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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 14; 334(7597): 768.
PMCID: PMC1851991

Swapping scrubbing brushes for stethoscopes

Refugee doctors face an uphill struggle trying to secure a job in the NHS, but with the help of Dr Sheila Cheeroth some have achieved their goal

A newspaper advertisement for Save the Children currently appearing in the national press says “I will be a refugee forever teacher one day” with the adage “Rewrite the future for children around the world.” Substituting “doctor again” for the word “teacher”—“I will be a refugee forever doctor again one day”—aptly describes what Sheila Cheeroth does one day a week, and which she says has taken over her life.

A GP in the east end of London, Dr Cheeroth is also director of the refugee and overseas qualified doctors' programme, which runs courses for refugee doctors who qualified outside the European Union and who have managed to get permanent resident status in the United Kingdom.

To many of the doctors, finding themselves unemployed and short of money comes as a terrible shock. “They come here from a middle class background and have been in a position with some status in their own country, and when they come here they become nothing,” says Dr Cheeroth.

She has taken it upon herself to try to rebuild that self respect by helping doctors overcome the obstacles to securing posts in the NHS. The process is often emotionally fraught, and it involves long days preparing for the Professional and Linguistic Assessment Board (PLAB) tests, a rigorous assessment of medical knowledge and its application in the UK set by the General Medical Council. It does not always end in success.

Dr Cheeroth recounts the case of a Somalian refugee who trained in medicine in Russia, became professor of obstetrics and gynaecology in St Petersburg, led the Red Crescent's relief effort when he returned to Somalia, and later held posts in Geneva working for the World Health Organization. He spoke five languages but couldn't get a job in the NHS.

“He was not acceptable to work at a senior level because he didn't know the NHS systems of working. But he wouldn't be accepted at a junior post either because he was deemed too experienced,” says Dr Cheeroth.

She can't recall a case where a refugee doctor entered the NHS at the level to which they practised back home. Most doctors have to switch specialty, because the one in which they trained is often too competitive here. They have to start from scratch, competing with year two foundation trainees for specialist training or GP training posts. For some, the flexibility demanded is just too great.

“Sometimes people find they can't make it in the climate of the NHS. They may not be able to adapt their skills or change direction so that they are able to find a job in the sector that will accept them,” says Dr Cheeroth.

Her students come from every war torn corner of the globe. When she set up the course 10 years ago, many of the refugee doctors came from Iraq, several from the former Yugoslavia, and a few from Pakistan, Somalia, Sudan, and Sierra Leone. They continue to flow in from Iraq, with more also coming from Afghanistan.

Dr Cheeroth points out that the programme takes only those refugees who have permanent residence rights and overseas doctors who have permanent residence rights (for example, those who are spouses of UK citizens). All doctors admitted on the courses have full employment rights, something that Dr Cheeroth says she has to advise students to highlight in their job applications so that potential employers are aware they will not need a work permit and thus will not be deterred from employing them.

Refugee doctors have other differences, too, from doctors who migrate to the UK in order to advance their careers with a stint working for the NHS.

“Our students come here when their lives are basically falling apart. They have dependants to look after and are often relied on to send money back home, a place where there are often difficulties and about which they are worried. Conversely, doctors who plan to come here to further their studies take PLAB when they are educationally at the right stage and often have the financial support of their families,” she says.

Her students learn about the programme, which is based at Queen Mary's School of Medicine and Dentistry, largely through word of mouth, often after many months looking for a path back to medicine while being advised to take up cleaning jobs by their local job centre.

The programme provides what financial support it can to students in the form of book grants, travel and childcare expenses, and PLAB exam fee subsidies. Between 2002 and 2005, 103 students enrolled on the programme, at a cost of £400 000 (€590 000; $790 000) over three years. Eighty five (83%) passed their PLAB exams and became “job ready,” with 73 (71%) securing NHS posts.

When it was set up in 1997 the programme survived largely on charity donations. But a £300 000 grant from the Mercers' Company of the City of London for 2002-5 gave it long term prospects and allowed Dr Cheeroth to develop a formal and comprehensive syllabus over the next three years.

When the Mercers' money came to an end, the North East London Strategic Health Authority continued funding in 2005-6, and it seemed the programme would become mainstream. However, grants in the cash strapped NHS of 2007 are more difficult to come by, says Dr Cheeroth. The course is currently funded till the end of June 2007. After that the future is uncertain.

At a cost of £5500 per working doctor—compared with the £250 000 it takes to train a doctor from a school leaver in the UK—her programme produces doctors at a cheaper rate than anybody, says Dr Cheeroth.

But what the programme does is much more than that. “What we are doing is giving people who are not using their potential and who have been doing low income jobs and often drawing benefits back their pride. We are turning them into fully contributing members of society who will pay quite a lot of taxes and give to the community,” says Dr Cheeroth. Everybody wins.

Getting doctors at all stages of their career to refresh their medicine across the full spectrum of specialties and learn the “British way of doing things” is hard work, says Dr Cheeroth, but “fantastically rewarding” when it ends in success.

Dr Cheeroth does not underestimate the value that refugee doctors bring to the NHS. “The accusation always levelled at the medical profession is that they are out of touch, that they have been privileged, and that they do not reflect the people they serve and therefore do not understand patients' positions and are less able to help them.

“Refugee doctors are people who have often been homeless, who have had to sit in housing offices, live in council flats, and send their children to sink schools—and who have had to help their community members facing difficulty to access health care because of language and other barriers.

“They have often seen UK health and social care from the other side, and because of that they bring a real richness of understanding to what they can do for their patients. They come from a variety of cultures with a variety of religions and languages. In bringing them into the NHS we are making the service more culturally responsive in the broadest sense across language groups, creeds, and classes.”

Articles from The BMJ are provided here courtesy of BMJ Publishing Group