You may be here because you are about to start your new job, if so, congratulations!
Or you may be one of those people who plan really far ahead and would like more information about what it’s like to start work in the NHS as an IMG. In that case, welcome! Your forward thinking is an important quality of being a successful IMG in the UK.
Whatever situation you are in, we hope this article will help prepare you for the emotional rollercoaster that many IMGs go through when they start working in the NHS.
The feelings we discuss here are based on not only our own personal experiences when we first started in the UK, but also on the experiences of many others shared by friends in real life, on Facebook, or by email.
We hope that by helping you prepare yourself early on, you will be able to adapt much faster and smoother than we did!
You may feel… anxious
We’ve read post after post on FB, and received email after email, from IMGs who are terrified of making a mistake at work. Will you lose your license? Be deported? Jailed?
Anxiety can also be centred around what other people think. Will you be criticised? Demoted? Fired?
Being worried shows that you are a conscientious doctor who obviously cares about your patients and your job, but being overly anxious can affect your performance and make you more prone to mistakes and criticism which can turn this fear into a self-fulfilling prophecy and vicious cycle.
Anxiety can be crippling so finding ways to cope is extremely important. It’s essential to get on top of this emotion since there are many more things to be anxious about in our medical careers such as exams, applications to specialty training, interviews, appraisals, incidents, etc.
Building up our resilience to anxiety and external pressures is a skill that we must learn as doctors.
Resources to manage anxiety
- Preparation can help to reduce your anxiety about work, read our tips on 10 ways to prepare for your first job in the NHS as an IMG
- NHS advice on managing anxiety, fear and panic
- Great blog post by Dr Omar Alam about dealing with a lot of worry as an IMG
If you feel that anxiety is affecting your ability to function, please don’t be ashamed to recognise that you need outside help. Your mental health is tremendously important to your well-being so make an appointment with your GP to discuss how to manage it.
You may feel… inadequate
One of the most dangerous things you can do for your confidence and self-esteem is to constantly compare yourself to others, especially those that have been working in the NHS for longer than you. If you do this, you will fill yourself with feelings of inadequacy because you’re not able to perform at the same level.
The first step to managing this, is to accept that in the beginning you will not be as efficient as your peers. That’s just how it is.
Accept that you will not have as good rapport with the team as those who have been there longer. Accept that you will take longer to arrange a CT scan compared to those more junior to you.
This is not because you are inadequate.
This is simply because you are NEW.
And this is completely normal.
The issue is almost never due to inadequate clinical knowledge, but rather the shock of a new system, not knowing the local guidelines, and not knowing what is expected of you. Once you adjust to the system, you will be just as good as the other members of your team!
If you’re having a hard time, try to remember these 2 important points:
- The GMC approved your registration and granted you a license to practice in the UK so you are competent to do your job.
- Your CV got past the shortlisting phase and the interview panel deemed you to be the best applicant for this job. You deserve to be here.
Remember these things because you are not being fair to yourself when you compare yourself to UK graduates or IMGs who have been working in the NHS for a few years. Be kind to yourself and give it some time.
What if you lack knowledge?
You may be well aware of the basics, but there is so much to learn in each specialty that you will inevitably find gaps in your knowledge.
That’s fine, nobody is expected to know everything, but you are expected to strive to be better.
All you need to do is read more and find the answers to questions you can’t answer. Lifelong-learning is part of being a doctor after all!
Make time each week to study cases and bring a reference book to work every day. This is why I highly recommend having a pocket reference book like the Oxford Handbook for the Foundation Programme (Amazon link). It contains the presentation, examination, clinical management, prognosis, and some pathophysiology of many common conditions you’ll encounter which are highly condensed into a very portable book. It serves as a great reference point whenever you are in doubt and was my go-to book at work.
You may feel… marginalised
When you start a job in a new place, you will meet some lovely friendly people who are very welcoming to newcomers, and you will meet people who take a lot more time to warm up to you. Rarely, you may also meet people who are cynical, abrasive, and seem to take pleasure in watching you stumble.
It’s easy to take a cold attitude personally, and even easier to blame it on “racism” or “discrimination”, but doing this means that you contribute to the barrier between you and the other person without finding a solution.
Try to reflect on these situations later on and find out what the real cause of the problem is rather than simply blaming it on racism.
Take a step back and try to approach the situation with an open mind. Perhaps the other person is simply stressed and not coping with it very well and needs extra support. Give them the benefit of the doubt and try to be the bigger (more professional!) person. We have no control over other people’s actions, but we certainly have control over our own emotions and actions.
