Troubled times for International Medical Graduates in UK – Part II
posted in - Education, - UK Doc |UK Doc is Guest Blogger for today and this is his article he submitted which summarises the position of overseas doctors in UK:
Further to Lord Warner’s announcement on 7 March 2006 about the new Work Permit requirement for IMGs intending to work in UK, I thought I should summarize what the new rule means to Malaysian doctors & medical students in UK.
1. All doctors wishing to work in the UK from outside the European Union (EU) will be required to have a work permit from April 2006. The move means that any NHS trust wishing to employ a doctor from outside the EU will have to prove that a ‘home-grown’ doctor cannot fill the vacant post, ending the current permit free training arrangement for international doctors. If there is one British or EU applicant for a certain training post, Malaysian doctors who have no Permanent Resident (PR) status in UK will not be eligible to apply. Practically, Malaysian doctors in UK without PR status can forget about post-graduate training in UK except:
2. Non-EU doctors who studied in UK universities are allowed permit free training to complete their TWO years Foundation Programme which is equivalent to the previous Pre-registration House Officer (PRHO) & first year Senior House Officer (SHO) level of training. This is to enable them to register with the General Medical Council (GMC). Thereafter, they too will be subjected to Work Permit requirement practically excluding them from further post-graduate training in UK.
3. Malaysian doctors who are currently working in UK will be allowed to complete their remaining contracts. After then they will not be eligible for further application or extension of post-graduate unless the Work Permit condition can be fulfilled (which is practically impossible). Those whose permit free visas are expiring but whose employment contracts remain valid will be allowed to extend their visa in the form of Work Permit to complete the remaining terms of their employment. There after they too will only be eligible to apply for posts that cannot be filled by EU or UK doctors. Effectively, if you are in the Type I Specialist Registrars’ post, you are safe. As for the rest, you have missed the boat.
4. Malaysian doctors who are in the process of applying for jobs will find their CVs literally thrown into the bins.
5. Those short-listed will be barred to proceed in their job application.
6. This is a tragedy to many Malaysian doctors affected by the new ruling. It means they will have to uproot their families, sell their houses and cars etc, come home and start from the bottom again, unless the Malaysian government is prepared to do something to bridge and complete their post-graduate training. The announcement came with virtually no warning and no grace period for people to adjust or make necessary arrangement.
7. Those who intend to sit the PLAB exam please stop doing it. PLAB has practically lost its reason to exist.
8. Malaysian prospective students and parents SHOULD NOT send their children to UK unless they are certain that they only want to come to UK for undergraduate training only. JPA on the other hand no longer has to worry about the issue of non-returning scholars.
9. There is protest going on. BMA and the Royal Colleges are speaking on IMGs behalf. The rule is unlikely to change in the near future but they are trying to help those IMGs who are already working in UK who have been most unfairly treated.
References:
1. Extra Investment and Increase In Home-Grown Medical Recruits Eases UK Reliance On Overseas Doctors
2. Overseas Doctors : Change to the Immigration Rules for Postgraduate Doctors and Dentists
Further reading:
3. The ‘Work Permit’ saga continues…(Greener Pastures Blog Post)
Related MMR Post:
Troubled times for International Medical Graduates in UK
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May 10th, 2006 at 5:08 am
@huajern and poor doc: I agree with your description about the Bolehland doctor situation. I have been there before and served as a “Paediatrician” in a very adverse situation in Borneo when I returned “to serve my country” (as an Internist) in 1981. I was made a “Paediatrician” overnight just because I had 2 years of SHO experience in Paeds and Neonates pre and post MRCP.
By God, I fought the system and got about 60% of what I wanted but over a period till the day I left. My pay never exceeded that of a Medical Officer with a Clinical Specialist’s pay (i.e. RM 1360 + 400 + some allowances). I had some fantastic exposure to medicine but unequalled to that in my London teaching hospital where I was a HP to the prof of medicine. Sure, after Bolehland, I could see 50 patients in a busy clinic but what quality care can I offer them?
Sure, despite being an oncologist, I should still be able to do a Caesar and insert a intra-arterial line or a transvenous pacing wire. But, this is only “hot air” type boasting – as the quality is dubious. After all it was the “Boleh” spirit
I might even question the notion whether I am doing my patients any good! It is akin to Malaysian voters choosing between the devil and the deep blue sea 
The point is this: serving one’s country is voluntary and is often disguised with the term ‘patriotism’ – but being forced to do so under unjust circumstances (including the compulsory service) is more dubious. Like you, I went in with my eyes half opened because of family etc. 20 years later, I still left and with my late father’s blessing…..
