First off, let me introduce myself for those who don’t know me. I’m Zainab Abudan Al-Masry, from the 4th Alfaisal batch. I completed my internship at the end of June 2017.
As this group lacks UK-related information in comparison to the US, I will be sharing some information and thoughts on the UK pathway, and shedding some light on some of the common misconceptions revolving around it.. I will call this series “The Road to UK Training”, and as I have a lot to share I will be posting in “episodes” or parts or whatever you’d like to call them.
Episode 1 – Overview of the UK pathway
***Before anything, here’s a general tip for all junior medical students.***
I started exploring my residency options by the end of 3rd year. Yes! Aim to have at least an idea of what your plan A and plan B are by the summer of 3rd year. It isn’t too early to start preparing for your steps, learn a language or ask around and understand the UK system by that time whether you’re settled on the US, Germany, UK, etc. respectively.
I’ve been following and reading on the UK system for 3 years now with barely any clear guidance at the time. So, here it is for anyone contemplating it or maybe you will start considering it following this post..
Here are a few reasons why you would consider the UK for your post-graduate training:
The UK has a major shortage for doctors, so they need you here
They are very IMG friendly. Granted, they do sometimes prefer EU nationals for the simple fact that they can start right away and don’t need a work visa. Now to clarify, this means that if 2 candidates apply for a job, one is EU and one is non-EU, and they are both equally qualified, then they are likely to pick the EU national. However, if they find the non-EU better suited for the job (better qualified) then they will choose this candidate over the EU. Hence, you find so many international doctors working here, way more than you can imagine.
There is little to no discrimination in the NHS whatsoever, and they always take measures to ensure that selection is as much as possible based solely on how qualified the applicant is, regardless of age, race, gender, nationality, religion, disability, and even sexual orientation, etc.
All jobs in the UK are paid. The salaries will obviously depend on your post and will increase as you progress. For instance, a foundation doctor (that will be explained below) is paid around £ 30 K per annum. Added to that is the non-social hours (on calls, nights, weekends), so usually 50% banding = ± £ 45 K per annum. Again this only applies for the first year
PLAB is a much easier test than the USMLE. You have several chances at it instead of just 1, and you only need a pass! It is 2 parts, both of which are clinical NOT basic. One which is theoretical and can be done anywhere, and the second is the practical one that is done exclusively in the UK.
You can work as soon as you complete your internship. No gap year! Just prepare in advance and you’ll be saving a lot of time.
You get to choose the field you want to specialize in and apply for it rather than them choosing it for you.
It is an English-speaking country, so you will not need to learn a new language as you’re English-educated during your medical school at the least.
One major con to the UK system and the only one I can think of is the long programme (explained below). If you can get past that and you don’t mind it, then the UK is a good option for you and you are good to go.
One point you should be aware of is the taxes here, yes you pay an arm and a leg for taxes but you get lots of benefits for those on the long run. For example, all NHS (National Health Service) services are 100% free for the public. As crazy as it sounds, the NHS which you will be working for is funded by the public taxes, so that they cover literally every and any medical need you may have, from a simple consultation to even major surgeries. Besides that, you will be included in the NHS Pension Scheme which gives you and your family lots of benefits even after you retire The first £10 K you earn are tax-free, but then you start paying gradually until they reach 40%. so take it as a pro or a con depending on how you think about it.
Now with regards to the UK system, the internship year is equivalent to Foundation Year 1 training in the UK. So, if you are to complete your internship anywhere (provided it meets the criteria, explained later) you skip this year and are promoted directly to Foundation Year 2. Here’s an illustration explaining the general route that most doctors take (again, there are different routes explained in future episodes).
I apologize if this still sounds complicated, because it is.
By now, if you’ve read this far you should have an idea whether the UK suits you or not. Think of your priorities first. Ask yourself what is really important to you when it comes to your training? For instance, some people just want to specialize in anything as long as they live in the US. Someone else might have a certain specialty in mind and want to only do that wherever, in which case the UK is a better option for him/her. So again, set your priorities and think accordingly.
