
for the NHS and have had an academic four postgraduate posts in the UK, in Scotland
appointment. I have never worked full-time in and England, which makes things even more
complicated. As a positive, being questioned so
the NHS. I did have to adapt a little when I came
over but I felt it was very easy as I have spent much has pushed me to work even harder and
‘The structure of the NHS is really very good.
my whole life adapting in terms of teaching, looking back I have done a lot. Having worked in environments with less
practise and research in diff erent languages
and in diff erent countries. 10. What information, advice, support, would
structure, the protocols here are good to fall
have made your entrance to the UK and the back on. Further, there is safety in protocol.’
8. What have been your best experiences NHS easier?
working in the NHS as an IMG doctor? I became a member of the BMA within months
The structure of the NHS is really very good. of arriving back in the UK. Within a year I was
Having worked in environments with less on the junior doctors committee and the
structure, the protocols here are good to fall medical academic staff committee. We put
back on. Further, there is safety in protocol. together a publication about IMG doctors in
Charilaos Minas
referring to my accent – not that this

had a bearing on the quality of care 13. Which 3 words would you use to
provided. On the whole people were describe your career in the NHS
friendly, accepting and helpful. so far?
Varied
1. What is your name? 10. What information, advice, support, Challenging
Charilaos Minas would have made your entrance to Worthwhile
the UK and the NHS easier?
2. What is your position and where do you work? The support off ered to newly arriving 14. What do you miss the most from
Salaried GP, Bristol, appraiser for 12 years, educator for GPs, and undertake CQC inspections international doctors now is far better home?
than it was when I fi rst arrived. Back It used to be the weather, but now I
3. Where were you born? then I only had access to the GMC can go back quite a lot. I am not as
Serres, Greece website, which as you can imagine was keen on the hot weather now, as it
very limited at the start of the 1990s! can limit your working.
4 Where did you complete your medical training? I did not know that you needed
Aristotle University of Thessaloniki, Greece particular references, or what I needed 15. What would you miss the most if
in order to work in the UK. you left the UK?
5. When did you come to the UK? I have been here 23 years now. The
1991 11. What can the BMA do to help IMG fi rst few years, I mentally belonged
doctors working in the NHS? at home, then I was in limbo for
Firstly, relevant signposting. Secondly, a few years, and now I feel like I
some deaneries have a mentoring belong here. I would be a foreigner
6. Why did you decide to come to the UK? What He acted as my referee, which proved to be scheme in place. The BMA could in my country of origin if I were to
were your goals/ambitions? far more useful than the references that I had introduce a similar informal scheme, return now.
It was very much a career move for me – the from Greece and the United States. even just with emails, with international
opportunity to undertake postgraduate doctors who have been through the 16. What would you miss the least if
training in the UK was too good to turn down. 8. What have been your best experiences experience already. you left the UK?
Following compulsory army training in Greece, working in the NHS as an IMG doctor? This is an easy answer – the
the waiting list was up to four years long for I have learned a lot through being a part of 12. What are the main contributions of bureaucracy and endless political
postgraduate training there. diff erent teams. There were long sessions in IMG doctors to healthcare in the UK? meddling in medicine.
the early days, so I forged strong, close working IMG doctors make up a huge amount of
7. In starting your work as a doctor in the NHS, relationships with fellow team members. We the NHS workforce – 20 years ago there
what did you find difficult? What did you find were actual teams then, rather than a team of was a shortfall in doctors, and the NHS
helpful? individuals as oft en is the case nowadays. I also would have collapsed under the strain
I found it diffi
cult obtaining a post, even as a found it enjoyable working in so many diff erent of demand if not for IMG doctors fi lling
locum/sessional doctor. Until I found a referee, locations and cities, such as London, Essex, vacant posts. We have also brought our
getting any sort of work was impossible. Bath, Bristol, and South West Wales. respective cultures to the UK, and have
I submitted 120 applications, and received 119 enriched the NHS, which suits the UK as
rejections. I was close to returning to Greece, 9. What have been your worst experiences it is a multicultural country.
until I was fi nally successful with a urology working in the NHS as an IMG doctor?
locum post. It was Easter 1991 and they could I had to work extremely long sessions. There
was a lot of death and destruction around,
fi nd no one to cover the 72-hour locum.
and little counselling available in those days,
‘We have also brought our respective cultures to the
I found the support off ered by an Australian which took its toll physically and emotionally. I UK, and have enriched the NHS, which suits the UK
also found that there were unsatisfi ed patients
surgical consultant was the most helpful thing.
as it is a multicultural country.’
60 British Medical Association The contribution of IMG (international medical graduate) doctors to the NHS – Interview questions 61
Jemal Gemta Mohammed
however I refuse to take this exam up 10. What information, advice, support, 12. What are the main contributions
to 40 times (and pay £10,000) as some would have made your entrance to of IMG doctors to healthcare in
Jemal Gemta Mohammed
doctors do. To me, this is extremely the UK and the NHS easier? the UK?
unfair. It is the commercialisation of Authentication of honest doctors IMGs are and can be a huge
medicine and learning in an extreme coming to this country would have support to the system. It is the
Not currently working
and discriminatory way based on age helped me a lot. An initial 30 minute commercialisation of medicine which
and race. interview by an experienced doctor is the source of the problem. Nobody
would help an IMG. All IMGs are can deny the immense contribution
Yambo, Ilubabor province, Ethiopia
Passing exams are a by-product of not the same and they should not of Asian and other doctors in this
studying. That is why IMGs are so be treated like children. Respect country, but as things stand now I
oft en criticized in this country. All for the experience of the IMG doubt whether that will continue.
Addis Ababa University, Ethiopia
you are expected to do is learn the should be valued alongside their
questions and answer what will come communication skills – I support this
up in the exams and just sit them. unequivocally. 13. Which 3 words would you use to
2010
Sometimes you luckily get a repeat describe your career in the NHS
exam and pass it without a clue, 11. What can the BMA do to help IMG so far?
but then you will be a doctor living doctors working in the NHS? I only have one word; shocking.
in terror with no confi dence. Then I think the best thing is to evaluate
6. Why did you decide to come to Once I got out of the camp, I was was taught high school in English,
comes the media and public opinion doctors as doctors – give them 14. What do you miss the most
the UK? What were your goals/ exiled to Kenya. Within three months medical school in English, I was an
looking down on the quality of IMGs. patients and ask them to take from home?
ambitions? I was working and overcame the English teacher and had worked in
This weakness is the result of poor their history, make an impression, I miss the big scientifi c
I graduated in Ethiopia in the eff ects of my detention. I practiced in English. I found it very confusing to
evaluation systems. diff erential diagnosis, investigation and discussions – but really I mostly
1980s. During the early 1990s, I was one place for seven years and learnt study English for an exam. I had been
so on. If a doctor does not do that in miss my profession. Working
undertaking my postgraduate training so much – it was the best practice studying it lovingly for ages, especially
Now I am teaching my daughter. England or Siberia or Africa, you should with pure doctoral confi dence
and working as a registrar in Addis of my life. I love learning and I was in the detention camp. Naturally I was
I would like to go back home to question whether he is a doctor or not. amenable to another doctoral
Ababa. My job used to include teaching teaching as well which I loved. In an anglophile and I did not see why I
Ethiopia but I don’t know if I can due This isn’t a case of a noun, pronoun, or comment, no political comments
and every day I was developing. As a Kenya there is an effi cient use of was being pushed to learn a language
to many issues. verb! The BMA can lead by example and in doctors business. There is too
young and angry idealist, I volunteered external doctors though corruption is which I can talk fl uently and even
help to change the evaluation system. much politics in the NHS.
to treat parties in armed confl ict. I rife. While in Kenya I worked in a busy write a poem in. I started to study but
8. What have been your best The long term eff ect of squandering
was however detained in a military clinic, I practised medicine as I had I did not get over seven in the IELTS
experiences working in the NHS doctors will be far reaching. 15. What would you miss the most
camp for 10 years by the winners of never done before. I thought that the exam. It unnecessarily exhausted
as an IMG doctor? if you left the UK?
the confl ict. I witnessed all sorts of hard work and confi dence I developed me and for the fi rst time in my life I
Not applicable. African doctors bite the dust because I would miss the tolerant British
torture in the detention camp, and in Kenya would help me in my future started to feel tired.
their governments have not negotiated people whose tax money funds
my life became politicised. I dedicated work.
9. What have been your worst EU treaties for them. Doctors from the the NHS.
my service to the people in need and This aspect of the education had
experiences working in the NHS Commonwealth countries are more
treated them with dignity. I was not In 2010 the UNHCR (United Nations made the desire for honest learning
as an IMG doctor? likely to become effi cient doctors in UK 16. What would you miss the least
idle in the detention camp, the military High Commissioner for Refugees) irrelevant. The formula became to
Not applicable. than the EU unless some other factors if you left the UK?
used to let me work when it served sponsored me to come to the UK. So I get enough money and take as many
play a role. It is ridiculous to exhaust The hypocrisy of British politics.
their interest. Those practices gave me didn’t really choose to come here. IELTS exams as your money and time
doctors who have gone to primary
suffi cient experience of how human would allow you. I am a middle aged
school, high school and university in
