Introduction
Anaesthesia is the largest single hospital specialty in the NHS. It’s a highly varied field that treats patients of all ages and has subspecialties in all kinds of surgical procedures, as well as critical care and pain medicine.
Whether you are already an Anaesthetist overseas, or just starting out on your journey to a career in Anaesthesia, there’s a path to the UK for you here in this comprehensive IMG guide.
The steps to work in the UK
These are the general steps for any IMG to work in the UK:
- Understand the UK Anaesthesia training pathway
- Determine your long-term goal
- Get registered with the GMC
- Find a suitable job
- Obtain a work visa
- Start work
It is possible to do steps 2 & 3 simultaneously depending on the type of job. It is also possible to interchange steps 2 and 3 by finding a job first, and obtaining GMC registration after you’ve received a job offer as long as the employer agrees to this in advance.
We also have a short course where we explain how it is possible to get into UK training in 2 years time. Enrol now for free.
The UK Anaesthesia training pathway
Whether you plan to enter the UK training pathway or not, it’s important to understand the pathway so you have an idea of what it takes to become a recognised UK Consultant Anaesthetist.
Anaesthesia training for UK medical graduates is currently 9-10 years long in total after medical school and consists of the following stages:
- 2 years UK Foundation Programme
- One of the following core training programmes:
- 2 years in Core Anaesthetic Training (these years are designated CT1 and CT2) OR
- 3 years in Acute Care Common Stem – Anaesthesia (these years are designated CT1, CT2 and CT3)
- Whichever programme is completed, a resident AKA trainee must pass the Royal College of Anaesthetists primary exam (FRCA) in order to proceed to higher specialty training.
- 5 years in higher specialty training
- These years are designated ST3, ST4, ST5, ST6 and ST7.
- The first 2 years of this stage of training is known as intermediate level training, while the final 3 years are known as advanced level training.
- Trainees must pass the Royal College of Anaesthetists final exam (FRCA) before they can proceed from intermediate to advanced level training.
For IMGs, the pathway can look a little different. We’ll go into the possible alternatives a bit later.
The application process for core training and higher specialty training are separate ie. 2 separate applications. This makes Anaesthesia training what’s called an “uncoupled” training programme.
Overview of the UK Anaesthesia training pathway
Determining your long-term goal
Now, before you can set out on our journey, you really need to determine your long-term goal. This is the step that many IMGs skip and as a result, they end up taking a sad long winding road.
So before you continue reading, pause for a minute to answer this question: what do you want to get out of coming to the UK?
There are 3 main choices when it comes to clinical work:
- Become a recognised UK Consultant Anaesthetist
- Whether you want to stay in the UK long-term or migrate elsewhere after, is up to you.
- Work long-term in Anaesthesia in the UK without becoming a recognised Consultant
- Complete a UK Anaesthesia fellowship/gain UK experience then return home
What is the answer for you?
By answering this question early on, you can save yourself the wasted time and money spent following a pathway that does not lead to your end-goal.
Other options
Of course, there are other options such as pursuing a career in research, medical education, pharmaceuticals, hospital management etc. However, these careers are not covered in this article. This article, and the entire Savvy IMG blog for that matter, deals mainly with clinical careers.
How to reach your long-term goal
The good thing about the UK, is that the pathways are flexible and there are a lot of options. But that is also why it is so confusing.
Here I’ll go through each of the 3 possible long-term goals in more detail.
Goal #1 – Become a recognised UK Consultant Anaesthetist
If you want to be recognised as a Consultant Anaesthetist in the UK, and be eligible to apply for permanent Consultant posts in the NHS, you need to be on the GMC specialist register.
You can enter the specialist register via 3 possible routes:
These 3 routes differ by how much of the UK Anaesthesia residency programme (specialty training) you complete.
CCT route
This route involves completing both a UK core training programme for Anaesthesia and UK the higher specialty training – that’s 7-8 years in total.
Upon completion of the programme, you will be awarded a Certificate of Completion of Training (CCT) in Anaesthesia.
