Posts Tagged ‘Overseas recruitment’

Government to cut overseas doctor recruitment

By Mike Broad - 17th November 2009 7:00 pm

The Prime Minister has announced that fewer doctors will be recruited from overseas.

Eleven consultant specialties are to be removed from the shortage occupation list that identifies gaps in the English labour market, making it harder to recruit doctors from outside the European Economic Area (EEA).

Specialties that will no longer be on the list include paediatrics, dermatology, immunology, plastic surgery, intensive care and renal medicine.

Doctors’ representatives warned it would reduce the NHS’s ability to recruit flexibly.

Dr Ramesh Mehta, president of BAPIO, said: “Mr Brown’s statement seems to be more for political consumption than being realistic.

“The NHS has not yet recovered from the immigration rules fiasco of 2006 - it wouldn’t be surprising if the rules are reversed quickly when the recruitment crisis gets worse.”

In his first major speech on migration in nearly two years, Gordon Brown agreed the Migration Advisory Committee’s (MAC) plans to reduce the number of posts on the shortage occupation list.

Seen as a response to the rise in anti-immigration sentiment, the Prime Minister said he wanted “rising levels of skills, wages and employment” for British residents.

Terry John, chair of the BMA’s international committee, said: “The immigration system must be responsive to the needs of the NHS, and flexible enough to recruit overseas doctors where they are needed. There are still hospitals that are unable to fill junior doctor and consultant vacancies.

“It is therefore important that changes to immigration rules do not damage our ability to recruit the doctors we need to staff our NHS.”

In Scotland, the MAC rejected evidence from Scottish ministers seeking to retain biochemistry, ophthalmology, oral surgery and ENT on the list of consultant shortages. Only consultant radiologists remain on the shortage list.

In England, the only training grade added was ST4 level in paediatrics. Dr Mary McGraw, vice president of training at the Royal College of Paediatrics and Child Health, welcomed the move. “There is a big crisis at that level. It’s when female trainees go on maternity leave, start working part-time and gaps are created.”

Trusts will have to prove they can’t recruit from the EEA before looking further afield for doctors in specialties not on the list.

Consultant specialities remaining on the list include audiological medicine, GUM, haematology, microbiology and virology, neurology, nuclear medicine, O&G, occupational medicine and paediatric surgery. In psychiatry, the disciplines of forensic, general, old age and learning disabilities are also included.

Just last week Hospital Dr reported on record numbers of junior doctor vacancies following WTD implementation.

And, in September, we reported on how the bureaucracy surround the Medical Training Initiative was delaying the recruitment of overseas doctors and causing service chaos.

Read a BMA blog on the issue.

Read the full list of shortage occupations in the Tier 2 category.

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Will immigration changes add to recruitment woe?

By Dr Shree Datta, chair of the BMA's junior doctor committee - 12:55 pm

Last week saw Gordon Brown get tough on immigration.

In the Daily Mail, we heard that the government was cracking down on immigration starting with a curb on doctors. Self sufficiency should be the goal of workforce planning, but are we really there yet?

My previous blog on rota gaps highlighted the problems many junior doctors have working on understaffed rotas and the fact, which even the Department of Health acknowledges, that part of the rota gaps problem is due to a previous crackdown on immigration.

Predicting the numbers needed to staff the NHS is complicated and whilst we may have competition for jobs in some parts of the country, other parts may have problems recruiting the doctors they need to deliver services to patients.

Earlier last week I was talking on BBC Radio Cumbria about the North Cumbria University Hospitals NHS Trust. This trust is recruiting junior doctors and consultants from India because they can’t find home grown candidates, which clearly illustrates the problem with a heavy handed approach to immigration. My worry is that this will affect the quality of care patients in the NHS are getting and the amount of training that junior doctors are exposed to - leaving them ill-equipped to be the consultants of tomorrow.

Of course, as with most government announcements, there seems to be very little policy behind the rhetoric but in his effort to sound tough on immigration Gordon Brown must not ignore the fact we need a flexible system that does not leave the NHS short of doctors.

The BMA’s junior doctors committee is working to ensure that international doctors are able to take up the posts they are offered without being hindered by the red tape that surrounds visa applications. With 2010 around the corner, it’s very much a case of watch this space to see how the immigration changes on top of the European Working Time Directive affect junior doctor recruitment.

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South Asian doctors deserve recognition for their contribution

By Mike Broad - 28th October 2009 1:15 pm

Migrant doctors have made a huge contribution to the NHS over the past 60 years and yet it has gone largely unrecognised.