beings behave psychologically in 7. In starting your work as a doctor in doctor who neither has the money
English to sit an English exam rather
the NHS, what did you find difficult? nor the energy for the unfair IELTS
diff erent circumstances. I saved many
lives under very trying circumstances What did you find helpful? examination. I don’t believe the IELTS
‘I was a confident doctor than an exam specifi cally on the skills of
communication.
which helped me to show my human I was a confi dent doctor and system is a true or good evaluation and communicator.
communicator. I never thought that system. It does not genuinely
quality and fi nally some members of
the army started to trust and consult English would be my downfall. evaluate your capabilities. There was
I never thought that We need research on doctors like me.
There is a defi ciency in the evaluation
me, as I was doing my job proudly and Once I arrived in the UK I was placed so much pressure to pass this exam English would be my system and we need to research why
confi dently. It was very diffi
cult but it on an English training course for and ultimately it is all about exam
made me a stronger doctor. It was one IMGs at Salford Royal Hospital in technique rather than the ability to
downfall.’ this is happening and how we can
change it.
great chapter in my life. Manchester. I was really shocked. I speak English. I love my profession,
Anonymous Villabona
changed. Discrimination does go on, it 12. What are the main contributions of
is a struggle to fi nd your feet and prove IMG doctors to healthcare in the UK?
your strength. You need to persevere Most hospitals have at least 30 per cent
and prove yourself through your overseas doctors, there are only two
personality. local doctors on my team. There are
1. What is your name? people from all over the world working
Not disclosed 10. What information, advice, support, here and the NHS depends on them.
would have made your entrance to
2. What is your position and where do you work? the UK and the NHS easier?
Consultant I think coming to the UK, it would 13. Which 3 words would you use to
be very helpful to have an induction describe your career in the NHS
3. Where were you born? programme. Workshops should be so far?
Not disclosed given by overseas doctors because Successful
they understand how it is to join a new Discrimination
4. Where did you complete your medical training? system. I think it would be important Struggle
Not disclosed to give the new doctors between four
and six weeks to shadow and learn how 14. What do you miss the most from
5. When did you come to the UK? the system works. Overseas doctors home?
1992 who have learnt the system understand My family the most, but I also miss
best the type of information that new my patients. There is a group of us
doctors will need. Within the induction, that go back every few months and
expectations of new doctors should give medical workshops so I do go
6. Why did you decide to come to the UK? diff erent system, you need to know how the be explained. I also don’t think doctors back and help when I can.
What were your goals/ambitions? system works. Though I was very senior when should have to work straight away, but
When I fi nished my postgraduate studies I was I came here it wasn’t enough. I didn’t have when they feel comfortable. 15. What would you miss the most if
sent over to the UK as part of my training. diffi
culty with the surgical side of work, but you left the UK?
I stayed because there were many communication and counselling the patients 11. What can the BMA do to help IMG The system, the NHS. It is a very
opportunities for further training. During this was very hard. doctors working in the NHS? good system.
time my wife was doing a degree here and I I think the BMA should provide these
became a consultant. 8. What have been your best experiences courses and I think they should be free. 16. What would you miss the least if
working in the NHS as an IMG doctor? you left the UK?
7. In starting your work as a doctor in the NHS, Learning everything, every day. The NHS is a I don’t really have a social life here
what did you find difficult? What did you find very good system. If you don’t keep up to date, so that is what I would miss the
helpful? you do get left behind. least.
It is a completely diff erent system here, it is
hard to fi t into this system and very diffi
cult to 9. What have been your worst experiences
communicate. People were not very helpful working in the NHS as an IMG doctor?
and I found that there was nobody to guide or Discrimination. There have been cases where
help you. Communication can be very hard, you go for a job, and you have more experience,
but because you are foreign a local doctor is
language and so on, and when you go from one
environment to the next so quickly, it can be chosen instead of you. I have been a consultant
‘Discrimination does go on, it is a struggle to
diffi
cult to adapt. One night I was working in since 1998 and I don’t think that things have find your feet and prove your strength. You need
changed since then. Even now when I am on a
my home country, the next day I arrived in the
UK and that weekend I was on-call. In a totally panel, I can see and hear that things have not
to persevere and prove yourself through your
personality.’
Telal Mudawi
‘I would have of this happening from other IMG doctors and people diff erently is something that happens
subconsciously and people are unaware that
to say what I I think it can be worse for younger doctors. As
a registrar and trainee, I knew that I needed to they are doing it.
found most demonstrate my worth. I learnt that this was
helpful were a part of life and that you can’t change the
world, so you must change yourself and the doctors to healthcare in the UK?
Telal Mudawi the senior world will follow. For example, when I started Between half and two thirds of UK doctors
are foreign graduates. If they all left and went
doctors, a job in Liverpool, the staff doubted me, but
I persevered and saw the job through. I am home, the health system would fall apart. I am
Consultant interventional cardiologist, Wrightington, Wigan and Leigh NHS, clinical divisional perhaps friends with them all now. I think that things are amused when far right politicians talk about
foreigners coming over to use the NHS. They
director, honorary consultant clinical governance lead at Manchester University Hospital, and
clinical advisor on cardiology for parliamentary health ombudsman
too helpful still the same, things haven’t changed. Most
people aren’t xenophobic, people just aren’t portray foreigners in a very negative light
at times. used to people from diff erent backgrounds. If I and always ignore the positive contributions
3. Where were you born? of foreign doctors to the health system.
Omdurman, Sudan
I try to be were to summarise my bad experiences of the
NHS in two words it would be the sensation of Collectively, IMG doctors are a major pillar of
helpful with being ‘excluded’, which can lead you to feeling the NHS.
University of Khartoum, Sudan
the younger marginalised, and having feelings of ‘doubt’.
doctors now. Having said that, when you have lived in 13. Which 3 words would you use to
5. When did you come to the UK? describe your career in the NHS so far?
1996
I think the Sudan you learn to put up with anything and
everything. I came here with a lot of resilience, Successful
thing that is so my bad experiences here weren’t really that Fulfi lling
Inspirational
most difficult awful or very diffi
cult for me to deal with. The
reason that many IMG doctors stay is because
6. Why did you decide to come to the UK? diffi
cult for foreign doctors is actually the for foreign their previous experiences were so much worse. 14. What do you miss the most from home?
What were your goals/ambitions? Being with my parents. I get to see them at
My goals have changed over the years. Initially
diff erence in background and culture, not
racism.
doctors is 10. What information, advice, support, would least once a year, sometimes more. I wish
I planned to come to the UK to gain a western actually the have made your entrance to the UK and I was with them all the time. My sisters are
8. What have been your best experiences the NHS easier? there to care for them, but I also want to be
post graduate training and membership to
a royal college and then go back to Sudan. working in the NHS as an IMG doctor?
difference in It is hard to say what would have made there so I can play my part.
My goals changed however as there was the Working in the NHS as an IMG doctor has background a diff erence. In terms of support I think
really broadened my experience. My early life mentoring with doctors that went through 15. What would you miss the most if you
opportunity here for further training that I
wanted to accomplish. in Sudan with the lack of health care taught
and culture.’ similar experiences would be very helpful. left the UK?
me to put up with a lot of challenges. I have Sometimes the cycle of doubt and exclusion So much! It is diffi
cult to even put into
7. In starting your work as a doctor in the NHS, transformed into a Brit. People moan about can begin a downhill spiral and young IMG words. I’d miss the way of life and job
what did you find difficult? What did you find the NHS, but it is always on quite a trivial basis. doctors can begin to doubt themselves. The satisfaction. Nowhere else in the world
helpful? Coming from Sudan and working as an IMG more junior you are, the more vulnerable you would I be able to get the same job
The mentality of a Sudanese person is very doctor has given me resilience. are. Young doctors can be aff ected very badly. satisfaction, even in the US. In other
diff erent to a British person. It took me years Mentoring could be a really useful way to stop countries, the health system is privatised
to understand this, which caused me many 9. What have been your worst experiences this and build confi dence. and driven by quotas and it’s not right.
diffi
culties. This of course isn’t the fault of working in the NHS as an IMG doctor?
anyone in particular; it is a case of diff erent I had to prove my worth in every hospital I 11. What can the BMA do to help IMG doctors 16. What would you miss the least if you
backgrounds, upbringing and culture. For me, it worked in while I was a new doctor. It wasn’t working in the NHS? left the UK?
didn’t cause any disasters, and people were and racism, but simply that people didn’t know I think mentoring for clinical and secretarial Moving into a new environment and
are very helpful. me. If I started at the same time as a British staff to help them to understand and being mistrusted. In Britain I am looked at
doctor, he was assumed to be a good and appreciate IMG doctors a bit more and help to diff erently, and I wouldn’t miss that.
I would have to say what I found most helpful reliable doctor, whereas I was assumed to be make their lives more comfortable. Mentoring
were the senior doctors, perhaps too helpful the opposite. People changed their opinions should not be for the new doctors but for the
at times. I try to be helpful with the younger once they saw me working and got to know me, existing ward staff as there is a need to address
doctors now. I think the thing that is most and through that I gained respect. I have heard the real problem: attitudes. I think treating
Anonymous

