UK passes new law to exclude overseas doctors

[Retinamark]

The UK has just changed the law to say that hospitals can only pick overseas medical graduates if there is no local candidate who can do the job and if there is no local candidate, they must pick an EU graduate.

http://www.mmc.nhs.uk/pages/careers/overseas-doctors
http://www.nhsemployers.org/workforce/workforce-723.cfm
http://www.admissionsforum.co.uk/showthread.php?t=15044

This will make it almost impossible for Americans / Canadians / Australians / Indians etc to work in the UK, which is a shame. I would have liked to work in London for a year.

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[southerndoc]

Imagine how much outcry there would be if the US did a similar thing.

 

[Solideliquid]

Imagine how much outcry there would be if the US did a similar thing.

See, it does look bad on the surface. On the other hand they are putting their citizens first. Which IS something I would like to see in this country, altough not at the extreme level reached by England.

 

[Retinamark]

Yes, that's true, I can see why it's a good thing to put your own country's citizens first.

On the other hand, one of the reasons that the US has been so successful, and is such a desirable place to live, is that jobs, and success are more based on qualifications and ability, rather than birthright.
A country that actively attracts and recruits the best and brightest, will be more successful.

I think this is a step backwards for the UK. They should make sure that there are enough jobs for their own graduates, that's fair enough. But positions should be awarded on the basis of merit, in my opinion

 

[Solideliquid]

We have that luxury, but only because our country is so big. Think of the size issue faced by the UK. How many hospitals can you build on that island.

Yes, that's true, I can see why it's a good thing to put your own country's citizens first.

On the other hand, one of the reasons that the US has been so successful, and is such a desirable place to live, is that jobs, and success are more based on qualifications and ability, rather than birthright.
A country that actively attracts and recruits the best and brightest, will be more successful.

I think this is a step backwards for the UK. They should make sure that there are enough jobs for their own graduates, that's fair enough. But positions should be awarded on the basis of merit, in my opinion

 

[gibber09]

See, it does look bad on the surface. On the other hand they are putting their citizens first. Which IS something I would like to see in this country, altough not at the extreme level reached by England.

Are you referring US citizens or US medical school graduates? Because quite a few US citizens happen to be IMGs...

 

[Solideliquid]

Are you referring US citizens or US medical school graduates? Because quite a few US citizens happen to be IMGs...

In the UK, they are putting UK or EU citizens before the citizens of countries like India and Pakistan.

I do not think it means citizens of the UK or EU are being limited for going to medical school in the US or other countries.

P.S.>I happen to be a US citizen IMG.

 

[spalatin]

The UK has just changed the law to say that hospitals can only pick overseas medical graduates if there is no local candidate who can do the job and if there is no local candidate, they must pick an EU graduate.

http://www.mmc.nhs.uk/pages/careers/overseas-doctors
http://www.nhsemployers.org/workforce/workforce-723.cfm
http://www.admissionsforum.co.uk/showthread.php?t=15044

This will make it almost impossible for Americans / Canadians / Australians / Indians etc to work in the UK, which is a shame. I would have liked to work in London for a year.

Canadians and Australians are Commonwealth citizens may be exempt them if they can demonstrate to the Home Office that they have British Ancestry.
Americans, however, are not.

God Save the Queen!

 

[Fantasy Sports]

Imagine how much outcry there would be if the US did a similar thing.

Imagine how much outcry there would be if the US had year-long waiting lists for life-saving, time-sensitive surgeries, have treatments rationed, and had to sue their government to get the latest chemotherapy.

The reason the US has the most advanced medicine in the world (though it unfortunately does not reach all people) is because we are a capitalistic, competitive society where anyone who is smarter or more technically skilled can enter your field regardless of where they were born.

So if people want authoritative laws dictating what nationalities can practice medicine, move to Britain and become a general practioner making about 1/4 of what you make now-- because for better or for worse, the current system has made America vastly superior to Britain in medicine and science.