In an attempt to rectify this, researchers at the Open University have carried out 60 interviews with retired and serving overseas-trained doctors from South Asian countries about their experiences of working as geriatricians in the NHS from 1948 to the present day. The interviewees obtained their initial medical qualifications in India, Bangladesh, Sri Lanka, Pakistan and Burma and at the time of the interview ranged in age between 40 and 91.

They all followed a longstanding tradition of migrating from South Asia to the UK. Several had lived and worked in India during the colonial period, with one remarking about his teachers that “most had royal college qualifications”. He explained: “I’m one of the Midnight’s Children - I was born in 1946 just before partition. So, the British influence was very much in the family and it was sort of ingrained. And then when you see your teachers they all had their British degrees behind their names…” (born in Bihar, 1946, arrived in UK in 1972).

From its inception, the NHS depended on recruiting staff from overseas. Immigration legislation in the 1960s and 1970s targeted migrants from the Commonwealth countries. Legislation on racial discrimination in employment, enacted in 1976, and growing concerns about staff shortages in the NHS also influenced doctors’ career opportunities.

Overseas doctors can be seen as a mobile army of labour, particularly in the lower rungs of the medical hierarchy and in the less popular specialties, among which was geriatrics.

A crisis of staffing in the 1960s meant that by 1974 over 60% of consultant geriatric posts were filled by overseas trained graduates. This compared with 3% in general medicine and 9% of all NHS consultants.

This workforce development was not always viewed positively. Professors of geriatric medicine wrote to the Royal Commission on the NHS in 1976 saying: “The present pattern of education of medical students, nurses and other health personnel in Britain does not reflect the needs of this high risk group…so that elderly people have grave difficulties in attaining the healthcare appropriate to their needs…This concentration of overseas graduates in what remains a low status specialty is undesirable on many grounds.”

Contrastingly, many of the doctors interviewed expressed great enthusiasm for the NHS. For some it matched their own value systems: “I had to stay here. And I was never going back. I had a lot to go back to, wealth, position, knowing people. I would have risen there then much better, financially much better…I hope they don’t change it… There is no institution like National Health.” (born in Bombay, 1927, arrived in the UK in 1953).

Many also appreciated differences in the way doctors worked in the NHS: “I had a very good relationship with the ward sister…here we saw nurses more or less as equal and they were not subservient and you asked for their opinion about things that they were good at. You didn’t tell them, you asked them. In the Indian scene…doctors were only for doctoring and so a lot of things, even maintaining notes, we had in our hospital, we had a separate person like a clerk who went round with us and wrote down in the notes, medical notes.” (born in Bangalore, 1945, arrived in the UK in 1973).

Geriatrics was a ‘Cinderella’ specialty. In the early days of the NHS, care of older people with chronic conditions was little more than tending and took place in the back wards of large municipal hospitals, ex-Poor Law infirmaries and cottage hospitals.

Patients might go for years without seeing a doctor and were often confined to bed permanently. The founders of the geriatric specialty attempted to change this situation, in part as a more humane approach to medical care and treatment in later life but also in response to a demand to find ways to release hospital beds for use by other patients.

The specialty’s poor image resulted in marginalised groups of doctors such as GPs, women returners and migrants being recruited.

The South Asian doctors’ accounts provide testimony to the prevailing attitudes of the time towards older patients: “Geriatrics came to occupy as a second class doctors doing second class service for second class clients. I would not accept that. When I first started becoming a consultant I started here. I used to get great wad of letters. ‘Will you kindly see this patient and advise’.

“They bloody well didn’t want my advice. They wanted me to remove the body blocking their beds. And I said to myself, I will never become a clinical undertaker. Never. I have learned some medicine and I want to practice it.” (born in Bombay, 1927, arrived in the UK in 1953)

The doctors interviewed found that opportunities for career progression tended to be limited - even today more than twice (42%) as many white as overseas non white (17%) doctors are consultants in the NHS.

Geriatrics did, however, offer a way to progress. Many of those interviewed followed the pioneers in this respect, often taking the advice of senior colleagues as this doctor recalls: “Because my consultant, who was exactly like me…he was a trained cardiologist and then there were openings in geriatrics so he quickly moved into that area and he said if you want to go through the fast track up then this is a less crowded road.” (born in Madras, 1958, arrived in the UK in 1996).

But professional advancement was not always the whole story. Also important was personal achievement for both doctor and patient: “It took me five years but I got him back to work…I’m not joking, I cried that day. I cried that day when that fellow - he was a butcher - I got him back to work.” (born in Kerala, 1941, arrived in the UK in 1968).

