The Savvy IMG

Career options in the UK for IMGs 2023

Review the different options available to IMGs who want to work or train in the UK.

Table of Contents

International medical graduates have different career options for working in the UK as doctors. Both short-term and long-term training. IMGs can become specialists through 3 main routes: CCT, CESR-CP or CESR

Updated: February 15, 2023

There are several pathways to work in the UK as an IMG. It’s a flexible system which is both a blessing and a curse. A blessing because it means there numerous pathways for all IMGs of different backgrounds, but also a curse because all these pathways can be very confusing to choose from.

In this article, we aim to alleviate some of that confusion and help you decide which pathway is best for you depending on your background and your specific long-term goal. 

What are the options?

There are 3 main options when it comes to working in the UK as a clinician. Of course, there are options to work in research, academia, pharmaceuticals etc, however these careers are not covered in this article.

1. You want to become a UK GP or Consultant

If you want to be a UK recognised Consultant, then you need to be on the GMC Specialist Register. There are 3 routes to enter the Specialist Register:

  1. CCT  (Certificate of Completion of Training)
  2. CESR-CP  (Certificate of Eligibility for Specialist Registration – Combined Programme)
  3. CESR  (Certificate of Eligibility for Specialist Registration)

If you want to be a UK recognised GP, then you need to be on the GMC GP Register. There are 2 routes to enter the GP Register:

  1. CCT  (Certificate of Completion of Training)
  2. CEGPR  (Certificate of Eligibility for GP Registration)

Please take note that medical graduates without any postgraduate training are not considered GPs in the UK. UK GPs are family & community medicine specialists with 5 years of postgraduate training. 

The different routes vary depending on how much of your training you complete in a GMC-approved UK training programme. This diagram should make it clear: 

Pathways to become a UK recognised specialist through the CCT CESR-CP and CESR routes 2
CCT - Certificate of completion of training / CESR-CP - Certificate of Eligibility for Specialist Registration Combined Programme / CESR - Certificate of Eligibility for Specialist Registration

The CCT route

If you enter UK training in the first year (called CT1 or ST1) and complete the entire training programme, then you will be awarded a Certificate of Completion of Training (CCT). This is known as the CCT route.

The CCT pathway is best for new graduates, those who have not already completed postgraduate training in their target specialty, or those who are not considered overqualified.

Is this pathway suitable for you?

Yes, if you fit any of the following profiles:

  • You have not completed internship and plan to complete internship in the UK (Foundation Programme)   OR
  • You have completed internship and have not worked after internship   OR
  • You have completed internship and you have worked after internship, but you have not completed specialist training (residency) and you are not overqualified for your target specialty   OR
  • You have completed internship and you have started but not finished specialist training (residency), and you are not overqualified for your target specialty   OR
  • You have completed internship and specialist training (residency) but want to change specialty, and you are not overqualified.

What does overqualified mean?

Some specialties have experience limits if you want to apply for a first-year position (ie. CT1 or ST1). If you exceed the limit, you will be deemed overqualified to apply for ST1 or CT1 in that specialty.

We have compiled a list of all the ST1/CT1 experience limits for all specialties which you can download for freeYou can also read all about the limits in this dedicated blog post.

If you are overqualified and still want to become a UK recognised Consultant, you can use the CESR-CP or CESR route.

What are the steps for the CCT route?

  • If you intend to complete internship in the UK, the steps are here in Pathway A.
  • If you intend to or have already completed internship overseas, the steps are here in Pathway B.

Read more about how UK training works in this blog article.

Entering UK training is a real challenge for IMGs. We have a dedicated premium course to help you improve your chances of getting into UK training. If you’re interested in the step-by-step guidance to make the process easier, you can read more about it here in our IMG Masterclass

The CESR-CP route 

You can enter a UK training programme in the second year or later, this is the CESR-CP route. CESR-CP stands for Certificate of Eligibility for Specialist Registration Combined Programme meaning you completed part of a GMC-approved programme. 

Those who complete the CESR-CP route are usually awarded a certificate that says “CESR” but this is changing. Most doctors on the CESR-CP route will soon be awarded CCT.

The CESR-CP pathway is best for IMGs who have already completed postgraduate training in their target specialty, or are considered overqualified.