Oh, and Im a white male

 

[aredoubleyou]

because for better or for worse, the current system has made America vastly superior to Britain in medicine and science.
QUOTE]

On what evidence - i hope not mortality or morbidity, both lower in the UK. And in Japan where there are no enforcement of restrictions on any MD practicing any specialty, even without formal training (beyond medical school) and where a person can often expect to have limited access to advanced (expensive) meds and imaging has the lowest mortality...and its not just tofu!

Also, dont think as a US MD grad you're not being protected...we get preference in the match even though, if you think about it - an Indian overcoming the thousands of hurdles to land a community IM or FM spot in the US is almost certainly objectively more academically gifted than most of us americans in competitive specialties.

 

[aredoubleyou]

The UK has just changed the law to say that hospitals can only pick overseas medical graduates if there is no local candidate who can do the job and if there is no local candidate, they must pick an EU graduate.

http://www.mmc.nhs.uk/pages/careers/overseas-doctors
http://www.nhsemployers.org/workforce/workforce-723.cfm
http://www.admissionsforum.co.uk/showthread.php?t=15044

This will make it almost impossible for Americans / Canadians / Australians / Indians etc to work in the UK, which is a shame. I would have liked to work in London for a year.

I am pretty sure that similar laws apply in the US for work visas (only if there is no american that can do the job) - they just don't mean much.

 

[Solideliquid]

I am pretty sure that similar laws apply in the US for work visas (only if there is no american that can do the job) - they just don't mean much.

Perhaps you are not aware that the UK healthcare system recruited and saught out the help of foreign doctors. They had a physician shortage and ASKED those people to come into the country (not that they didn't want to).

Now they are asking them to leave, casting them off because they have more medical graduates from UK schools.

That is of course one facet of the situation, another is blocking new doctors from coming into the country. I can appreciate that they want to let their own citizens have first pickings of jobs, though.

 

[Retinamark]

I am pretty sure that similar laws apply in the US for work visas (only if there is no american that can do the job) - they just don't mean much.

Are you really sure. I don't know what is in the fine print of the visa laws, but the visa is the easiest thing for a foreign medical graduate to get. It's the medical board license that is tough.

On what evidence - i hope not mortality or morbidity, both lower in the UK. And in Japan where there are no enforcement of restrictions on any MD practicing any specialty, even without formal training (beyond medical school) and where a person can often expect to have limited access to advanced (expensive) meds and imaging has the lowest mortality...and its not just tofu! .

There are many factors which affect morbidity and mortality, not just the health system - ie genetics, diet, environment. There are not many people who could legitimately argue that if they had a medical problem, they would rather have it treated in the British National Health Service than at the Mayo Clinic, or even any state university medical center in the US.

 

[aredoubleyou]

I agree that temporary work visas are very easy to get - but I do remember a couple people I've known who were studying abroad here and when they went to get jobs the companies had to change their job title into something that would sound like it would be difficult to find americans for. And to clarify, I am not 100% sure, but I do know that in both cases this happened because of work visas. Also, in highly trained jobs like science, medicine, computers, etc...I think less justification is needed - in both cases these people went into secretarial type jobs.


I am aware that there are many factors affecting mortality & morbidity - BUT, when I hear people say that the American helth care system is the absolute best in the world, and they have full confidence in that statement mostly because the US throws more money at patients (latest medicines and devices, more specialist consultations, probably more imaging) what has that resulted in? It is humbling to me to think that the US, often convincing ourselves that everything we do is the best and greatest, has a great number of healthcare parameters that fall behind not a few, but quite a few other industrialized nations. Also, part of healthcare is prevention, which is one the main focuses of primary care - and is relatively ineffective on many accounts. Perhaps the British, having more GPs per population than the US have done a better job of preventing disease - or perhaps they just eat less McDonnalds and have fewer guns & gangs...theres no way to know. But in my mind, if the US was overnight transformed into the british system, I doubt mortality will steeply increase - as if the American healthcare system (vs a socialized one) is the only thing preventing us from falling far further down the list...maybe it is, but I personally doubt it.