The South Asian doctors talked not only of the stigma of working in geriatric medicine but also of personal encounters with discriminatory practices. They tended to focus on three areas where, as outsiders, they experienced discrimination: in getting their first post in the UK; when attempting to get a post as a specialist registrar; and in the allocation of discretionary merit awards and consultant positions.

Some picked out particular instances where interviews were unfairly conducted, promotions denied and work went unrecognised. Opportunities to secure promotion in the more popular specialties were few, even for experienced, well qualified doctors as preference seemed to be automatically given to UK trained doctors.

“Well chances were nil. I mean let us not beat about the bush. In those days if in an interview you found a local graduate you might as well walk off. But you could only get if there were more than one or two, three posts and you were competing amongst yourselves.” (born in Haryana, 1947, arrived in the UK in 1975).

Many found it difficult to secure posts in London and the south east and instead opted to work in more peripheral areas such as the northwest and Wales and in non-teaching hospitals where there was perceived to be less competition from UK graduates.

Those interviewed were nearly all consultants and one way of measuring their success was through the receipt of merit awards. South Asians and geriatricians were far less likely to receive merit awards than white doctors in other specialties.

“I think the main reason, without trying to be critical, is that the geriatricians had a hard, heavy, workload, clinical workload and had little time left to do other extra work, like research, publications and in terms of giving awards these other aspects were given more importance than the guy who was providing sort of a bread and butter service.

“And without trying to be cynical, maybe old schoolboy ties and that sort of thing can play a part. But I better not say anything more than that!” (born in East Bengal 1935, arrived in the UK in 1967).

Developing service provision in hospitals often meant struggling for resources for the care of older people. And South Asian doctors helped develop the idea of age-related admission to a unit which focused exclusively on older patients, with doctors, nurses and medical students trained in old age medicine. Collaborations with GPs, social workers and other professionals were also seen as essential to improving service provision.

While this research examined the challenges of the mid to late twentieth century, many of the issues that the NHS and its doctors face today remain the same.

New immigration rules exclude many non-EU doctors from training in the UK but the introduction of the European Working Time Directive has led to staff shortages, reminiscent of the earlier period. And, of course, providing good care to an ageing population continues to be a pressing issue.  

The research makes a case for the need to recognise the achievements of international medical migrants in the past, and suggests they can help the NHS and its patients in the future.

It was led by Professor Joanna Bornat and funded by the Economic and Social Research Council.

Prof Bornat said: “We wanted to record and highlight the huge contribution these doctors have made in shaping medical provision in the UK, and their experiences of working in the NHS, before these first-hand accounts were lost forever.

“Their determination and dedication has meant that the quality of care for our older population has progressed at a truly tremendous rate.”

Find out more about this research.

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Doctor immigration delays causing service chaos

By Francesca Robinson - 16th September 2009 6:38 pm

Strict new immigration rules are creating problems with recruiting junior doctors from overseas and leaving hospitals short of staff.

Gynaecological services at Erne Hospital in Enniskillen, Northern Ireland, were suspended recently because only one of six new junior doctors recruited from the Asian subcontinent was able to start work on time. The doctors have been told it will take at least 9 to 12 weeks for their work permits to be issued.

“It is bureaucracy gone mad,” said Professor Mahen Varma, a cardiologist at the hospital.

In South Wales, the Abertawe Bro Morgannwg Trust has recruited nine middle grade doctors from India who are waiting the green light from UK immigration. The trust currently has 73 vacant doctor posts at all grades, according to figures collected by South Wales West Welsh Assembly Member Alun Cairns.

Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin (BAPIO), said they had heard of similar problems across the UK with the Working Time Directive making the situation even worse.

He said the problems related to bureaucracy created by the new Medical Training Initiative (MTI), launched in February, which allows international medical graduates (IMGs) to work in the UK for two years and then return home.

The immigration process involves paperwork from five organisations - the royal colleges, deaneries, the GMC, NHS Professionals and the Home Office. 

BAPIO has proposed that all the paperwork should be coordinated by the royal colleges. It has also asked for IMGS to be allowed to stay for longer than two years because it takes them six months to settle in and that they should be given more training under the scheme.

“The immigration process for IMGs is taking too long while hospitals have acute shortages of doctors. These people in their ivory towers should wake up and let these doctors come here and get on with some good work,” said Dr Mehta.

A Department of Health spokesman said: “We are not aware of any delays caused by immigration, however, we will respond to any issues raised with us.”

He said the royal colleges could never take over the role of UK Border Agency (UKBA) or issue the overseas visas. 