Greater awareness and information so far?
about the working and processes of the Insecurity
1. What is your name? NHS – shared decision making between Supportive
Not disclosed patients and clinicians. Communication Possibilities
skills training as well, as I know that a
2. What is your position and where do you work? lot of IMG doctors oft en struggle with 14. What do you miss the most
Specialty doctor, forensic psychiatry this. The opportunity to be able to talk from home?
to someone that has made it through a Russian people are emotionally
3. Where were you born? similar transition to the other side would more open than people in the UK,
Moscow, Russia have been helpful. so I sometimes feel isolated here.
4. Where did you complete your medical training? 11. What can the BMA do to help IMG 15. What would you miss the most
Moscow Medical Academy, Russia doctors working in the NHS? if you left the UK?
Courses on communication skills and Family and friends.
5. When did you come to the UK? acclimatisation courses highlighting
2005 diff erences in cultural norms etc. 16. What would you miss the least if
you left the UK?
12. What are the main contributions of Tabloids!
6. Why did you decide to come to the UK? 8. What have been your best experiences There is a biased view of IMG doctors
What were your goals/ambitions? working in the NHS as an IMG doctor? in the UK. I fi nd that IMG doctors end
I wanted to further my education and gain There were lots of uncertainties but generally up going into specialties that are not
postgraduate training. There are also more my colleagues were very helpful. I found that attractive to UK graduates. They end
opportunities for research in the fi eld that I am in the UK patients understand more about up fi lling the gaps that no one else
interested in here in the UK than in Moscow. their conditions and are more empowered as a wants to fi ll.
result. Patients were mostly understanding and
7. In starting your work as a doctor in the NHS, supportive though some patients did not hide
what did you find difficult? What did you find their racist attitudes or being frustrated at the
helpful? constant change in healthcare professionals.
Unfamiliar administrative systems were diffi
and jargon that people may use assuming that
cult,
9. What have been your worst experiences
‘Having a mentor and spending long enough with a
you will know what they mean. There was a lack working in the NHS as an IMG doctor? team that were willing to accept my contributions
Not being able to continue training due to
of clarity in both the roles of my colleagues and
what was expected of me. Further, the system the whole debacle with modernising medical
was really helpful.’
itself is a completely diff erent system in terms of careers and the MTAS system. I have also found
assessments and exams. some members of the public, mainly relatives
of patients, a little aggressive and this has
Having a mentor and spending long enough given me a bit of an inferiority complex.
with a team that were willing to accept my
contributions was really helpful. I was really
impressed with the high level of training and
expertise that the other colleagues on the
team had.
Amit Mukherjee
‘I like the fact I caught up eventually. I also struggled

that when to get to grips with the amount of
paperwork. describe your career in the NHS
it comes so far?
10. What information, advice, support, Hard work
to treating would have made your entrance to Inspiring
Amit Mukherjee patients, the the UK and the NHS easier? Exciting