As I had said before it takes 2 to tango and if one goes out of step, the other one does too.
In this world of equal opportunity the drafter of an agreement has to get things right: if not, the other party is deemed the winner in any dispute or debacle (http://www.rasmusen.org/x/2005/05/12/contra-preferentum-the-drafter-loses/) – and in this case, it appears to me that it has been and will continue to be the JPA scholars who will win. And, we should not blame the MOH but instead, the inefficient bureacracy of the JPA as they employ people including doctors. It appears that till they get their act together, there will be no winners.
And, ultimately, those who should take the responsibility are the monkeys who cannot even conduct themselves properly in their work chamber in the Lake Gardens in KL.
May 10th, 2006 at 7:33 am
Missus, I have just made a comprehensive coverage of the HSMP situation under my new post: HSMP – closure of another loophole. Just go to my weblog for full details. Too much to post as a comment here.
May 10th, 2006 at 8:24 am
>>This is why a Malaysian doctors can see 50 patiens at 1 session, do 10 Cesarean section in a row >>
These are dangerous situations. Our patients deserve better care. Hopefully, these situations have improved. The “unreasonable” doctor would not allow these situations to persist. Nothing to be proud of here – better planning needed.
A doctor who has done many caesareans with initial little guidance may not be safer than one who has done a few in better training centers before being allowed to work unsupervised.
LF’s globe-trotting behaviour in search of career development and establishment reflects his brilliance, hardiness and resourcefulness. Perhaps, less productive than a Malaysian doctor in terms of turnover of patients but the system probably allows him to reach his potential abeit lesser money in his pocket through his admission in his post.
There is a shortage of oncologist/radiotherapist in the private sector, in my opinion he will do well working in the private sector in Malaysia. His decision to be in Oz is based on, the cost and benefit assessment, that all migrants would have considered in great depth.
His dislike of the government, but not his love of Malaysia, is strongly motivated, persistent and intense. You will need to appreciate him better to understand this. ; )
May 10th, 2006 at 10:26 am
poor doctor,
I don’t think knowledge is tested so much in terms of our workload, but more of stamina. I have done all which you have described, except the Caesarean part; but it was because someone had to do it, not because it is something to be proud of. The care we provide for our patients is definitely suboptimal, due to time constraints. It is something to be improved upon by the authorities, as maximum has already been wrung out of the existing medical staff.
Missus,
There is nothing wrong in wanting happiness. I too would want a better work-life balance. Who doesnt? You have nothing to feel bad about on this account. But those who breach their contract should bad, very very bad. To me a person’s word should mean something, more so a person’s name/signature. Agreeing to serve in return of sponsorship is an oath, and breaking an oath is a ‘bad’ thing, whether to steal RM 1 billion, or RM 1000. It is still dishonesty, theft and lack of honour.
May 11th, 2006 at 2:37 am
UK Doc-Thanks a million. Your website is very informative. I think the people who will potentially benefit from HSMP the most really are people who studied in the UK for the full 5 years and did their JHOs (old system). That means by the time they come to their 10th year, the will be ready for a registra post. However,I am not sure of the implications for the new medical system. It is going to prove tricky for people who already not in the system.
Huajern-Completely agree with you.My comments were 100% related to non government sponsored students. Government sponsored students dont have a choice cause potential students who would have come back have been sidelined. So there is a deeper moral issues there. To summarise:
-Tax payer’s money (MOST important)
-Lost opportunity for other students who would have come back
-Breach of contract
-Mockery of the system as a whole
May 11th, 2006 at 6:50 am
You are welcome.
May 11th, 2006 at 3:36 pm
Let us continue…..it is very interesting amongst all this dust that no one has actually mentioned who the defaulters might be! My guess is that the majority of them are bumiputeras, children of wealthy BN leaders or supporters or civil servants and who are not interested in returning not because of the money but because of their other choices. There are actually very few non bumiputera JPA scholars who may have defaulted.
If what I have stated is correct, then, all the hot air in the world (even if they unsuccessfully apply the contra preferentum rule) will not get them back. Besides, the wealthy daddies and mummies will be able to pay the cash up front
May 11th, 2006 at 4:34 pm
Most doctors will be in the upper middle social class. The super-rich is less likely to encourage their children to be doctors – just an observation. How is the ethnic issue relevant for this discussion?
By the way, for those who are not participating in the doctor’s section of MMR, here are the lastest fee schedule for doctors.
Seventh Schedule
Fee schedule (Professional Fees)
Part 1- Medical Fees
A. Consultation Fees
1. General Practitioners (Non specialists)
(a) Clinic with pharmaceutical services (Consultation only; consultation with examination; consultation with examination and treatment plan)
RM 10 – RM 35
Consultation after stipulated clinic hours – Up to 50% above the usual rate.
