1. Improving information for International Medical Graduates about job prospects in the UK.

Transcription

1 Council May 2004 To consider 7c Information for International Medical Graduates Issue 1. Improving information for International Medical Graduates about job prospects in the UK. Recommendation 2. To endorse the steps being taken to provide better information for International Medical Graduates about job prospects in the UK (paragraphs 13-17). Further information 3. Amanda Watson Jo Mullin

2 Background 4. The Professional and Linguistic Assessments Board test is designed for doctors qualifying outside the UK and EEA who wish to practise medicine in the UK under limited registration. The test assesses a doctor s ability at the level of a first appointment senior house officer in a UK NHS hospital (that is, the equivalent point at which a UK graduate achieves full registration). Doctors passing the PLAB test are eligible for limited registration (a form of probationary registration). Once they have satisfactorily completed a period of UK experience (usually one year), they can move from limited to full registration. 2. The test is in two parts: a. Part 1 is a three-hour, 200-item extended matching question examination. From September 2004 this examination will also include single best answer questions. b. Part 2 is a 14-station objective structured clinical examination. 5. The aim is to ensure that the test is self funding, with the level of fees (currently 145 for Part 1 and 430 for Part 2) designed year on year to cover the costs but not to generate a surplus The Registration Committee has direct responsibility for all aspects of the PLAB test. A separate Board (the PLA Board), appointed by the Registration Committee, is responsible for all the technical aspects of running the test (including setting questions and marking). The PLA Board reports annually to the Registration Committee. Administration (bookings, physical delivery of the tests, and results) is undertaken by the Registration and Education Directorate. 7. We are reviewing the test in anticipation of changes that might be needed when limited registration is abolished and to ensure the test remains fit for purpose. The Review Group is chaired by Lord Patel. The review s conclusions will be put to Council later this year. In the meantime, this paper addresses the provision of information to International Medical Graduates about their job prospects in the UK. 8. Over recent years we have seen an increase in registration activity. Some of the increase is no doubt related to the Department of Health s international recruitment campaigns for consultants and GPs but for the most part the increase in registration is associated with junior doctors. This is reflected in the rise in grants of limited registration: in 2001, 2,700 doctors were granted limited registration for the first time. This rose to 3,600 in 2002 and to 4,700 in International Medical Graduates seeking limited registration in the UK are required to demonstrate their capability for practice. They can do this in one of four ways: a. A pass in the PLAB test. 1 Memorandum accounts for the PLAB test show a net surplus for the year of 155,137 (3.3%, from an income of 4,669,621) demonstrating that the PLAB test broadly breaks even. 2

3 b. An approved sponsorship scheme. c. Completion of Basic Specialist Training, which is achieved through passing recognised Royal College examinations. d. Appointment to a Type 1 specialist registrar post (obtained through open competition). 10. Over recent years there has been a shift in the most common route to limited registration, with increasing numbers and proportions applying for the PLAB test. Table 1 compares the position in 2003 with that in In % of doctors applying for limited registration for the first time did so having passed the PLAB test. By 2003 this figure had risen to 79%. Table 1: Demonstrating capability for practice, first grants of limited registration, 1998 and (numbers) 1998 (%) 2003 (numbers) 2003 (%) A pass in the PLAB test 1,008 45% 3,771 79% Sponsorship % % Basic specialist training and former senior doctor route 2 Appointment to a Type1 SpR post Total first time applicants for limited registration % 277 5% 0 0% 13 1% 2, % 4, % Demand for the PLAB test and the link with subsequent employment 11. We have recorded an increase in demand for the PLAB test since late Table 2 sets out the numbers of candidates taking Parts 1 and 2 of the test since The Senior Doctor route was abolished in September