But he said the current length of leave for IMGs to stay in the UK and proposals to increase training benefits were currently under discussion.

“The DH continues to work closely with UKBA to ensure the MTI can bring maximum benefit to IMGs and the NHS,” he said.

It’s planned that MTI will provide 750 placements a year for IMGs.

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Discrimination fears for overseas doctors

By Francesca Robinson - 10th September 2009 8:13 am

An international doctors’ group is considering providing their own officials for the new revalidation process because they are so concerned about the level of complaints against overseas medics.

The British Association of Physicians of Indian Origin (BAPIO) says they have major concerns about the new system of responsible officers being appointed to relicence doctors because they are likely to be medical directors.

Responsible officers will have the authority to handle complaints locally about the conduct and performance of individual doctors and refer those who fall short of fitness to practise standards to the GMC.

BAPIO is concerned because they claim that most complaints to the GMC about international medical graduates (IMGs) come from professional colleagues and medical directors rather than patients.

A disproportionate number of overseas medics are referred to the GMC following fitness to practise complaints. The GMC has commissioned research to find out why this is occurring.

GMC fitness to practise statistics showed that, in 2008, 44% of initial complaints involving IMGs were classed as serious and led to a full investigation compared to only 29% of referrals for UK graduates.

Dr Ramesh Mehta, president of BAPIO, said “We have been wondering how we can assist IMGS and are actively considering expanding in a major way so that we will be able to provide responsible officers in the same way as other organisations.”

He said they were concerned that research commissioned by the GMC into the over representation of IMGs in fitness to practise proceedings had not yet reported because the problems are so serious.

“The issues are complex. Part of the problem is colleagues’ inability to understand the cultural background of international doctors. Although they speak good English, maybe the way it is spoken or maybe the interpretation by the people they work with could be a problem. Misunderstandings can crop up easily about diversity and there is also no doubt that some doctors still have a problem of racism. So there is no straightforward answer to this.”

He said IMGs also lacked support from potential representative organisations. He said in a recent case a BAPIO member, who was refused support by other groups, took a grievance against a deanery and the Department of Health to an industrial tribunal. Initial advice suggested the doctor should accept financial compensation instead, but BAPIO took on the case and they won at tribunal.

“We know of several other cases like this where things could have been really different. We get at least one or two cases like this a week where the organisations who should have supported the IMGs locally have failed to do so,” said Mehta.

A BMA spokesman said: “This something we are concerned about but it is difficult to speculate about the reasons why more international doctors are referred to the GMC. The statistics are worrying. Whether procedures are more difficult or less sympathetic for these doctors, combative language such as accusing the medical director of racism makes things escalate or whether these doctors don’t have the infrastructure or networks that UK colleagues have needs looking at.

“But we need to see the GMC research before we can make any changes in policy.”

A GMC spokeswoman said the study, commissioned from the Economic and Social Research Council in November 2007, is due to report later this year.

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Advice for hospital doctors wanting to work abroad

By Mike Broad - 7th September 2009 6:33 pm

One of the great benefits of being a doctor is the development of geographically transportable skills. UK-trained doctors are often in demand in other countries, and many will consider working overseas - at least temporarily - at some point in their medical career.

Not only does it benefit the health system of country being visited, but it broadens the doctor’s experience and contributes to raising standards in the NHS upon their return. But it isn’t for everyone and there are many issues to consider when looking to work overseas:

1. Doctors should be clear in their own minds why they want to work abroad, which country would suit them and what role they want to perform? It makes finding the right job a lot easier. They should remember that less popular medical jobs in that country are going to be easier to secure.

2. Talk to another doctor who has been there and done it.

3. Research the move abroad thoroughly before signing up. Understand the medical system in the country you’re visiting and where you would fit in. UK training grades may not have an exact equivalent in another country. Get as much information as possible about the duties and responsibilities of the position and training structure.

4. Assess the procedural requirements of working in that foreign country - they vary a lot and can be extensive (see below).

5. Check the terms and conditions of employment. The last thing a doctor needs when they turn up in another country is a series of nasty surprises about pay, working hours, rotas and holiday entitlement. Get everything in writing first.

6. Doctors should assess the implications for their careers of working abroad. Doctors are generally advised to complete foundation years one and two sequentially before working abroad. Specialist and general practice training programmes in the UK are only open to those who have acquired and demonstrated foundation competencies.

7. Where should a doctor look for a job overseas? Check the jobs websites in the UK, such as the BMJ; check the international organisations that facilitate overseas recruitment; and check the recruitment agencies and jobs boards in the country of destination, for example the Medical Journal of Australia. 