 

[Mutterkuchen]

There are not many people who could legitimately argue that if they had a medical problem, they would rather have it treated in the British National Health Service than at the Mayo Clinic, or even any state university medical center in the US.

There are not many Americans that would argue that. Mostly because they have not been treated anywhere other than America. The Brits thing that they have the best heath system, the Germans also think that Germany has the best system. Call it national pride.

The biggest and only real argument with universal healthcare is that doctors might get paid less. Countries with universal care have better outcomes, and spend 1/2 to 1/3 of what we spend per capita.

But at least American doctors are super rich!

 

[Mutterkuchen]

Also, dont think as a US MD grad you're not being protected...we get preference in the match even though, if you think about it - an Indian overcoming the thousands of hurdles to land a community IM or FM spot in the US is almost certainly objectively more academically gifted than most of us americans in competitive specialties.

Plus we graduate 15,000 US medical students per year. We have over 20,000 residencies. Where are they going to come from?? Trees?

 

[Solideliquid]

There are not many Americans that would argue that. Mostly because they have not been treated anywhere other than America. The Brits thing that they have the best heath system, the Germans also think that Germany has the best system. Call it national pride.

The biggest and only real argument with universal healthcare is that doctors might get paid less. Countries with universal care have better outcomes, and spend 1/2 to 1/3 of what we spend per capita.

But at least American doctors are super rich!

Wow when did this start happening??

 

[pillowhead]

The Brits thing that they have the best heath system,

I think you'll find that most British people think that their health system is terrible. I was born there and still have most of my family there, and if any of them had serious health problems, I'd tell them to get over here immediately.

 

[Mutterkuchen]

I think you'll find that most British people think that their health system is terrible. I was born there and still have most of my family there, and if any of them had serious health problems, I'd tell them to get over here immediately.

Terrible is a very strong word. . . I don't believe that. Although I grant you that the fact that Brits spend less than 20% per capita than the US, probably enhances this perception.

And I also think that if you ask the Brits, Canadians, Spaniards, etc. if they would exchange their system for a system resembling America's, you would get a resounding NO.

 

[f_w]

The UK has just changed the law to say that hospitals can only pick overseas medical graduates if there is no local candidate who can do the job and if there is no local candidate, they must pick an EU graduate.

For the longest time, the UK medical system had difficulties filling their training positions. As a result, the system was relatively open for non-UK medschool graduates (and had a waiver of some of the usual requirements for a work visa. the shortage of physicians was universal and the immigration authorities didn't want to waste everyones time with unneccessary red-tape)

In recent years, there have been some changes in the structure of UK residency training. Away from the classic 'house officer' --> 'senior house officer' --> 'registrar' pattern to a 'foundation year1+2'--> 'registrar' system. Somehow, they f#)ed up their numbers for the required positions, and as a result for the first time there were UK medschool graduates unable to find training positions. Further aggravating the problem is the fact that the number of UK medschool graduates was recently increased.

The fact that UK citizens and medschool graduates became unemployed gave the labor department reason to rescind an exemption which allowed the NHS to hire medical trainees without the usual certification that no brit was available for the job. EU nationals on the other hand have to be given the same access to jobs that a UK citizen has. Freedom of movement for the labor force is one of the basic concepts of the EU contracts (so no, this is no evil conspiracy against pakistanis and indians, this is part of the contracts that allow the UK to buy and sell goods in the common market free of tariffs).

As long as the US has a net need for foreign trained physicians (24k residency positions vs 18k medschool graduates), I don't see this happening here. For a US graduate to not find a residency position, he or she has to be stupid, lazy and have the personality of a dead squid. Everyone else will find a residency (maybe not in their specialty of choice, but they all find something).

 

[pillowhead]

Terrible is a very strong word. . . I don't believe that. Although I grant you that the fact that Brits spend less than 20% per capita than the US, probably enhances this perception.

