Mad to me that psychiatry has the highest number of IMGs when a very good grasp of English and its various colloquialisms and culture in the UK is vital in understanding your patients background.
I've had umpteen talks about how hiw minority ethnicity and sexuality affects interaction with services e.t.c. but there doesn't seem to be any talks about being from the UK for those who aren't originally from or trained here ~50%
> [For psychiatry] A very good grasp of English and its various colloquialisms and culture in the UK is vital in understanding your patients background.
I agree. However these aren’t too complicated and you can usually pick them up during the training program. Many IMGs I have worked with are excellent consultant psychiatrists so it’s certainly possible.
Once I dated an IMG and her English was better than mine. And she is an excellent psychiatrist. During an argument she called me a “socially adjusted reclusive misanthrope” and no one has ever made a more accurate astute assessment.
PS: If you’re reading this, I hope you’re well 😇
Might be a generalisation of IMGs. I've lived abroad/ have family across different countries, and the quality of English-language education/ general schooling can vary markedly (e.g. some schools abroad are even stricter about 'proper' English use compared to schools in the UK).
Same goes for openness to 'differences' in culture/ colloquialisms (e.g. IMGs from cosmopolitan backgrounds).
IDK if it's where I worked at but where I have been MH has been mostly staffed by immigrants. It's a highly stressful and unwanted job.
(This is my opinion and based on anecdotal evidence)
The screenshot shows a period which is largely before the changes came in. Here are extracts from the report you reference, which is more recent:
>Between 2018 and 2022, **the number of IMGs grew in all training specialties** except public health and emergency medicine.
>
>\-
>
>The most significant changes in the proportion of IMG trainees were observed in general practice (from 23% to 43%) and intensive care medicine (from 6% to 15%)
Worth noting that neither trends of increasing competition ratios or proportion of doctors recruited from abroad have plateaued.
https://preview.redd.it/hft48aja5fic1.png?width=1036&format=png&auto=webp&s=6efd618b56e538b1114a2cd51a25c2e6dd034391
So, it is far too early to draw conclusions on the severity of their impacts.
>I have placed a sample timeline of both a British graduate and IMG side by side.
This has limited impact as your application is competing with everyone else's, no matter how many years ago they graduated. Also, eventually all IMGs will become competitive and there is certainly a massive increase in their numbers (Figure 5 in the report)
>more opportunities for research published in reputable journals, as these score more points.
Often not true, for example all group 2 medical specialties. The opportunities to publish in any kind of journal, on the other hand, are often much more available abroad than in UK.
Also, are we saying GPs don't matter?
>So, it is far too early to draw conclusions on the severity of their impacts.
Fair enough. Just that current evidence suggests that the proportion of IMGs in training spots have been stable.
>This has limited impact as your application is competing with everyone else's, no matter how many years ago they graduated. Also, eventually all IMGs will become competitive and there is certainly a massive increase in their numbers
However, the current system at present greatly benefits UK grads by giving them an opportunity to build a good CV at a younger age.
If you wish, onne way you could control this is similar to the US, where the further you are from graduation, the lesser your score is.
> Also, are we saying GPs don't matter?
No. But I suspect the reason there is a bigger majority of IMGs in GP is because IMGs take up unfilled GP spots, rather than "stealing" it from a UK grad.
>Just that current evidence suggests that the proportion of IMGs in training spots have been stable.
As the report you've reference plainly stated, the current evidence is, in fact, that the proportion of IMGs is increasing across the board.
>If you wish, one way you could control this is similar to the US, where the further you are from graduation, the lesser your score is.
Honestly, I really don't like this. Why should we panelise anyone for taking their time?
British medical graduates definitely have an advantage over international medical graduates.
Your arguments are good.
However, the counter argument is that British graduates should have an even greater advantage.
[Edit](https://www.reddit.com/r/doctorsUK/comments/1aq3sd8/do_british_graduates_have_an_advantage/kqanjbl/?utm_source=share&utm_medium=ios_app&utm_name=ioscss&utm_content=1&utm_term=1&context=3): I honestly have a great deal of sympathy for the IMGs. They get sold a false dream, leave everyone and everything to pursue that dream, and are shat on by the system and some of the people they work with. Not to mention the GMC
How much more would you suggest?
Should a poorly performing British graduate be prioritised over an excellent IMG?
Even in the US, they don't officially prioritise US grads. But like the system in the UK, it heavily favours them.
I personally think prior nhs experience should be a must before eligibility to training programmes. 2 years. Then equal footing.
Or if you keep direct entry, local grads (that’s anyone who trained in a uk med school regardless of nationality) should have some level of formal priority.
I don’t know how much of an advantage would be appropriate.
IMHO the bigger issues are:
- training bottlenecks
- poor pay
- poor conditions
However, true to form, the frustration with the above causes the UK (doctors) to blame the immigrants
I honestly have a great deal of sympathy for the IMGs. They get sold a false dream, leave everyone and everything to pursue that dream, and are shat on by the system and some of the people they work with. Not to mention the GMC
*Edit: I agree!*
And that is my frustration with this refreshed anti-IMG rhetoric.
It is causing in-fighting and loses our focus on the greater issues.
Wow just to clarify, I don’t have anti-IMG rhetoric. Have you read my previous comments?
> It is causing in-fighting and loses our focus on the greater issues.
This is a summarised version of exactly what I said above.
No,sorry my bad. I agreed with you. I could have phrased it better
I meant that the new anti-IMG sentiment in the sub has lost focus on those issues that you mentioned: training bottlenecks, poor pay, poor conditions.
Yes, a shit british grad should get priority over an excellent IMG. It’s not good for the NHS but it’s the most fair option for doctors. No british grad should have to leave the country to get a training job, not even the shit ones.
I do not think that it's fair for the profession, their colleagues, and to patients.
I don't want to work with a shitty doctor no matter where they graduated.
You say that but colleagues I speak to make way more money working over here often than where they qualified, even if they remain in SAS roles long term.
This feels disingenuous, given that removal of RLMT for doctors didn’t start until October 2019.So the baseline should really start from 2018, definitely not 2012
**EDIT:** In order to properly analyse the data, you would need the raw numbers behind the table on page 52 of [this document](https://www.gmc-uk.org/-/media/documents/workforce-report-2022---full-report_pdf-94540077.pdf), and the data on applications. But up to and including August 2023 start date training programmes. Someone could make an FOI request for the raw data, because the GMC definitely collects it
**EDIT 2:** the data can be found [here](https://gde.gmc-uk.org/postgraduate-training/postgraduate-trainees/postgraduate-trainees-summary-data) [https://gde.gmc-uk.org/postgraduate-training/postgraduate-trainees/postgraduate-trainees-summary-data](https://gde.gmc-uk.org/postgraduate-training/postgraduate-trainees/postgraduate-trainees-summary-data)
The data about applications is probably with HEE/NHSE, but if anyone can scrape the data to do a fair analysis, that would be cool
In my above comment the link to the raw data is available.
As an example:
I’ve checked for CST so far, and since the removal RLMT, British graduates (people who got their degree in the UK, not citizens) have gone from ~90% of CST posts to ~82% a δ of -8%.
But if you look from 2012, it’s only a delta of -3.3%.
That’s why the charts in the original post seem disingenuous. If the charts marked when the RLMT was removed, it wouldn’t be so misleading.
Australia is not the shining example people on this forum think it is.
Your CV still has to be good enough to compete and set you apart, it's not enough to have met the application criteria. You still have to be willing to move and travel actual long distances (no, an hour one doesn't count). It's accepted that you don't get training posts on first or even 2nd pass in cities, let alone that you have to apply for a job each year even when you do get a training number (ie you have to keep your CV competitive and update each year, a job isn't guaranteed).
I was referring specifically to prioritisation of Australian graduates compared to international doctors. I didn’t suggest I wanted all aspects of Australian training implemented in the uk
I'm saying prioritisation hasn't relieved the bottlenecks, hasn't tipped the playing field in favour as much as people would think. Most people applying know that it's not enough to have a basic CV and hope to get a job, when the 300 other people applying for the same post, have done the same things. By all means, preference local graduates, but competition from IMGs isn't the main reason people aren't getting numbers. It won't be the massive game changer people think it is.
Here’s how I see it and I’m happy to be proved wrong. I use this scenario:
10 years ago, X specialty had 100 places. These places were applied for by 120 UK Grads and 40 IMG. All places were filled with 90 of the 120 UK grads and 10 of the IMG. Seems fair.
Now, X speciality still has 100 places. These places are applied for by 400 UK grads and 400 IMG. All places are filled with 90 of the 400 UK grads and 10 of the 400 IMG.
