International medical graduates: supporting the backbone of the NHS

An American businessman, Zig Ziglar, once said, ‘difficult roads often lead to beautiful destinations’. Well, I moved to the UK in 2016 as an international medical graduate (IMG) without much thought or forward planning and I encountered difficulties almost immediately. There was no formal support process and little experience on how to support a smooth transition of IMGs into the NHS or my local trust. Unlike today, there were hardly any support groups. To be honest, I didn’t know myself what kind of support I would need and what I should expect or could ask for.

The unsurprising result was that I struggled in several ways, being new to the country, the culture and the NHS. Simple things, such as finding housing, were a struggle. Unlike doctors, letting agents don’t work unsocial hours, and back-to-back viewings had to be completed on Saturday mornings. In retrospect, I realise now that my work-related struggles were not down to a lack of knowledge or skills, but because the complexity of the NHS was completely new to me. (A good example was the need to learn new terms such as DALT, or Drug and Alcohol Liaison Team, and DNACPR, or ‘do not attempt cardiopulmonary resuscitation’, to name but a few.) 

My husband, himself an IMG, was my biggest pillar of strength during these difficult times. Within months, my confidence came back as I felt more settled, and I was able to give 100% to the NHS and my patients. I found myself enjoying life outside work as well! 

It was at this point that I took a moment to reflect on how this might have been achieved sooner.

Soon after my arrival, a clinical fellowship programme (CFP) started in my trust, giving me the opportunity to help develop a formal support process and give something back to the system. 

The Chinese philosopher Lao Tzu said, ‘the journey of a thousand miles begins with a single step’. I started my leadership journey with CFP as the pastoral lead and was soon appointed as chief clinical fellow, and then as chief registrar at the trust, which was a first for a locally employed doctor. During this journey, I have been fortunate to work with like-minded and passionate people on improving the transition of IMGs into the NHS. 

We have developed a variety of support services, including a buddy system, on-call inductions, IMG education sessions and portfolio pathway (formerly known as Certificate of Eligibility for Specialist Registration, or CESR) support services, to name but a few. The programme has grown quickly and supported individual IMGs to have successful careers. 

One key element to our success has been an innovative approach and the development of several support processes from scratch. Such successes have provided great encouragement in sustaining this perspective. Lack of success has only spurred people on. We have listened to feedback from IMGs to help shape improvements, which reminds me of plan, do, study, act (PDSA) cycles, with each step a movement in the right direction. I have enjoyed both successes and failures, which has helped me to grow as a leader and taught me humility, courage and perseverance. 
My senior colleagues have been highly supportive, while helping me stay grounded. As my mentor often quotes, ‘we are not doing something that others have not thought of, but we are actually doing it!’

‘Actually doing it’ has involved a lot of blood, sweat and tears, and the achievements are down to the work of our IMGs themselves, whose passion stems from their own individual struggles, leaving no stone unturned to deliver support for others. This makes the programme unique, and to misquote former US president, Abraham Lincoln, the programme is ‘of the IMGs, for the IMGs and by the IMGs’ – all of whom contribute ceaseless support, enthusiasm and hard work. 

When I gave the Turner-Warwick lecture at the RCP Update in medicine - Birmingham recently, there was a wide appreciation of the efforts made by our IMGs to help others without additional incentive. It also speaks volumes for the Royal Wolverhampton NHS Trust where we work. We feel valued and respected, which motivates us to do our best.
Recently several organisations, including the NHS, GMC, BMA and the Medical Protection Society, came together to publish a guide to induction for IMGs recruited to the NHS. This is an excellent step in supporting IMGs across the UK. If I had a magic wand, I would ensure that all NHS trusts and health boards are able to provide support to IMGs when they come to work in the NHS, especially as this has been clearly shown to improve performance and, in turn, patient care. Here in Wolverhampton, we hope to build on the services that we currently offer and proactively develop new ones as needed. 

There is an African proverb: ‘it takes a village to raise a child’. Well, this is a picture of our village – many team members may have moved on to greener pastures, but we are confident that people will continue to contribute their time and energy to support fellow IMGs, spurred on by the recollection of our own struggles, how we were supported by others, and our desire to pay it forward and improve the NHS for those who follow in our footsteps.

Dr Roopa Chopra
Clinical lead for general internal medicine
Acting-up consultant physician 
New Cross Hospital, Royal Wolverhampton NHS Trust

Read more about Roopa’s award-winning work to support IMGs in her trust. 

The prestigious RCP Turner-Warwick lecturer scheme is open to early-career doctors across the UK. The 2026 scheme will open for applications in February 2025. Register your interest here. 

You can also watch previous lectures on our streaming platform, RCP Player. 

This piece is part of the RCP's #NextGenPhysicians series of guest blog posts. If you are an early career doctor with a story you’d like to tell, please contact Hannah.Perlin@rcp.ac.uk.