NHS does not I would have found advice on clinical
attachments and visa regulations 14. What do you miss the most
Higher specialty registrar in general adult and old age psychiatry in Barnet, discriminate very helpful. I found that there was no from home?
My family, and the food.
Enfi eld and Haringey Mental Health NHS Trust
based on organisation that I could turn to for
help, including the BMA, or the human
3. Where were you born? financial resources department of the various 15. What would you miss the most
if you left the UK?
Mumbai, India
capacity NHS hospitals. I was surprised that even
certain diaspora organisations did not Professionally I would miss working
4. Where did you complete your medical training? of an help me because I had no money to in a publicly funded health system
like the NHS that treats people as
Maharashtra University of Health Sciences, Mumbai, India
individual.’ pay for their membership – I thought
they would understand my need for equals – a diff erent type of system
5. When did you come to the UK? help as they shared similar cultural leads to corruption, ethical issues
2006 backgrounds. and dilemmas.
11. What can the BMA do to help IMG Personally, I would miss the lifestyle
doctors working in the NHS? here. I would also miss snow!
6. Why did you decide to come to the UK? 8. What have been your best experiences The BMA these days (unlike in the
What were your goals/ambitions? working in the NHS as an IMG doctor? past) is doing a lot already – such as its 16. What would you miss the least if
I was very keen to undertake a postgraduate I like the fact that when it comes to treating visa alert service, working more with you left the UK?
course in psychiatry. The UK is world-renowned patients, the NHS does not discriminate based diaspora organisations, holding more Professionally, the paperwork
for psychiatry training, so it was to further my on fi nancial capacity of an individual, it is very diversity and leadership events, which and management interference in
expertise and career. much based on socialist principles – unlike acknowledge the diversity of the NHS. clinical decision making.
the Indian system. This is a very good thing to
7. In starting your work as a doctor in the NHS, see. I also like that there are many research 12. What are the main contributions of Personally, the English weather
what did you find difficult? What did you find opportunities, and it is easy to keep up to IMG doctors to healthcare in the UK? – the long winter nights and the
helpful? date with the latest advances. There are good IMG doctors fi ll in the service gaps unpredictable rains.
I found getting an attachment very diffi cult as libraries in most of the hospitals in the country. in the short term – such as over the
I didn’t know anyone. It was not a streamlined For me these are very inspiring. Christmas period, as well as in the long
process – I was blindly targeting hospitals. term for staff shortage. International
Frequent changes in visa rules also made it 9. What have been your worst experiences doctors also see things from a diff erent
diffi
cult for me to manage my circumstances. working in the NHS as an IMG doctor? perspective, and cater to the ever
I have sensed that there may be a racial bias, increasing diversifi ed population of the
Once I had started my fi rst attachment I found or maybe another sort, in terms of progression UK by understanding cross-cultural
networking with both UK graduates and IMGs of training – I have experienced a delay in issues.
very helpful. It helped me understand the NHS progress for no reason. At the start of my
better, pick up techniques on how to do well training, lots of doctors at my level knew what
in interviews and set up a portfolio for training to do, whereas I was unsure due to lack of any
posts. structured focussed induction for IMGs.
Raj Murali

I was very lucky as I had friends already so far?
in the UK, so I was very well informed. A Jolly good indeed.
1. What is your name? diff erent body used to exist back then
Raj Murali that provided much of the information 14. What do you miss the most
that I needed. from home?
2. What is your position and where do you work? I miss cultural aspects, and my
Orthopaedic consultant, Wrightington, Wigan and Leigh NHS Trust and honorary professor, 11. What can the BMA do to help IMG family and friends.
University of Edge Hill doctors working in the NHS?
I don’t think that there should be 15. What would you miss the most
3. Where were you born? special treatment for IMG doctors – all if you left the UK?
Chennai, India doctors should be equal, the playing Professionally I would miss the
fi eld should be level. However, as issues ability to practice in the NHS – the
4. Where did you complete your medical training? such as the membership of the Royal system is fantastic because it is free
Madras (Chennai) Medical College, India College of GPs exam have shown there at the point of delivery, and I do not
is not a level playing fi eld. I think that have to worry about whether or not
5. When did you come to the UK? the BMA should explore the problems the patient can aff ord treatment.
1987 behind these issues, or whether it is The ability to carry out national
just a case of statistics. The BMA should trials is particularly something to be
also be actively involved in the career proud of in the NHS.
progression of specialty doctors which
6. Why did you decide to come to the UK? 8. What have been your best experiences is largely staff ed by those who do not From a personal point of view, I
What were your goals/ambitions? working in the NHS as an IMG doctor? progress to be a consultant. have become part of this society, so
The UK off ered much better facilities for My training was absolutely brilliant. Aft er I would miss the friends that I have
training, so I wanted to complete my surgical completed my training I was able to get a 12. What are the main contributions of made here.
training here. consultant job in 2000, and before that had IMG doctors to healthcare in the UK?
held a variety of junior roles across the surgical They have made a huge contribution. 16. What would you miss the least if
7. In starting your work as a doctor in the NHS, spectrum. I am proud to work in the NHS, and While UK gradates tend to go from you left the UK?
what did you find difficult? What did you find am glad that it has progressed my career. trainee to consultant or GP, IMG doctors The weather!
helpful? have many more grades across the
From a medical point of view, I didn’t fi nd 9. What have been your worst experiences system, and make up the vast majority
anything particularly diffi
cult. It did take me working in the NHS as an IMG doctor? of these grades, which number in the
a few months however to understand the The NHS is good for career progression, but for thousands. These posts are essential to
cultural diff erences, such as the diff erence in an IMG doctor this is at a much slower rate than maintain core emergency services as
names. British culture places emphasis on fi rst for UK graduates. I had to work much harder these cannot be run by only the training
and second names, and how to address people, and compete fi ercely to prove why the job grade doctors.
which we have no concept of in India. It was should be mine. What took me 12 years as an
also diffi
cult adapting to the weather and food IMG, would take eight years for a UK graduate.
– I couldn’t believe it when I saw people eating
salad, but now I think it’s quite tasty.
‘The NHS is good for career progression, but for an
In terms of what I found helpful, my team was IMG doctor this is at a much slower rate than for UK
brilliant, and they all gave me any help that I
needed to settle into my role and training.
graduates. I had to work much harder and compete
fiercely to prove why the job should be mine.’
Carlos Oroz