And I also think that if you ask the Brits, Canadians, Spaniards, etc. if they would exchange their system for a system resembling America's, you would get a resounding NO.

okay, maybe not terrible, but how about "very bad"? As in, being told that once you're 65 years old, you don't need mammograms anymore because if you haven't gotten breast cancer by then, you probably never will. My aunt's GP told her that last week.

I do realize this is just one anecdote, but if you flip through british newspapers, you will see this kind of thing again and again and again. I would say that in general, you get better care in the US if you live in a major urban area with a decent county hospital even if you are uninsured or on medicaid. For those in rural areas with fewer public services, things may be different. And of course, it always sucks to be the one in between who earns just enough not to qualify for medicaid. But overall, I still think most people are better off in the US despite some exceptions.

 

[spalatin]

Terrible is a very strong word. . . I don't believe that. Although I grant you that the fact that Brits spend less than 20% per capita than the US, probably enhances this perception.

And I also think that if you ask the Brits, Canadians, Spaniards, etc. if they would exchange their system for a system resembling America's, you would get a resounding NO.

Guess you missed the first ministers meeting in Halifax two years ago. Ottawa started this marvelous system 30 years ago, raised taxes and made new ones, so that the national government could tell the provincial ministers what they could and could not due for health care. Then Ottawa ran out of money and gave the program to the provinces who, also have no money. There is a good reason why all the Canadian nurses and doctors living in border towns decided to work on the US side of the border and why many hospitals in border cities get many Canadians in their clinics and pay cash. And it ain't because their healthcare system is rosey either.

I don't think a resounding NO is what you would hear from many Canadians, providers or consumers. BTW does anyone else think that health care involves doctors and patients instead of providers, guests, clients, customers? Just wondering?

 

[Mr. Peanut]

See, it does look bad on the surface. On the other hand they are putting their citizens first. Which IS something I would like to see in this country, altough not at the extreme level reached by England.

How in the world is this "putting their citizens first?" It seems they are putting their Doctors first, in that UK docs won't have external competition for their jobs... but, that seems likely to make the situation WORSE for the average citizen, since it would seem to me that the competition would likely benefit them.

 

[wook]

And I also think that if you ask the Brits, Canadians, Spaniards, etc. if they would exchange their system for a system resembling America's, you would get a resounding NO.

My relatives in Canada come to the US for their medical care; they do not want their care in Canada. This is only an n=2, though (ie small sample size).


Wook

 

[driedcaribou]

Imagine how much outcry there would be if the US did a similar thing.

The US already does something like this now.

You have to write the Step 1, 2 and perhaps even 3 before you can work in the US even if you are already qualified and practicing attending/consultant in your home country.

Every country has its own rights to protect their own doctors.

 

[Retinamark]

True, the US makes it tough, but the important difference is that it is a merit based system - if you are good enough, you can get a job

This new UK rule means for example that an outstanding, gifted american physician who applied for a fellowship at Moorfields Eye Hospital would be passed over for a below average local candidate. That does not benefit patients.

 

[dnw826]

Imagine how much outcry there would be if the US had year-long waiting lists for life-saving, time-sensitive surgeries, have treatments rationed, and had to sue their government to get the latest chemotherapy.

The reason the US has the most advanced medicine in the world (though it unfortunately does not reach all people) is because we are a capitalistic, competitive society where anyone who is smarter or more technically skilled can enter your field regardless of where they were born.

So if people want authoritative laws dictating what nationalities can practice medicine, move to Britain and become a general practioner making about 1/4 of what you make now-- because for better or for worse, the current system has made America vastly superior to Britain in medicine and science.

Oh, and Im a white male

Hold on, I read that France, I believe, has the most advanced medicine???

 

[f_w]

So if people want authoritative laws dictating what nationalities can practice medicine, move to Britain and become a general practioner making about 1/4 of what you make now-- because for better or for worse, the current system has made America vastly superior to Britain in medicine and science.