The CCT route is best for new graduates or those who have less than 18 months experience in Anaesthesia.*
Click image to enlarge
CCT route
This route involves completing both a UK core training programme for Anaesthesia and UK the higher specialty training – that’s 7-8 years in total.
Upon completion of the programme, you will be awarded a Certificate of Completion of Training (CCT) in Anaesthesia.
The CCT route is best for new graduates or those who have less than 18 months experience in Anaesthesia.*
Click image to enlarge
*If you have more than 18 months experience in Anaesthesia after internship anywhere in the world, you are overqualified for CT1 and cannot pursue the CCT route. To become a Consultant, you must pursue either the CESR-CP or CESR routes described below.
Suitable first jobs for this route
Before you can start UK Anaesthesia training, you need 24 months clinical experience. This includes 12 months of internship, and 12 months post-internship.
If you have not completed internship overseas, then your only option is to join the 2-year UK Foundation Programme as a first job.
If you have already completed internship overseas, the most suitable first jobs for this route include non-training FY2, Standalone FY2, WAST, or any SHO level post in any specialty with acute medical responsibilities. Any of these jobs will help you gain the 12-months post-internship experience required before starting Anaesthesia specialty training.
Related:
UK internship (Foundation Programme) open to all IMGs for 2020
10 reasons why you should apply to WAST
Standalone FY2: Your chances as an IMG and how to optimise your application
CESR-CP route
If you don’t complete one of the UK core training programmes for Anaesthesia but you do complete the 5-year higher specialty training programme, then you are on the Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP) route.
The CESR-CP route is best for IMGs who already have more than 18 months of experience or training in Anaesthesia.
According to new GMC rules, those on the CESR-CP route who complete at least 3 years of UK training in Anaesthesia will still be awarded CCT. Those who complete less than 3 years of UK training will be awarded CESR.
CESR-CP route
If you don’t complete one of the UK core training programmes for Anaesthesia but you do complete the 5-year higher specialty training programme, then you are on the Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP) route.
The CESR-CP route is best for IMGs who already have more than 18 months of experience or training in Anaesthesia.
According to new GMC rules, those on the CESR-CP route who complete at least 3 years of UK training in Anaesthesia will still be awarded CCT. Those who complete less than 3 years of UK training will be awarded CESR.
Suitable first jobs for this route
If you already have 2-3 years experience in Anaesthesia, you can apply for junior-grade Anaesthetic positions such as CT1, SHO, or junior clinical fellow posts. Through these posts, you can work on the requirements needed to apply for higher specialtytraining.
If you have more than 3 years of experience, you could apply for non-training middle-grade positions such as specialty doctor, senior clinical fellow, and registrar posts. Again, through these posts, you can work on the requirements needed to apply for higher specialty training.
Just a word of caution, if you start your first job at middle-grade level, it is recommended that you arrange an adjustment period of working at a junior level for a short period before stepping up to middle-grade responsibilities.
Related:
CESR route (AKA Article 14)
If you do not complete any part of the official UK Anaesthesia residency programme, you can still be recognised as a Consultant by providing proof (ie. documentation), that you have the equivalent experience and training.
This experience and training can be from overseas, from the UK, or a combination of the two.
The CESR route is best for those who have completed training and have been practising as a Consultant for at least a few years, or those who have completed residency and fellowship overseas and do not wish to repeat their training.
CESR stands for Certificate of Eligibility for Specialist Registration.
CESR route (AKA Article 14)
If you do not complete any part of the official UK Anaesthesia residency programme, you can still be recognised as a Consultant by providing proof (ie. documentation), that you have the equivalent experience and training.
This experience and training can be from overseas, from the UK, or a combination of the two.
The CESR route is best for those who have completed training and have been practising as a Consultant for at least a few years, or those who have completed residency and fellowship overseas and do not wish to repeat their training.
CESR stands for Certificate of Eligibility for Specialist Registration.
