Doctors who come to the UK after graduating in another country are essential to the NHS workforce, but they face considerable challenges in adapting to their new lives and working practices, as a new BMA report shows
Moving to another country to start a new life will always be fraught with challenges, but for doctors it can bring its own particular set of obstacles.
As well as integrating into a new country and health system, IMGs (international medical graduates) often face barriers to career progression and problems with how they are perceived.
A third of doctors on the medical register today gained their qualifications outside the UK, improving the diversity of the profession, filling specialty shortages and bringing a fresh approach to healthcare.
To raise the profile and celebrate the successes of IMG doctors, the BMA has published a report sharing the personal stories of 39 individuals from around the world. These stories provide the opportunity to hear first-hand about their experiences.
When she was a child, London GP Farah Jameel’s family was involved in charity work and it was this experience that initially attracted her to becoming a doctor.
She says: ‘Growing up I did a lot of volunteer work and through this became acutely aware of suffering and sickness at a young age.
'I wanted to be able to heal, help and be there in hard times as a support system — that’s where medicine came along and, further down the line, general practice.’
After completing her medical training at Gulf Medical University in the United Arab Emirates, she joined the foundation programme in the UK in 2007.
One of the most difficult things she has found about adjusting is the cultural difference in how doctors are perceived.
She explains: ‘Coming from a country where the doctor is practically worshipped, I initially struggled with the general lack of public respect for doctors.’
Another difficulty was the nuances of the English language — she was perplexed by words such as ‘knackered’, and the use of the word ‘pants’ to describe underwear rather than trousers.
She adds: ‘I am only just beginning to understand and value the subtlety of the English language, both written and spoken in the UK. It can certainly knock one’s confidence and make you question your language skills.’
A period of shadowing helped Dr Jameel to ease into her job as a foundation doctor 1 at a large teaching hospital and she was part of a supportive team that regularly socialised together.
However, her experience as a foundation doctor 2 at a district general hospital in a small town was a different story.
She struggled to find a support network and began to question medicine as a career and her decision to relocate to the UK.
She says: ‘My job, like every other F2’s, was a hectic one. I remember the toughest phase was during my acute medical unit posting.
'The job was monotonous and never-ending, the ward dark without many windows and the social circle of friends I’d made in F1 had all gone their separate ways.
‘My day-to-day life revolved around long days at work and then home.
'I was really just very lonely, stuck in what felt like a dead-end job, far away from family and friends and very quickly it got too much to cope with.
‘It saddens me to this day to think of how miserable I was back then.’
Dr Jameel thinks it is important to highlight the work of IMG doctors.
She says: ‘There’s a lot of negative press about IMG doctors. Statistics suggest they appear to fail more exams, are complained about more, and the media has a field day portraying them as second-class doctors.
‘This perception appears to leave its mark among many British colleagues and patients and we’re having to work much harder to break down these preconceived ideas that have been formed about us.
‘There are excellent doctors and there are less excellent doctors — they are not degree/race/country of origin-specific and that’s where the discussion should end.’
Ultimately, she feels her experience in the UK has been fulfilling.
She says: ‘I have been able to build a career and life for myself in the UK from scratch.
‘It may not seem like much to many, but to leave a family, home and everything you’ve ever known and move half way across the world isn’t easy.’
Growing up as a frail and sickly child, East Sussex specialist in anaesthesia and critical care Mona Sallam (pictured above) dreamed of one day becoming a doctor.
She explains: ‘We had a marvellous family physician who used to alleviate all my pain and anxiety every time — I think I was inspired by him.’
Coming to the UK seemed the ideal way to gain experience and, after completing her training at Ain Shams University in Egypt, she moved to England in 2013.
Dr Sallam lists the greenery and carrot cake among her favourite things about the UK, but has suffered from feelings of alienation and being an outsider.
She has sometimes felt treated with ridicule as an IMG doctor.
She says: ‘I think stereotyping will always remain an issue here.
'It is not uncommon for IMGs to find themselves perceived as an imminent danger to patients’ welfare.
'This happened to me more than once, especially on night duty when it was just me and the nursing staff.
‘It took a long time before I could establish trust between me and nursing staff and other junior colleagues and, in the meantime, I had to avoid being stubborn.
'More than once I had to seek seniors’ approval of my clinical decisions, as once I was told you have to swallow your pride.’
By the end of her first job, she felt part of the team but had to start from scratch again after moving hospitals.
Dr Sallam says: ‘Sometimes I still get tired from having to explain myself over and over again, especially with moving from one hospital to another.
'However, I’m aware it’s not easy to tell how much an IMG could do compared to another doctor who has been brought up within the system, so I give a brief introduction about myself and never feel embarrassed while voicing rationale behind a clinical decision or the steps of a clinical procedure.’
Dr Sallam believes IMGs need more acknowledgement.
She explains: ‘IMGs are still recruited to the UK to keep the service running. They mostly work in non-training jobs.
'However, it is very difficult to get a level of experience or skill adequately acknowledged in a context that qualifies you for a training job.’
This was the position Dr Sallam found herself in when she wanted to take her FRCA exam, but was unable to because she lacked the basic training level and was unable to get her overseas obstetric anaesthesia training acknowledged.
She says: ‘I have always been told that I’d have to go through a whole training module like the trainees here.
'The chance to get that is very limited, as there are always one or two trainees doing the module at a time, leaving no space for a non-trainee.’
Her time in the UK has taught her a lot about herself.
Dr Sallam says: ‘I am definitely becoming more patient and calmer. I have always been a chatterbox — however, now I listen and observe more than I talk.
‘Admittedly, my self-confidence as a doctor plummeted during my early months here and, as a person who had the whole of my life balanced around my profession, I got depressed.
‘On the other hand, I learned to value other qualities I have apart from being a good doctor.
'I learned the importance of family, friends and other forms of social support.’
To acknowledge the vital work that IMG doctors do in the NHS, the BMA has produced a report: The Contribution of International Medical Graduate Doctors to the NHS.
The report shares the experiences of 39 IMG doctors, who bring their knowledge and enthusiasm from all over the world.
Doctors featured include:
- Christopher Magier, a substantive consultant paediatrician in the Isle of Wight. He came to the UK from Poland in 2004. He is grateful for his initial shadowing period with a ‘very helpful’ consultant
- Pedro Cunha, a clinical fellow in general surgery in London. He completed his medical training in Brazil and arrived here in 2009. He feels his knowledge gained outside the UK is valuable to the NHS
- Manish Adke, a consultant anaesthetist in Wales. Originally from India, he came to the UK in 1994. He has found the support the NHS provides for career development ‘fantastic’.
Read the report
Find out more about working in the UK
The story so far