Actually, the GPs in the UK make allright money. Not all physicians in the US are 'crazy rich', there are enough primary care people who make less than USD 150k. Compared with that, 60-80k GBP is certainly not 1/4 (given the level of goverment provided services like basic healthcare and subsidized education, one could argue that 80k GBP is about the same as 150k USD).

Hold on, I read that France, I believe, has the most advanced medicine???

If you talk to the french, you will hear them bitch about it. But you don't see them seeking care in the US or neighbouring european countries (unlike wealthy brits and spaniards for example). French medical research is certainly underrepresented in the english language literature, but plenty of innovative stuff came out of france before it made it to other countries and finally the US.

 

[HA123]

The US already does something like this now.

You have to write the Step 1, 2 and perhaps even 3 before you can work in the US even if you are already qualified and practicing attending/consultant in your home country.

Every country has its own rights to protect their own doctors.

And to protect their own citizens. Licensing requirements are not only to protect U.S. doctors from competition. They also exist to ensure public safety.

 

[Gregg]

okay, maybe not terrible, but how about "very bad"? As in, being told that once you're 65 years old, you don't need mammograms anymore because if you haven't gotten breast cancer by then, you probably never will. My aunt's GP told her that last week.

I do realize this is just one anecdote, but if you flip through british newspapers, you will see this kind of thing again and again and again. I would say that in general, you get better care in the US if you live in a major urban area with a decent county hospital even if you are uninsured or on medicaid. For those in rural areas with fewer public services, things may be different. And of course, it always sucks to be the one in between who earns just enough not to qualify for medicaid. But overall, I still think most people are better off in the US despite some exceptions.

As opposed to the HMO doc in California that told my 65 year-old mother with anemia to take iron pills and didn't order a colonoscopy (she'd never had one, and her father died of colon cancer)? So, a year later (on different insurance and with a different doc) she finds out she has colon cancer and had surgery and just finished the 2nd round of chemo due to recurrance of cancerous cells. Her 80 year-old sister in England has no complaints with her health care, and my cousin with some strange neurological disorder has no complaints with his care, either.

 

[driedcaribou]

And to protect their own citizens. Licensing requirements are not only to protect U.S. doctors from competition. They also exist to ensure public safety.

Agreed.

I also agree with someone's other comment that the US is merit based and if you're good enough, you can get work.

 

[notdeadyet]

Perhaps you are not aware that the UK healthcare system recruited and saught out the help of foreign doctors. They had a physician shortage and ASKED those people to come into the country (not that they didn't want to).

Now they are asking them to leave, casting them off because they have more medical graduates from UK schools.

This is how overseas recruitment ALWAYS works EVERYWHERE. It's always seasonal employment. In some places it's seasonal by decades (70s/80s the middle east hiring American pilots) in others by time of year (seasonal fruitworkers in parts of the US). No one who went to the UK as a physician expected to retire there.

 

[LADoc00]

See, it does look bad on the surface. On the other hand they are putting their citizens first. Which IS something I would like to see in this country, altough not at the extreme level reached by England.

This will happen one day in the US. The first step would be to exclude IMGs from the match until all US graduates have scrambled. This is common sense, no idea why it hasnt been implemented so far....

As for not being able to go to the UK, boo Fing hoo, like someone would even want to go there and get paid equivalent of 20 bucks an hour+government cheese! I applied to the visiting NHS scholar thing and the offers were so piss poor, I would have been better off doing pharma research...

 

[LADoc00]

Hold on, I read that France, I believe, has the most advanced medicine???

LOL, advanced? I havent met a French investigator yet in my field (Pathology) who does more than repackage US clinical/basic science research with an attempt at pawning it off as his own in a French language perodical....

 

[Solideliquid]

This will happen one day in the US. The first step would be to exclude IMGs from the match until all US graduates have scrambled. This is common sense, no idea why it hasnt been implemented so far....