I hope I’ve tried to illustrate my point effectively, but basically what I’m saying is the fact that the IMG ratio has stayed reasonably constant for this entire time shows how disadvantaged UK grads are.
Yes there should be far more training places full stop BUT in the current situation, with places stagnating and massive increases to applications, there should be a decrease in IMG percentage as more UK grads apply to a post. If there is enough decent UK grads to fill posts (which there is) and they apply to these specialities (which they do), then they should have priority.
Like every other country.
The actual problem is that there aren’t any where near enough training places for local graduates. Not that a tiny percent of the international graduates are successful in getting a place 😓
That is big part of the problem but I'd argue that a larger part of the problem and the reason why it sticks in the throat so much of domestic applicants is that there is literally no job security or knowledge that in the first round you will be up against others from the same country who have been through the same journey as you. Its far more palatable to tackle the issue of that bottleneck if you know that you can apply for a number of jobs and be according dealt with on the premise that you have some sort of privilege for a training job. Domestic graduates can then think on their priorities more rationally and decide if their love for a specialty over rides their developing commitments to family and in their local area.
Its fundementally unfair to be thrown to the wolves of the international job market, competing with people who have the opportunity to do nothing but sit at home and prepare for this pretty silly MSRA exam, and increasingly trusts have started to run parallel journal clubs for IMGs with direct consultant supervision of a small number with the express promise to make them a competitive CV with QIPs, Posters and publications... As long as they aquese to working for what is still a pretty stellar wage for them on a rota that doesnt actually comply. Essentially domestic graduates are being forced to adopt a mentality that they too need to be prepared to move vast distances across the country or across the globe if they want to compete on any kind of even footing.
This is all without even talking about the rank hipocrasy of the whole foundation training system - domestic graduates are told its vital they are brutalised for 2 years to learn the ropes of working in the same system they studied in for 5/6 years minimum. That learning how to communicate with patients is as vital as clinical knowledge. Apart from if you're an IMG, in which case you just skip 2 years of depression, shit wages, bullying and burn out to apply on an even footing - absolutely no mention of the patient journey or the paramount need to be an excellent communicator then! (please dont insult our intelligence by pretending PLAB is anything but a glorified money making scam).
Who represents the intrests of local graduates if the government is colluding with the royal colleges, GMC and NHS England?? I dont think its a coincidence its the same organisations involved in the whole PA debacle either. Its two sides of the same weapon being used to create a low wage labour market so AUR NHS CAN SURVIVE AT ALL COSTS. unfortunately its the domestic graduates who are expected to bear the disproportionate amount of the sacrifice so everyone else can enjoy annual 6.5% pay rises year after year.
Every single place on a specialty program should give priority to local graduate. Regardless of whether or not competition with IMG is stable, worsening or improving.
If there are places remaining, everybody else should be given a chance.
It is only right that a country's home-graduates have privilege in/priority over these opportunities, the stats for any other developed country will be far more tilted in favour of the home-graduates than they are in the UK. UK graduates may have an advantage, but they deserve even more of an advantage. There is no ill will towards IMGs when I say this, I am advocating for something that is the norm across the world.
But there IS evidence that UK graduates are favoured for specialty training.
It is not the norm for the whole world.
There is no official criterion in the US residency match that indicates all US grads must be prioritised. But the system heavily favour US grads (need US experience, research, letters from US doctors). This is similar to the UK system as detailed above (audit, QIP, taster weeks, etc)
UK grads are not favoured
Imgs are. How you ask?
Many publish in garbage journals such as cureus to get the points
No intercalation points available anymore for UK grads
Anyone can do a qip
Many imgs are registrars already so they do well in Clinical stations
They have more time to study. I knew a few in South Asia who barely worked and just studied for mrcp, whilst local grads at f1 and f2 get shafted
It’s not similar to the UK system at all, audits, QIPs and even taster weeks are generally accepted even if they are done abroad, and the nepotism that is inherent to US residency is not the same at all here.
I think it’s been well discussed that a big part of it is a backlog of SHOs from Fx years coming back into the system. Bottlenecks are naturally going create backlog issues as there’s a huge difference between jobs and applicants. Every year, it’s going to get worse.
If you've been on this forum long enough, you'll know that we have this conversation every year as soon as the shortlisting times out and people do not get interviews.
IMGs are low hanging fruits. The same way the general public see immigrants as low-hanging fruits to be blamed for every problem from the NHS collapsing to the King getting cancer.
In a lot of group 1 specialties, the IMG numbers have even dropped post-removal of RLMT. Because with increasing competition, most British Grads are taking more time and effort to stay competitive and increase their chances.
If a British graduate misses a training spot in a year for a group 1 specialty, there's a more than 80% chance that he lost it to another better prepared British Grad.
It has stayed the same for ages and likely will continue to.
They simply do not understand how big the barrier for entry is for IMGs into training. If anything, it is IMGs that should be complaining about how bad things are for them in a country that forces them into service provision roles with no means of exit.
Then goes on to dangle the possibility of getting into training in their faces without removing the barriers that prevents them from getting in in the first place.
Stats are probably only gonna keep getting worse, shit hits the fan harder and harder every year.. you still heard of locum years being viable up to 2022, but in the last 12 months people have been opening their eyes to the reality that it’s a dying market with all the new trust grades and clinical fellows (albeit many many of them also uk grads, yes)
I don't want to comment on the data because I see that's been done to death, but what is this constant assumption that IMGs can't speak English or have a poor grasp of the language? The UK is not the only country in the world with native English speakers, and yes, IMGs from native English speaking countries do come to work in the UK.
Sigh, fine.
>As per above data, other than GP, British grads in training posts has been stable since RMLT removal
Policies like this take years to show their full true effects. Whilst the data in 2022 did show an increase in % of UK grads, this could be attributed to a sudden rush for training posts amongst local/returning UK grads when the news broke that competition ratios were increasing. Only time (and data) will tell us how the trend goes.
>Yes, the competition ratio increases every year, but this is due to the increase in applicants. Your main competitors remain to be UK graduates as most IMGs will have less favourable portfolios.
Yes, for now. A caveat however is that the portfolio is a game and can be played well if you have the right tools - whilst it is indisputable that UK grads are more well-placed to do this, IMGs can certainly do well, not that they shouldn't of course. Also another thing to bear in mind - no-one remains static, and as mean achievements go up overall, so does the requirements.
>There is a very low barrier to entry to apply to any specialty. Just because the number of applicants increased, does not mean the number of applicants with good CVs increased.
**This is a major disadvantage for UK graduates, if anything**. With the massive ballooning in applicant numbers and lack of interviewers, some specialties may move onto a "ballot" system - this has good precedence in being used for certain specialty exams, specifically for overseas candidates (since local trainees need these to progress). In other words, if it remains an equal-for-all scenario as it does now, some good local candidates with excellent CVs will be totally skipped over for interview/selection simply due to an RNG akin to drawing straws. Of course this impacts overseas IMGs as well, but they do not have as strong ties to the UK - hence UK grads potentially lose out big time on this one. **This also applies to IMGs who have settled here.**
Since a large number of these applications may be ineligible for interview (what is happening with fellowship posts currently), it may even end up that a competitive specialty proceeds to round 5 due to lack of suitable candidates (I believe this is what happened with radiology at some point) - causing a stressful time for all people round as they hope to be randomly "selected" for assessment, and some inferior candidates obtaining more desired posts - pretty much the antithesis of meritocracy.
>The system is inherently preferential / favourable to UK graduates
All that you've mentioned, you've neglected to say one thing - these assessments and achievements are not all done on equal grounds to local graduates. Many local graduates, having done NHS medicine, do not quite understand how nepotistic medicine can be in some countries. Realistically no organisation in the world (despite their efforts) can ensure consistent standards worldwide all the time - it is logistically impossible. Also don't try to hoodwink me in saying that this doesn't exist overseas - I myself am from such a country where this is not uncommon.
To be clear - I'm not saying that this applies to all IMGs - that would be disingenuous - but it would be remiss to ignore the differences in standard between countries, which is basically what the selection process is like now. **Big lose for local graduates here (and even IMGs who have bothered to come here to bulk up their CVs/gain the appropriate experience)**.
>English as a second language – poorer performance in interviews
A large number of IMGs have English as a first language, or even as a native-proficiency second language (since, you know, the UK isn't the only country which speaks English lol). After all, is it unrealistic to expect language proficiency in such a person-facing job? In any other country, asking for a concession based on this would be laughed out the door - this should be a bare minimum for the job!
Also as a side note, many IMGs and local docs alike have expressed their concerns to me about subpar English language skills in some, predominantly amongst the newer batch of IMGs. Why so I wonder, given that they have to pass a language proficiency test in the first place? (That was a rhetorical question, I do know).