So, a hospital doctor works through these issues, applies for a job abroad, gets it and then makes ready to go. What do they have to do before they go overseas?

1. Junior doctors should talk to their postgraduate dean, royal college and PMETB if they want their overseas work to count towards their training in the UK.

2. Taking time out of specialty training has to be agreed with the postgraduate dean. It will not normally be agreed until a trainee has been in a programme for at least one year.

3. Specialty registrars must establish whether their NTN will be held for them. Prospective training approval must be received from PMETB and the requirement for annual review must be satisfied.

4. A doctor working abroad will have to take out separate indemnity insurance. UK-based defence bodies can advise you about the overseas cover they offer.

5. A doctor going to work in a foreign country must protect their pension in the UK. They should talk to their current HR team or, if a BMA member, read advice on its website.

6. It is also worth checking with their GP on what immunisations are required, and consider private health insurance if not included in terms and conditions of employment.

Immigration requirements

Enquiries about immigration should be addressed to the appropriate High Commission or embassy in the UK. A directory of foreign embassies in the UK is available from the Foreign and Commonwealth Office.

What is generally required before starting an overseas job?

1. A visa allowing the doctor to work in the country. 

2. A medical. 

3. Evidence of current registration.

4. Certificate of good standing from current and previous registration boards.

5. Degree certificates.

6. References from senior medical colleagues. 

7. An English language test. 

8. Registration with the country, state or territory Medical Council or medical licensing authority.

9. A letter of appointment from your new employer. 

Australia - registration and implementation

Registration without conditions enables doctors to practise unsupervised. It is only available to UK trainees who have applied for migrant status and have completed the Australian Medical Council examinations and a period of approved training.

Registration with conditions is available to overseas medical graduates who will be temporarily in Australia to work in one of the following areas: postgraduate training, supervised training, teaching or research, public interest or areas of need, such as positions or locations where there are shortages. The types of conditions vary depending on the category of registration and the individual doctor.

The preferred temporary visa pathway for doctors is the Temporary Business (Long Stay) visa (Subclass 457) which has a streamlined application process. In order to apply for a visa you must first find a post, you will also need to provide evidence that you are eligible for registration with the appropriate State Medical Board.

There are lots of locum agencies specialising in employment in Australia. Many doctors find that once they have been offered a post, the employer will organise their registration and a visa for them.

For further information visit: the Department of Immigration and Citizenship’s website and Doctor Connect.

Other sources of jobs include:

Mediventure; Queensland; Tasmania; Flying Doctor; Seek jobsite

Canada - registration and immigration

British medical graduates must establish professional competence. Each province has a licensing authority, which will require UK doctors to pass the Medical Council of Canada Evaluating Examination (MCCEE), administered by the Medical Council of Canada (MCC). This is an exam for international medical graduates which tests general clinical competence in comparison with graduates from Canadian medical schools.

Employment authorisation and a work permit are needed from the Canadian High Commission and doctors have to have a medical examination.

Once the MCCEE is passed, doctors can take the MCC Qualifying Examination (MCCQE) Part 1. This is a one-day computer based test assessing an individual’s competency for entry into supervised clinical practice in postgraduate training programmes.

Quebec has separate immigration procedures.

New Zealand - registration and immigration

In New Zealand there are no registration categories. Instead, doctors are registered in a ’scope of practice’. Your scope of practice will depend on your qualifications, experience and the purpose and duration of your employment in New Zealand.

All new registrants, regardless of seniority, must work under supervision for at least their first 12 months in New Zealand to become familiar with the culture.

Registration is only granted when a doctor has a confirmed job offer under supervision in an approved hospital, practice or educational institution. The registration application should be submitted to the prospective employer, who will check it and send to the Medical Council of New Zealand with a supporting application.

Registration and the NZREX examinations - which doctors have to sit if they don’t meet the scope of practice - are regulated by the MCNZ. If the doctor intends to stay less than three years in New Zealand, they should apply for a temporary work permit.

Jobs are advertised in the New Zealand Medical Journal.

USA - registration and immigration

UK trained doctors need certification from the Educational Commission for Foreign Medical Graduates (ECFMG) in order to be eligible to enrol in a GME program and eventually apply for licensure to practice medicine.

To proceed towards ECFMG certification, the doctor’s medical school and the year that they graduated must be in the International Medical Education Directory.

The doctor will need to satisfy a Medical Science Examination Requirement and Clinical Skills Requirement. Visit the ECFMG website for full details.

