Outsourced docs on the drip

For years, Indian doctors practically ran UK's National Health Service. Now, with
the new laws, they are being treated like interlopers.

By Our Correspondent

When the UK was short of doctors, the government advertised widely and invited thousands of them from around the world—especially from the Indian subcontinent (17,000 at last count) and Nigeria—to appear for the Professional and Linguistic Assessment Board (PLAB) exam. This is the basic medical qualification that stands up to UK standards. When I came to the UK in 2002 the exams were held only a few times a year. Now they are churning out ‘PLAB pass’ doctors almost every other week.

The consequent glut of outsourced junior doctors soon began irking their UK counterparts, who, since 2005-end, have been hard-pressed to find jobs.

But the General Medical Council that holds the PLAB exams continued holding them as usual. Then, earlier this month, the Home Office and the Department of Health issued a press release saying that doctors would not be allowed permit-free training any longer.

This was expected. What was not was that their ruling would apply equally to doctors who were already working for the National Health Service (NHS). In effect, what the government was saying was, “Thank you for your help, we are okay now, so get out!” It's not a pretty story. While it's the doctors from overseas who have kept the NHS going since its inception in 1948, the ruling would have them be treated as third class citizens and discriminated against when they are applying for future jobs. That means the overseas folks will now only be filling shunting jobs in the remotest corners of Scotland and Wales that the British don't want.

Doctors in training like myself might now be compelled to opt for less competitive specialties to train further, or relocate. The ruling, I feel, needs to be widely publicised in India, considering that so many Indian doctors still aspire to train in the UK. They should know that there are altogether too many of them already languishing there in worse than Third World conditions. They are without jobs, and some of them are so deeply in debt they can’t even afford the flight back home.
Dr Ajay Vijayakumar

The doctor who sent the above email, and thousands of others like him, are seeking a remedy. Will he find it? The most optimistic answer to that is: miracles occur.

You would need one if you consider the might of the opposition whose jobs are on the line—a fact that has caused extensive changes to be made in immigration rules.

The thousands of non-European doctors who once flooded the UK expecting a better life—and found it— will now need to produce work permits. Thus far, doctors from outside the European Union (EU), including from India, could take up National Health Service (NHS) jobs under 'permit-free' training schemes. It meant that their jobs were considered part of training and did not require work permits.

But now employers will need to obtain work permits before taking on these doctors, and have to prove that no British or EU doctor is suitable for the jobs on offer. This nearly obliterates any chance of non-EU doctors finding employment in the UK.

The 25,000-strong British Association of Physicians of Indian Origin has been holding public protests, claiming that jobless doctors are being forced to live off charity. They have been trooping into gurudwaras in London and elsewhere in Britain.

With the new rules hitting all those who had managed to find work in the NHS even minor jobs have been attracting applications from thousands of highly-qualified doctors. The government says it's helpless. Health minister Lord Warner said: "We now have more than 117,000 doctors working in the NHS, 27,400 more than in 1997, as well as record levels of doctors-in-training in UK medical schools. This investment and expansion, coupled with the reform of medical education, is leading to increased competition for medical posts as vacancy rates fall…We recognise that international doctors have made a huge contribution to the NHS. However, increasingly the NHS will be less reliant on international medical recruitment."

The health department justifies the squeeze by arguing that both the needs and structure of the health service and medical training programmes had changed considerably, as also the immigration provisions for UK-bound overseas nationals.

"In addition," it says, "the number of places in UK medical and dental schools has increased, meaning that there are now more UK graduates seeking relevant training posts. There is therefore no longer a need for a specific category in the immigration rules to enable doctors and dentists to train in the UK for many years."

Even some British doctors are critical. J M Purcell, a Carlisle-based senior doctor, says: "In essence, this means that the doctors I have seen investing time, commitment and resources in the NHS stand to lose the opportunity to continue training here with no warning or chance to alter their plans. It will mean that doctors who have dedicated themselves to the NHS and begun to study for their UK postgraduate exams, but who were born in India, will be second choice to a Polish doctor who has no experience of the NHS. I have profound concerns about this unjust shift, which speaks volumes about the unfair way in which the immigration system operates in the UK and the high personal cost this has for individuals."

Now, over 6,000 doctors who passed the PLAB test may never find jobs; indeed not even have enough to return home. A General Medical Council survey shows that fewer than half of those who cleared the test in the summer of 2004 found work within six months, and a quarter were still out of work a year later. And things are only worsening. The British International Doctors' Association accuses the government of charging doctors hefty fees each time their visa is renewed. NHS trusts also charge doctors hundreds of pounds for just a few weeks' work experience, which improves their chances of finding a paying job.

Dr Ramesh, who qualified in Bangalore five years ago, says that he has applied for 100 jobs in anaesthetics, but has not been called for an interview since he cleared his PLAB test last September. Dr Rohit, 28, from Punjab, who passed the test a year ago and has made between 150-200 applications for clinical attachments—unpaid work experience—says, "I could just find one post, a three-week attachment which cost £100 (paid to the NHS trust), plus £50 for the medical tests."

How much is the fare to fly back home?