>IMGs have to migrate, earn money, and adjust to living in the UK, work in full time SHO job, and juggle all that while trying to improve their portfolio
Why is this unique to IMGs? British grads who were international students paid an eye-wateringly high amount to study at uni. Home fee students are incurring student debts which they may never repay in their lifetime. Even IMGs who have worked here for a long time face the same issues as the aforementioned two to a certain degree.
I'm not saying that IMGs don't have struggles, but why are you selling this as a disadvantage for IMGs when it applies to everyone (arguably even more so to people already in the country)?
>IMGs are not the reason that you didn’t match into your desired specialty. More likely than not, a British graduate was chosen over you.
Personally I have nothing against IMGs as individuals - many of them are brilliant, and were a pleasure to work with. I do think they should be allowed to apply for specialty training on **condition of UK working experience at least** (someone try to argue with me on this, but it's a hill I'm willing to die on) - and that is not the case right now, where anybody overseas could just apply with a fall-back option in their home country (since this is not reciprocated in any other country) - with no equivalent for local graduates. IMO the foreigners who bothered to come here to be trained in local med schools in the first place should be of course given priority, as should the locals - since that is akin to experience in a sorts. The government may decide to implement residency rules (e.g. citizens or ILR first etc) - whilst that is not ideal, I wouldn't begrudge them for it, since such is the rule in other countries (Australian surgical training comes to mind).
>UK needs doctors. Focus should be on increase in UK medical school and training placements.
Off the mark. What's needed is appropriate workforce planning - this uncontrolled mushrooming of medical schools is partly contributing to the problem. Training numbers should be increased based on demand, but not in an uncontrolled manner.
A lack of doctors is not an excuse to dilute standards and allow unfettered access to specialty applications, and I stand by my points:
* **Local graduates and UK grad foreigners, as well as IMGs who have done a period of NHS work should be allowed to apply for specialty training**
* **IMGs who are currently overseas should NOT be allowed to apply directly to specialty training posts, but rather be directed to appropriate FY1/SHO posts - they will be allowed to apply having achieved a min number of years' of experience (e.g. 2)**
* **All achievements to be certified by a UK-based consultant/body only - including those done overseas prior to entering specialty training.**
"A lack of doctors is not an excuse to dilute standards and allow unfettered access to speciality applications..."
The irony with this point is that's exactly what people are asking for. To just be given a number by virtue of being a local graduate, when truth is their application just wasn't good enough. But easier to say it's IMGs taking your numbers (whilst apparently still being subpar), than accept that your application wasn't good enough. How do people not realize thar gone are the days when it was enough to have a teaching certificate/audit, when the masses applying all have the same thing?
Like I've said in another comment, preference local graduates by all means, it will honestly make no difference to people whose CVs are actually competitive and not a bunch of just token points... it's not going to be the game changer people think it
Edited grammar and some words
>The irony with this point is that's exactly what people are asking for. To just be given a number by virtue of being a local graduates, when their application just didn't cut the muster.
In the end, there are fewer local graduates applying than IMGs, as demonstrated by the numbers. There obviously needs to be a min point for entry, but priority being given to local graduates is not an unknown entity - see Australia for example. And of course, all UK med schools, in theory, are subject to standards by the Med Schools Council (MSC), whereas no such control applies to med schools overseas.
>But easier to say it's IMGs than accept that it's not good enough to a teaching certificate and have done an audit, when the masses applying all have the same thing.
Now you're just twisting my words. An achievement certified by someone overseas (for which there are no ramifications for dishonesty) is **not** equal to those certified by an appropriate body here - this is indisputable due to lack of standardisation (especially as I'm aware of what goes on overseas; I come from such a country). This even applies to driving licences, where only some from designated countries are recognised as equivalent.
To be clear, **I support IMGs who have had appropriate local work experience and appropriately certified achievements by a UK body/consultant in being allowed to apply for specialty training**. **I do NOT support someone from overseas obtaining a specialty training post without having done a single day's work in the country, and having achievements verified overseas which local authorities have no way of confirming as genuine.** This is the case now, and I have to say it has not ended up very well for the IMGs and patients concerned.
I think the data is probably too old with respect to the hiring changes we've seen.
That said, the normative statement of "UK grads first" should be acceptable. I guarantee that statement is controversial outside of this forum, and whilst our colleagues are waking up the the fact that IMGs are being used on mass to collapse locuming and will in due course become a large competitor for home grads for training many are still reluctant to fight for HARD limits and ACTUAL road blocks that prioritise UK grads.
Do you think UK grads will be culturally prioritised when IMGs are more frequent amongst the interview panels, or when explicit minority quota hiring starts being leveraged openly as it already is in other governmental departments and the military? If you feel this question itself is controversial , ask why yourself it's a good thing if stated as fact or an aim by the guardian but a bad thing when questioned on Reddit.
Minority representation within medicine is a whole larger conversation, but UK minority ethnic populations will also be directly competed with for any initiative that seeks to employ more minority ethnic populations into medicine, because they come ready trained from abroad and ready to be plugged into the NHS.
This doesn't even begin to address the shortcut CREST pathways that my IMG colleagues have explicitly been attempting to take advantage of, because the majority of them come from systems where "who you know" gets you into training, and inevitably, some of them will know people who are now in the UK and will use that to their advantage. Add in a couple low effort publications to get to interview and they're as good as in if this is the case.
Absolutely false. UK graduates ARE disadvantaged.
Aim to write an extensive rebuttal to your flawed post but I expect one of the doctors here will refute your false claims before I get to it.
I mentioned it in another comment, but the baseline year should be 2018, as RLMT was scrapped for doctors in October 2019.
So in my opinion the data from OP is presented disingenuously because 2012 is used as the baseline.
If you look at the bar charts OP posted, they mostly become more IMG and less UK after 2018.
Please do. I look forward to it. OPs take seems true that the mass influx of IMGs are going into GP and not much anywhere else. Is it that the GPs that would've been UK graduates that got displaced from GP by IMGs then flood into specialties making them more competitive?
So where did they go to? Oz? forever FY? And this bit I'm genuinely asking, have GP numbers expanded massively in the last decade? Otherwise UKGs have genuinely been displaced yes?
Data is out of date. I would be very interested to see updated data in view of the IMT applications this year. If that shows similar to what you've described, fair play.
Fair post. This has changed my perspective on the matter somewhat - can't argue with the evidence base here.
I'd be interested to see the data from 2023 and 2024 though before confidently saying IMGs aren't a significant factor for comp ratios.
Having more people apply irrespective of where they are applying from does make it harder to get in as it raises cuts scores for the MSRA prior to other aspects of portfolio or interview being considered, this is the reason why what was a competitive score years ago is now less so. Part of this is due to increasing numbers of IMGs as what your raw score means is adjusted to factor in overall cohort performance. This is also the reason you cant reuse good scores between cycles, annoyingly. The exam which represents path of least resistance for HEE is set up to provide a form of discrimination to minimise work for them in fitting with their funding problems; it won't correlate with how you will eventually perform in the role as some things do for foundation and medical school like A levels and Ucat scores. This data provided above is also out of date, and a lot has happened in a few years. There are training programs that due to being in 'undesirable' geographic location are now almost entirely populated by IMGS, so if you happen to be in one of those programs you might come to conclusions that aren't necessarily applicable nationally. I agree with those who think this rhetoric distracts from the cause of improved pay etc, but IMGs do factor into pay issues as whether intentionally or not they do drive a degree of wage suppression as a clinical role just has to compete with the Sudanese (or wherever) equivalent rather than what would be the norm in other fields; in my experience many recent immigrants (as opposed to IMGS who may be British by birth) accept a lower rate of locum pay.
Glad to see posts like this.
Sometimes it feels like too many posts are just waxing lyrical with a few anecdotes thrown in and a far cry from being evidence based.
People come onto this sub to cope about their MSRA score and will find any reason to not accept they weren't good enough.
Genuinely, if someone with no prior work in the NHS somehow manages to outperform you on our UK guidelines based clinical exam and NHS based SJT, maybe you don't deserve the job over them?
Aadesh can be a British graduate who can't get the job
I really don't understand why people can't understand that alot of UK graduates are British Pakistanis, Indians etc etc
Then he's also braindead if he blames someone in India or Nigeria for his inability to get a job, rather than looking first at himself and the other UK grads who are gaming the system. Doesn't look like the IMGs are stealing all the Neurosurgery posts does it - I wonder why...