Suitable first jobs for this route
If you have already completed Anaesthesia training overseas, you can apply for posts such as senior clinical fellow, registrar, and specialty doctor.
If you have worked as a specialist for many years, you can even apply for locum Consultant jobs.
Through these posts, you can work on the documents you need for CESR. It’s critical that you find a department that will support your plans to apply for CESR. I recommend making your goals clear at the job interview.
What documentation do you need to provide for CESR?
The GMC and Royal College of Anaesthetists (RCoA) have specific guidance for the requirements for CESR. You can find the updated list of requirements here:
Related: How to become a UK specialist without entering a UK training programme
Equivalence
In the UK, all 3 routes CCT, CESR-CP and CESR, are seen as equivalent. You will be recognised as a UK Anaesthetist via any of these 3 routes.
But please be aware that this may not be the case overseas. Some countries do not accept CESR as equivalent to CCT, so if you plan to migrate after becoming a UK Consultant, be sure to check with the medical authority of that country first.
Goal #2 – Work long-term in Anaesthesia in the UK without becoming a recognised Consultant
Not all doctors aspire to work as a Consultant, the responsibilities are significant and some doctors find the role unattractive.
If you don’t want to become a Consultant, rest assured that you can still work in Anaesthetics in the UK with decent pay and a good work-life balance.
What positions can you work in?
You can apply to any position you feel you are qualified for according to your previous experience and the job description. Potential job titles include clinical fellow or specialty doctor.
It is also possible to apply for locum consultant jobs. Locum consultant posts do not require you to be on the GMC Specialist Register.
Whatever job you start with, you can always seek promotion with the same employer or apply for more senior positions as you gain more experience.
Related:
What if you want to become a Consultant eventually?
This is possible. Most Anaesthetists in this position go through the CESR route.
Goal #3 – Complete a UK fellowship training/gain experience in Anaesthesia in the UK then return home
Many doctors wish to gain experience and training in the UK in order to better serve their patients back home. If this is something you’re interested in, there are a few ways to do this.
Apply for an established fellowship programme
There are a few established fellowship positions for Anaesthesia. Here are a few, please visit their website for more information about vacancies and how to apply:
Find a job yourself on the NHS jobs website
Jobs on the NHS website will range from junior to senior level. You will need to review the job title and job description to determine whether it is suitable for you and your goals.
The steps for this are pretty simple:
- Visit the NHS Jobs website
- Search “Anaesthesiafellow” or your preferred subspecialty like “pain medicine fellow”
- Apply to jobs you like and are suitable for
- Once you have been accepted for a job, apply for GMC registration (please note, some jobs require you to have GMC registration before applying.)
Fish for a fellowship
If there is a specific Consultant who you would like to do a fellowship with or a specific centre that you would like to gain experience at and you can’t find a job opening anywhere, it’s worth sending a direct email to inquire about a possible fellowship.
Be sure to include a well-formatted up-to-date CV and a convincing cover letter about why you want to work with them and how you can be an asset to them as a fellow.
GMC registration for short-term training
You still need GMC registration to work in the UK as a doctor, even if you don’t plan to stay here long-term.
To gain GMC registration, you can use any of the methods already mentioned above: PLAB, FRCA, an overseas qualification, or RCoA sponsorship/MTI.
The registration you gain is permanent and will not be revoked after the fellowship.
Work visas for a UK fellowship
To obtain a visa to work in the UK as a fellow, there are 2 options:
- Tier 5 temporary work visa (maximum 24 months in the UK on this type of visa) – this is done through RCoA as part of the MTI scheme OR
- Tier 2 standard work visa (no maximum period) – this is done through the hospital you’ll be working at
After completing your fellowship training and gaining UK experience, you simply return home after the job contract ends.
Anaesthesia residency in the UK
Let’s talk a bit more about the UK Anaesthetics training programme.
It is 7-8 years long in total with 2-3 years in core training (designated CT1, CT2 +/- CT3), and 5 years in higher specialty training (designated ST3, ST4, ST5, ST6 and ST7). You have to apply for core training and then seperately for higher specialty training so it involves 2 applications.