If you finally decided that the UK is a good option for you, here’s how you start planning for it. To simplify, you will need 2 things:
Full GMC registration with a license to practice (which you’re eligible for once you’ve completed your internship)
A job offer for a Foundation Year 2 post
Episode 2 – What are my chances as as IMG?
Before we can discuss statistics, you need to understand the routes of UK training that doctors here take. There are 3 routes, which route you take depends on the specialty of interest. The route mentioned briefly earlier:
internship -> Foundation year 2 (FY2) -> Core Medical/Surgical Training (CT1,CT2,AKA ST1, ST2) (2 years) -> Specialty training (ST3, ST4,ST5, etc.) (4-6 years). This is the most common pathway simply because if you’re interested in any medical or surgical specialty, this is the route you’ll be taking. A con with this route: there are multiple application processes as you can see, getting into one doesn’t necessarily guarantee proceeding into the next.
Few points worth mentioning:
FY2: you do not need to do it in the UK. Any post-graduate work you’ve done outside the UK can count as your FY2 provided you have been supervised for a minimum of 3 months, your supervisor then has to complete your competencies form to show that you’ve gained all the skills/knowledge expected at the end of FY2. Having said that, there have been cases where abroad forms were still rejected, so just be aware.
CT: the point of Core Training programmes is for doctors to give all their MRCP/MRCS parts during this time. By the end of CT, doctors must have completed all their exams before they can progress to specialty training. So, if a doctor has passed his/her MRCP, they skip CT and start ST immediately. I personally do not recommend skipping CT for 2 reasons.
The responsibilities and duties expected of a specialty trainee are way more than those of a core trainee, so it will be harder in the beginning to join and get used to the system. It’s always preferable to get an experience working in the UK before that stage.
Those who complete CT in the UK get to compete with other UK/EU nationals for the specialty training seats, making them have equal chances to them. The only obstacle then remains the number of posts available and competing for them.
GP training: this is a 3-year programme. GPs play a major role in the UK in the healthcare of patients. Any UK resident has to be registered with a GP, who will have all his medical history and information. Your GP is the first person of contact in case of medical illness, unless it’s an emergency, in which case the hospital will contact your GP for your data. GPs are paid highly (just as much as a consultant), and have easy working hours in addition to the short programme, making doctors go for it. I would recommend GP training if you’re planning to settle in the UK.
If your field of interest does not fall under either of the abovementioned, then it most probably has a “run-through programme”. Run-through programmes mean that you will immediately start with your specialty training following FY2, no core training phase. This means once you’re in the system you’re guaranteed to become a consultant. They run between 5-8 yrs. Fields that have a run-through programme include:
Community Sexual & Reproductive health
Obstetrics & Gynaecology
cardiothoracic surgery (in some deaneries)
trauma and orthopaedic surgery (in some deaneries)
Now that that’s out of the way, on to how application works:
Let’s take Core Training as an example.
There are 2 rounds of application every year:
Round 1 – November: for UK/EU nationals
Round 2 – February: for everyone
CT starts on August of every yr
Based on the latest match statistics taking place in 2016-2017
Core Medical Training: 2516 applications were submitted in the first round competing for 1640 seats. Of those, 1218 were filled, which left 422 seats for IMGs.
Core Surgical Training: much less seats. 1622 applications were submitted for 642 seats, which left only 5 seats for IMGs.
IMGs can apply for Specialty training in the 1st round after successful completion of Core Training in the UK. They are also eligible to apply in the first round of GP and psychiatry programmes.
NOTE: There has been debate on including IMGs in the first round of CT applications as well. This is still on-going and has not been implemented however. If approved, this will open up doors to surgical training.
For application, post numbers and competition ratios for a specific medical specialty, the first link in the references is great, and will give you the exact numbers for any medical specialty and its trends in the last 3 yrs for both rounds.
For surgical and some other specialties, check the tables. Data was obtained from the latest match from Round 1 however. (No statistics for competition ratios for round 2)
I also left seat availability in round 2 statistics for the different specialties.