I would have preferred more information so far?
on what is expected of you when you Intense
1. What is your name? begin your training. Perhaps more Enjoyable
Carlos Oroz information about practising in the Fulfi lling
UK arranged by professional bodies,
2. What is your position and where do you work? including NHS Employers, would have 14. What do you miss the most
Associate specialist, sexual health, Chalmers Centre, Edinburgh been helpful. I think the GMC is now from home?
better prepared for this. I miss my family, although I now
3. Where were you born? have my own family in Edinburgh.
Zaragoza, Spain 11. What can the BMA do to help IMG
doctors working in the NHS? 15. What would you miss the most if
4. Where did you complete your medical training? I would like to see the BMA off ering you left the UK?
University of Zaragoza, Spain introduction courses to practising I would miss my family here! I would
medicine in the UK for international also miss my job.
5. When did you come to the UK? doctors.
1994 16. What would you miss the least if
12. What are the main contributions of you left the UK?
IMG doctors to healthcare in the UK? The weather!
Dedication and hard work. IMGs enter
6. Why did you decide to come to the UK? respectful and I also found that the general the NHS with energy and enthusiasm,
What were your goals/ambitions? public had great respect for the medical and they carry this through their time in
I moved to the UK to take up a training post profession. the system. Their cultural and linguistic
to further my medical skills. I found that it limitations make adapting to the system
was too competitive in Spain to get a training 8. What have been your best experiences harder but I also think that international
post at the time and the training system was working in the NHS as an IMG doctor? doctors bring a fresh approach to the
not fl exible enough. So the youthful feeling of Well, I am still here 20 years later so I must British system, which benefi ts not only
adventure took me abroad, and I knew that the have had a very positive experience! I enjoyed domestic doctors, but also the patients
UK was a good place for training. I found I fi tted working here much more than in Spain, that we treat.
into the system better here, although I had no and I have found that I fi t this system much
long term plans – I only thought that I would be better. The vast majority of doctors and nurse
here for six months to a year. colleagues made me feel very welcome. I like
to think that we IMGs bring something diff erent
7. In starting your work as a doctor in the NHS, to the NHS.
‘International doctors bring a fresh approach to the
helpful? 9. What have been your worst experiences British system, which benefits not only domestic
I found that I had diffi
culty with the language
barrier and the working hours. Being a junior The culture of hierarchy in hospital medicine
doctors, but also the patients that we treat.’
doctor in 1994 was very tough and the is very much a barrier. I did not expect this
European Working Time Directive was not fully upon my arrival in the UK. I occasionally get
implemented at that time. a comment that I perceive as negative with
regards to being an IMG, but this is very rare.
I found the fl exibility of the system very helpful, When I fi rst started, some patients preferred to
and the practical and sensible approach to trust a UK graduate, but I understood this.
healthcare that the NHS took at the time.
Colleagues (all healthcare staff ) were very
Anonymous
Netherlands, and it became apparent 12. What are the main contributions of
that he did not want me there. I didn’t IMG doctors to healthcare in the UK?
get the job, and shortly aft erwards I I have friends in the NHS from diff erent
received a phone call from another countries who are doing good jobs
member of the board who explained across the board. They are as important
1. What is your name? why I hadn’t got the job, but also to as any other doctor.
Not disclosed apologise for his colleague’s behaviour.
I later worked for this nice board
2. What is your position and where do you work? member and I always remembered his 13. Which 3 words would you use to
Not disclosed fair and kind words. describe your career in the NHS
so far?
3. Where were you born? 10. What information, advice, support, Unusual
The Hague, Netherlands would have made your entrance to Successful
the UK and the NHS easier? Enjoyable
4. Where did you complete your medical training? I was younger when I arrived, and it was
Radboud University Nijmegen Medical Centre, Netherlands an adventure to me. The GMC wanted to 14. What do you miss the most
know all sorts and were very strict but I from home?
5. When did you come to the UK? now understand why they were. During Not a lot – as home is so close I see
1990 my geriatric training a colleague created my friends and family oft en.
a list of every abbreviation that a doctor
may encounter, so that would have been 15. What would you miss the most
particularly helpful from the beginning. if you left the UK?
6. Why did you decide to come to the UK? In terms of what I found helpful, I had a very I live in a beautiful part of the
What were your goals/ambitions? open-minded GP trainer, which really helped. 11. What can the BMA do to help IMG country, and I would miss the very
I came to the UK for general practice Aft er my GP training I could go for any GP job, doctors working in the NHS? varied, unspoilt countryside a lot.
training as there was a large waiting list in there were no regulations like there are today. I still receive calls from doctors based in Holland is very regulated, over-
the Netherlands. Aft er elective training in the Netherlands looking to work in the organised and living in the UK is
Birmingham for two months, a head of GP 8. What have been your best experiences UK, but I have no idea how the central for me, much more natural and
training at the GP Institute in Nijmegen, working in the NHS as an IMG doctor? register works anymore. I think that enjoyable.
Netherlands received a request for a Dutch GP I am happy that people here – both colleagues the BMA should help these students or
trainee to be based in Southampton for a year, and patients – have never had a problem with graduates navigate this system. 16. What would you miss the least
starting August 1990. Despite originally only my background. I enjoy that people ask me if you left the UK?
planning to be here for one year, I have been where I am from, why I am here, and what is People in the Netherlands are more
here ever since. diff erent. I have had the chance to return to the outspoken and straight forward
Netherlands to train and work, but have chosen – in the UK people tend not to be
7. In starting your work as a doctor in the NHS, to stay put – the healthcare system in the direct, not straight with each other,
what did you find difficult? What did you find Netherlands is even more over-regulated than
‘Abbreviations and colloquialisms! and I have learned to read between
helpful? in the UK. In England there seem to be so the lines. What people say is not
necessarily what they actually
Abbreviations and colloquialisms! In England
there seem to be so many for illnesses, names 9. What have been your worst experiences
many for illnesses, names and mean. I have learned to be more
and organisations. The one that I remember working in the NHS as an IMG doctor? organisations. The one that nuanced in expressing my opinions
The worst experience that I can think of and how I express them.
well was a female patient telling me she had
trouble spending a penny… It was quite an (though there haven’t been many) was when
I remember was a female patient
intense crash course when I started. I also I was being interviewed for a GP rotation telling me she had trouble
position aft er my training year. One of the
found that training in the Netherlands was not
as practical as it could have been, certainly by a people on the interview board kept asking
spending a penny…’
British standard. me why I was in England rather than the
Ana-Catarina Pinho-Gomes
‘A registrar 10. What information, advice, support,