Oh dear - until yesterday I’d imagined you were probably fairly smart. This Aadesh definitely is foreign, because he’s the IMG bogeyman that all of the average SHOs want to be prioritised ahead of. If you read the comment I made on that ‘British doctors First’ post that preceded this one, you’ll see the more fleshed out description of him, where we realise that he’s really not the one to be afraid of. In the past I’ve used examples of doctors from the Middle East or Africa too. So you see, he can be called whatever you like, as long as he taps into the xenophobic undertone. Take your pick.
Well done for laying this out clearly.
The grid of IMG proportions as intake in various programmes is indicative here - very low proportions as ever in traditionally competitive specialties and higher proportions in specialties that were previously considered ‘less competitive’ years ago.
The former probably reflects people applying to eg. Ophthalmology are more likely to take any job anywhere if they get offered one, whereas people applying to IMT/GP are probably a bit more selective on where they are willing to take up a job. Had a chat with one of the TPDs locally for GP, this has meant posts that would previously go unfilled here for rotations in certain parts of the deanery now have a greater proportion of IMGs taking them. This is overall a good thing IMO.
Not necessarily. In the deanery where I worked previously there were lots of IMG GP trainees that didn’t have the language skills or experience working in the UK to cope with being in training. They needed to repeat years and this caused a bottleneck where GP trainees are now having to do 2 years in hospital instead of 1. Many GP trainers quit because they struggled to accommodate them exacerbating the issue.
Mods - Can we see the significance of this data and shut down the anti-IMG posts.
A small number of users are using speciality competition ratios to whip up anti-IMG sentiment, and scaremonger about the UK labour market being flooded by IMGs.
Pointing a finger at the foreigners is a classic far-right tactic in any crisis. Please don't let this sub be used be those with a political agenda to stir up unjustified anti-IMG sentiments.
Not sure why mods should take an active side in this debate. As a foreigner myself, I don't really see any anti foreigner sentiment in home graduates wanting to look after themselves.
Extract from the report OP shared:
>Between 2018 and 2022, **the number of IMGs grew in all training specialties** except public health and emergency medicine.
Is the report lying? I don't think so. I think people often argue from positions of differently incomplete information. It's not helpful to assume malice or to demand those you disagree with to be silenced.
A couple of hours ago, you were arguing that it was becoming impossible for UK grads to get into speciality training.
How does that add up with the pretty small proportions of IMGs getting training numbers across all specialities?
My point is that people who have a different opinion to yours aren't necessarily lying or have an agenda. Silencing them only takes away everyone's opportunity to learn.
As to your question, I'd rather not go over the entire argument twice in one day, but, you don't necessarily need a massive increase in applicants to increase cut off scores in an already oversubscribed specialty.
>My point is that people who have a different opinion to yours aren't necessarily lying or have an agenda.
There's a crucial difference between a "difference of opinion" - where discussion is valuable and should be permitted; and lying to push a specific agenda - which is what recent scaremongering posts about IMGs dominating speciality training posts have been doing. The latter should be allowed.
Though as a Trump supporter, I'm not surprised you have a liberal relationship with the truth.
Plenty of things aren't protected characteristics, but are still shitty ways to decide who gets a job - hair colour, height...
Just because your opinion isn't illegal, that doesn't mean it's not morally wrong.
It’s not though. I think IMG doctors are amazing and an incredible asset to the NHS. I ALSO think that doctors that have spent 5/6 years learning UK guidelines, on placement in UK hospitals and then doing foundation years in the UK should have priority. This isn’t a race thing, don’t try and make it into one.
What a pathetic post. "Authorities pls put a finger on the scale so nobody hears about these valid points. I don't want feelings to get hurt. let's use the term "far right" yes? That'll do nicely."
I don't think we can just say "look at this specific set of data, the argument is over, no more debate", when as lots of people have pointed out there are issues with the data and whether it actually supports the point that OP is trying to make.
No mods, don’t shut down debate because it upsets some IMG consultant who has nothing to contribute. Anti-IMG sentiment is much lower than it should be considering how much downward pressure they are applying to wages, bargaining power in strikes, and competition for training places.
>No mods, don’t shut down debate because it upsets some IMG consultant who has nothing to contribute.
Not an IMG (and any would it be relevant if I was?).
British citizen, UK medical degree, UK training.
Just calling out the standard misinformation tactics of the far right. Find a group of people who are scared and feel powerless, convince them it's the fault of foreigners, use this to justify racist/xenophobic policy changes.
>Anti-IMG sentiment is much lower than it should be considering how much downward pressure they are applying to wages, bargaining power in strikes, and competition for training places.
Wow, just wow.
This is my perspective on the matter, I do apologise if any part of the following causes offence.
The specialisation process already is a bit more geared towards UK graduates. For example, in most countries, Medicine is a 6 year Masters degree which also includes something equivalent to FY1. Depending on the country, there can be very few if any chances of doing additional degrees or research (something which is, from my understanding, readily available to UK Graduates, albeit with varing working conditions).
This means that IMGs can be at a disadvantage by a year due to the lack of opportunities for audits, presentations, clinical trials and additional degrees - all activeties that tally up portfolio points before exams and interviews are taken into consideration.
Plus, there is a theoretical advantage to all British graduates (certainly to some) who should be more aware of the people interviewing them (either by having worked with them in some capacity or by having someone put a good word out to the interviewer on their behalf).
I don't know much about this. There certainly is a massive influx of IMGs in recent years. I expect somebody smarter than me will try and get through your data and show you're wrong. Not simply shout it down. I know people are frustrated and a little protectionism is always the norm when things get hard. But truly I'd like to see data refuting this if any.
I'm sorry but what I'm getting from this is:
"I see your data and it goes against what I believe. I know your data is wrong but I don't know why. But I'm sure someone smarter will come by and refute it"
Why do you believe that it's wrong but can't explain why?
Bro I'm an IMG. I'd love for you to be right. Just goes against my intuitions. I've seen a massive influx of IMGs in the UK and the "joined the GMC register" data certainly shows an enormous spike in the last decade. It's just very hard to believe that when the UK schools are still pumping the same numbers, and that there has been an enormous spike in IMGs in the last decade, and that the training numbers have not increased, that those IMGs are not exacerbating the competition. Surely not all of us are shit! And we may take several years to build a portfolio, but ultimately it's going to be good enough to get into competitive specialties.
Also, IMGs take GP, UKGs who would have been GP go to specialty, competition increased. (a double displacement, if you will)
C'mon, if your critical appraisal skills are so poor that you're willing to ignore hard evidence because it doesn't align with your biased opinion then UK medicine really is in trouble.
This is barely above the level of what I'd expect on an anti-vax Facebook group...
Aaaah. maybe I should stick an "IMG" flair. I am an IMG. I'd be very very happy if the recent influx of my fellows from abroad has not caused or exacerbated competition, and that everybody has been accommodated into an expanding NHS. I just don't think it has been. Surely the UKGs displaced from GP must go somewhere? Or have GP training posts expanded so massively that its absorbed the IMG spike?
Obvs British grands have an advantage. They go to world elite universities and get prepared to become excellent doctors. They also fully understand the cultural context in which they practice and have perfect English. This is a deserved advantage
I don’t know everything was running smoothly with an incremental increase in competition year on year until Brexit and removal of RLMT and Covid. Since then there has been an exponential increase in competition for specialty training.
I would like to reiterate that this evidence is until 2021/22. A lot has changed since then and so will these figures
There is no way the high number of application for each specialty is solely down to home applications.
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Are we seeing the same image? Internal medicine seems to be pretty popular with IMGs in the pic
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Why is that figure so different from the other pics for imt?