In general, if you’re pursuing Core Medical Training, GP or psychiatry it’s safe to say that it’s relatively easy to get in. Surgery requires hard work and dedication in terms of participation in audits, research, teaching, courses, conferences, presentations, etc. It is certainly difficult at the moment but not impossible.
18-month rule: A doctor cannot apply for Core Training with an experience of >18 months in the field post FY2. (Bear in mind FY2 doesn’t count towards your allowed 18 months). This is because at that level, trainees are expected to have completed their MRCP/MRCS exams, and are expected to apply directly to specialty training (no max limit of experience for ST). More likely than not, doctors match the first time anyway and will not approach this limit. HOWEVER, as some experienced doctors still prefer to go through CT this rule has now been waived from the Core Medical Training and most other programmes’ person specification starting from this year’s upcoming match in November 2017. Be mindful that this rule still stands for Core Surgical Training!!
Rules are continuously changing, but this is the most up-to-date information at the moment.
Dr Naseer Khan, a well-known IMG doctor training in the UK, has started a blog dedicated to helping IMG doctors. His blog tremendously helped me get started. I had the honor of meeting him and he gave me permission to use his material. Be sure to check his blog linked below to learn more.
If you finally decided that the UK is a good option for you, here’s how you start planning for it. To simplify, you will need 2 things:
Full GMC registration with a licence to practise (which you’re eligible for once you’ve completed your internship)
A job offer for a Foundation Year 2 post
This post will carry on from there and will go in depth into the first item.
Episode 3 – GMC Registration part ½ - requirements
GMC or the General Medical Council is the licence-awarding body in the UK. This means that before you undertake any medical job in the UK you must be on the medical register as eligible to practise medicine. (This excludes electives or observerships). The GMC is the most efficient organization I worked with. They have such pleasant and helpful employees who make things much easier. They provide amazing service in terms of responding to all queries whether through the phone or emails. Emails do take around 4 working days till you hear back from them, so if you were to be in a position where you need immediate answers it’s always worth giving them a call and clarifying things directly with them, most of the time you won’t even have to wait on hold. Overall, they are very prompt and supportive and such a pleasure to communicate with. The website is also quite informative.
For newly qualified doctors, there are two types of licences offered by the GMC
A provisional licence is one that’s given to a fresh graduate who has not completed his/her internship or FY1.
A full licence is what you should apply for if you have completed your internship. Mind you both of them have similar requirements.
FAQ 1 – Does that mean I can apply for a provisional licence after 5th year if I’m interested in doing FY1 in the UK?
A: In most parts of the world the answer would be yes, unfortunately this is not the case in the Saudi System. This is because our internship is a prerequisite for the MBBS degree. When you do apply for a provisional/full licence you will need to have obtained your degree upon submitting your application. Not just that, but it is also a requirement in order for you to give your PLABs. Now, is it possible to get a letter from the university stating that you have completed the medical requirements and the degree is pending internship completion? I have personally tried that and it failed. If they can make exceptions to that rule I am not aware, so if you really want to by all means give it a try. However, I personally do not think it makes much of a difference whether you join at FY1 or FY2 level as long as your internship is acceptable by the GMC.
Acceptable internship must be 12 continuous months, with 3 months minimum in each of medicine and surgery. Any gap of more than 20 days between your rotations is of significance and must be reported to the GMC providing a reason.
Before you apply to the GMC, 2 major requirements you need to clear are IELTS and PLABs.
only IELTS is accepted as an English proficiency test. They do not recognise any other tests. It is valid for 2 years, and is a requirement of everyone who does not satisfy the following criteria. You are only exempted from IELTS if you can prove that. Your medical qualification was taught in English and at least 75% of the interaction with patients is in English. In that case you can get a letter from the university stating the above, and submit it in place of the IELTS certificate and it should be accepted. However, since we do not satisfy the second point in the criteria we all have to give IELTS.
FAQ 2 – What if I still managed to get a letter from the university with the above points?
