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Assisting International Medical Graduates Applying for Their First Post in the UK: What Should Be Done?

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Assisting International Medical Graduates Applying for Their First Post in the UK: What Should Be Done? I PROFESSIONAL ISSUES Assisting international medical graduates applying for their first post in the UK: what should be done? Peter N Trewby Peter N Trewby ABSTRACT – The number of international medical The problem started around five years ago.1 MD FRCP, graduates (IMGs) passing the Professional and Remarkably, until then the supply of non-EU inter- Consultant Linguistic Assessment Board (PLAB) examination national medical graduates (IMGs) in the UK Physician, was six times greater in 2004 than in 2000.This approximately matched the number of available Darlington has resulted in unprecedented numbers of appli- junior posts. But no more. Since then there has been Memorial Hospital; cants for junior posts, with some attracting over Chair, RCP working a six-fold increase in the numbers of IMGs passing 1,000 overseas graduates. The Royal College of group on the Professional and Linguistic Assessment Board International Physicians working group on IMGs was estab- examination (PLAB), with 6,392 passing in 2004, Medical Graduates lished in 2004 to address the problems that face compared to 1,120 in 2000 (Fig 1). The reasons are newly qualified IMGs. The group has ascertained not entirely clear. The Department of Health’s (DH) Clin Med and now publishes current levels of competition overseas recruitment campaign for senior doctors, 2005;5:126–32 for junior posts in order to inform overseas grad- the opening of the General Medical Council’s (GMC) uates of the levels of competition they are likely PLAB examination centre examining up to 10,000 to encounter. The group is seeking ways of candidates per year, and the favourable pay and con- selecting applicants when such large numbers ditions of UK junior doctors compared to those over- apply for posts and is looking at ways of seas may all have played a part. The unprecedented improving clinical attachments. The paper con- numbers of applicants for junior posts, some now siders these and other difficulties that IMGs face attracting more than 1,000 applicants (Fig 2), have when they first seek employment in the UK and resulted in considerable disquiet amongst overseas discusses possible solutions. doctors.2 The UK has a duty at least to ensure that any period KEY WORDS: clinical attachments, international of unemployment for overseas doctors is kept to a medical graduates, junior doctor posts, overseas minimum. Our survey of 870 curricula vitae of appli- doctors, PLAB cants for a pre-registration house officer (PRHO) post in February 2004 showed that IMGs spent on average 11 months unemployed between stopping work at home and obtaining their first post in the Key Points UK; half of this time was pre PLAB, half post PLAB.3 Applicants for this one PRHO post alone had wasted In 2004, 6,392 international medical graduates (IMGs) passed the PLAB 800 ‘doctor years’. One projection suggests that there examination compared to 1,120 in 2000 will be between 3,500 and 6,000 unemployed overseas The result has been unprecedented numbers applying for junior doctor graduates in the UK by December 2005, compared to 4 posts, with at least eight posts attracting over 1,000 applicants in the 500 in 2003. past six months. The average number of applicants for medical senior The GMC now surveys doctors one year post house officer posts is now 288, and for medical pre-registration house PLAB and, using the date of registration as a marker officer posts 481 of the date of first employment and knowing the date Publishing this information allows IMGs to make an informed judgement PLAB was passed, can calculate the length of time about when and whether to come to the UK unemployed.5 Their figures, slightly more optimistic than ours (although of necessity reflecting events one There is considerable scope for improving clinical attachment posts and year ago), show that 67% obtain a post within six for improving the selection of IMGs for definitive posts months of passing PLAB. However, for many this The UK welcomes and will always welcome overseas graduates who first post may only be a locum post. constitute one-third of the junior NHS workforce, but they should not International medical graduates in 2002 made up be disadvantaged because of lack of information on the current high 28% of hospital medial staff (Table 1),6 and their wel- level of competition for junior posts and the possibility of fare particularly concerns physicians. The GMC’s unemployment. post-PLAB survey found that 30% of IMG respon- 126 Clinical Medicine Vol 5 No 2 March/April 2005 Assisting international medical graduates applying for their first post in the UK 9,000 Competition for posts 8,000 Here