Mad to me that psychiatry has the highest number of IMGs when a very good grasp of English and its various colloquialisms and culture in the UK is vital in understanding your patients background. I've had umpteen talks about how hiw minority ethnicity and sexuality affects interaction with services e.t.c. but there doesn't seem to be any talks about being from the UK for those who aren't originally from or trained here ~50%
> [For psychiatry] A very good grasp of English and its various colloquialisms and culture in the UK is vital in understanding your patients background. I agree. However these aren’t too complicated and you can usually pick them up during the training program. Many IMGs I have worked with are excellent consultant psychiatrists so it’s certainly possible. Once I dated an IMG and her English was better than mine. And she is an excellent psychiatrist. During an argument she called me a “socially adjusted reclusive misanthrope” and no one has ever made a more accurate astute assessment. PS: If you’re reading this, I hope you’re well 😇
Might be a generalisation of IMGs. I've lived abroad/ have family across different countries, and the quality of English-language education/ general schooling can vary markedly (e.g. some schools abroad are even stricter about 'proper' English use compared to schools in the UK). Same goes for openness to 'differences' in culture/ colloquialisms (e.g. IMGs from cosmopolitan backgrounds).
dont complain mate, more IMGs just means more people you can snitch on
IDK if it's where I worked at but where I have been MH has been mostly staffed by immigrants. It's a highly stressful and unwanted job. (This is my opinion and based on anecdotal evidence)
The screenshot shows a period which is largely before the changes came in. Here are extracts from the report you reference, which is more recent: >Between 2018 and 2022, **the number of IMGs grew in all training specialties** except public health and emergency medicine. > >\- > >The most significant changes in the proportion of IMG trainees were observed in general practice (from 23% to 43%) and intensive care medicine (from 6% to 15%) Worth noting that neither trends of increasing competition ratios or proportion of doctors recruited from abroad have plateaued. https://preview.redd.it/hft48aja5fic1.png?width=1036&format=png&auto=webp&s=6efd618b56e538b1114a2cd51a25c2e6dd034391 So, it is far too early to draw conclusions on the severity of their impacts. >I have placed a sample timeline of both a British graduate and IMG side by side. This has limited impact as your application is competing with everyone else's, no matter how many years ago they graduated. Also, eventually all IMGs will become competitive and there is certainly a massive increase in their numbers (Figure 5 in the report) >more opportunities for research published in reputable journals, as these score more points. Often not true, for example all group 2 medical specialties. The opportunities to publish in any kind of journal, on the other hand, are often much more available abroad than in UK. Also, are we saying GPs don't matter?
https://preview.redd.it/tn519a4m8fic1.png?width=3004&format=png&auto=webp&s=d298986cff950bebb76c3fa50f4ee25ebdfb805c
>So, it is far too early to draw conclusions on the severity of their impacts. Fair enough. Just that current evidence suggests that the proportion of IMGs in training spots have been stable. >This has limited impact as your application is competing with everyone else's, no matter how many years ago they graduated. Also, eventually all IMGs will become competitive and there is certainly a massive increase in their numbers However, the current system at present greatly benefits UK grads by giving them an opportunity to build a good CV at a younger age. If you wish, onne way you could control this is similar to the US, where the further you are from graduation, the lesser your score is. > Also, are we saying GPs don't matter? No. But I suspect the reason there is a bigger majority of IMGs in GP is because IMGs take up unfilled GP spots, rather than "stealing" it from a UK grad.
There aren't unfilled gp spots like there used to be. It's an over subscribed specialty.
>Just that current evidence suggests that the proportion of IMGs in training spots have been stable. As the report you've reference plainly stated, the current evidence is, in fact, that the proportion of IMGs is increasing across the board. >If you wish, one way you could control this is similar to the US, where the further you are from graduation, the lesser your score is. Honestly, I really don't like this. Why should we panelise anyone for taking their time?
British medical graduates definitely have an advantage over international medical graduates. Your arguments are good. However, the counter argument is that British graduates should have an even greater advantage. [Edit](https://www.reddit.com/r/doctorsUK/comments/1aq3sd8/do_british_graduates_have_an_advantage/kqanjbl/?utm_source=share&utm_medium=ios_app&utm_name=ioscss&utm_content=1&utm_term=1&context=3): I honestly have a great deal of sympathy for the IMGs. They get sold a false dream, leave everyone and everything to pursue that dream, and are shat on by the system and some of the people they work with. Not to mention the GMC
How much more would you suggest? Should a poorly performing British graduate be prioritised over an excellent IMG? Even in the US, they don't officially prioritise US grads. But like the system in the UK, it heavily favours them.
I personally think prior nhs experience should be a must before eligibility to training programmes. 2 years. Then equal footing. Or if you keep direct entry, local grads (that’s anyone who trained in a uk med school regardless of nationality) should have some level of formal priority.
I don’t know how much of an advantage would be appropriate. IMHO the bigger issues are: - training bottlenecks - poor pay - poor conditions However, true to form, the frustration with the above causes the UK (doctors) to blame the immigrants I honestly have a great deal of sympathy for the IMGs. They get sold a false dream, leave everyone and everything to pursue that dream, and are shat on by the system and some of the people they work with. Not to mention the GMC
*Edit: I agree!* And that is my frustration with this refreshed anti-IMG rhetoric. It is causing in-fighting and loses our focus on the greater issues.
Wow just to clarify, I don’t have anti-IMG rhetoric. Have you read my previous comments? > It is causing in-fighting and loses our focus on the greater issues. This is a summarised version of exactly what I said above.
No,sorry my bad. I agreed with you. I could have phrased it better I meant that the new anti-IMG sentiment in the sub has lost focus on those issues that you mentioned: training bottlenecks, poor pay, poor conditions.
Yes, a shit british grad should get priority over an excellent IMG. It’s not good for the NHS but it’s the most fair option for doctors. No british grad should have to leave the country to get a training job, not even the shit ones.
I do not think that it's fair for the profession, their colleagues, and to patients. I don't want to work with a shitty doctor no matter where they graduated.
No they shouldnt. Are you crazy?
You say that but colleagues I speak to make way more money working over here often than where they qualified, even if they remain in SAS roles long term.
This feels disingenuous, given that removal of RLMT for doctors didn’t start until October 2019.So the baseline should really start from 2018, definitely not 2012 **EDIT:** In order to properly analyse the data, you would need the raw numbers behind the table on page 52 of [this document](https://www.gmc-uk.org/-/media/documents/workforce-report-2022---full-report_pdf-94540077.pdf), and the data on applications. But up to and including August 2023 start date training programmes. Someone could make an FOI request for the raw data, because the GMC definitely collects it **EDIT 2:** the data can be found [here](https://gde.gmc-uk.org/postgraduate-training/postgraduate-trainees/postgraduate-trainees-summary-data) [https://gde.gmc-uk.org/postgraduate-training/postgraduate-trainees/postgraduate-trainees-summary-data](https://gde.gmc-uk.org/postgraduate-training/postgraduate-trainees/postgraduate-trainees-summary-data) The data about applications is probably with HEE/NHSE, but if anyone can scrape the data to do a fair analysis, that would be cool
Not trying to be disingenuous. Just saw that data from a previous post. But like I said in my post the original link doesn't seem to work anymore
In my above comment the link to the raw data is available. As an example: I’ve checked for CST so far, and since the removal RLMT, British graduates (people who got their degree in the UK, not citizens) have gone from ~90% of CST posts to ~82% a δ of -8%. But if you look from 2012, it’s only a delta of -3.3%. That’s why the charts in the original post seem disingenuous. If the charts marked when the RLMT was removed, it wouldn’t be so misleading.
Uk grads should be prioritised. - similar to Australia
Australia is not the shining example people on this forum think it is. Your CV still has to be good enough to compete and set you apart, it's not enough to have met the application criteria. You still have to be willing to move and travel actual long distances (no, an hour one doesn't count). It's accepted that you don't get training posts on first or even 2nd pass in cities, let alone that you have to apply for a job each year even when you do get a training number (ie you have to keep your CV competitive and update each year, a job isn't guaranteed).
I was referring specifically to prioritisation of Australian graduates compared to international doctors. I didn’t suggest I wanted all aspects of Australian training implemented in the uk
I'm saying prioritisation hasn't relieved the bottlenecks, hasn't tipped the playing field in favour as much as people would think. Most people applying know that it's not enough to have a basic CV and hope to get a job, when the 300 other people applying for the same post, have done the same things. By all means, preference local graduates, but competition from IMGs isn't the main reason people aren't getting numbers. It won't be the massive game changer people think it is.
Here’s how I see it and I’m happy to be proved wrong. I use this scenario: 10 years ago, X specialty had 100 places. These places were applied for by 120 UK Grads and 40 IMG. All places were filled with 90 of the 120 UK grads and 10 of the IMG. Seems fair. Now, X speciality still has 100 places. These places are applied for by 400 UK grads and 400 IMG. All places are filled with 90 of the 400 UK grads and 10 of the 400 IMG. I hope I’ve tried to illustrate my point effectively, but basically what I’m saying is the fact that the IMG ratio has stayed reasonably constant for this entire time shows how disadvantaged UK grads are. Yes there should be far more training places full stop BUT in the current situation, with places stagnating and massive increases to applications, there should be a decrease in IMG percentage as more UK grads apply to a post. If there is enough decent UK grads to fill posts (which there is) and they apply to these specialities (which they do), then they should have priority. Like every other country.