A: Any document you submit to the GMC will be thoroughly investigated, and if they discover any falsified information you are risking being permanently banned from working in the UK, so if you’re seriously planning for the UK, I highly suggest you steer clear of any falsification or manipulation. Do not to try to outsmart them, it is just not worth it.
FAQ 3 –Which IELTS should I give? The Academic or General Training one?
A: You need to do the Academic version for GMC purposes. However, if you do require a visa to come to the UK (i.e. if you are not an EU national) you will then need to do the IELTS UKVI version as well. So to kill two birds with one stone just do the academic UKVI IELTS.
The scores you need are a 7.0 in each band and an overall of 7.5 all in one exam sitting, and they take your most recent scores.
Sources for IELTS preparation are mainly past paper questions. You can find those online or if you prefer books many are available at Jarir Bookstore. Get familiar with the format of the questions and time yourself before the real exam and you should be good to go. How easy or hard it is to pass the required scores depends obviously on your English background. I will also provide a link for some PDF Cambridge exam papers for you to get a taste of the actual exam.
unless you are an EU national then PLAB is a must. The UK does not care much for where you graduate from, but rather your nationality. This is because if you are an EU national, you automatically have the right to work in the UK with no restrictions. Having said that, if you are a British national, you are not exempted and must give PLAB. Mind you, this rule will change in the coming few years. PLAB will be replaced by the UKMLA which will be the licensing exam, and it will be mandatory for anyone planning to come to the UK whether you are EU or IMG, just like the USMLE. This change is expected to take effect in 2022.
PLAB is a two-part exam, the first being theoretical and can be given anywhere. The second is practical and only done in the UK, and you have to pass the first part before you can do the second.
As stated previously, one can only give PLABs after getting the qualification and passing the required scores in IELTS.
TIP # 1 To save time I would suggest you start studying during your internship year. The first step is giving IELTS, then start preparing for PLABs so that as soon as you receive your diploma you can go ahead with booking the tests.
PLAB 1 is a 200 question exam that tests your clinical knowledge rather than basic sciences. It is held 4 times in the UK, in March, June, September and November, and twice elsewhere in March and November. Look out for registration opening and closing dates. Expected duration of preparation is 1-3 months. There is a test centre in Riyadh. For study material you only need to do past questions. It is an easy test. Check the link at the end of the post.
PLAB 2 consists of 18 stations and is only conducted in Manchester, and you can take it throughout the year. Make sure to book in advance though as seats fill up very quickly. For PLAB 2 taking a course in the UK is highly recommended. The course usually lasts around 15 days and you need a few weeks to practise the stations on your own following the course. Study material will be provided to you by the academy.
Each of the two parts can be sat a maximum of 4 times, with an additional conditional 5th final attempt, and only a pass is required. The score does not matter at all.
Now that you’ve cleared PLAB congratulations! You are now eligible to apply to the GMC. I could not get into the details of the actual GMC application process just yet, so that will be continued in a separate post.
Please keep in mind that GMC requirements are constantly changing, so make sure you’re always up to date with any changes by checking the website from time to time. This is especially true for EU nationals. The future of EU nationals working in the UK is still unclear, but it is likely that the Brexit will affect certain aspects including GMC requirements, visa status, etc., but everything I’ve stated here is true as of today and to the best of my knowledge.
If you haven’t noticed by now, the posts are sequential, so you will not need to worry about this until you have your diploma.
Let’s break it down, the GMC application process is divided to 3 main stages.
Submitting an online application
Posting documents by mail
The first stage is pretty straightforward. An online application has to be submitted at the end of which you will have to pay 200 pounds. No documents or evidence will need to be submitted with the application whatsoever.
TIP: You will not be told this by the GMC, but you can and I highly recommend you book your ID check in the GMC as soon as you submit your application, because the soonest date you will find will be around 2 months from the time you book it. Allow a minimum of 6 weeks from the time you book till the ID check date if you know you have all your documents ready, and at least 8 weeks in advance if you are expecting any delays.
Around a week later, you will receive an email asking you to post copies of some documents.
