Last week, the RCP launched new educational and career support guidance for locally employed doctors (LEDs) and international medical graduates (IMGs).
In this blog from our #NextGenPhysicians series, Dr Hafsa Shafique, an LED in west Wales and an IMG from Pakistan, writes about her long-held dream of working in the NHS and how she managed to achieve it earlier this year. In July 2024, Hafsa presented at an RCP Cymru Wales Cyswllt visit to Bronglais Hospital in Aberystwyth, where she talked about her experience of a clinical attachment in west Wales. Find Hafsa on Instagram or Threads at @hafsashafique.
#NextGenPhysicians: Are you an early career doctor? Are you part of the next generation of physicians? If you have a story you’d like to tell, please contact Hannah.Perlin@rcp.ac.uk.
Since its inception in 1948, the NHS has relied heavily on the contribution of doctors from overseas. A GMC report from November 2023 revealed that in 2022, IMGs made up over half (52%) of new joiners to the medical register and play a crucial role in all areas of the medical workforce. So why do so many IMGs choose to work in the UK? In short, to gain work experience in one of the world's largest healthcare systems, receive top quality training and career development, and for the opportunity to gain specialist UK royal college qualifications.
From an early age, I knew I wanted to work outside of Pakistan to gain experience and learn skills that would have been unachievable at home. The choice in my mind was between the UK and the USA. I made a great many lists before I settled on the UK!
In some ways, I was very naïve. Perhaps I started out thinking that a good medical education was enough – but I discovered that this is just the beginning of a long and, at times, tedious process involving endless bureaucracy and assessments. With growing competition for fewer jobs, it’s not simple, and there’s no secret magic trick that I can share with you. But I’ll try to list a few things that might help the aspiring IMG who wants a job in the NHS.
To be able to work in UK as an IMG, you need to get yourself registered with the GMC. There are many ways to do this, but the most common is the PLAB (Professional and Linguistic Assessments Board) route, a demanding two-part test accompanied by an English language proficiency exam.
I finished medical school in Pakistan in March 2022, and by April 2023 I’d completed my internship year. To my joy, I passed the English language proficiency test during my internship, at the first attempt. Despite working a 90-hour week, I was determined to study for PLAB 1, which I passed in early 2023, after many sleepless nights. I was on cloud nine that day!
Filled with renewed determination, I booked my PLAB 2 exam for September 2023. This is held only in the UK, so I needed to apply for a visa. I flew to Manchester that summer and began applying for clinical posts while I studied – I could not believe my eyes when I received the email telling me I’d passed PLAB 2 that October. I was another step closer to achieving my dreams, and soon afterwards, I applied for GMC registration. This was by far the easiest step of this journey.
Over the past few years, as the number of GMC-registered doctors has increased while the number of training posts has stagnated, it feels as though we’re reaching market saturation for entry-level roles for doctors. However, a clinical attachment can prepare an IMG for working in the NHS. This involves shadowing a consultant without the responsibility of patient care, and usually lasts between 2 and 4 months, costing from £400. The idea is to provide insight into how the NHS functions, boost the chances of securing a job, increase confidence, improve communication skills and network with other medical professionals.
The best time to apply for a clinical attachment is after PLAB 2, and I was lucky enough to receive offers from three different hospitals. Due to visa constraints, I accepted two of them: 3 months in psychiatry in Manchester, followed by 6 weeks in general medicine in mid Wales. I had my visa extended during this time and I was able to learn first-hand how the NHS works, which makes a big difference during job interviews. I passed my ALS (advanced life support) course and took part in an audit cycle, both additions to my CV that helped me with job applications.
My supervisor in Manchester was an enthusiastic tutor who introduced me to the NHS and supported me to develop the skills needed to become a junior doctor. After this, I moved to Wales and was blessed with the best mentors. In only 6 weeks, I learned a huge amount.
All this time, I was actively applying for jobs. Each application took a tremendous amount of effort and skill, and there were days where I would constantly refresh my emails in the hope of a single interview. I kept pushing every day because I knew that the universe had plans for me!
Only a month before my visa extension was due to expire in May 2024, lo and behold, I received my first interview call. I knew that this might be my only opportunity for an NHS position, and I prepared day and night for 2 weeks, practising my interview skills. Finally, my dream came true. After 2 years, I secured my first proper job in the NHS in Bronglais Hospital in Aberystwyth.
Reflecting now, I am amazed at how much I discovered about myself during those 2 years. In many ways, the experience froze me in time. A number of times, familiar themes crept into my mind. Time and time again I asked myself, ‘will I succeed?’ Yet I had transitioned to new, exciting chapters in my life before, and I was always confident that I could do it again.
My advice to all those IMGs who dream of working in the NHS: approach the journey with a childlike wonder. Remember, one day you will look back and realise how far you have come. I learned at an early stage that I shouldn’t be afraid of how little I know, because it means I am growing and will evolve a little each day.
Top tips for IMGs
- Be organised with your paperwork.
- Seek teaching experience – it develops your own knowledge and communication skills and demonstrates your keenness to train others. Try to secure proof (documentation) of your experience, such as a certificate or feedback from your students.
- Other qualifications can be very useful – I completed an intercalated BSc degree in Pakistan, which helped with my UK applications.