Throughout the 7-8 years you will be administering anaesthesia for all kinds of inpatient and outpatient procedures, seeing patients in clinics, consulting with other medical and surgical teams on the wards, managing emergencies overnight and on weekends, and attending teaching sessions and conferences.
In most programmes, you will rotate to a new hospital every 6-12 months (usually 12 months) throughout all 7-8 years.
You will be paid a salary while you are training.
Related: How much do doctors in specialty training (residency) earn in the UK?
Programme structure
The Anaesthetics training programme is generally structured as follows:
| Year | Stage |
| CT1-2 or CT1-3 | Core Anaesthetic training |
| ST3-4 | Higher specialty training (Intermediate level) |
| ST5-7 | Higher specialty training (Advanced level) |
Related: How specialty training (residency) works in the UK: A complete beginner’s guide
Exams
The official exam for UK Anaesthetics is the Fellowship of the Royal College of Anaesthesia (FRCA). There are 2 stages of the exam, each with multiple components:
- Primary FRCA – This exam has 3 components: (1) Multiple Choice Question examination (MCQ), (2) an Objective Structured Clinical Examination (OSCE) and (3) a Structured Oral Examination (SOE).
- UK Anaesthetic trainees must pass the Primary FRCA before they can proceed to higher specialty training.
- Anaesthetists who trained overseas who wish to sit this exam must first obtain a Temporary Examination Eligibility (TEE).
- Final FRCA – This exam has 2 components: (1) Final FRCA Written examination, and (2) the Structured Oral Examination (SOE)
- UK Anaesthetic trainees must pass the Final FRCA before they can proceed to higher specialty training.
- Anaesthetists who trained overseas who wish to sit this exam cannot do so until they have completed 12 months experience in the NHS.
You can read more about the exams on the RCoA website.
Applying for UK Anaesthetic training
The requirements differ depending on whether you apply for core training, or higher specialty training.Anaesthetics CT1
CT1 - Entry requirements
- Full GMC registration by the time you start CT1
- 24 months clinical experience by the time you start CT1
- This includes 12 months of internship + 12 months after internship.
- F2 competences or CREST (Certificate of Readiness to Enter Specialty Training)
These are the basic requirements. Please see the CT1 Anaesthetics person specifications for the full requirements.
CT1 - Restrictions
If you have more than 18-months experience in Anaesthetics after internship anywhere in the world, you are considered overqualified for ST1 and will not be eligible to apply.
CT1 - Competition
Competition is typically expressed as a ratio. This is calculated by the number of applicants divided by the number of available posts.
Eg. If there are 600 posts for Anaesthetics CT1, and 1,200 applicants, then the competition ratio is 2.
Here are the competition ratios for Anaesthetics CT1 over the past 5 years:
| 2015 | 2016 | 2017 | 2018 | 2019 | |
| Anaesthetics CT1 | 2.06 | 2.09 | 2.16 | 2.46 | 2.35 |
I would consider a competition ratio of less than 2 as having low to moderate competition, between 2-4 as highly competitive, and a competition ratio of more than 4 as extremely competitive.
CT1 - Application Timeline
There is usually 2 opportunities to apply for Anaesthetics CT1 each year, these are called Round 1 and Round 2 re-advert.
The exact dates for each round are released each year but the general timeline is as follows:
Round 1
These jobs typically start around August of each year.
| Nov | Applications open |
| Jan | Interviews |
| 2-3 weeks later | Results are released |
| August | Training starts |
Round 2 re-advert
Jobs that are open during Round 2 re-advert start in February. There are usually much fewer posts for this round compared to Round 1.
| Jul-Aug | Applications open |
| Oct | Interview |
| 2-3 weeks later | Results are released |
| February | Training starts |
You do not need to apply in Round 1 in order to apply in Round 2 re-advert.
