Practicing Medicine in the UK: Medical licensure, Jobs, Immigration

This is the final part of the three-part installment on practicing medicine in the UK! The prior two installments explored the NHS and the medical education structure. This context will help you dive into the nitty gritty of moving to and practicing medicine in the UK. You will find a glossary of the lingo at the end of this post.

Overview

The process of obtaining medical licensure and jobs is involved and lengthy. A long-term move will make jumping through these hoops worthwhile. The three key steps to transitioning to the UK are obtaining a medical license, finding a job, and immigration. 

Medical License/Registration

The General Medical Council (GMC) is the governing body which provides medical licensure.

Full Registration

Previously American graduates needed to take the Professional and Linguistic Assessment Board Test (PLAB) to obtain Full registration. However as of January 12 2021, the GMC will accept USMLEs qualifications to obtain Full Registration. You also will have to pass an English language test or obtain an exemption (an attestation from your medical school and residency stating your coursework and exams were in English). There are several ways to obtain a Full medical license:

1. Passed USMLEs: You will need to have attended a medical school recognized by the World Directory of Medical Schools and have passed the USMLEs step 1, step 2 clinical knowledge, and step 2 clinical skills on or before March 13, 2020. If you fulfill these requirements you can apply for full registration.

2. Sponsorship: This is the least common route, though the easiest and fastest way to get a medical license. An international medical graduate (IMG) can apply to a job posted by a GMC approved sponsor. With the job offer in hand, the employer will sponsor the medical license without any additional examinations. The IMG must be qualified and must have been in medical practice for the last 3 out of 5 years, including the last 12 months.

3. Acceptable Post-Graduate Qualifications: Currently if you are board certified by the American Board of Anesthesiology or the American Board of Radiology, this certification proves that you have the knowledge and skills needed to apply for a full medical license. You do not need to take additional exams. The full medical license must be granted by the GMC within 3 years of passing the board certification exam.

For Internal Medicine sub-specialists, if you have passed all three parts of the Membership of the Royal College of Physicians exams (MRCP) this demonstrates that you have the knowledge and skills to apply for full registration. The MRCP consists of two written exams and one called PACES. The PACES exam is a clinical exam involving real patients with real clinical findings that must be identified and diagnosed accurately. These exams are typically taken by UK trainees on the Internal Medicine Training pathway. Overall the MRCPs are tough to pass.

4. PLAB 1 & 2: You can take PLAB 1 & 2, which are easier versions of the USMLE step 1 and 2. PLAB 1 results are typically available 6 weeks after the exam. Once you pass PLAB 1 you can apply for PLAB2.

In general, applications for a medical license involves visiting the GMC offices in person, having your diplomas and other documents verified, and having an identity check. The GMC will verify your medical school coursework to ensure it meets their requirements for the number of weeks on medicine, surgery etc. You may need to provide evidence such as a medical school syllabus and/or your rotation coursework and schedule. You may also need to highlight how an ENT rotation and urology rotation each contribute to the UK’s required length for a surgical rotation.You will likely need a letter from your residency detailing the number of weeks on each rotation

Once you have a full medical license, you are on the GMC register and you can work! The GMC does not help to finding jobs or target the right level for your training. You need to make this assessment yourself and may need to meet with the employer to decide if your experience is appropriate. In order to apply for consultant level jobs in your specialty you need to provide the additional paperwork as noted below.

The process of obtaining a full medical license can take up to a year.

Obtaining Specialty Recognition

The Certificate of Eligibility for Specialist or GP registration will provide specialty recognition. This pathway requires documentation proving that your knowledge, skills, and experience are equivalent to the UK training in your specialty. You must provide detailed evidence of clinical experience from medical school, residency, fellowship, and work experience. The dossier comprises residency/fellowship curricula, patient logbooks, case load statistics, departmental case load statistics, and prior job descriptions.

The documentation is often hundreds to thousands of pages and can take 1-2 years to collect. The GMC can take up to 6 months to review this evidence. Often the GMC will not grant specialist registration immediately and will request more evidence. This is the most labor-intensive route and it can hard to prove you have these qualifications. It is also the most comprehensive approach to getting on the GMC register. It allows you to apply for substantive jobs immediately, rather than taking locum jobs.

Finding a Job

There are several types of jobs available within the NHS.

A Locums job is paid hourly and arranged through a hospital’s human resources department or through an agency.