Employment visas are usually not issued until you have obtained ECFMG certification. Temporary visas are available as an Exchange Visitor (J1), for those taking an appointment under an officially approved programme and sponsored by an educational institution, and as a Temporary Worker (H1), for those working in a highly skilled job for which there is no US worker available. This must have prior approval by the Immigration and Naturalization Service. The ECFMG is authorised to sponsor foreign national physicians for the J-1 visa. Read more

They are only issued to doctors who have a letter from the Department of Health, confirming that they will return to the UK on completion of their training. Visit the AMA website for comprehensive information.

More detailed information on residency programs is available from the AMA’s FREIDA Online database (Fellowship and Residency Electronic Interactive Database Access).

Developing world - useful links 

The Department of Health’s code of practice for the international recruitment of healthcare professionals.

Médecins Sans Frontières is an independent humanitarian medical aid agency providing emergency medical relief to the victims of natural and non-natural disasters.

Médécins du Monde UK is a medical, humanitarian, non-governmental organisation which relies on volunteer health professionals to participate in its projects throughout the world.

Medical Emergency Relief International’s aim is to improve the health of populations affected by conflicts, natural disasters, epidemics and health systems collapse.

RedR builds the skills of local people and communities in areas of disaster.

VSO is an independent development charity that works through volunteers.

Europe

For information on working as a doctor in Europe read the BMA guide Opportunities for doctors within the European Economic Area.

Further sources of advice:

The BMA’s guide to working abroad

Support4Doctors

Advice from Southampton University Hospitals NHS Trust

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Safety fears as European doctor numbers revealed

The Telegraph - 12:30 pm

Of more than 20,000 EU doctors registered to practice in this country, 4,061 have arrived since safety checks were removed five years ago.

The figure comes amid increasing concerns about the lack of scrutiny of medics who migrate to this country.

Figures from the General Medical Register show that among the foreign doctors registered to work in the UK, more than 5,000 are from former Eastern bloc countries.

Of those, the greatest exporter was Poland, which trained 1,800 medics now on the British register, followed by Hungary, which sent more than 1,000. More than 700 came from the Czech Republic and almost 800 from Romania.

Under an EU directive passed in 2004, doctors who qualify in any EU state can move to work in any other member state without tests of their language skills or clinical competence - even though experts last night warned that there is little consistency in the medical training, treatments and medications used across Europe.

Read more at The Telegraph.

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Crack down on incompetent European doctors

By Francesca Robinson - 27th August 2009 10:35 am

The GMC is calling for all doctors coming to work in Britain from Europe to undergo tests to prove they are fit to practise in this country.

The issue is being raised with European Commission following the case of a German doctor who killed a patient after giving him an overdose of a painkiller on his first UK weekend shift as a locum GP.

Last week Hospital Dr reported the concerns of consultant anaesthetist Dr John Hutchinson who is campaigning for a new agency to be established to monitor foreign locums and provide them with professional support when they are in the UK.

GMC chief executive, Finlay Scott, told The Guardian that the current system did not guarantee the level of patient safety that the UK required. He is calling for European doctors to undergo the same stringent language and clinical knowledge tests that are required of doctors from outside the EU before they can work in the UK.

“We have to persuade the EU to change its long standing policy so we can test knowledge and skills at the point of first registration,” he said.

Dr Hutchinson, head of the department of anaesthetics at Hereford County Hospital, has written to the Royal College of Anaesthetists outlining his experience of employing two foreign locums whom he had to swiftly sack because of their clinical incompetence.

One of the doctors was a young paediatric neuro-anaesthetist from Eastern Europe who had poor standards in both spoken English and clinical decision-making.

He said he and many of his colleagues have frequently had to reject locums applying for posts following conversations about their competence with previous employers.

“If my experience is reflected across all acute specialities around the NHS, there is a colossal clinical governance issue,” he warned.

Dr Hutchinson is proposing that an agency should be set up by the royal colleges, the Department and Health and NHS Employers to provide foreign doctors with advice on how the NHS system works before they leave their home countries.  It could also give them an objective assessment of their clinical competencies and provide those whose skills are not up to scratch, a period of clinical attachment prior to starting paid work.

“I appreciate that this is a major undertaking and will require funding but I believe that it is overdue,” said Dr Hutchinson. 

A Department of Health spokesperson said: ”In line with European policy the UK is required to recognise professional qualification of EEA nationals throughout the European Union.

“NHS organisations have a legal duty to ensure that all doctors are fit to practice and deliver services to the required standard. To do so they would be expected to look at professional experience to ensure that an individual would be fit for the role not just their qualifications.”

