Refugee doctors—a valuable resource

Requalifying in the United Kingdom

The estimated cost for courses and exams to requalify in the United Kingdom is £3500, which compares favourably with the cost of training a medical student (£200 000). In order to practise in the United Kingdom refugee doctors must register with the General Medical Council (GMC). To achieve this, doctors must pass the International English Language Testing System (IELTS) examination, and the Professional Linguistic Assessment Board (PLAB) exam, parts I and II. To assist, the Department of Health established the Refugee Health Professionals Steering Group in November 2000. This steering group has overseen the distribution of £2m ($3.5m; €2.95m) for projects to help refugee health professionals, including refugee doctors, dentists, and nurses.² Additionally, the GMC now waives the fee for PLAB I for refugee doctors. It also offers a reduction in the cost of limited registration. Despite these positive moves, many refugee doctors face professional disappointment, frustration, and humiliation. Indeed, the professional, financial, and cultural obstacles facing refugee doctors have been well documented over the past five years.^1-5

Research findings

To investigate these issues further, in depth interviews were conducted with 42 refugee and asylum seeker doctors across the United Kingdom during 2002. The main aim of this research project was to listen to the voices of refugee and asylum seeking doctors as a means to uncovering the problems they encounter in the United Kingdom. This sample is not representative of all refugee doctors but does provide insight into the main problems.

Key messages from the interviews with refugee doctors

• They face many hurdles in the United Kingdom

• The route to GMC registration can be long and complex

• They can be forced to take unskilled, non-medical posts

• They are less likely to be shortlisted for a position

• They experience difficulties in progressing their medical career

• They can lack professional networks and personal contacts.

Ways to help refugee doctors

• Contact and learn more about refugee doctors in your local area

• Consider offering a clinical attachment or period of work experience or shadowing to a refugee doctor

• Be willing to write a reference if an individual successfully completes an attachment or period of work shadowing

• Encourage your colleagues to have a positive attitude towards refugee doctors

• Reflect on how you and your colleagues shortlist candidates for training schemes and job positions

• Take a personal interest in refugee doctors

• Consider being a mentor to a refugee doctor (www.timebank.org.uk)

bmjlearning.com

This article is a shortened version of a learning module that is available on www.bmjlearning.com, an interactive learning website for general practitioners and hospital doctors. On the site you can access online learning resources for GPs to help with appraisal and revalidation. You can also look at learning resources for hospital doctors on core generic topics (such as how to work in a team) and emergency topics (such as heart failure). The site also enables you to assess your learning needs and plan and record your learning online. To access any of these features, click on www.bmjlearning.com.

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Many steps have been taken to assist the initial requalification of refugee doctors. For example, courses are increasingly being made available to doctors preparing for PLAB, and it is now the post-PLAB situation that poses the most challenges. Indeed, gaining the first substantial medical post in the United Kingdom is extremely difficult. In July 2005, there were 1002 doctors registered on the BMA/Refugee Council database. Of this number, only 71 doctors are currently working in the NHS, with 195 doctors being job ready (ie they have successfully passed PLAB II, or are exempt from PLAB, but are not yet working). The figures seem to suggest that very few refugee doctors have actually gained a substantive post in the United Kingdom. Some problems faced by refugee doctors in gaining their first post are discussed below.

Being shortlisted for a job

Most doctors felt disadvantaged at the shortlisting stage.

“I've not even been shortlisted. Taking into account that those who are competing with me are fresh graduates and senior house officers who have just done some basic training or practice and have no experience, I find this very disappointing and frustrating. I'm trapped on the dole.” (Male refugee doctor from the Middle East.)

Many of the interviewees explained that the time spent leaving a country and requalifying in a new location left a gap in their CVs. There was also the initial professional disadvantage of not having practised medicine for some time. And despite government measures to speed up the process, most of those interviewed said it took them years to enter a full time medical post.

Career progression

“I think that the thing is, that nobody considered what experience I've had overseas at all. I worked as a doctor for 14 years. They consider only the past six years as my medical career and I find myself working with people who have only just graduated.” (Female doctor from the Middle East.)

Once a refugee doctor is working in the health service, the problems do not necessarily stop. Many of the doctors experience career stagnation or only get the jobs that other candidates do not want; their overseas experience seems to count for nothing. Refugee doctors perceive that the system has a preference for local candidates, and some doctors also reported preferential treatment of European doctors. European candidates are also exempt from the IELTS exam, which frustrates refugee doctors.

Personal issues

Finally, refugee doctors face many personal issues. First, they have to adapt to the NHS. The lack of professional and personal networks, as well as limited family support, makes initial integration difficult. There are also problems in adapting to a different culture and living in a foreign country. Most notably, doctors explained the severe mental effect of being undervalued, underused, and deskilled as a doctor. A key contributing factor was the time taken to re-enter the profession. The doctors interviewed expressed a real feeling of frustration, demoralisation, and hopelessness.

Overcoming the hurdles

The refugee doctors sampled spoke clearly of the discrimination at every level in the NHS. Some have been successful and are content, but most have not. Although measures have been taken to open the doors within the United Kingdom, the full potential of this resource is untapped. More must therefore be done to help refugee doctors overcome the hurdles so they can fully enter the health service at a time when the NHS needs doctors. ■