The Savvy IMG

7 ways IMGs can be considered equally alongside UK graduates for specialty training (residency) [ARCHIVED]

Here's how you can get your foot in the door of UK specialty training even if you graduated overseas.

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Get your foot in the door as an international medical graduate applying to specialty training in the UK. Here we talk about which specialties are open to IMGs and how to get your food in the door of those that aren't.

This post is out of date as of October 6, 2019. It remains published here for historical information purposes only, and should not be used to make future plans.

For the change in immigration law that made IMG-friendly specialties a thing of the past, please see the article: 9 ways the new Shortage Occupation List affects IMGs dreaming of UK specialty training

UPDATED: August 17, 2019

The advantage that UK medical graduates have over IMGs is that they are exempt from the Resident Labour Market Test (RLMT). RLMT means that employers eg. NHS hospitals, have to make sure there are no suitable applicants who are already settled in the UK before they can sponsor an immigrant on a visa. Therefore UK graduates are prioritised through exemption from RLMT.

But IMGs can also gain exemption from RLMT, and once exempt, IMGs will be considered equally alongside UK graduates.

You will not be rejected for specialty training based on your nationality or where you graduated once you are exempt from RLMT. 

So here I have listed 7 ways you can gain exemption from RLMT and be considered alongside UK graduates. These are all based on the rules listed in the 2019 Medical Specialty Recruitment Handbook and are applicable for training jobs at ST1/CT1 level and above.

1. Apply for a shortage specialty

IMGs are automatically exempt from RLMT for any specialty on the Shortage Occupation List, this means you will be considered alongside UK graduates for these specialties. So if you are interested in any of these that’s great news. 
 

As of January 2019 these are the training positions on the list for the whole UK:

  • Emergency medicine – CT3, ST4-7
  • Psychiatry – CT1

These are the training positions on the list for Scotland only:

  • Radiology – CT3, ST4-7
  • Psychiatry – all grades except CT1
  • Paediatrics – all grades
  • Anaesthetics – all grades
  • Obstetrics & Gynaecology – all grades

Posts beyond CT1/ST1 require prior experience to apply. All requirements to apply for each grade will be listed in the relevant person specifications here.

2. Apply for Standalone FY2

A standalone FY2 post is a training job within the official UK Foundation Programme. It’s called “standalone” because it is just one year of the 2-year programme. Standalone FY2 lasts for 12-months starting each August and being in it allows you to apply to a first year training post (CT1/ST1) in Round 1.

This is because Standalone FY2 is a training post therefore if you require a visa to work in the UK, your sponsor will be a government organisation such as Health Education England (HEE) instead of an individual hospital. Scotland, Wales and Northern Ireland have their own counterpart training organisations.

When you come to apply for another training post like CT1/ST1, you will not make a new visa application for the new job. Instead you will simply be extending your visa with the same sponsor rather than making a new application. This exempts you from RLMT and makes you eligible to apply in Round 1.

Restrictions

Keep in mind that you will only be considered in RLMT-exempt for ST1/CT1 applications when you apply during your FY2 year. After FY2 you will no longer be exempt. This means you should have been working on your portfolio even before you start Standalone FY2 so you will be ready for applications almost immediately (FY2 starts in August, Round 1 of applications open in November).

Also you will only be considered RLMT-exempt in the same UK nation you are an FY2 in. Eg. If you are an FY2 in England, you will be exempt from RLMT when applying to ST1/CT1 posts in England but subject to RLMT for positions in Scotland, Wales and Northern Ireland.

What else you should know

Standalone FY2 is most suitable for those who plan to apply to a first-year training post (CT1/ST1). It is not an appropriate career move to do FY2 then apply for ST3. Although there doesn’t appear to be any specific rules against this, bear in mind that ST3 jobs have requirements that will not be satisfied through FY2.

3. Apply for WAST

The Widening Access to Specialty Training scheme is essentially an alternative to FY2 aimed specifically at IMGs. The programme also lasts 12 months and awards you a Certificate of Readiness to Enter Specialty Training (CREST) which is required for application to CT1/ST1.

Similar to Standalone FY2, the visa sponsor for WAST is a government organisation – specifically HEE (England). Again this exempts you from RLMT and makes you eligible for Round 1 of applications.

Restrictions

You will only be exempt from RLMT for ST1/CT1 applications when you apply during your WAST year. After completion of  WAST you will no longer be exempt. This means you should have been working on your portfolio even before you start WAST so you will be ready for applications almost immediately (WAST starts in August, Round 1 of applications open in November). Also you will only be considered exempt from RLMT in England as WAST is only available in England. This is great for those who want to work in England long-term.

What else you should know

Again, similar to Standalone FY2, WAST is most suitable for those who plan to apply to a first-year training post (CT1/ST1). It is not an appropriate career move to do WAST then apply for ST3. Although there doesn’t appear to be any specific rules against this, bear in mind that ST3 jobs have requirements that will not be satisfied through WAST. WAST has many benefits including a £5,000 relocation package, less stringent English requirements compared to standalone FY2, and the possibility to apply before you’ve even started your PLAB journey.