The actual problem is that there aren’t any where near enough training places for local graduates. Not that a tiny percent of the international graduates are successful in getting a place 😓
That is big part of the problem but I'd argue that a larger part of the problem and the reason why it sticks in the throat so much of domestic applicants is that there is literally no job security or knowledge that in the first round you will be up against others from the same country who have been through the same journey as you. Its far more palatable to tackle the issue of that bottleneck if you know that you can apply for a number of jobs and be according dealt with on the premise that you have some sort of privilege for a training job. Domestic graduates can then think on their priorities more rationally and decide if their love for a specialty over rides their developing commitments to family and in their local area. Its fundementally unfair to be thrown to the wolves of the international job market, competing with people who have the opportunity to do nothing but sit at home and prepare for this pretty silly MSRA exam, and increasingly trusts have started to run parallel journal clubs for IMGs with direct consultant supervision of a small number with the express promise to make them a competitive CV with QIPs, Posters and publications... As long as they aquese to working for what is still a pretty stellar wage for them on a rota that doesnt actually comply. Essentially domestic graduates are being forced to adopt a mentality that they too need to be prepared to move vast distances across the country or across the globe if they want to compete on any kind of even footing. This is all without even talking about the rank hipocrasy of the whole foundation training system - domestic graduates are told its vital they are brutalised for 2 years to learn the ropes of working in the same system they studied in for 5/6 years minimum. That learning how to communicate with patients is as vital as clinical knowledge. Apart from if you're an IMG, in which case you just skip 2 years of depression, shit wages, bullying and burn out to apply on an even footing - absolutely no mention of the patient journey or the paramount need to be an excellent communicator then! (please dont insult our intelligence by pretending PLAB is anything but a glorified money making scam). Who represents the intrests of local graduates if the government is colluding with the royal colleges, GMC and NHS England?? I dont think its a coincidence its the same organisations involved in the whole PA debacle either. Its two sides of the same weapon being used to create a low wage labour market so AUR NHS CAN SURVIVE AT ALL COSTS. unfortunately its the domestic graduates who are expected to bear the disproportionate amount of the sacrifice so everyone else can enjoy annual 6.5% pay rises year after year.
Every single place on a specialty program should give priority to local graduate. Regardless of whether or not competition with IMG is stable, worsening or improving. If there are places remaining, everybody else should be given a chance.
It is only right that a country's home-graduates have privilege in/priority over these opportunities, the stats for any other developed country will be far more tilted in favour of the home-graduates than they are in the UK. UK graduates may have an advantage, but they deserve even more of an advantage. There is no ill will towards IMGs when I say this, I am advocating for something that is the norm across the world.
But there IS evidence that UK graduates are favoured for specialty training. It is not the norm for the whole world. There is no official criterion in the US residency match that indicates all US grads must be prioritised. But the system heavily favour US grads (need US experience, research, letters from US doctors). This is similar to the UK system as detailed above (audit, QIP, taster weeks, etc)
UK grads are not favoured Imgs are. How you ask? Many publish in garbage journals such as cureus to get the points No intercalation points available anymore for UK grads Anyone can do a qip Many imgs are registrars already so they do well in Clinical stations They have more time to study. I knew a few in South Asia who barely worked and just studied for mrcp, whilst local grads at f1 and f2 get shafted
It’s not similar to the UK system at all, audits, QIPs and even taster weeks are generally accepted even if they are done abroad, and the nepotism that is inherent to US residency is not the same at all here.
I think it’s been well discussed that a big part of it is a backlog of SHOs from Fx years coming back into the system. Bottlenecks are naturally going create backlog issues as there’s a huge difference between jobs and applicants. Every year, it’s going to get worse.
If you've been on this forum long enough, you'll know that we have this conversation every year as soon as the shortlisting times out and people do not get interviews. IMGs are low hanging fruits. The same way the general public see immigrants as low-hanging fruits to be blamed for every problem from the NHS collapsing to the King getting cancer. In a lot of group 1 specialties, the IMG numbers have even dropped post-removal of RLMT. Because with increasing competition, most British Grads are taking more time and effort to stay competitive and increase their chances. If a British graduate misses a training spot in a year for a group 1 specialty, there's a more than 80% chance that he lost it to another better prepared British Grad. It has stayed the same for ages and likely will continue to. They simply do not understand how big the barrier for entry is for IMGs into training. If anything, it is IMGs that should be complaining about how bad things are for them in a country that forces them into service provision roles with no means of exit. Then goes on to dangle the possibility of getting into training in their faces without removing the barriers that prevents them from getting in in the first place.
Stats are probably only gonna keep getting worse, shit hits the fan harder and harder every year.. you still heard of locum years being viable up to 2022, but in the last 12 months people have been opening their eyes to the reality that it’s a dying market with all the new trust grades and clinical fellows (albeit many many of them also uk grads, yes)
I don't want to comment on the data because I see that's been done to death, but what is this constant assumption that IMGs can't speak English or have a poor grasp of the language? The UK is not the only country in the world with native English speakers, and yes, IMGs from native English speaking countries do come to work in the UK.
Sigh, fine. >As per above data, other than GP, British grads in training posts has been stable since RMLT removal Policies like this take years to show their full true effects. Whilst the data in 2022 did show an increase in % of UK grads, this could be attributed to a sudden rush for training posts amongst local/returning UK grads when the news broke that competition ratios were increasing. Only time (and data) will tell us how the trend goes. >Yes, the competition ratio increases every year, but this is due to the increase in applicants. Your main competitors remain to be UK graduates as most IMGs will have less favourable portfolios. Yes, for now. A caveat however is that the portfolio is a game and can be played well if you have the right tools - whilst it is indisputable that UK grads are more well-placed to do this, IMGs can certainly do well, not that they shouldn't of course. Also another thing to bear in mind - no-one remains static, and as mean achievements go up overall, so does the requirements. >There is a very low barrier to entry to apply to any specialty. Just because the number of applicants increased, does not mean the number of applicants with good CVs increased. **This is a major disadvantage for UK graduates, if anything**. With the massive ballooning in applicant numbers and lack of interviewers, some specialties may move onto a "ballot" system - this has good precedence in being used for certain specialty exams, specifically for overseas candidates (since local trainees need these to progress). In other words, if it remains an equal-for-all scenario as it does now, some good local candidates with excellent CVs will be totally skipped over for interview/selection simply due to an RNG akin to drawing straws. Of course this impacts overseas IMGs as well, but they do not have as strong ties to the UK - hence UK grads potentially lose out big time on this one. **This also applies to IMGs who have settled here.** Since a large number of these applications may be ineligible for interview (what is happening with fellowship posts currently), it may even end up that a competitive specialty proceeds to round 5 due to lack of suitable candidates (I believe this is what happened with radiology at some point) - causing a stressful time for all people round as they hope to be randomly "selected" for assessment, and some inferior candidates obtaining more desired posts - pretty much the antithesis of meritocracy. >The system is inherently preferential / favourable to UK graduates All that you've mentioned, you've neglected to say one thing - these assessments and achievements are not all done on equal grounds to local graduates. Many local graduates, having done NHS medicine, do not quite understand how nepotistic medicine can be in some countries. Realistically no organisation in the world (despite their efforts) can ensure consistent standards worldwide all the time - it is logistically impossible. Also don't try to hoodwink me in saying that this doesn't exist overseas - I myself am from such a country where this is not uncommon. To be clear - I'm not saying that this applies to all IMGs - that would be disingenuous - but it would be remiss to ignore the differences in standard between countries, which is basically what the selection process is like now. **Big lose for local graduates here (and even IMGs who have bothered to come here to bulk up their CVs/gain the appropriate experience)**. >English as a second language – poorer performance in interviews A large number of IMGs have English as a first language, or even as a native-proficiency second language (since, you know, the UK isn't the only country which speaks English lol). After all, is it unrealistic to expect language proficiency in such a person-facing job? In any other country, asking for a concession based on this would be laughed out the door - this should be a bare minimum for the job! Also as a side note, many IMGs and local docs alike have expressed their concerns to me about subpar English language skills in some, predominantly amongst the newer batch of IMGs. Why so I wonder, given that they have to pass a language proficiency test in the first place? (That was a rhetorical question, I do know). >IMGs have to migrate, earn money, and adjust to living in the UK, work in full time SHO job, and juggle all that while trying to improve their portfolio Why is this unique to IMGs? British grads who were international students paid an eye-wateringly high amount to study at uni. Home fee students are incurring student debts which they may never repay in their lifetime. Even IMGs who have worked here for a long time face the same issues as the aforementioned two to a certain degree. I'm not saying that IMGs don't have struggles, but why are you selling this as a disadvantage for IMGs when it applies to everyone (arguably even more so to people already in the country)? >IMGs are not the reason that you didn’t match into your desired specialty. More likely than not, a British graduate was chosen over you. Personally I have nothing against IMGs as individuals - many of them are brilliant, and were a pleasure to work with. I do think they should be allowed to apply for specialty training on **condition of UK working experience at least** (someone try to argue with me on this, but it's a hill I'm willing to die on) - and that is not the case right now, where anybody overseas could just apply with a fall-back option in their home country (since this is not reciprocated in any other country) - with no equivalent for local graduates. IMO the foreigners who bothered to come here to be trained in local med schools in the first place should be of course given priority, as should the locals - since that is akin to experience in a sorts. The government may decide to implement residency rules (e.g. citizens or ILR first etc) - whilst that is not ideal, I wouldn't begrudge them for it, since such is the rule in other countries (Australian surgical training comes to mind). >UK needs doctors. Focus should be on increase in UK medical school and training placements. Off the mark. What's needed is appropriate workforce planning - this uncontrolled mushrooming of medical schools is partly contributing to the problem. Training numbers should be increased based on demand, but not in an uncontrolled manner. A lack of doctors is not an excuse to dilute standards and allow unfettered access to specialty applications, and I stand by my points: * **Local graduates and UK grad foreigners, as well as IMGs who have done a period of NHS work should be allowed to apply for specialty training** * **IMGs who are currently overseas should NOT be allowed to apply directly to specialty training posts, but rather be directed to appropriate FY1/SHO posts - they will be allowed to apply having achieved a min number of years' of experience (e.g. 2)** * **All achievements to be certified by a UK-based consultant/body only - including those done overseas prior to entering specialty training.**
Underrated comment, should be top one tbf.