Take note: in the UK residency application process, you make a single application for England, Wales and Scotland, and Northern Ireland. You do not apply to individual hospitals.
If you want to learn more about how residency applications work in the UK, check out this essential guide: What IMGs need to know about applications to specialty training in the UK
Higher specialty training ST3
ST3 - Entry requirements
- Full GMC registration by the time you start
CCT route
- You must be in your final year (CT3) of UK core Anaesthetic training or you have already completed UK core Anaesthetic training.
CESR-CP route
There are 3 main eligibility requirements:
- Experience
- Minimum 18 months experience in Anaesthetics AND
- Additional 6 months experience in either Anaesthetics or Intensive Care Medicine
- Total of 24 months experience after internship
- Competence (one of the following)
- Basic Level Equivalence form (BLE) or Core Level Equivalence form (CLE) when you submit your application
- Core Level Training Certificate
- Confirmation of Core Level Equivalence
- Guidance about these forms
- Primary FRCA
These are the basic requirements. Please see the ST3 Anaesthetics person specifications for the full requirements.
ST3 - Restrictions
Applicants with less tha 4 years experience in either Anaesthetics or Intensive Care Medicine are preferred however there are no strictly enforced experience limits.
Having said that, as with all specialties, those who have enough experience and training to be eligible for recognition as a Consultant can potentially be deemed overqualified for training, but I’ve not yet seen this happen.
ST3 - Competition
Competition is typically expressed as a ratio. This is calculated by the number of applicants divided by the number of available posts.
Eg. If there are 400 posts for Anaesthetics ST3, and 800 applicants, then the competition ratio is 2.
Here are the competition ratios for Anaesthetics ST3 over the past 4 years:
| 2016 | 2017 | 2018 | 2019 | |
| Anaesthetics ST3 | 1.29 | 1.24 | 1.36 | 1.54 |
I would consider a competition ratio of less than 2 as having low to moderate competition, between 2-4 as highly competitive, and a competition ratio of more than 4 as extremely competitive.
ST3 - Application Timeline
There are usually 2 opportunities to apply for Anaesthetics ST3 level – Round 2 and Round 2 re-advert. Applications are submitted through the website Oriel. The exact dates are released each year but the general timeline is as follows:
Round 2
Jobs that are open during Round 2 start in August. This is when the majority of posts are available.
| End of Jan – Mid Feb | Applications open |
| Mid-March to Mid-April | Interview |
| 2-3 week later | Results are released |
| August | Start of training |
Round 2 re-advert
Jobs that are open during Round 2 re-advert start in February. There are usually less posts for this round compared to Round 2.
| Jul-Aug | Applications open |
| Aug-Oct | Interview |
| 2-3 week later | Results are released |
| February | Start of training |
Take note: in the UK residency application process, you make a single application for England, Wales, Scotland, and Northern Ireland. You do not apply to individual hospitals.
If you want to learn more about how residency applications work in the UK, check out this essential guide: What IMGs need to know about applications to specialty training in the UK
Is it difficult to get into UK Anaesthetic training?
Anaesthetics is a specialty with moderate to high competition levels at CT1 level, and low to moderate competition at ST3 level, so the chances for an IMG to be successful with landing a training job are decent.
Fortunately, as of October 2019, immigration laws changed in a way that meant that UK graduates are no longer prioritised for training posts. This means that IMGs will be considered alongside UK graduates and the only determining factor of success, is the application score.
Related: 9 ways the new Shortage Occupation List affects IMGs dreaming of UK specialty training
How do I improve my chances of success?
To succeed with your application to core Anaesthetic training, you’ll need to maximise your application score.
The application score is equally split into 2 components:
- The Multi-Specialty Recruitment Assessment (MSRA)
- We recommend Dr Aman Arora’s course. Don’t forget to use ARORASAVVY10 on check out get 10% off!
- Your CV/portfolio
- Your interview performance
Do well in these 2 areas and you will have a decent chance of landing a spot.
