My family and I moved to London for 6 months in 2020 for my husband’s rotational position. We arrived in February of that year with a 6-week-old baby. I had negotiated a 9-month unpaid maternity leave with my job, and we had grand plans for travel and adventure.
Instead, we were plunged into the depths of the initial UK COVID-19 lockdown shortly after arriving. When our stint ended in August, we returned to the US. We felt at that time that if we loved living in London even during the pandemic, we could dream of the opportunity to return.
In 2024, we received an opportunity to move back to Europe for my husband’s career. It seemed like a now-or-never type of opportunity, so although it involved moving our three young children and leaving a job I loved, we decided to do it.
This was post-Brexit, and the job boards were telling me that retaking exams (the PLABs) was no longer necessary in the UK for American-trained doctors. It seemed easy! I started the paperwork in May 2024 in preparation for an August 2024 move.
The Licensing Maze: General Medical Council Specialist Registry
By our August move, my licensure with the General Medical Council (GMC) was still a few months out. I had been asked to dig up documents ranging from my marriage certificate to my graduation diploma for residency. Each week, I received feedback from my GMC adviser, and then I had to wait another week for a response.
There was a hiccup in processing the paperwork as American internal medicine residency did not align with the traditional post-graduate training program in the UK. For example, we spent 4 weeks going back and forth about why I had not completed 3 months of surgery training during my residency. I ended up having to obtain transcripts from my residency, including all rotations completed and their dates. They accepted my ER and ICU training as fulfilling my “surgery” training requirements.
This was a very frustrating time for me. We were adjusting to living in a London flat in a city without many personal connections, and now my licensing was delayed. I tried multiple times to get someone from the GMC on the phone, but was told that I needed to wait for my adviser to respond via email, in due course. I found a telemedicine position that seemed like a temporary stopgap and started work there in September.
I achieved “registration with a license to practise” in November and could technically practise unsupervised; however, I wasn’t on either the GP (general practitioner) registry or the Specialist (consultant/attending) registry. Without either of these, I didn’t meet the criteria for attending-level jobs in the NHS, and most private groups found their indemnity (malpractice) providers wouldn’t cover me either.
Pro Tip 💡: I would have started the GMC Licensing process and the Specialist Registry concurrently if I were doing it again. I would also expect that the full licensing process would take1-2 years.
Dream vs Reality: The Job Hunt
Being internal medicine trained, I looked at primary care roles as well, but most primary care in the UK encompasses both adult and pediatric patients, so I’m not qualified for this. I have had several interviews with private GP groups that see only adults; however, I have not yet found an indemnity provider (medical malpractice insurance). In fact, I’ve been declined by multiple indemnity providers because my training is different from the standard.
Both Acute Medicine and General Internal Medicine (hospital-based practices) require the Specialist Registry to work as a consultant, and the Specialist Registry makes the GMC licensing process look like a breeze. I am trying to complete the Portfolio Method (formerly CESR), but it seems almost impossible if one has never held a clinical position in the UK.
I am also in touch with a locums agency, as it is possible to find locum consultant work while waiting for specialist registration; however, this is much more likely in underserved areas outside of London.
Pro Tip 💡: If you have location flexibility, this might be the easiest way to get clinical experience while in the UK before joining the specialist registry.
Making It Work in the Meantime
I worked for a telemedicine company from abroad for 12 months, although several policy changes there have made that much less sustainable. Although they technically allow overseas work, they recently changed their policy so that I’m not allowed to prescribe controlled substances while overseas. Given that a large portion of their patient population (maybe 50% of my monthly panel) were patients with ADHD, this has been an inhibiting change. I’ve also recently started contracting with a company as an AI trainer.
Pro Tip 💡: Telemedicine can be a lifeline, but policies change quickly. Consider diversifying income streams (telehealth + non-clinical work)
Family Life in London
This has been a wonderful surprise. We have a lovely community in London. Our primary school is a public (state-run) school located across the street. The sense of community from going to school pick-up and drop-off daily is heart-warming, and my daughters have been welcomed into their school groups.
One challenge was that the UK school system is a year ahead (children start Reception, a full-day kindergarten-equivalent, when they are 4 years old). My daughter jumped from first grade in the US to Year 3 in the UK. This was a significant knowledge leap, but she has adapted well and has felt supported by her teachers in the change.
Apart from our day-to-day school life, we have enjoyed interacting with families from around the world. London is a truly international city, and our peers are no exception. We also love the breadth of interesting weekend activities. We explore museums, visit National Trust (historic buildings) sites, and regularly visit the countryside. London is also a gateway to Europe, and we have enjoyed relatively inexpensive European travel (Paris, Norway, Malta, Edinburgh, Billund (Denmark), all in the last year!)
Pro Tip 💡: The UK school system is a year ahead of the US, making it a knowledge leap for students who transfer, but our experience was very supportive. Travel within and outside the UK makes it all worthwhile.
Reflections: Career Costs & Rewards
Living in London has been a dream for my family, but it has had significant career costs. All this to say, it’s not a straightforward process. I hope to one day be able to practise medicine the way I enjoy in the country I am living in!
My advice would be to start the Specialist Registry as soon as possible, and to look for locum work or telework in the US in the meantime. I would also have realistic salary expectations, as salaries in the UK are less than 50% of what I have previously made. Combined with a high income tax bracket, it often seems that telework might be the most lucrative option.
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Dr. Katie Cramer is an American internal medicine hospitalist who left her teaching position after 9 years and moved to London with her family.