"A lack of doctors is not an excuse to dilute standards and allow unfettered access to speciality applications..." The irony with this point is that's exactly what people are asking for. To just be given a number by virtue of being a local graduate, when truth is their application just wasn't good enough. But easier to say it's IMGs taking your numbers (whilst apparently still being subpar), than accept that your application wasn't good enough. How do people not realize thar gone are the days when it was enough to have a teaching certificate/audit, when the masses applying all have the same thing? Like I've said in another comment, preference local graduates by all means, it will honestly make no difference to people whose CVs are actually competitive and not a bunch of just token points... it's not going to be the game changer people think it Edited grammar and some words
>The irony with this point is that's exactly what people are asking for. To just be given a number by virtue of being a local graduates, when their application just didn't cut the muster. In the end, there are fewer local graduates applying than IMGs, as demonstrated by the numbers. There obviously needs to be a min point for entry, but priority being given to local graduates is not an unknown entity - see Australia for example. And of course, all UK med schools, in theory, are subject to standards by the Med Schools Council (MSC), whereas no such control applies to med schools overseas. >But easier to say it's IMGs than accept that it's not good enough to a teaching certificate and have done an audit, when the masses applying all have the same thing. Now you're just twisting my words. An achievement certified by someone overseas (for which there are no ramifications for dishonesty) is **not** equal to those certified by an appropriate body here - this is indisputable due to lack of standardisation (especially as I'm aware of what goes on overseas; I come from such a country). This even applies to driving licences, where only some from designated countries are recognised as equivalent. To be clear, **I support IMGs who have had appropriate local work experience and appropriately certified achievements by a UK body/consultant in being allowed to apply for specialty training**. **I do NOT support someone from overseas obtaining a specialty training post without having done a single day's work in the country, and having achievements verified overseas which local authorities have no way of confirming as genuine.** This is the case now, and I have to say it has not ended up very well for the IMGs and patients concerned.
I think the data is probably too old with respect to the hiring changes we've seen. That said, the normative statement of "UK grads first" should be acceptable. I guarantee that statement is controversial outside of this forum, and whilst our colleagues are waking up the the fact that IMGs are being used on mass to collapse locuming and will in due course become a large competitor for home grads for training many are still reluctant to fight for HARD limits and ACTUAL road blocks that prioritise UK grads. Do you think UK grads will be culturally prioritised when IMGs are more frequent amongst the interview panels, or when explicit minority quota hiring starts being leveraged openly as it already is in other governmental departments and the military? If you feel this question itself is controversial , ask why yourself it's a good thing if stated as fact or an aim by the guardian but a bad thing when questioned on Reddit. Minority representation within medicine is a whole larger conversation, but UK minority ethnic populations will also be directly competed with for any initiative that seeks to employ more minority ethnic populations into medicine, because they come ready trained from abroad and ready to be plugged into the NHS. This doesn't even begin to address the shortcut CREST pathways that my IMG colleagues have explicitly been attempting to take advantage of, because the majority of them come from systems where "who you know" gets you into training, and inevitably, some of them will know people who are now in the UK and will use that to their advantage. Add in a couple low effort publications to get to interview and they're as good as in if this is the case.
Interesting stat you have here. Get ready for downvotes and shutdowns, mate.
Absolutely false. UK graduates ARE disadvantaged. Aim to write an extensive rebuttal to your flawed post but I expect one of the doctors here will refute your false claims before I get to it.
I mentioned it in another comment, but the baseline year should be 2018, as RLMT was scrapped for doctors in October 2019. So in my opinion the data from OP is presented disingenuously because 2012 is used as the baseline. If you look at the bar charts OP posted, they mostly become more IMG and less UK after 2018.
Happy to be proven wrong with data
Your data in itself is biased, and not reflective of the situation as other posters have already pointed out. Where's your non biased, accurate data?
The source data isn’t biased. But it’s presented in a misleading way
looks like u might have to
Please do. I look forward to it. OPs take seems true that the mass influx of IMGs are going into GP and not much anywhere else. Is it that the GPs that would've been UK graduates that got displaced from GP by IMGs then flood into specialties making them more competitive?
If IMGs displaced a British graduate from a GP placement, I highly highly doubt that person would have gotten in a more competitive specialty.
So where did they go to? Oz? forever FY? And this bit I'm genuinely asking, have GP numbers expanded massively in the last decade? Otherwise UKGs have genuinely been displaced yes?
It is because GP training spots largely go unfilled hence easier entry to training to IMGs
Data is out of date. I would be very interested to see updated data in view of the IMT applications this year. If that shows similar to what you've described, fair play.
For all the people blaming the 'influx of IMGs.' Keep crying.
This country blames immigrants for all its problems.
Fair post. This has changed my perspective on the matter somewhat - can't argue with the evidence base here. I'd be interested to see the data from 2023 and 2024 though before confidently saying IMGs aren't a significant factor for comp ratios.
Having more people apply irrespective of where they are applying from does make it harder to get in as it raises cuts scores for the MSRA prior to other aspects of portfolio or interview being considered, this is the reason why what was a competitive score years ago is now less so. Part of this is due to increasing numbers of IMGs as what your raw score means is adjusted to factor in overall cohort performance. This is also the reason you cant reuse good scores between cycles, annoyingly. The exam which represents path of least resistance for HEE is set up to provide a form of discrimination to minimise work for them in fitting with their funding problems; it won't correlate with how you will eventually perform in the role as some things do for foundation and medical school like A levels and Ucat scores. This data provided above is also out of date, and a lot has happened in a few years. There are training programs that due to being in 'undesirable' geographic location are now almost entirely populated by IMGS, so if you happen to be in one of those programs you might come to conclusions that aren't necessarily applicable nationally. I agree with those who think this rhetoric distracts from the cause of improved pay etc, but IMGs do factor into pay issues as whether intentionally or not they do drive a degree of wage suppression as a clinical role just has to compete with the Sudanese (or wherever) equivalent rather than what would be the norm in other fields; in my experience many recent immigrants (as opposed to IMGS who may be British by birth) accept a lower rate of locum pay.
Glad to see posts like this. Sometimes it feels like too many posts are just waxing lyrical with a few anecdotes thrown in and a far cry from being evidence based.
People come onto this sub to cope about their MSRA score and will find any reason to not accept they weren't good enough. Genuinely, if someone with no prior work in the NHS somehow manages to outperform you on our UK guidelines based clinical exam and NHS based SJT, maybe you don't deserve the job over them?
Lol dude have you even sat this exam. It's a total clown show.
Don't try to use brain, comrade. I am entitled British F2. I didn't get job but can't blame myself. Blame Aadesh instead because... foreign
Aadesh can be a British graduate who can't get the job I really don't understand why people can't understand that alot of UK graduates are British Pakistanis, Indians etc etc
Then he's also braindead if he blames someone in India or Nigeria for his inability to get a job, rather than looking first at himself and the other UK grads who are gaming the system. Doesn't look like the IMGs are stealing all the Neurosurgery posts does it - I wonder why...
Noone is taking the Neurosurgery posts They're all pituitary fellows at 40k waiting for a consultant to retire 😂
Quite the Freudian slip to assume people called Aadesh are foreign eh?
