New regulations affecting International Medical Graduates (IMGs) have been criticised by leading members of the medical profession and immigration practitioners.
The NHS has developed and utilised the skills of IMGs, essentially Black doctors from Third World countries, since its inception in 1948. The arrangement between IMGs and the health service has traditionally been seen as advantageous to both parties, with the former gaining postgraduate medical training and the latter capitalising on a skilled, young and mobile workforce. In the late 1980s, the Thatcher government introduced a permit-free training scheme to ‘facilitate and formalise this exchange’. But the new Labour regulations require IMGs to hold work permits, which some critics believe will ‘virtually stop the immigration of doctors to the UK’. These measures will no longer allow for the training of IMGs under special immigration regulations, which means that the training of White European Economic Area (EEA) doctors will effectively take priority.
The new regulations, set out in the ‘Statement of Changes to the Immigration Rules’, were announced on 7 March and those pertaining to IMGs came into effect on 3 April. Whilst other proposals included in the document will be ‘developed and tested’ before implementation, the speed at which the regulations relating to overseas doctors came into effect has been criticised. Parvati Raghuram, a Lecturer in Geography at the Open University, has attacked the regulations for ‘their content, the ways in which they have been introduced and the ways in which they are being implemented’. She points out that there has been no public consultation process and no dialogue with the relevant and affected parties.
The price of training
The retrospective application of the new regulations is also regarded as unjust. It means that IMGs, who have already moved to the UK and have begun contributing to the NHS, will face job losses, an end to their training and a forced return to their home countries. In order to train in this country, these doctors will have had to have passed the professional and linguistic assessment – a costly exam which requires the candidate to travel to the UK. The cost to doctors from non-EEA countries can be in excess of £2,000 and it may take African doctors ‘many years simply to pay back the debts incurred in coming to sit these examinations’. The British Association of Physicians of Indian Origin has highlighted the fact that at least 15,000 doctors may be forced to leave the UK ‘with debt but no diploma’. Dr Ramesh Mehta described the government legislation as ‘an absolute betrayal’.
The president of the Association of Surgeons of Great Britain and Ireland has publicly expressed his concerns regarding the new regulations affecting IMGs in a recent letter to The Times, in which he commented that: ‘Another nail has been placed in the coffin of surgical excellence by this most illiberal of governments.’ He articulated his fears that, by favouring ‘home-grown’ doctors over international candidates, the NHS will lose out on applicants with ‘superior experience, qualifications and CVs’. The probability of an overseas graduate being shortlisted in any competitive medical field will be low. He claimed that the new legislation ‘effectively means that the meritocracy is dead’.
Dr Hsu Phern Chong, Senior House Officer in Obstetrics and Gynaecology, Birmingham, also criticised the regulations in a letter to The Times. She noted that: ‘Few observers realise that the new ruling will also affect foreign doctors who are British graduates.’ These international students spend up to £70,000 on tuition fees for a five-year medical degree, but this boost to the economy may well be lost if these students are faced with the prospect of unemployment and lack of postgraduate training.
The government claims that the new regulations will reduce reliance on overseas doctors and will enable more British medical graduates to gain employment. The movement of health professionals from non-EEA countries to the UK has been identified by the World Health Organisation (WHO) as a problem, as it impacts on the provision of healthcare available in these developing countries. Timothy Evans, WHO assistant general has commented that: ‘Not enough health workers are being trained or recruited where they are most needed and increasing numbers are joining a brain drain of qualified professionals who are migrating to better paid jobs in richer countries.’ Yet despite this view, WHO does not support the implementation of measures that prevent health workers migrating, such as those advocated by the British government. Manuel Dayrit, the WHO director of human resources for health commented that: ‘WHO supports the right of people to migrate and follow their aspirations. More must be done to encourage doctors and nurses to stay, rather then preventing them from leaving.’