4. Apply for a training post in a less competitive specialty first

Let’s say your target specialty is specialty X but it doesn’t go to Round 2. You can apply to a less competitive specialty first, let’s call it specialty Y, and then apply to specialty X the following year. 

By doing this you basically use specialty Y as a stepping stone to get to specialty X because as mentioned in number 2 and 3 above, being in a training job with a government sponsored visa makes you exempt from RLMT when applying for another training job.

Now this is not something I necessarily advocate as I don’t believe that any specialty should be a “used” to enter another, but if viewed the right way there are several advantages to this route.

Advantages 

Disadvantages

Restrictions

You must maintain sponsorship with the same visa sponsor between the 2 training jobs to be exempt from RLMT. 

If you quit specialty Y before you start specialty X and you either change visa sponsor between the 2 jobs or your visa sponsorship with specialty Y ends before your sponsorship with specialty X starts, then you will no longer be exempt from RLMT and your job offer may be withdrawn. 

You will also only be considered in Round 1 for the same UK nation you are in for your training job. Eg. If you are a trainee in England, you will be in Round 1 when applying to ST1/CT1 posts in England but in Round 2 for positions in Scotland, Wales and Northern Ireland.

5. Study for a higher degree in the UK

The current specialty recruitment handbook states that those on a Tier 4 student visa studying a UK Masters or PhD are eligible to apply for Round 1. Those on the Tier 4 Doctorate Extension Scheme are also eligible for Round 1. 

Having a higher degree attracts additional points during specialty recruitment so aside from helping you reach Round 1, it can give you a competitive edge amongst other applicants. But don’t do an additional degree for the sake of it. Consider whether you really want to pursue further education and how it might benefit you overall.

Restrictions

To be exempt from RLMT, you must complete the Masters degree in the UK, or complete 1 year towards a PhD by the time you are offered a job which is usually around March.

6. Await Indefinite Leave to Remain (ILR)

After 5 years on a Tier 2 visa you will be eligible to apply for ILR. This is permanent resident status in the UK and means you will be able to live and work here without restrictions ie. you will be exempt from RLMT for the whole UK pretty much forever.

But five years is a long time to “wait”. During that time you will most likely be working in non-training jobs and if you work in the same specialty you want to apply to for too long, you can actually be disqualified from applying to a first year post. 

So if you want to be more proactive in your career, you may want to consider acquiring your CT1/ST1 and CT2/ST2 experience and competences through non-training jobs, and work towards applying for ST3 instead. 

There are 2 pathways on the alternative route:

  1. CESR-CP – this is where you use your experience in non-training jobs to demonstrate equivalence to core training then apply to ST3 posts while subject to RLMT OR
  2. CESR – this is when you use your experience in non-training jobs to demonstrate equivalence to the whole training programme and apply directly for specialist registration as a Consultant. This can take longer than a training programme but it is a possibility.

7. Marry your RLMT-exempt partner

Many IMGs move to the UK to be with their beloved. If that person happens to be exempt from RLMT because they are a UK or EU national or have ILR, then this privilege may extend to you as their partner/civil partner/spouse provided your visa/BRP does not have a specific restriction that states “no employment as a doctor or dentist in training.”

Obviously don’t arrange a marriage just to become exempt from RLMT! That’s called immigration fraud my friend.

Just know that if you are moving to the UK to be with your partner, it doesn’t mean you have to be disadvantaged as an IMG. I would hate for any doctor to think that their medical career has to come to an end when they move here just because they’re not aware of this.

With this type of exemption you will be exempt from RLMT throughout the UK every year.

If I am exempt from RLMT and apply in Round 1, will I definitely get a training job?

No, of course not. Nothing in life is guaranteed. You still have to compete against other applicants so build up your CV and don’t waste this opportunity!

But if you are in Round 1, you are on level playing field with UK graduates and you will not be discriminated against as an IMG. This situation is the best you can hope for, it really is an incredible opportunity that you just don’t get in the US. If you are unsuccessful in Round 1, at least you know it won’t be because you graduated overseas. 

I’ll go over the many ways you can build up your CV in a future post. As always, subscribe so you don’t miss it!

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22 Responses

  1. Hi Nick,
    I’m a little confused. How does the current situation of all IMGs being exempt from RLMT affect what you’ve written here?
    Thank you

  2. Hi ,
    I am graduated from India with MBBS then completed my mrcp till part 2 and currently pursuing msc in cancer and clinical oncology . How can i get entry into speciality training in oncology and at which level i will be accepted.
    Please help.