As for not being able to go to the UK, boo Fing hoo, like someone would even want to go there and get paid equivalent of 20 bucks an hour+government cheese! I applied to the visiting NHS scholar thing and the offers were so piss poor, I would have been better off doing pharma research...

Well no, a large chunk of IMGs are US citizens so there you go. And most programs ALREADY choose AMG over IMGs, as IMGs get the last pickings so the system is in place already.

Sometimes I wish there was a pill for arrogance. Solve the worlds problems.

 

[f_w]

This will happen one day in the US. The first step would be to exclude IMGs from the match until all US graduates have scrambled. This is common sense, no idea why it hasnt been implemented so far....

Because it would turn the US into canada (take the worst canadian before taking the best qualified FMG).

 

[LADoc00]

Because it would turn the US into canada (take the worst canadian before taking the best qualified FMG).

Always curious, how do you judge the "best qualified" residency applicant?? Board scores, grades? Personality? Overall ability to suck up?

This is a labor issue, pure AND simple. The medical community in the US should have stepped in long ago to ensure we arent flooded with foriegn degrees who's main purpose is to provide large HMOs and goverment healthcare facilities with cut-rate practitioners.

On one hand, you have to admire fields like derm who keep supply LOW in order to offer better work conditions for its specialists. Others would be well advised to look at their example.

 

[f_w]

Always curious, how do you judge the "best qualified" residency applicant?? Board scores, grades? Personality? Overall ability to suck up?

I don't know. I mean there is clearly not discernible difference between the caliber of people you will encounter in IM or pathology vs. the orthopods.

This is a labor issue, pure AND simple. The medical community in the US should have stepped in long ago to ensure we arent flooded with foriegn degrees who's main purpose is to provide large HMOs and goverment healthcare facilities with cut-rate practitioners.

And that is why FMGs make so much less than US grads, because they work at cut-rate prices. Clearly, bottom of the barrel FMGs like Elias Zerhouni should have never been allowed to dilute the US medical education system.


(btw. canada severely restricted the influx of foreign grads for many years and has a considerable undersupply in physicians. As you can clearly see, this did a great deal to improve the work environment for their physicians and things are near perfect now. Scores of suppressed US docs are just itching to move north, into the doctors paradise)

 

[LADoc00]

I think they should allow anyone who demonstrates "competence" to practice medicine. Screw medical schools AND residency. Lets have a complete free for all and NO immigration restriction either. Just the like hippies envisioned, free healthcare for all, so-called doctors can just live on love and air

I changed my mind, IMGs own! You win.

Hey you are soooo right, I think we should tell Zerhouni that the rest of Algeria should come on down, open the borders and all that. I hear the Medical University of Sudan is rocking these days, we could learn alot. What was I thinking, go go globalization!

Open dem borders and let everyone in, we have it too good, we must share. It's only fair.

 

[GeoJungle]

The UK has just changed the law to say that hospitals can only pick overseas medical graduates if there is no local candidate who can do the job and if there is no local candidate, they must pick an EU graduate.

I don't understand why would the UK cut their supply of physicians? They have large and growing shortage of MDs there. They face the same reasons for the shortage the US faces (aging population, more demand for care, etc.). The UK NHS also has a unique problem caused by the recent imposition of an EU work rule for resident hours. EU limits residents to a 48 hour work week! Holy ****!!! Residents in the past worked up to 120 hrs a week, like in the US system before its work rules.

This leaves many hospitals virtually denuded of physicians at night. Unfortunately, the NHS has responded, not by trying to hire or train more physicians, but by using nurses as MD replacements without any MD oversight. Lots of unhappy physicians (who believe in the idea of NHS, BTW) there due to this "dumbing down" effect on the quality of care.

 

[aredoubleyou]

though of this thread when i read this today

Study Shows Americans Sicker Than English

http://news.yahoo.com/s/ap/20060502/ap_on_he_me/sick_america

 

[f_w]

- because the brits are on average not as fat as the americans.
- taking a bus or walking to a grocery store are not considered to be signs of low socioeconomic class