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CV writing and job interview advice for doctors

By Mike Broad - 29th May 2009 7:48 pm

The first step for a doctor to get a new job is to write a strong CV. A doctor’s CV will often have less than a minute to convince a recruiter of their suitability for a role in a competitive specialty. A doctor’s CV must be concise, well designed and easy to skim read in search of important information.

Application forms

Increasingly electronic application forms are requested for NHS job applications. These do not replace the well written CV and it is standard pratice for doctors applying for a role to send a CV in advance, or bring a CV with them when visiting the hospital prior to interview. Standardised application forms include all the usual sub-headings of a CV but will also include interview-type questions on leadership, management, personal strengths and weaknesses.

Medical CV structure

1. Title page: name and qualifications only.

2. Personal identity (full name, date of birth, nationality, sex).

3. Professional memberships (GMC, royal medical college, NTN, CCT date, indemnity number).

4. Contact details (postal address, telephone, email).

5. Qualifications (dates, institution, location).

6. Education (dates, institution, course, prizes, other achievements).

7. Prizes and presentations.

8. Current position.

9. Work history (date, position, employer, supervising consultant, duties and achievements – all in reverse chronology).

10. Summary of skills and achievements.

11. Courses and conferences attended.

12. Research.

13. Publications (original papers, reviews, chapters and abstracts in that order).

14. Teaching (training and experience).

15. Audit (training and experience).

16. Management (training and experience).

17. Leisure interests and activities.

18. Career intentions.

19. Referees – names and contact details of three people.

Common mistakes made by doctors in their CVs

At the top of the list of CV mistakes is poor spelling, grammar and typos. Doctors must spell check their CVs. They should also ask a friend, colleague or mentor to proof read the completed CV.

Doctors should also be careful not to make the CV too duty-oriented, at the expense of outlining the individual’s experience and achievements. Applicants should avoid long paragraphs and use concise bullet points instead.

Other problems include inaccurate or missing contact information, poor formatting, long-winded paragraphs and inappropriate personal information.

The doctor should ensure the CV is written in active language and competently printed on white paper. It is unnecessary to have the CV professionally printed on thick paper – the candidate is going to be judged on the words and how they’re presented.

A doctor’s covering letter

The doctor’s covering letter should be tailored to the role. It should convey the doctor’s interest in – and suitability for – the job. It must be both informed and enthusiastic about the role, team and employing organisation. The recruiter must be left in no doubt on what the applicant would bring to the role and how that separates them from others. It should be no longer than one side of A4 paper.

Job interview preparation for doctors

Medical interviews should not be taken lightly. They are demanding at all levels, seeking to assess a doctor’s character, attitudes and flexibility of thought as well as their medical expertise. The panel format (typically eight to 12 people) can also be intimidating for some. Many good doctors have failed to secure the role they wanted because of poor preparation and interview technique. Planning and preparation can significantly improve a doctor’s chances.

Interviewers’ objectives in a medical interview

They are seeking to appoint the right doctor for the role, and a colleague they can envisage working with. To do this they will examine a doctor’s motivations, career aspirations and potential, technical competence, team working abilities and professionalism.

For a consultant interview, the panel will also be looking for a doctor’s ability to work independently, work with managers, lead a team and move the service forward.

Getting prepared for the interview

The formal interview is not the chance to find out more about the job – the doctor should already have done this. Clarity is needed on the following issues:

1. Yourself: a doctor should be clear on their ambitions, priorities, and clinical and outside interests.

2. The role: review the person specification in depth and detail all of the key competencies, personality skills and clinical skills required. 

3. The organisation: find out about the department, hospital and trust. Doctors should visit its website and read the annual report or executive summary. They should visit the team in person and ask lots of questions about the role and service, and talk to any contacts who have worked there. Doctors should understand the team’s and organisation’s history, activities, strengths and weaknesses and future direction.

4. The interview panel: the interviewee should find out, if possible, who will sit on the panel. For a consultant interview there will be at least seven members potentially including the trust chair, chief executive, medical director, lead clinician from the team, college representative, academic representative, patient representative and a member of the HR team. It is worth exploring the clinical interests of the medical members.

Candidates for consultant roles should ensure that they meet the chief executive, medical director, clinical director, as well as the current consultants in the relevant team in their visits to the trust. They may also wish to meet allied health professionals as well.   

Commonly panel interviews take a structured approach, with each interviewer taking it in turn to ask questions.

5. Specialty issues: read relevant medical journals closely for three to six months preceding the interview, and are aware of any recent NICE or MHRA guidance.