  3. Thank you for the information. That is very helpful.
    I am towards the end of my specialty training in my country (paediatrics) with one year to go.
    Would it be easier to go to the route of CESR or PLAB?
    Thank you

  4. Hello Nick,

    Are CT3 (Emergency medicine) AND DRE-EM ST3 (Emergency medicine) both on Shortage Occupation list as of now?

    Thank you

    1. Hi Jay, looks that way! But the shortage occupation list is about to change to include all jobs so we’ll have to wait and see what happens.

  5. Hi, Thank you very much for providing such valuable information to IMgs. As you said
    ‘If you quit specialty Y before you start specialty X and you either change visa sponsor between the 2 jobs or your visa sponsorship with specialty Y ends before your sponsorship with specialty X starts, then you will no longer be exempt from RLMT and your job offer may be withdrawn. ’
    What can we do to prevent this. Should we not quit first training job until we start next job? Is it possible?

  6. Hi. I want to pursue speciality training in uk.I have cleared my mrcp part 1 exam . Though i have heard feom many people to take the plab route, one of my friends advised me to give mrcp part 2 ( and 3 if i can clear it in 1 go ) give ielts and go for mti job and apply for st3 once paces is cleared. This way i can bypass having to write the plabs.please advise

    1. Hi, it’s really up to you how important it is to avoid PLAB. To be honest, it’s not a very difficult exam. This article can help you decide. Also bear in mind that if you do MTI then apply for ST3, you will not be exempt from RLMT so you will be limited to the specialties that have a competition ratio of less than 2. If you want a more competitive specialty, doing PLAB then UK core training will make you exempt from RLMT and you can apply for any specialty.

  7. Hi ,
    Thank you so much for guiding in a detailed and organized way .

    I want to ask that I am joining as st3 nontrainee in obst gyne n have Mrcog , so what is best way to approach the cesr route .
    Thank you very much

    1. Hi, I would say the best thing to do is to let your clinical supervisor know your intentions to pursue CESR. Get in touch with the college tutor for OBGYN at your hospital for advice. Start familiarising yourself with the CESR requirements for MRCOG which can be found on the GMC website and start collecting the evidence. Best of luck!

  8. Hello there! I finished my PLAB in Jan 2019, and recently got a job in Psychiatry as a trust grade doctor. I took it up to build my CV and get NHS experience. I am interested in Oncology- will a psychiatry job hinder my chances, even if I clear my MRCP the coming year?

    1. Hi, doing any specialty does not hinder your chances for any other specialty except that it prolongs your journey. You’ll still need to meet the eligibility requirements for Oncology which you won’t get through psychiatry. You’ll need to complete IMT or equivalent and fulfill the other eligibility requirements which you can read in the Oncology person specification. Best of luck on your journey!

  9. Hello !
    I am confused as to what would be a better path to obtain an ST3 level post. Should I give PLAB after graduating from med school or would it be better to pursue post graduate training in surgery in my own country and then try to apply through the CESR-CP route after MRCS.
    I am currently in my third year of med school and if my aim is to do a surgery residency in the UK which would you say is a better route to pursue?
    You’ve made an amazing website on this topic, it’s kind of confusing to figure out where to find all the information online, thank you for all your hard work!

    1. Thank you for your kind words! Unfortunately, I cannot tell you what to do but only provide the information so you can make the right decision for yourself. Specialties with a competition ratio of more than 2 tend not to have any seats for those without RLMT exemption. Check the competition ratio for the surgical specialty you wish to apply for. If it’s more than 2 then you need to think about how you will gain exemption from RLMT otherwise the chances are slim to nil. Of course, competition ratios change each year so it can go up or down. Completing surgery back home does not confer any advantage except for prolonging your training, you are highly unlikely to gain a position as an ST3 surgical registrar without prior UK experience even if the specialty has a low competition ratio. I would encourage you to do further research, please see the Useful links page of this website. Also, contact the Royal College of Surgeons for more advice, and join the UK IMG surgery Facebook group for more answers. Best of luck!

  10. hi, if i hold an MRCS already, and work in my desired specialty, say general surgery, till I get ILR and apply for ST3 training, is there a chance to get rejected?

    1. Hi, yes there is a chance to be rejected. There are no guarantees to get a training spot, you have to have a good CV, good interview skills, and you need to compete with other applicants.

    2. Hi.

      I am currently working in the philippines as a doctor in a regional hospital. Im planning to apply for next year’s training in UK. I have a masters degree in public health and I just passed the boards last year. What pathway can you recommend? Im planning to take the ielts and plab 1 this year so that i can join august 2020’s training but i dont know where to start. hope u can help me. Thank you ?

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Meet the Team

Hi, we’re Drs Nick & Kimberly Tan, the two IMGs behind The Savvy IMG. We write comprehensive guides, create courses, and provide one-to-one guidance to help other overseas qualified doctors on their journey to the UK.
We have scoured the official guidance to put these posts together, but we can make mistakes! If you spot anything that is incorrect, please get in touch and we’ll put it right.
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