that I worked the UK and the NHS easier? describe your career in the NHS
with once I think that any direct support given so far?
to IMG doctors would look like Challenging
took me discrimination, as we are all capable of Rewarding
Ana-Catarina Pinho-Gomes aside and doing the job. I think it would be better Valuable
if we were helped to become more
told me that confi dent in our roles. 14. What do you miss the most
Foundation year two, Oxford University Hospital NHS Trust I should go from home?
11. What can the BMA do to help IMG I do not miss the country itself,
back home. doctors working in the NHS? but I miss my friends and family.
Porto, Portugal At that point I think that the BMA website could
be helpful in explaining who can help 15. What would you miss the most
I had only and support doctors when they are if you left the UK?
The Faculty of Medicine, University of Porto, Portugal been here struggling with personal or professional I would miss my work – I really like
issues and their supervisors/employers my job.
for three are not attending to their needs.
2013 months, so 16. What would you miss the least
12. What are the main contributions of if you left the UK?
it was very IMG doctors to healthcare in the UK? The weather!
distressing A vital contribution is the diff erent
6. Why did you decide to come to the UK? 8. What have been your best experiences perspective that IMG doctors off er.
and dealt a The more multicultural a system is,
The medical training is much more organised, I am glad to be part of an organisation that blow to my the better it is. Although the NHS
places quality fi rst, along with safety, and is is a great system, there is always
comprehensive and demanding here than in
Portugal. The NHS is also a much better system seriously committed to provide the best care
confidence.’ something that can be improved, and
than the Portuguese equivalent and I am very possible bearing in mind that the whole system these improvements can come from
proud to be a part of it. needs to be sustainable. People are very other systems, or from the wealth of
supportive and accommodating, and they knowledge that IMG doctors bring with
7. In starting your work as a doctor in the NHS, help to ensure that you are learning. them. IMG doctors are fl exible and it
what did you find difficult? What did you find is undeniable that without them, the
helpful? 9. What have been your worst experiences UK health system would not be able to
I found the level of discrimination diffi
cult – working in the NHS as an IMG doctor? support itself.
discrimination within my job, rather than from A registrar that I worked with once took me
the general public. Some colleagues looked at aside and told me that I should go back home.
me very diff erently. Fortunately I am adaptable, At that point I had only been here for three
so I did not struggle too much. My English is months, so it was very distressing and dealt
good, but I was not used to colloquialisms, so a blow to my confi dence. I think that it is a
that has been a challenge. For the most part question of rationalising and learning to
the majority of people that I have worked with ignore this.
have been very helpful towards me.
Mona Sallam
‘It has been 9. What have been your worst experiences When you fi rst register as a doctor the GMC
working in the NHS as an IMG doctor? gives you a starter pack – this has nothing
extremely IMGs can come to the UK through very specifi c for IMGs – maybe the BMA can put
difficult to diff erent routes. The earlier they join the NHS some information/leafl ets for IMGs in these
starter packs.
progress – the better the integration into the system is.
It is really diffi
cult to progress in the UK and
Mona Sallam you end up many IMGs become trapped in specialty doctor A mentoring programme would be good where
a newcomer is helped by a more established
in the same positions. It is very hard to gain experience
unless you’re in a training post but those are IMG. There shouldn’t be too big of an age gap
Specialty doctor, anaesthesia and critical care, East Sussex NHS Trust jobs again basically impossible to get onto! between the two though. This could be really
useful in getting acquainted with your new role
and again. Some doctors come here to settle, have a family and could help to overcome obstacles.
I was born in Mecca, Saudi Arabia, but I am Egyptian I came to the and don’t mind staying in a midgrade position
UK with all for a long time and then they retire. Other IMGs,
like me, come here to become professionally doctors to healthcare in the UK?
Ain Shams University, Egypt these dreams accomplished. If I saw myself progressing and IMG doctors are versatile team members. They
can come into the system at diff erent levels,
and now my gaining experience and learning then I would
consider settling. But I haven’t – so far it has fi ll in any gaps in the team and can help with
2013 goal has been been extremely diffi cult to progress – you end indirect teaching processes and workplace
training. They contribute a lot but it is really
reduced to up in the same jobs again and again. I came
to the UK with all these dreams and now my about how they are acknowledged in my
sitting my goal has been reduced to sitting my exams and opinion. I think when it comes down to formally
6. Why did you decide to come to the UK? recognising the skills of IMGs, this doesn’t
you have a diff erent background and diff erent
experiences. The majority, however, do not and
exams and moving to another country.
really happen. If they were allowed there would
I decided to come to the UK to gain experience tend not to deal well with IMGs, these people moving to 10. What information, advice, support, would be so much more that they could contribute.
oft en act as if IMGs know nothing and they can have made your entrance to the UK and the
as a practicing doctor. Doctors that have
worked abroad can get a much higher degree be very ridiculing. Sometimes I would like to
another NHS easier?
in their specialty when they come back remind these people that I have been a qualifi ed country.’ There are one day inductions but because 13. Which 3 words would you use to
to Egypt. I came to work, train and sit the doctor for almost 10 years! I would really they wait until there are enough new starters describe your career in the NHS so far?
fellowship examination. appreciate some respect. It can take a great to fi ll them, it was actually a bit too late for it Tedious
deal of energy to remain composed in situations to benefi t me. It would have been really useful Challenging
7. In starting your work as a doctor in the NHS, like these. It really started to aff ect my self- to have the inductions right at the beginning Frustrating
what did you find difficult? What did you find confi dence and made me doubt my professional when I started.
helpful? abilities, which stunted my career progression. 14. What do you miss the most from home?
Firstly, communication has been a really large IMG forums would also be really useful, where My family.
problem. When you come to the UK as an IMG Honestly speaking, I think by the end of my people can give information about what to
you have to maintain a high IELTS score – this is fi rst job I did feel a part of the team and that expect as an IMG – I think sometimes the 15. What would you miss the most if you
something I’ve maintained for three years but people understood me. I was largely accepted, expectations of IMGs aren’t met when they left the UK?
really it is irrelevant. The language is so diff erent but now that I have moved I have to start the come here and that can be frustrating. If The greenery and also carrot cake!
to the day to day language used here. There is process all over again. I’m still facing these you come in the right frame of mind it might
local vocabulary and dialects to consider that can challenges but I guess my attitude is changing actually be easier to adapt in the long run. 16. What would you miss the least if you
actually change from county to county in the UK. so it is becoming easier. left the UK?
Also, the medical jargon used here is terrible. In 11. What can the BMA do to help IMG doctors My failure to get a driving license!
Egypt we were taught not to use medical jargon. I 8. What have been your best experiences working in the NHS?
felt very lost here and it took me a few months to working in the NHS as an IMG doctor? The BMA off ers good services but people may
decode the jargon, which is also used in medical The system here is good compared to back not really know this. I think people just think
notes! I am still learning every day. home. I do appreciate the service the NHS of the BMA as a trade union – I didn’t know
provides to people– I think it is important to the BMA could help to provide specifi c
Secondly, I felt really alienated, an outsider acknowledge this. The allocation of resources services to IMGs.
to the system. Some people understand that is also much better and a lot less is wasted.
Kasra Taherian
‘Mentoring advantage of trainees to get them to 12. What are the main contributions of
and learning do the maximum amount of work for
minimum rights. Fortunately, all that has Fundamentally, I don’t think that the
in the form changed now, following the subsequent contributions of IMG doctors are any
diff erent from the contributions made
of one day reforms to postgraduate training.
by doctors trained in the UK. However,
Kasra Taherian seminars or Also during the initial stages of my IMG doctors come with experience from
their own countries and that brings with
2. What are your positions and where do you work?
workshops training in the UK, the system for training
and recognition of equivalence training it a unique perspective which serves to
Consultant ophthalmologist, Lancashire Teaching Hospitals NHS Foundation Trust, national lead plus support changed suddenly and without any prior enrich the system here.
clinician for Ophthalmology, Health Education England (e-learning for healthcare), honorary secretary,
trustee & chair of the governing council, North of England Ophthalmological Society, member
via e-learning notice. I found myself moving from being
an applicant for registrar positions and
education committee and chair of e-learning subcommittee, Royal College of Ophthalmologists would be attending interviews for the same to 13. Which 3 words would you use to
extremely having to languish a further 18 months in
a senior house offi
cer position due to an so far?
Tehran, Iran helpful.’ abrupt moving of goalposts without any Rewarding
chance to seek any redress. Challenging
4. Where did you complete your medical training? Frustrating (at times)
Agra University and the All India Institute of Medical Sciences, New Delhi, India 10. What information, advice, support,
would have made your entrance to 14. What do you miss the most
5. When did you come to the UK? the UK and the NHS easier? from home?
1997 At that time there was no clear My family and parents.
information on the most appropriate
route that I was supposed to be taking to 15. What would you miss the most
complete my training with a number of if you left the UK?
6. Why did you decide to come to the UK? 8. What have been your best experiences diff erent avenues open. The British people.
To gain a fellowship from The Royal College of As a result of my working here in the UK I was 11. What can the BMA do to help IMG 16. What would you miss the least
Surgeons of Edinburgh and The Royal College awarded a scholarship to do a master’s degree doctors working in the NHS? if you left the UK?
of Ophthalmologists. in clinical education at Leeds University. This In those days when I was trying to gain The weather.
has been very helpful in progressing my career my fi rst job in the NHS I had very limited
7. In starting your work as a doctor in the NHS, and developing a special interest in medical fi nancial resources at my disposal to
what did you find difficult? What did you find education. pay towards membership fees, and I
helpful? would have benefi tted most from the
Initially, it was very frustrating for me having 9. What have been your worst experiences BMA’s guidance at that crucial juncture
to repeat exams (PLAB as well as parts 1-3 of working in the NHS as an IMG doctor? in my career. I think it would be really
FRCS) without being able to talk to the various During my training towards gaining helpful if the BMA off ered a subsidised
agencies (stakeholders like the GMC or royal accreditation there were some partially membership rate for IMGs at their initial
colleges) about seeking equivalence for the funded non-standard jobs that I took which, stages of entry into the UK and before
four years of postgraduate ophthalmology though counted towards my training, were they have secured any employment,
training that I had already received in India as advertised at a very low salary (about one-third similar to what medical students are
there was no mechanism for that at that time of the norm) along with reduced employment off ered. Mentoring and learning in the
unless one was already at consultant level. privileges. The issue was that some trusts form of one day seminars or workshops
took the view that some trainees would have plus support via e-learning would also
I was however able to draw on the experiences no choice but to take these jobs in order to be extremely helpful.
and advice of colleagues that had gone through complete their training. I felt that this small
similar experiences, which was a great help. minority of trusts used this excuse to take
Anonymous
‘A course improve things. I also came to the UK