How to build rapport with your colleagues
It would be nice if everyone was warm and welcoming right from the beginning, but that’s just not how life works and you will have to make an effort to integrate yourself into the team.
Here are some tips to achieve that:
- Ask everyone’s names, try to remember them, and greet them when you see them. It means so much to people when you show that you remember their name.
- Bring in some treats for the team like cookies or cake.
- Offer to make tea or coffee for colleagues at meetings or when you’re free and they’re clearly busy.
- Offer to help colleagues with tasks at work or swapping shifts for important life events.
Is there really no racism in the NHS?
We have not personally encountered racism at work before, and many IMGs have had long happy careers in this country without facing any discrimination.
Also, when it comes to things like applying to specialty training, there is little room for racism, sexism or other bias to influence your application. That’s because the process is very transparent and objective.
But sadly racism does still exist in the NHS, just like it does in any country all over the world. If you think that there is real discrimination towards you because of race, sex or any other reason, just remember this: you do not have to accept discrimination at work.
There are ways that it can be dealt it. Accusations of this type are very grave and they are taken seriously.
Here are some resources to combat discrimination:
You may feel… homesick
Starting work in a new system is one thing, doing it in a new country is quite another!
While you are feeling anxious, inadequate and marginalised, you are bound to sorely miss your loved ones, the weather, the food, and even the TV shows and music.
We’ve all been there as IMGs. The days at work when thinking of home brings tears to your eyes, the cold nights where you feel alone, the heart pangs of seeing photos of your friends back home celebrating weddings and birthdays.
The pain of missing home is real!
But don’t forget the hardships that you went through to get here. The exams, paperwork, and even the discouragement. You rose above all that and now here you are living your dream!
You should celebrate your success and view this as an exciting time, a whole new chapter to your life. When you have this mindset, it’s much easier to enjoy your life in the present than mourn your life in the past.
Ways to cope with being homesick and enjoy your new life
- Talk or video chat with your friends and family back home regularly.
- Have lunch with your colleagues, get to know them and make new friends! Locate restaurants with your home foods and invite them for a meal.
- Plan your annual leave in advance, swap out your on-calls early enough so you can take 2-3 weeks off to travel back home.
- Explore your local area. The UK has a lot to offer in both cities and the countryside! Find the beauty in a long walk or the joy in watching a live musical.
- Take up a new hobby. With less working hours compared to your home country, you’ll have a lot more free time to learn new skills or engage in recreation. I learned to cook and enjoy trying new recipes and experimenting with new ingredients!
Eventually, you will feel… accomplished!
Once you’ve been working in the NHS for a few weeks or months, you will get used to how the system works and your abilities will really start to shine!
Your colleagues will come to appreciate you as a valued member of the team and you will feel like a true NHS doctor and not just “a doctor from overseas”.
It does take time to get to this stage so please be patient. You’ll stumble at certain points but pick yourself back up, tackle your negative feelings one-by-one, and you too can find your way here just like many of the IMGs who came before you.
Just remember to pay it forward whenever a new doctor joins. There’s nothing more hurtful than someone who has been in your shoes as a newbie who treats you like an outsider. Let’s be kind to each other and help one another
How you can help new doctors
- Start a blog or write a guest post about your experience.
- Join an IMG Facebook group and answer questions from newcomers. You can find a list of IMG Facebook groups in our Useful Links page here.
- Start an IMG mentoring program at your hospital.
- Organise regular IMG induction sessions for your trust.
These efforts will be truly appreciated by new IMGs and can look good on your CV or portfolio too!
Working in a new country with a new system and culture is both exciting and terrifying.
You may feel one or all of these negative feelings at first, but because you’re now aware these things can happen, you can mentally prepare yourself. Doing so will hopefully allow you to overcome these emotional obstacles faster than we did!
If you need additional support, there are resources available for you that we’ve listed above. We hope you find them helpful, and always remember: you are not alone on this journey!
As you can imagine, adjusting to the UK will take up alot of your time, energy, and focus. Add to that the stress of simultaneously building on professional development and preparing for applications to specialty training. That is a LOT of stress.
This is why we always advise our readers to plan way in advance and start improving your portfolio even back in your home country.
Follow our general tips to maximise your chances of success when applying for UK specialty training.
Disclosure: There are some affiliate links in the article above. This means that at no additional cost to you, we may earn a commission if you make a booking or purchase by clicking on the link. We only recommend products and services that we use ourselves or have proven success amongst IMGs.