House calls or home visits – Up to 100% above the usual rate
(b) Clinic without pharmaceutical services (Consultation only; consultation with examination; consultation with examination and treatment plan)
RM 30 – RM 65
Consultation after stipulated clinic hours – Up to 50% above the usual rate.
House calls or home visits – Up to 100% above the usual rate
2. Specialist Fees
Note: Applicable to all medical specialties unless specified otherwise.
(a) First Visit/Initial Consultation (Consultation only; consultation with examination; consultation with examination and treatment plan)
RM 60 – RM 180
Consultation after stipulated clinic hours – Up to 50% above the usual rate.
House calls or home visits – Up to 100% above the usual rate
(b) Follow-up visit/follow-up consultation (Consultation only; consultation with examination; consultation with examination and treatment plan)
RM 35 – RM 90
Consultation after stipulated clinic hours – Up to 50% above the usual rate.
House calls or home visits – Up to 100% above the usual rate
Ref:
Warta Kerajaan
Published 1.4.2006
Private |Healthcare Facilities and Services (Private Medical Clinics or Private Dental Clinics) Regulations 2006
May 11th, 2006 at 5:30 pm
Ethnicity was not mentioned; only a preferred status (i.e. bumiputera)It is a fact and I can confirm it because during my wanderings in the UK and Oz, most of the Malaysian PSD scholars I have observed (and also told about by medical students) in medicine are bumiputeras.
Is this a concern? What was the fee schedule for?
May 11th, 2006 at 6:32 pm
>Is this a concern?> This is a political question better directed to someone in politics.
The various universities in the world have been eager to provide places for PSD scholars as they are at least guaranteed that the places they offered will be taken up. A university offered places to non-PSD students and was upset when only a fraction took up its offer when the examination results were released, thereby depriving them of significant income for that year. This university now reserves the majority of the places for PSD scholars although a few places are still available for privately funded students.
LF: Sorry, the fee schedule is out of context for this discussion. I posted it for those doctors who may be interested. There is a short section on fees for oncology and radiotherapy if you are interested.
May 12th, 2006 at 4:18 am
@ngchmd: thanksfor the clarification : I am not particularly intereseted what the “oncologists” in Bolehland charge.
Are we saying then, that a very much more complicated plot exists between PSD scholars, where they are sent and why they may not wish to return to serve their bonds? Is the university you have mentioned located in Eire? And, is academia subservient to commercialism where the ability to pay (even by a government)rides above that of the ability to excel academically? Perhaps the opposition may wish to pressurise the government to hold an inquiry into the award of overseas JPA scholarships in medicine?
May 12th, 2006 at 4:34 am
The awards of scholarship to persue medicine oversea is an outdated strategy. We have more than enough medical schools in Malaysia (soon will flood the market). Basically, not much difference in term of quality of work among doctors graduated from various medical schools from different countries. What Malaysia lack is specialist and subspecialists. The money should be used to send doctors for further subspecialist training in overseas. To train one doctor with basic degreee in Western country would cost about RM 1 million but with this aount of money, 3 doctors can be sent for subspecialty training and they are more likely to bring new skills back to the country and more importantly stay in public services.
May 12th, 2006 at 5:27 am
As the comment section here is becoming very long, it will take the page a long time to load, especially if you are on a slow dial-up. I am hance closing the comment section and you may continue in the MMR Forums in this thread:
http://forum.malaysianmedicine.com/topic.asp?TOPIC_ID=599
May 21st, 2006 at 6:18 pm
As I now have Paged Comments, I am reopening the Commments section for this topic but you are still welcome to comment in the MMR Forum thread:
http://forum.malaysianmedicine.com/topic.asp?TOPIC_ID=599
June 8th, 2006 at 6:30 am
Spotted two letters in Malaysiakini on this topic:
‘Get lost’ – that’s the British for you
Better for doctors to get basic degree here
June 20th, 2006 at 7:57 am
Thursday, 15 June 2006
Thousands of doctors could be forced to leave the country because of lack of opportunity in the NHS, the British Medical Association is warning.
The association says around 21,000 junior doctors are competing for 9,500 training posts in England in 2007.
http://news.bbc.co.uk/1/hi/health/5082244.stm
This is due to the phasing out of senior house officer posts next year following a revamp of medical training.
A BMA survey last year indicated that most junior doctors would prefer to continue their training overseas than to take up a non-training post.
Australian authorities have already come to the UK to recruit doctors.