there has been improvement, at 7,000 least in publicising the current levels of Part 1 competition. The GMC’s website 6,000 emphasises that PLAB is not linked to 5,000 appointment and now states that it 4,000 could take a year or longer to find a first 5 Part 2 post. The RCP working group obtained 3,000 Numbers passing numerical data on current levels of com- 2,000 petition for all posts suitable for post- 1,000 PLAB IMGs. The results (Tables 2 and 3) are now available on the BMJ Career 0 2000 2001 2002 2003 2004 Focus website (www.bmjcareers.com/ Year juniorcomp) and are regularly updated. A doctor will send off on average 227 Fig 1. Numbers of candidates passing PLAB part 1 and PLAB part 2 examinations applications if applying for a senior between 2000 and 2005 (courtesy of General Medical Council Registration house office (SHO) post, 430 applica- Directorate). tions if applying for an advertised PRHO post. Competition is greatest for posts in dents obtained their first post in medicine and that, of the posts Wales (Table 3). Posts in medicine, accident & emergency (A&E), advertised as suitable for recently qualified IMGs, there were and surgery are the most sought after (Table 2). Eight advertise- twice the number for medicine than for any other specialty5 ments have attracted more than 1,000 applicants, 80 more than (Table 2). Our survey of applicants for a medical PRHO post 500. A grant from the DH has enabled these figures to continue showed that 76% of those who listed obtaining a postgraduate to be published regularly. When combined with the GMC figures diploma as a reason for coming to the UK wished to take MRCP. for unemployment available on www.gmc-uk.org/register/ Data from the examination office of the Royal College of default. htm, they should alert overseas graduates as well as Physicians show that 46% of those taking the final MRCP PACES employing authorities and the DH to trends in the number of exam in 2003 were IMGs. unemployed graduates and the current competition for posts. In June 2004, the Royal College of Physicians set up a working group to address the problems facing newly qualified IMGs coming to the UK. This paper focuses on four issues discussed Problems in selection by the working group: How does one select a shortlist from 1,000 applicants all with • competition for posts near-identical CVs? A recent SHO advertisement in BMJ Career • selection for shortlisting Focus specifically stated in their advertisement that random • specific posts for IMGs methods might be used, and five trusts replying to the RCP clinical attachments. questionnaire stated that only the first 100–200 applicants • received were considered for shortlisting, the remaining CVs being discarded. Such methods are not satisfactory and will disadvantage talented UK graduates as well as 1,200 IMGs. Could the mark IMGs obtained in PLAB part 1 be used as an indication of merit? Candidates not in 1,000 the top 25% of PLAB part 1 might be less inclined to come to the UK if they were aware of the current very 800 high number of applicants for posts and knew that 600 their score would form part of the shortlisting process. However, the GMC are reluctant to change PLAB, 400 arguing that it is a pass/fail exam to assess minimal per advertisement competencies needed to work at SHO level, not to Number of applicants 200 grade candidates. Nevertheless, if it were possible to give grades above pass reflecting the top 10 or 20% of 0 marks at each sitting, it would offer one possible way of 2000 2001 20022003 2004 grading IMGs for the purpose of shortlisting. The Date grade may not be a fair way of judging whether an IMG Fig 2. Number of applicants for medical PRHO posts advertised in will be a capable and caring doctor but would be Darlington between January 2000 and October 2004. preferable to the random methods currently used. Clinical Medicine Vol 5 No 2 March/April 2005 127 Peter N Trewby Could the first part of a postgraduate diploma be used as a the candidate’s home country, to prevent candidates having to mark of aptitude and knowledge? Our survey found that 10% of give up their posts at home to take the exam in the UK.7 applicants for a medical PRHO post had already passed MRCP The financial implications of any central scheme need to be part 1 and a further 20% were taking the exam at the next sitting considered. A joining fee from IMGs could cover the costs with or before the post commenced. Charges of discrimination could be without a surcharge on PLAB fees or on employing authorities. levelled if the same criteria were not applied to UK graduates. In But should not the UK taxpayer fund the scheme? Ten thousand reality, for PRHO posts this situation rarely arises as there are IMGs, all trained at the expense of overseas taxpayers, currently few UK applicants for unfilled PRHO posts (the 1,090 appli- work for the NHS in training grades (Table 1).
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