that covers with the expectation of being given the
opportunity to teach as I enjoy this, but describe your career in the NHS
how the have been told that I cannot due to lack so far?
Unfulfi lling
NHS works, of experience and knowledge, which is
very disappointing. Obstructive
Not disclosed funding and Undermining
how the would have made your entrance to 14. What do you miss the most from
Part-time specialty doctor, psychiatry system of the UK and the NHS easier? home?
My family and the friends that I have
investigation Having a course or materials that
highlight practical information for left behind.
Cairo, Egypt works would internationally educated medics/
15. What would you miss the most if
have helped health professionals. A course that
covers how the NHS works, funding and you left the UK?
Cairo University, Egypt me greatly how the system of investigation works I would miss the British way of life
and learning new skills.
to see the would have helped me greatly to see
the bigger picture and understand the
2005 bigger whole situation. 16. What would you miss the least if
you left the UK?
picture and 11. What can the BMA do to help IMG Bureaucracy and the red tape of the
understand doctors working in the NHS? NHS.
6. Why did you decide to come to the UK? What
were your goals/ambitions?
diagnosis on the basis that I am from another
country and have diff erent religious beliefs,
the whole I think that the BMA could do a lot to
make life for IMGs easier in the UK. UK
To continue my career and learn new skills in therefore I do not understand the way of life situation.’ doctors need to be educated on how to
the UK. My partner, who is also a doctor, moved or culture of the UK. I also endured comments be more accepting of IMGs. IMGs need
to the UK to further his career so I moved here such as “if you are Arab why have you come to to be helped to integrate into the NHS.
with him. work here?” inferring that as Saudi Arabia is a Oft en IMG doctors sacrifi ce a lot when
rich country that I should not have come to they come to the UK but fi nd when they
7. In starting your work as a doctor in the NHS, the UK. get here that they are worse off .
helpful? 8. What have been your best experiences 12. What are the main contributions of
The start of my career in the NHS was not a working in the NHS as an IMG doctor? IMG doctors to healthcare in the UK?
conventional one. I went to an interview and New experiences and the information that I They make a great contribution. They do
then was taken straight onto the ward round. have managed to come across whilst working a lot of valuable work but are not valued,
During this, the consultant did not make any in the UK. do not receive recognition and are given
concessions for the fact that not only was I new little or no opportunity to progress.
to the job, but also to the NHS and the UK. I was 9. What have been your worst experiences
given no training or induction and felt as if I working in the NHS as an IMG doctor?
had been thrown into the deep end. I also think I fi nd that what has been issued in the policies
that consultants look down on IMG doctors in order to keep high professional standards
and assume that they are not well qualifi ed. is very good but what actually happens in
Additionally, I found that wearing my hijab also practice is very diff erent. When I tried to raise
caused me some problems, in that sometimes concerns about defects to the Trust, they view
patients were not prepared to accept my this as an attack rather that an opportunity to
Alex Theodossiadis
‘I had the 8. What have been your best experiences introduction to hospital work. I cannot think of
working in the NHS as an IMG doctor? anything that could have made it better for me.
option Becoming a consultant in 1975, just seven and
of doing a half years aft er joining the NHS was one of my 11. What can the BMA do to help IMG doctors
working in the NHS?
postgraduate best experiences.
IMG doctors at the beginning of their work in
Alex Theodossiadis training in I had many opportunities to see and be part the NHS need to familiarise themselves with
British culture. I examine for the GMC and
the UK and of changes such as modernising the NHS
and changing systems. When I started as a my college and come across a small number
Part time consultant psychiatrist for older people at the Royal Oldham Hospital. Previously, it was like consultant in 1975 I was based in a mental of doctors who struggle with the English
language and especially the vernacular. I made
a consultant psychiatrist in adult general psychiatry in North Manchester General Hospital
(1975-2008)
winning the health hospital where there was no community
based service. We had the opportunity there a resolution from the beginning of my work for
lottery to see to make plans to reduce dependency on beds, the NHS that I wouldn’t speak Greek with other
3. Where were you born? Greek doctors unless we were in private. I have,
Athens, Greece
how the NHS increase outreach, arrange visits to patients
in their own homes, improve working with however, noticed other colleagues speaking
worked in nurses, provide new services for patients, and their national tongue at work in front of other
4. Where did you complete your medical training? doctors and feel they are not doing themselves
Medical School of Athens, Greece
practice.’ make services more accessible. I developed,
with my colleagues, an acupuncture clinic – it any favours. I think there should be more of
was successful and we were able to provide a focus on the integration of IMG doctors,
5. When did you come to the UK? services, generate income and employ staff . particularly in terms of language assimilation.
1968 Medical staff could innovate within the NHS at
that time. We had local autonomy to provide 12. What are the main contributions of IMG
patients with what they needed. doctors to healthcare in the UK?
They provide energy, innovation, thinking
6. Why did you decide to come to the UK? considering what to do, I sent over 200 I oft en found that what kept me buoyant was outside the box, a fresh pair of eyes and
What were your goals/ambitions? applications and the vast majority were trust from patients and their relatives and enthusiasm.
There was no future for me in Greece because negative replies. Another hard period has working with frontline staff , all supporting one
it was ruled by a military junta from 1967-1974. been since the 1980s - the multiple tiers of another. Job satisfaction came from looking
I was keen not to waste my time in the army managers in the NHS generating tick box aft er patients and providing a good standard 13. Which 3 words would you use to
for two years; I would have spent my time exercises. of care; patients were appreciative of the describe your career in the NHS so far?
swatting fl ies and writing prescriptions for sore care they were receiving. I have also enjoyed Fulfi lling
tummies and runny noses. I had the option of The current crisis of acute mental health working on a team with colleagues sharing the Interesting
doing postgraduate training in the UK and it services is phenomenal – recently the press load, the diffi
culties and the rewards. Successful
was like winning the lottery to see how the NHS has been drawing attention to this problem.
worked in practice. I thought I would do my This is a real challenge. 9. What have been your worst experiences 14. What do you miss the most from home?
training and then go back to Greece, but things working in the NHS as an IMG doctor? Good friends and the weather.
changed when I choose my specialty – the However, working in a multidisciplinary team Sending more than 200 applications for senior
gulf became bigger. Good friends encouraged gave me a sense of belonging, so my alien house offi