6. Wider NHS issues: read non-clinical magazines, such as HospitalDr.co.uk and BMA News, to understand the current professional debates. Doctors should understand the current change agenda including the modernisation of services, Lord Darzi’s review, revalidation, changes to training and Foundation Trusts.

Practicalities of getting to the medical interview

It’s commonsense to check the employer’s location and travel details well in advance. Also find out where the interview is being held within the building beforehand. On the day of the interview travel early, or even consider the night before, and ensure that you don’t have to ‘cram up’ on information you should already have read.

Doctors’ presentations at interview

Doctors may be asked, in advance, to give a formal presentation as part of the interview process. Check what equipment will be available on the day and prepare appropriately. Make sure it is professional and formally delivered, but with pace and enthusiasm.

Answering questions at interview

There will be several candidates for the job. The applicant who is successful will be the one who is distinctive, enthusiastic, has something interesting to say and shows potential.

Doctors should not simply answer the question. They should also sell themselves. Doctors should populate their answers with real examples from their working life. They should also remember to demonstrate their understanding of the role, team and organisation in their answers. 

Be positive wherever you can. Panels like positive people. So when a doctor is asked about changes in the NHS, they should start their answer by stressing why change can be good before being more critical.

Rehearse strong answers on your skills, strengths and weaknesses (finding a positive way to frame your answer), experience and motivations. Draw up a list of other potential questions and think through answers – but don’t sound too pre-rehearsed.

First impressions

Initial impact is important. Doctors should dress smartly and be well groomed – they will never regret buying a plain suit. They should take a deep breath and calm themselves before entering the interview room. Candidates need to be confident. Close the door behind them.  Smile. Respond to offered handshakes firmly and sit quietly but alertly for the opening question. 

Positive body language is also important. The doctor should be responsive, leaning slightly forward, open arms, nodding. They should listen attentively and keep eye contact.

Style of response

The interviewee should look at the person questioning them and direct answers to them. They should glance around to engage the whole panel. Speaking slightly slower than normal is a good technique, and their voice should show their enthusiasm for medicine and the role. 

If they ask you whether you have any questions at the end, either ask a good one or don’t bother. Don’t ask one for the sake of it and avoid ones about terms and conditions. In a consultant interview, you should – from your previous visits – know the service ambitions of the chief executive or senior clinical representative and you could consider asking a more strategic question about those issues. At the end thank the panel for their time and leave in a smooth manner.

Practice makes perfect

Take time to practice. Try your ‘stock’ answers out in the mirror first and then on a colleague or mentor – preferably one involved in recruitment. If you’ve been asked to do a presentation, also run it past a friend or colleague as well. It’s the only way to still be able present yourself to the best of your abilities when you may be suffering from nerves.

Type of questions asked in a doctor’s interview 

A search of the web will reveal lists of questions that typically get asked in medical interviews for both juniors and consultants. 

Accepting failure and learning from it

If the doctor doesn’t get the job they should ask for feedback. However disappointed a doctor feels they need to learn from the experience and then try again.

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Exploitation risk for overseas trainees

By Francesca Robinson - 28th May 2009 4:17 pm

Employers are being warned not to exploit overseas junior doctors taking up new training placements in the NHS through the new Medical Training Initiative (MTI).

The MTI, which provided 250 two-year placements for doctors from developing countries last year, is now being expanded in stages to provide up to 750 opportunities.

Dr Ramesh Mehta, president of the British Association for Physicians of Indian Origin (BAPIO) fears the scheme could be used as a mechanism for filling posts left vacant following the April 2006 immigration ruling that led to the exodus of thousands of international graduates.

“The Department of Health should come clean on the service needs that have made such an initiative necessary. BAPIO’s policy has always been to press for proper workforce estimations and allowing the required number of overseas doctors to enter the UK and then giving them the opportunity to make progress by treating them on merit,” he said.

Dr Mehta said employers must ensure that MTI doctors are given proper induction, mentoring and training and the same pay as UK trainees to ensure they are treated fairly.

“Also it is important that it is made clear to these doctors at the outset the details about their prospective jobs and that this training will not lead to further career opportunities in the UK and that their training may be aborted if they do not demonstrate necessary competencies,” he says.

Juniors are voicing similar concerns. Delegates to the BMA’s recent Junior Doctors Conference, who noted that the scheme has striking similarities to the Permit-free Training Visa, passed a motion calling on the government to ensure that training places are genuine and of high quality.

Health minister Ann Keen said the MTI will enable international medical graduates from countries where medical training was not widely available to secure “vital” training and work experience in this country.

BAPIO’s view on the issue

 

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