A Substantive is a permanent job, a ‘job for life’. You must be on the specialist register and you are paid like a salaried employee on an agreed Programmed Activity contract (see UK Part 1for details). The job process spans several months and entails the application, pre-interview meetings, courses for interview prep (yes – you need to take a course for this), and the interview. This is the ‘be all and end all’ of jobs, a prestigious position, and is what every doctor in the UK strives for.

A Fixed Term position usually replaces a Substantive vacancy and you are paid like a salaried employee. These are usually temporary, e.g. 6 months to cover a maternity leave or long-term sick leave.

You can find a job by searching  NHS jobs, register with 2-3 locum agencies, or work with an international recruitment organization. The locum agencies will send you individual shifts you can choose from or inform you of long-term vacancies. There is no required period of time for supervision, though it would be helpful to have a local mentor to help you learn about the healthcare system

Below you will find our partner recruitment organizations. For complete transparency, some of the organizations are providing a referral award to Hippocratic Adventures which we will use to cover the costs of building and maintaining this website and to eventually provide an honorarium to our member-authors-speakers who have shared their time and insight with the community. If inquiring with the organization, mention that you are with Hippocratic Adventures and send us a message via Contact Us. You will support our community, website, and blog post authors.

Pulse Psychiatry is a leading UK psychiatry staffing agency matching your expertise and experience with your ideal role. Their recruitment team will work tirelessly to bring you exciting opportunities in the NHS and private sector, many of which are exclusive to Pulse. Whether you’re looking for a permanent or temporary role, their support will help you to exceed your career goals. Pulse Psychiatry offers relocation support, access to 1000’s of jobs, flexible opportunities, and a rewarding referral scheme. Pulse is proud to have been awarded Approved Supplier status by Procurement in Partnership and HealthTrust Europe (HTE). This award recognizes their commitment and expertise in supplying highly qualified locum and permanent doctors. 

Head Medical is a leading specialist in international medical recruitment, having helped 1,000s of physicians find new roles in amazing locations including UK,  Australia, New Zealand, Singapore, China, the Gulf, Canada and Caribbean.  So, if you think you might be interested in a new challenge and a change of scene, please get in touch for a chat with one of their recruitment specialists. Their expert team will support you with your licensing and immigration paperwork and provide practical advice to ensure your relocation goes as smoothly as possible.

Immigration

Once you have a job offer you can apply for immigration.

A General Work Visa (Tier 2), a long term visa, would be most applicable to an individual without any familial or spousal ties to the UK. Most NHS employers are “licensed sponsors” to sponsor an individual for a visa. You can apply for this work visa 3 months prior beginning your new job and you will find out the result within 3 weeks of submitting the application. With this visa, you can stay in the UK up to 5 years. 

A Family Visa is applicable for an individual whose spouse, partner, or family member is already a British Citizen or have settled in the UK.

Bottom Line

Living and practicing medicine in the UK is doable and is likely to be the most rewarding for those planning a long-term move. The NHS is the main employer and compared to the US, physician salaries are lower. If you are committed to a long term change, want to experience universal health care, and looking forward to tea, scones and clotted cream, this is the place for you!

Basic Lingo:

General Medical Council (GMC): This is the governing body which sets standards for medical schools in the UK, administers the Professional and Linguistic Assessment Board Test (PLAB), provides medical licensure, and sets standards for professionalism and ethics.

Professional and Linguistic Assessment Board (PLAB):  The PLAB is an exam for physicians who attended medical school outside the UK, EEA, or Switzerland. It assesses medical knowledge and ensures knowledge equivalency to a physician in their second year of the foundation program.

Royal College of [Insert Specialty]: This is the governing body for each specialty; i.e.  the Royal College of Physicians, Royal College of Surgeons, Royal College of Psychiatrists etc. The royal colleges develop the requirements for post-graduate training in that specialty as well as the competencies needed for that specialty.

General Practitioner Register: A list of physicians who have completed training and have obtained their CCT. The General Practitioner equivalent of the specialist register

Specialist Register: A list of physicians who havecompleted training in a particular specialty and have obtained their Certificate of Completion of Training (CCT). This registration is required to be appointed as a consultant in the NHS.

Programmed Activity: Consultant jobs are standard and are determined by a ‘job plan’. This includes a plan of Programmed Activities (‘PAs’) where 1 PA= half day session. A typical consultant job plan ranges from 10-12 PAs.

Dr Yunger is originally from the US and completed her Internal Medicine training and board certification in 2012. She now lives and works in the UK.

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