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J R Soc Med. 2006 June; 99(6): 272–273.
PMCID: PMC1472713

Requiem for international medical graduates

These men ask for just the same thing—fairness, and fairness only. This, so far as in my power, they, and all others, shall have.' Abraham Lincoln

The Department of Health, in conjunction with the Home Office, announced critical changes to immigration rules for international medical graduates from outside of the European Economic Area, which came into force in April.1-3 Until then, rules of immigration in the UK had fostered training of international medical graduates through the proviso of a permit-free training visa. By virtue of the new decree, this training visa will no longer be issued. Instead, overseas applicants will need work permits,4 if they do not have a right to live and work in the UK otherwise. To procure a work permit for an international medical graduate, trusts and deaneries must demonstrate to the Home Office that there are no suitable home-grown graduates available for the post.2 The crux of the problem understandably, lies here; hereafter, an applicant's country of origin and visa status will take predominance over merit and distinctions. Training opportunities for overseas doctors will become limited. What is indeed astounding, is the fact that these substantial changes have been unleashed with little warning and with retrospective effect, and will affect even those in training.

The ruling will expedite recruitment processes, as trusts and deaneries will now sift through a far fewer number of applications. It may also usher in a sense of relief for British graduates, by mitigating the frenzied job situation. For international medical graduates though—many of whom are already facing monetary and emotional hardship—it may be the final nail in the coffin. Entry into foundation programmes for most will remain a forlorn dream. Those already in foundation programmes or senior house officer posts may never make the leap to specialist training. They may suddenly find themselves in a unique predicament with neither post-graduate degrees nor specialist skills. With bleak prospects and without visas, they may be forced to leave the country. It may be particularly disheartening for those doing research (some on an honorary basis), in order to bolster their credentials. Academic distinctions may not lead to interviews and jobs anymore. Their meticulous work of several years duration may never bear fruit.

Certain transitional arrangements have been made for doctors currently on permit-free training. Their current employers will procure a work permit for the remaining period of their employment. However, these candidates will find themselves checkmated by the new ruling when applying for their next training position. For such individuals, the Highly Skilled Migrant Programme,5 which grants right to work in the UK, may provide a solution. But, those qualifying through this programme are only given short-term visas which may restrict them from being considered for long-term training posts. Furthermore, scoring the required points for qualification through this programme, is not easy for the relatively inexperienced. Returning to one's country of origin is another option. If one is indeed determined about specialist training and foreign degrees, migrating to USA or Canada may help realize these ends. Needless to say, both these options will set the clock back by a few years. The final recourse will probably be to settle for non-career grade or other less preferred posts in the UK.

Despite vicious competition in the job market and alarming rates of unemployment among overseas doctors,6 the General Medical Council, for reasons that are enigmatic, has continued to conduct the Professional and Linguistics Assessments Board test; and that, on a rip-roaring scale.7 Has the honourable institution been ignorant of this glut or is it resolute on selling an expensive ticket to fool's paradise? Why did the Department of Health not anticipate this overabundance a few years ago and introduce these measures then, by degrees? It could have spared thousands from this misadventure.

`There are no equal opportunities anymore'—is the quintessence of this unsavoury issue. It is indeed lamentable that Great Britain, the illustrious leader of the Common-wealth, should adopt this stance. Doctors from Common-wealth countries, have been an integral force in the National Health Service for decades. Suddenly, they have been unceremoniously sidelined. The well-being of British graduates certainly needs to be ensured, but not by culling others' careers. Are overseas doctors simply dispensable dogsbodies?

The sword of Damocles already hangs over the heads of international medical graduates in the guise of Modernising Medical Careers.8 The new immigration rules might just terminate their prospects in one swift stroke. Lives and livelihoods will be ruined. Many have already spent a substantial number of years to kick-start their careers in the UK. It will be heartbreaking for them to accept the fact that they may have to relinquish everything and start all over again. Will they ever realize their goals, their dreams? These stringent immigration rules, will leave countless bright young minds to face a grim and nebulous future.


Competing interests Both authors are international medical graduates.


1. Extra investment and increase in home-grown medical recruits eases UK reliance on overseas doctors. Department of Health press release notice 7 March 2006 []
3. Changes to the immigration rules for postgraduate doctors and dentists. Publication from Conference of Postgraduate Medical Deans []
4. Work Permits (UK) []
6. Thinking of coming to the UK to take part 2 of the PLAB examination? []

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press