4 Table 2: Demand for Parts 1 and 2 of the PLAB test Year Part 1 places Part 2 places ,440 1, ,682 2, ,920 3, ,707 6, For 2004 we forecast that around 16,000 doctors will take Part 1 of the test and around 9,000 will take Part 2. On that basis, we would expect some 7,000 doctors will pass part 2 of the PLAB test in Although the number of candidates has increased significantly over the last few years, we have been able to offer an improved service, increasing availability of places and improving the process for obtaining them through our on-line booking service. This gives candidates greater control over booking and has speeded up the process considerably. This is in sharp contrast to the situation in the mid 1990s when we received a number of complaints from candidates who were unable to obtain places on the test. Discussion 13. The increasing numbers taking and passing the test have led to concerns that the market for junior doctors is saturated and that many IMGs are committing significant sums with an inadequate understanding of their job prospects. A steady stream of articles, and recent press comments, suggest that a significant proportion of IMGS may be experiencing difficulty in obtaining posts. There is a perception that the GMC has a vested interest in encouraging demand for the test, based on a mistaken assumption that we generate a cash surplus. It has been argued in some quarters that we should ration or cap the number of doctors taking the PLAB test by reference to expected demand for doctors in the training grades. 14. All doctors applying for limited registration for the first time are required to submit evidence that they have been selected for a post. Consequently, we have some data about doctors success in gaining employment. Not everyone who takes the PLAB test does so with the intention of taking up employment in the UK (or at least not immediately). Nevertheless, according to our records, around 85% of those who pass the test have secured employment in the UK and in 2002 that rose to 90%. These figures are encouraging but they probably overstate the position because we do not record details of posts and it has been argued that a proportion of first time posts have been short term or in some other respect fall short of doctors aspirations. As with any employment market, however, competition in some locations and specialties may make it difficult for doctors to secure a first post in their chosen field or location. 15. We seek, through the test, to provide an accessible means for doctors to demonstrate that they have the knowledge and skills to practise in the UK. We do not believe that rationing test places would be appropriate. There is no obviously fair and equitable way of rationing and, even if that were not so, it is not self evidently the GMC s role to deny individual doctors the opportunity to demonstrate that they have the necessary competencies to work in the UK and to compete in the job market. 4

5 Rationing would see a return to the position in the mid 1990s, universally viewed as unsatisfactory. 16. We recognise, however, the difficulties that some doctors report in entering the UK job market and we are keen to work with others better placed than ourselves to ensure that doctors contemplating a move to the UK have adequate information on which to base their decision. We have been working in partnership with other, better placed, agencies to identify ways of improving guidance for doctors. We have identified several possible initiatives: a. Improving the information we have about the success of doctors who have passed the PLAB test in gaining substantive and continuous employment in the UK, by undertaking regular surveys of past PLAB candidates. The survey (which we envisage running monthly) will take views from successful PLAB candidates one year on about their experience in gaining their first and subsequent posts. The results of these surveys will be reported to the Registration Committee and will be used to inform the material we provide to potential PLAB candidates. b. Clarifying the target audience for the Department of Health recruitment campaign. The rise in demand for PLAB test places appears to have coincided with the first international recruitment advertisements. The advertisements were not targeted at junior doctors but they may, nevertheless, have created the impression that there were a large number of vacancies for doctors at all grades in the UK. We are working with the DH on this. c. Providing one clear source of information (preferably web-based) about the current availability of jobs (in terms of specialty, training programmes, future prospects and location) and future plans for the job market. We have asked the DH from time to time about the potential for a dedicated department or NHS website setting out information specifically for junior doctors. At present there are a number of different websites offering information about specific areas but these are often difficult to access with obscure address names and there is no single central place where doctors can access all the information they need (either directly or through links to other websites). In addition much of the focus of the website material is centred on specialists and in the absence of any other material this is leaving many with the impression that the UK s shortage of doctors applies equally to junior and more experienced doctors alike. d. Providing a means of learning about the NHS before applying for posts. We have agreed to help with a pilot project in which the London Deanery will invite IMGs to apply for a limited number of six-week clinical attachments. These are intended to prepare IMGs for work in the NHS, which will help to make them more attractive to UK employers. We have distributed the invitation on their behalf to 96 doctors who attended our Clinical Assessment Centre to take Part 2 of the PLAB test. 17. We believe that, taken together, these initiatives will lead to a better flow of information and address the concerns which have been expressed recently about a 5

6 lack of clarity about job prospects for International Medical Graduates, particularly those who have passed the PLAB test. Recommendation: To endorse the steps being taken to provide better information for International Medical Graduates about job prospects in the UK. Resource implications 18. These will be minimal but can be offset by savings made through providing an improved service to candidates. Equality 19. Whilst the PLAB test must reflect the high standards of professional practice we expect from doctors entering the profession, we would like to facilitate the registration of competent doctors in any way we possibly can. 6