Related: CESR-CP will soon be recognised as CCT

Is this pathway suitable for you?

Yes, if you meet any of the following profiles:

  • You have completed internship and specialty training (residency) overseas in your target specialty  OR
  • You have completed internship, you have started specialist training (residency) but haven’t finished yet, and you are overqualified for your target specialty  OR
  • You have completed internship, you have worked after internship, you have not started any specialist training (residency) but you are already overqualified for your target specialty  OR
  • You have completed internship and specialist training (residency), but want to change specialty and you are overqualified in your target specialty  OR
  • You have worked as a specialist for many years but you still want to enter UK training in the same specialty.

What are the steps for the CESR-CP route?

Read more about the UK training pathway in this blog article.

The CESR or CEGPR route

If you do not enter a UK training programme at all, you can still become a UK recognised specialist if you can prove that you have the training and experience equivalent to a UK trained specialist. 

To prove your equivalent training, you need to compile a portfolio of evidence to demonstrate achievement of all the required competences of the specialty. You then submit your portfolio to the GMC for approval. 

If your portfolio is accepted, you will be awarded the Certificate of Eligibility for Specialist Registration to become a Consultant or the Certificate of Eligibility for GP Registration to become a GP.

The CESR route is best for those who have completed training and have been practising for many years.

Is this pathway suitable for you?

Yes, if you meet any of the profiles in the CESR-CP route and you also fit the following circumstances:

  • You do not wish to re-enter a training programme  OR
  • You are unable to successfully land a place in a UK training programme.

We explain the CESR route in much more detail in this blog article.

What are the steps for the CESR route?

The steps can be found here in Pathway D.

CCT vs CESR vs CESR-CP

All of these qualifications are considered equal in the UK when it comes to being recognised as a Consultant. However, it is important to mention that they may not be equally accepted overseas. In some countries, only a CCT is recognised. You’ll need to check which qualification is valid with the medical authority of any country you plan to work in.

Is it difficult for IMGs to enter UK training?

The CCT and CESR-CP routes both involve entering UK training (residency). This used to be quite difficult for IMGs, however, training in the UK has become a whole lot easier.

In October 2019, changes in UK immigration law meant that IMGs have the same equal opportunity to enter training as local UK graduates!

You can read more about these ground-breaking changes in these articles:

2. You want to work in the UK long-term without becoming a GP or Consultant

Being a GP or Consultant is not for everyone. Fortunately, the salary and the flexible work patterns for non-Consultant doctors in the UK, allow for financial independence even if you are not a GP or Consultant.

These jobs are also less competitive so you will have little problem finding employment soon after gaining your full GMC registration.

Is this pathway suitable for you?

Yes, if you fit any of the following profiles:
 
  • You are content working as part of a team and not taking on the full responsibility of a GP or Consultant.
  • You prefer to work flexibly so you can have more time for your family or other interests.
  • Your primary goal in coming to the UK is to gain financial security and a better work-life balance rather than career progression.

Whatever your reasons are, there is nothing wrong with choosing this path.

What are the steps for this route?

The steps can be found here in Pathway E.

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.

These can include posts such as clinical fellow, specialty doctor, or locum Consultant. Locum consultant jobs do not require you to be on the GMC Specialist Register.

Read about all the different job titles for doctors here.

You can always seek promotion with the same employer or apply for more senior positions as you gain more experience. It is also possible to later on apply for locum consultant jobs.

What if you want to become a GP or Consultant eventually?

This is possible. You can do so through any of the 3 routes in option 1 depending on eligibility. Most doctors in this position go through the CESR route.

Suggested: How to transfer money back home from the UK

3. You want to obtain short-term fellowship training then return home

Many doctors wish to gain experience and training in the UK in order to add to their skill set and better serve their patients back home. Gaining UK experience can also be very prestigious for a career overseas and many IMGs consider this option.