cer posts in the winter of 1969 and 15. What would you miss the most if you
me to return to Athens when democracy was status did not come into play. I felt supported receiving many rejections. left the UK?
restored, but the government wasn’t trying to by all members - not just medical staff but the I like the British way of life: tolerance,
entice doctors back who had trained abroad, whole team, including nurses and occupational 10. What information, advice, support, would fairness and a good dollop of compromise.
and I was settled here so I stayed in England. therapists. It was nice because I didn’t feel have made your entrance to the UK and the I don’t think this is available elsewhere.
alone. There was a very diff erent attitude in NHS easier?
7. In starting your work as a doctor in the NHS, Athens where doctors were really seen as Before I started working for the NHS in 1968, 16. What would you miss the least if you
what did you find difficult? What did you find being superior to all other staff , with nurses as I had two clinical attachments at a hospital left the UK?
helpful? second class. I have learned a lot from non- in Dartford. Along with a six week placement Dreary, dull days with drizzling rain from
Understanding all the diff erent idioms that medical members of the team, and from my as a medical student in 1965, and 12 week mid-Autumn to mid-Winter.
patients and their relatives use was very patients, in the UK. placement in 1967, this helped me to improve
diffi
cult. In the winter of 1969 when I was my ability to speak English and gave me a solid
Alvaro Rojas Villabona
‘IMGs provide 8. What have been your best experiences 12. What are the main contributions of
working in the NHS as an IMG doctor? IMG doctors to healthcare in the UK?
diversity I really appreciate the guidance and support The UK hosts an extensive and growing
to the NHS that I receive from non-medical staff members international population with diff ering social
and health needs. IMGs provide diversity to the
which is a such as nurses, secretaries, radiographers etc.
They have extensive knowledge of the health NHS which is a key element when responding
Alvaro Rojas Villabona key element system and valuable experience that I am able to the challenges of a changing multicultural
population.
when to rely on. These members of staff support
many activities that are unfamiliar to IMG
Clinical research fellow, Gamma Knife Centre, National Hospital for Neurology and Neurosurgery, responding doctors.
Queen Square, London 13. Which 3 words would you use to
to the 9. What have been your worst experiences describe your career in the NHS so far?
3. Where were you born? challenges working in the NHS as an IMG doctor? Rewarding and challenging
Bucaramanga, Colombia
of a changing I cannot recall any specifi c negative
experiences related to working as an IMG 14. What do you miss the most from home?
4. Where did you complete your medical training? multicultural doctor in the NHS. I miss the variety of fruits found in tropical
Industrial University of Santander, Bucaramanga, Colombia countries like Colombia.
population.’ 10. What information, advice, support, would
5. When did you come to the UK? have made your entrance to the UK and the 15. What would you miss the most if you
2009 NHS easier? left the UK?
The structure of the medical and health I would miss the international atmosphere
systems in the UK is quite diff erent to their of London and the interaction with people
counterparts in Latin America and it was a very from diff erent places around the world and
6. Why did you decide to come to the UK? 7. In starting your work as a doctor in the NHS, frustrating experience to go through several diff erent walks of life.
What were your goals/ambitions? what did you find difficult? What did you find websites and documents to try to fi gure out
I did not specifi cally set out to come and helpful? what the roles of the BMA or the GMC are, or 16. What would you miss the least if you
stay in the UK, but it was mainly an interest The main challenges were understanding the why the royal colleges are so important. A left the UK?
in neuroscience that brought me to Queen structure of the NHS and the medical training single resource summarising the role of the I would not miss the NHS bureaucracy.
Square London. The initial interest came at system, including the institutions regulating most important institutions in the UK medical Especially the endless committees and
the end of my medical training as I was to the medical profession, the specifi c role of system would have been very helpful. meetings, forms and signatures required
undertake an elective rotation and I enquired non-medical and supra-specialised staff and for research projects.
about an internationally renowned centre to the expectations of doctors at diff erent levels. 11. What can the BMA do to help IMG doctors
learn about neuroscience, which was and is working in the NHS?
still my main area of interest. By that time, I The time spent doing an elective rotation Most information published online on
met Dr Luis Gabriel Cuervo, who had worked and a Master’s degree before gaining medical postgraduate medical training is intended
as editor of a publication of the BMJ group, and registration in the UK helped me to learn for UK medical graduates and very little
he directed me to the National Hospital for more about the country, the language and the information is available specifi cally for IMGs
Neurology and Neurosurgery in Queen Square culture, which I believe are essential elements in this respect. Information regarding access
where I successfully completed a three month for any medical professional. to postgraduate medical training for IMGs,
elective in neurosurgery followed by an MSc presented in a practical format such as a
in clinical neuroscience at University College video, could facilitate their integration with
London. the UK medical system and optimise their
contribution to the NHS.
88 British Medical Association
BMA equality and inclusion unit
British Medical Association, BMA House,
Tavistock Square, London WC1H 9JP
bma.org.uk
© British Medical Association, 2015
BMA 20150246

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The contribution of

BMA equality and inclusion unit British Medical Association

BMA equality and inclusion committee chair Krishna Kasaraneni

BMA equality and inclusion unit Yasemin Dil

Figure 2. Countries of origin of doctors who contributed to this resource.

We asked interviewees which three

11. What can the BMA do to help IMG

10. What information, advice, support,

‘It seems like 10. What information, advice, support,

2. What is your position and where do you work?

4. Where did you complete your medical training?

4. Where did you complete your medical training?

Kovoor Elias Cheriyan

10. What information, advice, support,

10. What information, advice, support,

10. What information, advice, support,

10. What information, advice, support,

10. What information, advice, support,

1. What is your name?

1. What is your name?

‘For me these diffi

2. What is your position and where do you work?

2006: a fairer future. I wanted to leave

referring to my accent – not that this

Jemal Gemta Mohammed

10. What information, advice, support,

‘I like the fact I caught up eventually. I also struggled

2. What is your position and where do you work?

10. What information, advice, support,

10. What information, advice, support,

‘A registrar 10. What information, advice, support,

‘A course improve things. I also came to the UK

Alvaro Rojas Villabona

© British Medical Association, 2015

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