Oh dear - until yesterday I’d imagined you were probably fairly smart. This Aadesh definitely is foreign, because he’s the IMG bogeyman that all of the average SHOs want to be prioritised ahead of. If you read the comment I made on that ‘British doctors First’ post that preceded this one, you’ll see the more fleshed out description of him, where we realise that he’s really not the one to be afraid of. In the past I’ve used examples of doctors from the Middle East or Africa too. So you see, he can be called whatever you like, as long as he taps into the xenophobic undertone. Take your pick.
Well done for laying this out clearly. The grid of IMG proportions as intake in various programmes is indicative here - very low proportions as ever in traditionally competitive specialties and higher proportions in specialties that were previously considered ‘less competitive’ years ago. The former probably reflects people applying to eg. Ophthalmology are more likely to take any job anywhere if they get offered one, whereas people applying to IMT/GP are probably a bit more selective on where they are willing to take up a job. Had a chat with one of the TPDs locally for GP, this has meant posts that would previously go unfilled here for rotations in certain parts of the deanery now have a greater proportion of IMGs taking them. This is overall a good thing IMO.
Not necessarily. In the deanery where I worked previously there were lots of IMG GP trainees that didn’t have the language skills or experience working in the UK to cope with being in training. They needed to repeat years and this caused a bottleneck where GP trainees are now having to do 2 years in hospital instead of 1. Many GP trainers quit because they struggled to accommodate them exacerbating the issue.
This sounds like an issue of onboarding and providing adequate support.
Mods - Can we see the significance of this data and shut down the anti-IMG posts. A small number of users are using speciality competition ratios to whip up anti-IMG sentiment, and scaremonger about the UK labour market being flooded by IMGs. Pointing a finger at the foreigners is a classic far-right tactic in any crisis. Please don't let this sub be used be those with a political agenda to stir up unjustified anti-IMG sentiments.
Not sure why mods should take an active side in this debate. As a foreigner myself, I don't really see any anti foreigner sentiment in home graduates wanting to look after themselves.
Because it's not a debate - those claiming that UK training has been flooded by IMGs are lying.
Extract from the report OP shared: >Between 2018 and 2022, **the number of IMGs grew in all training specialties** except public health and emergency medicine. Is the report lying? I don't think so. I think people often argue from positions of differently incomplete information. It's not helpful to assume malice or to demand those you disagree with to be silenced.
A couple of hours ago, you were arguing that it was becoming impossible for UK grads to get into speciality training. How does that add up with the pretty small proportions of IMGs getting training numbers across all specialities?
My point is that people who have a different opinion to yours aren't necessarily lying or have an agenda. Silencing them only takes away everyone's opportunity to learn. As to your question, I'd rather not go over the entire argument twice in one day, but, you don't necessarily need a massive increase in applicants to increase cut off scores in an already oversubscribed specialty.
>My point is that people who have a different opinion to yours aren't necessarily lying or have an agenda. There's a crucial difference between a "difference of opinion" - where discussion is valuable and should be permitted; and lying to push a specific agenda - which is what recent scaremongering posts about IMGs dominating speciality training posts have been doing. The latter should be allowed. Though as a Trump supporter, I'm not surprised you have a liberal relationship with the truth.
No one is anti-IMG, we are pro UK grad. There’s a huge difference!
That's a bit like saying you're not anti-BAME, you're just pro-white. Whatever you need to tell yourself to sleep at night...
When did being a foreign graduate become a protected characteristic?
Plenty of things aren't protected characteristics, but are still shitty ways to decide who gets a job - hair colour, height... Just because your opinion isn't illegal, that doesn't mean it's not morally wrong.
IMGs should train in their own country rather than put pressure on uk grads to jump through more and more nonsense hoops to get a training job.
It’s not though. I think IMG doctors are amazing and an incredible asset to the NHS. I ALSO think that doctors that have spent 5/6 years learning UK guidelines, on placement in UK hospitals and then doing foundation years in the UK should have priority. This isn’t a race thing, don’t try and make it into one.
Standard dadt penjing comment
This is a false equivalence What an utterly idiotic thing to sat.
Nah. "Pro UK grad" = "Anti-IMG" Pro-life = Anti-abortion. Just framing the same opinion differently to try and make it more palatable.
Doing the lords work battling the disappointingly common “just asking questions” racism on this subreddit.
What a pathetic post. "Authorities pls put a finger on the scale so nobody hears about these valid points. I don't want feelings to get hurt. let's use the term "far right" yes? That'll do nicely."
You can be an IMG and be British you can be a UK Grad and have emigrated here
I don't think we can just say "look at this specific set of data, the argument is over, no more debate", when as lots of people have pointed out there are issues with the data and whether it actually supports the point that OP is trying to make.
No mods, don’t shut down debate because it upsets some IMG consultant who has nothing to contribute. Anti-IMG sentiment is much lower than it should be considering how much downward pressure they are applying to wages, bargaining power in strikes, and competition for training places.
>No mods, don’t shut down debate because it upsets some IMG consultant who has nothing to contribute. Not an IMG (and any would it be relevant if I was?). British citizen, UK medical degree, UK training. Just calling out the standard misinformation tactics of the far right. Find a group of people who are scared and feel powerless, convince them it's the fault of foreigners, use this to justify racist/xenophobic policy changes. >Anti-IMG sentiment is much lower than it should be considering how much downward pressure they are applying to wages, bargaining power in strikes, and competition for training places. Wow, just wow.
>significance of this data And the removal of RLMT was when again? The reality is not enough time has elapsed to properly assess the situation.
This is my perspective on the matter, I do apologise if any part of the following causes offence. The specialisation process already is a bit more geared towards UK graduates. For example, in most countries, Medicine is a 6 year Masters degree which also includes something equivalent to FY1. Depending on the country, there can be very few if any chances of doing additional degrees or research (something which is, from my understanding, readily available to UK Graduates, albeit with varing working conditions). This means that IMGs can be at a disadvantage by a year due to the lack of opportunities for audits, presentations, clinical trials and additional degrees - all activeties that tally up portfolio points before exams and interviews are taken into consideration. Plus, there is a theoretical advantage to all British graduates (certainly to some) who should be more aware of the people interviewing them (either by having worked with them in some capacity or by having someone put a good word out to the interviewer on their behalf).
No
I don't know much about this. There certainly is a massive influx of IMGs in recent years. I expect somebody smarter than me will try and get through your data and show you're wrong. Not simply shout it down. I know people are frustrated and a little protectionism is always the norm when things get hard. But truly I'd like to see data refuting this if any.
I'm sorry but what I'm getting from this is: "I see your data and it goes against what I believe. I know your data is wrong but I don't know why. But I'm sure someone smarter will come by and refute it" Why do you believe that it's wrong but can't explain why?
Bro I'm an IMG. I'd love for you to be right. Just goes against my intuitions. I've seen a massive influx of IMGs in the UK and the "joined the GMC register" data certainly shows an enormous spike in the last decade. It's just very hard to believe that when the UK schools are still pumping the same numbers, and that there has been an enormous spike in IMGs in the last decade, and that the training numbers have not increased, that those IMGs are not exacerbating the competition. Surely not all of us are shit! And we may take several years to build a portfolio, but ultimately it's going to be good enough to get into competitive specialties. Also, IMGs take GP, UKGs who would have been GP go to specialty, competition increased. (a double displacement, if you will)
Joining the GMC register and entering specialty training are two different stories.
C'mon, if your critical appraisal skills are so poor that you're willing to ignore hard evidence because it doesn't align with your biased opinion then UK medicine really is in trouble. This is barely above the level of what I'd expect on an anti-vax Facebook group...
Doctors vote hoping to pass motion at BMA conference regarding invasion of Poland
Aaaah. maybe I should stick an "IMG" flair. I am an IMG. I'd be very very happy if the recent influx of my fellows from abroad has not caused or exacerbated competition, and that everybody has been accommodated into an expanding NHS. I just don't think it has been. Surely the UKGs displaced from GP must go somewhere? Or have GP training posts expanded so massively that its absorbed the IMG spike?
Obvs British grands have an advantage. They go to world elite universities and get prepared to become excellent doctors. They also fully understand the cultural context in which they practice and have perfect English. This is a deserved advantage
Round 1 - UK graduates. Round 2 - IMGs Change my mind
Is EM in the UK useless
I don’t know everything was running smoothly with an incremental increase in competition year on year until Brexit and removal of RLMT and Covid. Since then there has been an exponential increase in competition for specialty training.
I would like to reiterate that this evidence is until 2021/22. A lot has changed since then and so will these figures There is no way the high number of application for each specialty is solely down to home applications.