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Re: Plight of IMGs

Dear Editor

Sandhu's article on IMGs made interesting reading,[1] but gives the reader a lop sided view of the prevalent training environment for an IMG. The USMLE, the entry level exam for those who seek training in the United States, contentwise is much the same as the National Boards that the US medical graduates take. In contrast, the PLAB is a much tougher exam with published evidence that far fewer UK graduates ever achieve a pass percentage when administered the test vis a vis IMGs. Despite this, many of those who pass the PLAB exam struggle to make it to a training position, as they often compete with local graduates for a very limited number of training positions. The numbers taking the PLAB exam is on the swell, and while this augurs well for the coffers of the GMC, most takers of the examination have little or no idea of the limited training positions available to them and the convoluted higher medical training system that greets an IMG, once they have passed the examination. For many PLAB applicants, the cost incurred in this endeavour is humungous. The crunch is felt especially at the post-SHO training level, where there is a remarkable lack of transparency. IMGs are forced to learn the "lingo" - use of acronyms such as FTTA, LAS, LAT etc, while the type 1 results in a "NTN", a FTTA does not. When training positions come up, often jobs are advertised as LAT/FTTA with riders such as "the choice of programme would depend on the training needs of the candidate". This of course is nonsense, as often the decision depends on the training requirement of the establishment, with the IMGs more likely to land FTTA jobs than a non-IMG. The logical spin-off is that an IMG SpR has a lower odds of getting a job as a consultant, no matter how qualified he/she is. In my opinion, the SpR system merely legitimises the prevalent discriminatory attitudes of the system against IMGs. Non-progress through the training system ends up in many IMGs ending up as NCCGs - many of whom render sterling service to the NHS, while being paid less than their consultant counterparts, with no scope of moving up in the hierarchy. The innumerable stumbling blocks in the way of an IMG makes for disillusionment, and eventually compels several good doctors to leave the NHS.

It is incumbent upon the GMC to provide each and every PLAB applicant with the key facts about availability of training oppurtunities, or the lack of it, before the candidate appears for this exam. There is also a greater need for transparency in the system about SpR training. While it is fair that local graduates be provided with career choices they deserve, the system should make it extraordinarily transparent as to what an IMG should and should not expect, in a tangible objective way. This will help IMGs reprioritize their training goals without feeling desolate/lost and disenchanted.

References

1. Sandhu D P S. Current dilemmas in overseas doctors' training. Postgrad Med J 2005; 81: 79-82.

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Re: Author's reply

Dear Editor,

The PLAB test is, by itself, not a powerful discriminator of competitiveness. 80% of IMGs pass PLAB Part 2. PLAB is set at the level of a first year SHO and designed to assess the ability of IMGs to work safely in a first UK appointment. It is no surprise that IMGs will be more successful than home graduates in passing PLAB as the former cannot proceed without this qualification. Popular specialties in Surgery and Medicine will always be highly competitive, as they will also be, in under -developed countries. Yet IMGs remain a successful group with almost 20% of consultants having qualified abroad as well as a third of all trainees. The shortage, at present, in the UK is of consultants and GP principals but not trainees. The NHS culture and acronyms are no obstacle to this highly motivated group. The current problem of a shortage of training opportunities has been exacerbated with the influx of huge numbers of IMGs since 2003.

There is a genuine need to be explicit about competitive ratios of posts. This scenario can only get worse if passing PLAB is perceived as securing employment. To this extent, the GMC, Department of Health, the Academy of Medical Royal Colleges and the British Medical Association [1] are to be congratulated for including, on their websites, explicit, realistic information about training opportunities in the United Kingdom. These state that 'there are, on average, 210 applicants for each junior hospital doctor advertisement. Eight recent advertisements in December 2004 attracted over one thousand applicants. There are on average 400 applicants for each House Officer advertisement. Graduates who have not completed their House Officer posts (or equivalent) in their home country may find it very difficult to obtain a post in the UK.' The above initiative is to be welcomed as this should give an informed choice to IMGs.

References:

1. http://www.bmjcareers.com/gradinfo/index.html

http://www.gmc-uk.org/register/default.htm

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Re: Dilemmas for overseas doctors

Dear Editor,

We read with great interest the informative review article on current dilemmas in overseas doctors' training [1]. The recent restrictions on working hours have lead to an increase in the number of training posts. However, there still remains a large imbalance between the number of candidates passing the PLAB examinations and the number of training posts available to them. There have been anecdotal reports of long waiting periods for overseas doctors who have successfully completed the PLAB test.

The rising number of non-standard or non-training posts makes the training scenario more complex. A variety of job titles have been used for these posts [2], which makes the situation confusing for international medical graduates who are unfamiliar with the UK system. Many of these posts are filled up by overseas doctors who have already completed their basic training in their native land. Such posts, although not directly recognized for training, serve as a useful means of getting acquainted with the NHS.

News regarding the shortage of doctors, especially surgeons in the UK [3] lures many overseas doctors to rush into the PLAB exams without proper information of the present status of availability of training posts. Hence they eventually end up spending a substantial fee towards the exams without being able to secure a job. In order to get used to the different working system, many of these post PLAB trainees take up honorary clinical attachment posts. Several overseas doctors have changed their specialty interests just to be able to secure a job and earn a living in the UK.

Thus the current condition has demoralised many aspiring medical graduates. It seems prudent for international medical graduates to pursue their basic postgraduate training in their home countries and build up their academic qualifications and curriculum vitae prior to entry into the current competitive environment in the UK. The GMC should seriously consider restricting the number of doctors who can appear for the PLAB test in overseas centres. Also, correct information about training opportunities at all levels should be made available to all those international medical graduates who desire to train in the UK.

References

1. Sandhu DPS. Current dilemmas in overseas doctors’ training. Postgrad Med J 2005; 81: 79-82.

2. Dosani S, Schroter S, Macdonald R, Connor J. Recruitment of doctors to non-standard grades in the NHS: Analysis of job advertisements and survey of advertisers. BMJ 2003; 327: 961-964.

3. Kmietowicz Z. Shortage of surgeons might threaten NHS targets. BMJ 2005; 330: 379.