Author: Dr. Chirag Bhatia, Orthopaedic Surgeon, Currently in the UK
Shall I go to the west? This is a question faced by almost every medical student, fresh graduate and even post-graduates in India. Along with it comes another foray of questions as to what the best timing or the stage of career is to do so, whether to settle there or come back etc.
Having worked in the UK after my post-graduation and after my own research and analysis at different stages of my career I can say with much certainty that there is no right or wrong answer to this question. It is a subjective choice depending on several factors which may include your personal choice to settle in another country, stage of career you take the decision at, your specialty if you decide to go after post-graduation, kind of life you like for yourself, your personal/family circumstances. In the end it is your decision and that is what this piece intends to do, to help you make an informed decision.
I have been working in the UK for 4 years now after my post-graduation in India. So, the focus will be on training and life as a doctor in the UK, but I shall try and shed some light in brief on the situation in other countries as well from what I know of.
In order to work in the UK, one has to be registered with General Medical Council (GMC)1. UK offers different routes of entry for international medical graduates.
- PLAB exam pathway (suitable for fresh graduates)- to change to Medical licensing Assessment (MLA) exam in 2024
- MRCP/MRCS/MRCOG/MRCPsych/MRCS ENT (Note that the MRCS ENT part A is the same as MRCS General Surgery and ortho, unlike MRCS OG/ Ophthal etc) exam pathway (suitable for post-graduates)
- Sponsorship pathway (suitable for fellowships)
After the PLAB you start your career as any UK medical graduate by obtaining foundation doctor/Senior House Officer (SHO) jobs and building your portfolio to enter a speciality training program of your choice.
Going to the UK after Post-graduation
1If you chose to go after post-graduation, the second pathway will be a suitable choice as it provides you with an opportunity to start work straight away as a registrar (resident doctor equivalent of India) in your speciality. This translates to work and train as a non-trainee grade registrar which provides with variable and inconsistent training opportunities depending on the place of work. From here one can chose between 3 different routes depending on personal choice.
- Work and build a portfolio to enter the formal training program and become a consultant specialist, known as the CCT route
- Work and build a portfolio to become a consultant through CESR route.
- Keep working as a non-trainee doctor in jobs of your choice and possibly end up as a staff grade doctor (SAS) which is somewhere between a consultant and a registrar.
Remember you have the option to move back at any stage as per your personal choice.
CCT route is the most straightforward route to a consultant post. The time to train to be a consultant is different for each speciality. The competition in each specialty differs and there are extra monetary benefits to join some programmes due to not being in as high demand as others (hard to fill programmes) e.g. Emergency medicine, Psychiatry.
The requirements for CESR route differ for different specialties, tedious for some and not so tedious for some. There is ample information on what is needed for each speciality on the respective royal college websites2. The number of years one may have to spend with this route is variable depending on the speciality and one’s will to put in the effort. Do remember after all the years of hard work one may not succeed at the application if all the criteria are not met as per the GMC.
An option for those who wish to train for a short period:
The third route is an option if one wants to train for short period of time and return after you have had the learning you desired or may even chose to settle but not as a consultant.
The sponsorship pathway is suitable for those who want to pursue a fellowship and return to India. However, for the time being the route does provide with an opportunity to work after the fellowship as well, not guaranteed though.
The Healthcare System and Life as a Doctor in the UK
Coming to the healthcare system and life as a doctor in the UK. The healthcare system is mainly public, called the NHS (National Health Service). There are limited private hospitals which one can join after becoming a consultant only. Being a public healthcare system, training opportunities are ample even for non-trainee grade doctors. However, for non-trainee grade this can be variable depending on the speciality (medical/surgical) and the place of work.
Salaries as a trainee and consultant:
Salaries are decent as a trainee doctor but as with any public sector job the progression of pay is limited. Even on becoming a consultant the upgrade in pay is not a fascinating one when compared to other western counterparts unless you join a private hospital as a consultant which as I previously mentioned is a limited opportunity and depends on the speciality you practice. For instance, an emergency medicine consultant does not have a scope of much private practice as private hospitals only provide elective services and none of the acute/emergency services. Very limited specialities have a role in the private and not everyone gets an equal opportunity to join because of limited number of private hospitals. So, expect some competition there as well. Is the pay good enough if someone asks, it certainly depends on one’s personal lifestyle and family circumstances. In my opinion being solely dependent on the NHS salary will provide you an average lifestyle. The salaries are significantly lower than other professionals in finance, business, law, tech etc. You are not going to be able to afford a maid, cook, driver or take out everyday. Remember, you need to come back home after work and do everything yourself, everyday. I shall attach a link to know more about the pay scales in detail3. There are additional on-call allowances on top of the base pay depending on the commitments. On gross income there would be tax deductions, national insurance and pension deductions (not must). These put together can amount to approximately 40% of the gross salary.
Now in a broad comparison to other western countries (USA, Canada, Australia, New Zealand, Singapore) the country offers good training opportunities and various entry routes for international graduates. The gross salary as a trainee doctor is at par or even better than some of its counterparts e.g. Canada. However, as a consultant the salaries do not compare well to any of these countries and one of the main reasons for this is that UK is a public healthcare system whereas rest of these countries offer ample private practice opportunities.
Kindly visit the following link for the salaries (keep in mind that the salaries are before tax deduction, what you would receive in hand would be lower than what is listed here): https://www.bma.org.uk/pay-and-contracts/pay/junior-doctors-pay-scales/pay-scales-for-junior-doctors-in-england
Life in general
Life as a consultant in the NHS is not dramatically hectic but can be stressful. It does offer you a good work-life balance. Things are well planned and well organised. The basic infrastructure and hospital facilities for the patient are of the highest order. However, being a public healthcare system, it does have its limitations and problems.
To address another relevant query of the young medicos in India, which is Violence against the healthcare staff, I am pleased to say such incidents are next to zero in the UK. In fact, NHS is very much appreciated and respected by most of the general public.
The social structure in the UK is very different from India. However, there is a lot of Asian and Indian community in the UK and in the NHS, so if one desires a social life similar to what it is back home it should not be a big concern for someone willing. Similarly Indian food and items are not a difficult find depending on the region you are in.
* Please note all the information in this article is as of present-day scenario and may change in the future. Good luck to anyone reading this and may the force be with you in whichever path you decide to take.