A copy of your passport
A copy of your qualification
A copy of your internship certificate
A copy of your IELTS certificate
A copy of an employer’s reference or a certificate of good standing
(This list may or may not be exhaustive, please always refer back to the GMC)
Do not send in any documents before requested to do so, and do not send any original documents at this stage as they will not be returned. The internship certificate our university provides does not have the exact dates of the rotations, which is a requirement by the GMC, so when you do post your documents request another certificate to be done by the university which exactly shows all your rotations with the starting and end dates of each. Otherwise, the GMC will ask you for it later and it will just delay your registration process.
If you are registered in the Saudi Commission for Health Specialties, you will be asked to provide a certificate of good standing by them. If not, then you can submit an employer’s reference which is basically a form available on the GMC website which you’ll need to get signed by any consultant you’ve worked with.
Around a week after sending all the documents, the GMC assesses your application for any further documents required individually. In my case they requested 2
The internship certificate with the dates and
A letter from the Saudi Commission confirming that the internship I’ve done is an acceptable pattern in Saudi Arabia
To explain the second point, for some reason it is thought by the GMC that the internship in Saudi Arabia is post-graduate rather than pre-graduate. They will ask for this information in the online application. As I submitted that it is pre-graduate, it conflicted with their records, so they needed proof that it is pre-graduate and acceptable, and only wanted that information from the Saudi Commission. This document was a pain to get, and alone caused a month delay to get the approval from the GMC! I tried to fix that problem for everyone by finally getting in touch with someone from the SCFHS who agreed to clarify the situation with the GMC and emailed them to confirm my internship. I really hope that they will not need this clarification again when you do apply.
I received my approval email a week later, requesting to appear for an ID check. That is when they will formally ask you to book your appointment, if you have done it in advance you will not need to worry about it now. If you haven’t, depending on the time of the year you will be delayed by 1-2 months just to wait for your ID check which is why I recommend booking in advance. Do not mention it to the GMC if you do book it, as normally it is against what they recommend and they will cancel it for you if they find out.
The ID check is the last step of your GMC registration journey and is again pretty straightforward. You cannot appear for your ID check before being approved. There are two GMC offices where they are held, one in London and one in Manchester. It doesn’t matter where you book it but I would recommend the London one as I noticed they have more cancellations going on there so you might be able to find sometime sooner. They will ask you to present the original passport, degree and internship certificates. They will take a picture of you for the records and ask you to sign. It is around 30 minutes long. You can now work in the UK from the day you have your ID check, and will receive the licence in the mail in 4 working days.
In general, the GMC application process was very straightforward and everything was clear every step of the way because the GMC is very prompt and responsive to all queries. However, it took me exactly 2 months from the day I submitted my application to get approved because of the delay from the SCFHS side and getting someone to communicate with the GMC. That was the only unpleasant time of the application. The rest went smooth.
For your information
The GMC licence is approved by Australia and New Zealand for work purposes. It is recommended that you complete foundation training in the UK however and have some experience beforehand. The reason that the UK has been so short-staffed lately is due to the fact that most doctors fled there due to less working hours, better pay (almost double) and better weather conditions. So there you go, if that is something you are interested in.
The above is all based on my own experience with the GMC. It may or may not be similar to yours.
I’m getting nearer to concluding my series, so if you still have anything specific you’d like me to address now is the time to let me know and I will try to work on that.
I have received many concerns and questions with regards to FY2 jobs. This post is all you need to know.
Episode 5 – FY2 jobs
Start applying for jobs as soon as you have submitted your GMC application. You do NOT need to have your licence in order to apply. The first thing you need to know is that there are training FY2 and non-training FY2 jobs. To progress in your training however, it doesn’t matter which one you do. The idea will get clearer as you read this post.
While they are the best in terms of training, there are a few downsides.
Applications open once a year only, so if you miss it this year you will have to wait till next year.
IELTS scores required are 7.5 in each section with an overall 7.5. Although the difference sounds small, but it is not nearly as easily achievable as a 7.
