Can I stay or should I go?

The British association of Physicians of Indian Origin (BAPIO) demonstrating outside Downing Street in April 2006

Kuan Eng, a 23 year old Malaysian, pays £25,000 (€32,000; $50,000) a year to attend St George's Medical School in London. He is one of hundreds of international students who are studying medicine in the United Kingdom. The Medical Schools Council, a representative body for all UK medical schools, says that 7.5% of all medical students in the UK are “international”—that is, from outside the European Economic Area.

Between them they contribute a substantial amount to university funds, and according to Ian Noble, chairman of the BMA’s medical schools committee, “they also bring a valued diversity of experience and talent” to UK universities.

But the future of this sizeable and vibrant community in medical schools was thrown into doubt by guidance from the Department of Health in 2006 that says that international graduates would only be able to take up postgraduate training posts in the National Health Service if there are no domestic graduates available to fill them.

Miscalculated policies?

The rapid expansion in the number of domestic medical students in the past 10 years has not been matched by a corresponding increase in NHS training posts. A spokesman for the Department of Health explained, “It’s a bit like having a bath running. There’s only a limited amount of water that can be run into that bath. At the moment in the NHS it’s looking like there is oversupply, so you’ve got to find a way of turning off the taps.”

In outlining the rationale for the change in the rules, the secretary of state for health, Alan Johnson, acknowledged the “invaluable role” that foreign doctors have played in the NHS: “They have helped us fill key shortage areas such as psychiatry, obstetrics and gynaecology, and paediatrics. But as the number of UK medical school graduates expands, there should be less need to rely on overseas doctors for these specialties.

“It can cost up to £250,000 to train a UK medical student, and, with the increase in UK medical schools, we are moving to a policy of self sufficiency. If UK medical graduates cannot access specialist training because of a large number of applicants from outside Europe, then it is only right that we should consider what needs to be done.”

The 8000 international graduates (students who graduated in medicine from non-UK universities) already in the United Kingdom will be considered for training posts in the same way as British and EU graduates. This means that applications for training posts will remain competitive for the next few years. There are about three applicants for every place in 2008. The Department of Health would have restricted applications from international graduates in the latter part of this year had the House of Lords ruled in their favour, said a BMA spokesperson.

The British Association of Physicians of Indian Origin challenged the guidance when it was issued, and the House of Lords just ruled in their favour, ending a long legal battle.

Good news for some

The good news that emerged recently is that the guidance explicitly excludes “those applicants who have completed a medical degree in the UK and who have been granted leave to enter or remain in the UK.” This exemption represents a victory for those who have campaigned for the rights of international students who graduated in the UK to compete for NHS training posts.

Mr Noble says that it would have been “morally indefensible” to “recruit international medical students to study in the UK on the understanding that they could work in the NHS afterwards, and then to turn around to those same people after they’ve forked out around £100,000 for the privilege and say ‘actually we’ve changed the rules and you’ve got to go home now.’”

In one respect, the rules are an improvement for international medical students, because the two years spent in foundation training now count towards the five years of continuous work needed to apply for permanent leave to remain. Previously this was not the case.

Doubts remain, however, over the immigration status of international medical students who are older than 30 by the time they complete their second foundation, says Mr Noble. These candidates may be prevented from applying for training posts, but it’s unclear how many people would be affected by these amendments.

Trouble down under

Like their UK counterparts, Australian medical schools have also traditionally hosted a substantial number of international medical students. In its 2008 intake, Sydney University had a quota of 45 international students out of a total of 274. The graduate entry course at Flinders University, Adelaide, meanwhile, has places for about 15 international students each year, out of a 2008 cohort of 120.

Tony Edwards, chairman of the Flinders’ admissions committee, says that about one third of international students who graduate in Australia choose to stay in the country for postgraduate training. This is organised on a state rather than national basis.

Australia has experienced a shortage of doctors in certain disciplines in recent years, and applying for postgraduate training has been relatively straightforward and successful for international graduates from Australian schools. The number of medical school places and domestic students has, however, been expanding. As competition intensifies international students may find it harder to get postgraduate training.

Sydney’s guidance to international students states that, “Australian trained international medical graduates may stay on and work as interns in public hospitals and access vocational medical training. This policy however is subject to change.”

       

 Printable version     Download PDF    E-mail this to a friend    Respond to this article