Related: 8 tips to succeed when applying for UK specialty training
Further information about training and applications
- Official website for information about CT1 Anaesthetics applications
- Official website for information about ST3 Anaesthetics applications
- Oriel – Website where you apply including user guide and FAQs
If you have any questions about applying for Anaesthetics, you can email anro@hee.nhs.uk or recruitment@rcoa.ac.uk.
GMC registration for Anaesthetists
So now you’ve decided on your long-term goal, you need to think about how you’re going to gain registration with the General Medical Council (GMC).
The GMC are the medical authority in the UK. To work as a doctor here, you need to be registered with them. There are no exemptions to this no matter how much experience you have or where you come from. Every doctor working in the UK needs GMC registration.
How do you obtain GMC registration?
You’ll first need to create a GMC online account. You can find instructions on how to open an account here.
You’ll then need to submit an application for full registration. These are the requirements for an application:
- Proof of English proficiency (IELTS, OET or other)
- EPIC verification of your medical degree
- +/- EPIC verification of your acceptable postgraduate qualification (PGQ) if you have one
- +/- Internship certificate (if going through the PLAB route)
- +/- Certificate of good standing (if you are registered as a doctor anywhere else in the world)
Read more about the requirements for GMC registration in detail here.
On top of the above requirements, you need to provide proof of your clinical skills and knowledge. There are several options to do this for established and Anaesthetists.
PLAB
The PLAB exam is set at the level of a doctor who has completed internship. It is most suitable for IMGs who have not yet completed postgraduate training in Anaesthesia, however, it can also be taken by those who are already specialists. In most cases, it is the quickest and least expensive route.
FRCA
If you pass the Primary FRCA, then you can bypass PLAB. Primary FRCA exams are aimed at doctors who have already completed some postgraduate training in Anaesthesia.
RCOA sponsorship/MTI
You can gain GMC registration without PLAB if you obtain sponsorship through the UK Royal College of Anaesthetists (RCoA) via the Medical Training Initiative (MTI).
Overseas qualifications
You can gain GMC registration without PLAB if you hold overseas qualifications in Anaesthesia from the following places: Ireland, US, Australia & New Zealand, Pakistan, South Africa, Sri Lanka, West Indies and the European Diploma.
CESR
If you have already been practising as a specialist for many years, you can try applying for direct recognition as a Consultant via the CESR route. This is a difficult and tedious process that can take years to complete, but it’s an option for IMGs who do not go through any of the other routes mentioned above. You can read more about it below under the section “Become a recognised UK Consultant Anaesthetist”
Finding a suitable first job
There are 2 main questions to consider when looking for a suitable first job.
- Do you have the right training and experience for the job?
- You will find detailed information about the roles and responsibilities of the job in the job description. Read these carefully to decide whether you are suited for the post.
- Will it lead to your long-term goal?
- There is no point working in a job that will jeopardise your long-term goal.
- Read below to figure out the overall pathway and for tips on what a suitable first job would be in each pathway.
Related: UK doctor titles 101, The best first job in the UK for overseas doctors
Visas and immigration
Most IMGs will need the General work visa (Tier 2). With this type of visa, you can bring your family to the UK as well. Family means spouse and children, it does not include parents, siblings or other relatives.
After 5 years in the UK on a Tier 2 visa, you can apply for permanent residence AKA Indefinite Leave to Remain (ILR). After one year with ILR, you can apply for British citizenship.
Recommended books
Day-to-day clinical reference
Pharmacology
For both training and non-training jobs
Need more guidance?
All of this may be overwhelming and difficult initially but it doesn’t have to be. Start preparing early so you have time to take things slowly and plan out each step.
Just know that if you’re really struggling, then you don’t have to be alone. We run an online course called IMGs for UK ST1/CT1 Masterclass where we simplify the whole process.
You’ll get a step-by-step video series that you can watch at your own pace, providing you with a clear winning strategy to achieve the highest application score you can and increase your chances of getting a training job.
Visit our IMG Masterclass page for more information.
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