Stand-alone FY2 job posts are very limited, and most are taken up by those who started FY1 in the UK as they are a priority and have to be accommodated.
Non-training jobs still include optional lectures and teaching opportunities, and you will still be assigned a clinical as well as an educational supervisor to monitor your progress. However, you need to be more responsible for your own development as well. For instance, you need to make sure you book your ALS course in advance and involve yourself in audits (extremely important in the UK). More importantly though, it can count towards your training. There is a special form on the Core Medical Training website, also attached below, which explains all the competencies you need to have achieved. You can ask any consultant you have worked with for at least 3 months to sign it off for you in order to be eligible to apply for a training job whether it be Core Medical Training, GP, Surgical training or any run-through programme. Depending on your hospital, some may even offer non-trainees a study leave and budget just like their trainees. Non-training jobs are the more popular option due to their abundance and availability all year long.
Although available all year long, it is best to try and start the job August-September. This is so that by the time applications start for the training programmes (first round - November, or second round - February) you would have ample time to show your consultant you’re competent and he agrees to sign the form for you, in order not to have a gap year!)
These jobs start within about a month of advertising them. Applications to such jobs are submitted through another website, https://www.jobs.nhs.uk/where you can view job adverts and apply to the ones you like. Adverts are very detailed and explanatory in general, highlighting the length of the contract, your job and responsibilities, the specialties you will be working in, the salary, level of experience required etc. There is no limit to the number of jobs you can apply for. My advice would be to apply to as many jobs as possible, but only to ones you would actually accept if offered. Otherwise please do not waste your and their time by applying to jobs you are not interested in.
In terms of what jobs to apply for as a first job. I would say that depends on what field you are mostly considering as a future career. For example, if you’re thinking medical, apply to A&E, Medical Assessment Unit, general medicine. If you’re thinking surgical, go for Trauma and Orthopedics, which are quite abundant. This isn’t a mandatory requirement, but it shows commitment to your specialty of interest. Otherwise you can do your FY2 year in any field.
On average, it takes applicants around 1-3 months to start receiving interview invitations. Personally, I received my first interview after 3 weeks of applying. Many trusts accept Skype interviews so you do not need to be physically there.
The most important throughout this whole process is really your application. When you make your account whether on Oriel or NHS Jobs websites, take your time filling in your profile because this is what will be sent to the trusts, and this is what they choose the applicants based on.
In terms of the interview, they will challenge your clinical sense. Some may give you clinical scenarios (chest pain being a common one!), sometimes ethical situations. But they all discuss your future career plans and work with you to offer you what you really need. For instance, my trust offered rotations in Medicine, Urology, Psychiatry and Trauma and Orthopedics, but during the interview when asked about my plans, they canceled my Urology and Trauma and Orthopedics based on my preference selecting medical rotations. Overall, at least all my interviewers were very friendly and the interview was more of a discussion about what I want to achieve rather than anything else, very relaxed environment. All they want is for you to be a safe doctor. If you succeed in showing that you are, you most likely got the job. Normally by the end of the interview, you should have a good idea whether they are going to offer you the job or not. The reply is usually within an hour or 2 from the interview. Yes, they are that quick!
In order for you to get an idea of how long this whole process took me here is my experience.
I submitted my GMC application on June 15th, 2017
I started applying to jobs in July 2017, and received my first interview end of July
I traveled for my ID check in the GMC and received my license on August 15th.
My first day of work was on September 11th.
The first £ 11,500 you earn is tax-free.
For any amount between £11,500-43,000 you pay 20%
For amounts > £ 43,000 you pay 40%
To clarify here is an example. Dr Sawsan is a core medical trainee earning £50,000 per annum. The first £11,500 which are tax-free will be divided on every month, giving her roughly £950 a month free of tax. The rest of her monthly salary will be taxed 20% for most of the year. The last one or 2 months of the year when her annual earns have exceeded £43,000 she will pay 40% on the amount that exceeds 43,000, i.e. the last £7000 will be taxed 40%