If this is something you’re interested in, there are three main options:

  1. The Medical Training Initiative (MTI)
  2. A GMC-approved sponsor (outside MTI scheme)
  3. NHS jobs advertised as fellowships

Each option has pros and cons which I discuss in more detail in a seperate article. In the article, I also provides links to the various fellowship schemes for each specialty. You can read more about it here:

4. You’re Returning to medicine after a long career gap

If you do not have any postgraduate clinical experience other than internship and have not been practising medicine for a long time – let’s say more than 3 years, I would recommend that you start from the most junior job: FY1. This is not absolutely necessary however, it is up to you. 

Just remember: the GMC expects that as a doctor you will assess yourself honestly, recognise the limits of your competence, and make a decision based on what’s best for patients.

This is the step-by-step guide for IMGs in this situation.

Why start as an FY1?

Medicine is ever-changing and to be a safe doctor you almost need to retrain. You won’t have to repeat medical school but your clinical skills and acumen will require a lot of attention. 

How can you get an FY1 job?

You won’t be able to apply for an official FY1 post as these are reserved for doctors who have not yet completed any internship, but you can search for non-training jobs that are set at the level of FY1 through the NHS jobs website, and go from there.

You can also apply for SHO level jobs and negotiate an adjustment period for the first few weeks where you work at FY1 level first.

Related: The best first job in the UK for overseas doctors

What if you have previous experience after internship?

Finding a job for senior positions will be very difficult if you have a long career gap. Starting very junior will allow you to safely rebuild your skills in a new health system. If you had previous training then you can consider starting as an SHO then work your way up to your previous level, or apply for jobs at a senior level as long as your employer allows you to work at a junior level for the first few months.

Summary

Your career options depend on what training you have completed back home and what you want to get out of working in the UK. When you have a clear idea of what you want to achieve, the best path becomes more obvious.

Hopefully this post has given you a good idea about what your options are. If there is anything else you want me to discuss or anything I can do make things clearer let me know through the contact form!

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8 Responses

  1. Hi, I’m currently a 4th-year (out of 6 years) neurosurgery resident in Mexico. can I apply to these options right after I finish neurosurgery or is it mandatory to have 2-3 years post-graduate experience? thank you very much.

    1. Hi there, yes you have these options, your neurosurgery residency is considered postgraduate experience. It can get quite confusing so if you are looking for one-to-one guidance for your specific personal circumstances, you might be interested in booking a session to discuss your options. For more details, please visit our page here.

      https://calendly.com/drkimberlytan
      I look forward to speaking with you!
      Kimberly

    1. Hi there, unfortunately it seems that MRCGP does not appear on this acceptable postgraduate qualifications list from the GMC https://www.gmc-uk.org/registration-and-licensing/join-the-register/before-you-apply/acceptable-postgraduate-qualifications so that means you would need to sit another exam on this list or PLAB. If you require further clarification, we recommend contacting the GMC directly for advice. Their email address is gmc@gmc-uk.org and the phone number is +44161 923 6602. They are open Monday to Friday 8 am–5.30 pm and 9 am–5 pm on Saturday. You can also send them a message on FB messenger, they usually reply within a day or 2.

  2. I am from Canada, a IMG have MD completed MCCEE, NACOS,MCQ1 exam from Canada and passed all, I did not obtain a residency seat in Family medicine, I am very interested in ED, IM, Peds
    Please advise my route and fastest routine
    Thank you
    Bill

  3. Hi nick
    By the time I sit for plab 2 I will have completed 2 years psychiatry residency program in Sudan.

    As I have read in your website, psychiatry doesnt count people as over qualified

    Which pathway should I go for?

    1. Hi there, that’s totally up to you. If you wish to start from the beginning you can aim for the CCT pathway, or if you wish to proceed to higher training you can go through the CESR-CP pathway. Please see our guide for psychiatry.

  4. Hi, I am a boaed certified General Internal Medicine specialist from the Philippines. I have been in private practice for 2 years since I finished my residency training. I would just like to ask which pathway is the best for me to take if my goal is to get into a gastroenterology fellowship training programme in the U.K.? Will appreciate your guidance.

  5. Thanks for the detailed information Nick. I’m a Pathologist (MD) from India. Do you have any article which is specific to Pathology? Appreciate your help here. Thanks again.

    1. I’m afraid we’re not too familiar with a career in Pathology. There seems to be quite a lot of pathologists in the IMG FB groups, hope you can find someone who can advise your further there!

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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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