Introduction
Neurosurgery is a small specialty with one of the fewest number trainees and Consultants. Because of this, there are high levels of competition at every level. A successful career in this specialty requires intense dedication and commitment.
If you’re ready to pursue Neurosurgery in the UK, read on to find out how you can achieve this as an IMG – whether you are already a Neurosurgeon overseas, or just starting out. We’ve covered everything in this comprehensive guide.
The steps to work in the UK
These are the general steps for any IMG to work in the UK:
- 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.
Determining your long-term goal
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 Neurosurgeon
- Whether you want to stay in the UK long-term or migrate elsewhere after, is up to you.
- Work long-term as a Neurosurgeon in the UK without becoming a recognised Consultant
- Complete a UK Neurosurgery 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 Neurosurgeon
If you want to be recognised as a Consultant Neurosurgeon in the UK, and be eligible to apply for a 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 Neurosurgery residency programme (specialty training) you complete.
CCT route
If you complete the full 8-year UK Neurosurgery training programme, you will be awarded a Certificate of Completion of Training (CCT) in Neurosurgery. This means you started training from specialty training year 1 (known as ST1)*.
Click image to enlarge
CCT route
If you complete the full 8-year UK Neurosurgery training programme, you will be awarded a Certificate of Completion of Training (CCT) in Neurosurgery. This means you started training from specialty training year 1 (known as ST1)*.
Click image to enlarge
*If you have more than 48 months clinical experience in any specialty anywhere in the world, then you will be deemed overqualified for ST1 and cannot pursue the CCT route. The 48 months includes internship.
You will also be deemed overqualified if you have more than 12 months experience in any of the following specialties combined: Neurosurgery, Neurology, Neuro-radiology and Neuro-intensive care.
In these circumstances, you must pursue either the CESR-CP or CESR routes described below to become a UK Consultant.
Suitable first jobs for this route
Before you can start UK Neurosurgery training, you need 24 months clinical experience. This includes 12 months of internship, and 12 months post-internship. Your experience can be in any specialty as long as you don’t exceed the limits stated above.
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. Any of these jobs will help you gain the 12-months post-internship experience required before starting ST1 Neurosurgery.
CESR-CP route
If you complete less than 8 years of the UK Neurosurgery training, then you are on the Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP) route.
The entry point into training after ST1 is ST2 (specialty training year 2), so you would end up completing 7 years of the training programme.
This route is for those who have previous experience and training in Neurosurgery and therefore the experience limits of ST1.
According to new GMC rules, those on the CESR-CP route who complete at least 5 years of UK training in Neurosurgery will still be awarded CCT. If you complete less than 5 years of UK training, you will be awarded CESR.
CESR-CP route
If you complete less than 8 years of the UK Neurosurgery training, then you are on the Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP) route.
The entry point into training after ST1 is ST2 (specialty training year 2), so you would end up completing 7 years of the training programme.
This route is for those who have previous experience and training in Neurosurgery and therefore the experience limits of ST1.
According to new GMC rules, those on the CESR-CP route who complete at least 5 years of UK training in Neurosurgery will still be awarded CCT. If you complete less than 5 years of UK training, you will be awarded CESR.
Suitable first jobs for this route
If you are overqualified for ST1, then you can start by applying for non-training junior-grade Neurosurgical positions such as ST1, SHO, or junior clinical fellow posts. Through these posts, you can work on the requirements needed to apply for ST2.
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 ST2.
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.
CESR route (AKA Article 14)
If you do not complete any part of the official 8-year UK Neurosurgery 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.
This route is for those who already specialists overseas, or for those who did not get into UK training but have a lot of experience and want to be recognised as a Consultant.
CESR stands for Certificate of Eligibility for Specialist Registration.
CESR route (AKA Article 14)
If you do not complete any part of the official 8-year UK Neurosurgery 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.
This route is for those who already specialists overseas, or for those who did not get into UK training but have a lot of experience and want to be recognised as a Consultant.
CESR stands for Certificate of Eligibility for Specialist Registration.
Suitable first jobs for this route
If you have already completed Neurosurgery 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 Joint Committee on Surgical Training (JCST) 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 Consultant Neurosurgeon 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 as a Neurosurgeon 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 as a Neurosurgeon in the UK with decent pay and a good work-life balance.
However, do be aware that you may have less operating time compared to Consultants and trainees. This varies from hospital to hospital.
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:
Apply for an established fellowship position
This is possible. Most Neurosurgeons in this position go through the CESR route.
Goal #3 – Complete a fellowship 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.
The main programme available to match you to a job is the International Surgical Training Programme (ISTP). It is designed for IMGs who have some surgical experience but have not yet completed their full surgical training.
Read more about the programme through these links:
The Senior Clinical Fellowship Scheme is for doctors who have completed their full surgical training and wish to subspecialise further. It is meant to aid the transition from trainee to Consultant.
In order to apply, you need to contact the responsible Consultant to find out if there is a vacancy and request an application form.
The list of Neurosurgery fellowships can be found here:
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 “Neurosurgery 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.)
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.
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 4 methods already mentioned above: PLAB, MRCS, FRCS/JSCFE, or RCS GMC Sponsorship.
The registration you gain is permanent and will not be revoked after your fellowship ends.
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 RCS 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.
Neurosurgery residency in the UK
Let’s talk a bit more about the UK Neurosurgery training programme.
It is 8 years in duration and each year is numbered. The first year is termed ST1, each year the number goes up until the final year ST8.
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 Neurosurgery training programme is generally structured as follows:
| Year | Stage |
| ST1 | Core neuroscience training |
| ST2-3 | Initial neurosurgical training |
| ST4-5 | General neurosurgical training |
| ST6-7 | Advanced neurogsurgical training |
| ST8 | Special interest training |
Throughout the 8 years you will be seeing patients in clinics, managing emergencies overnight and on weekends, attending teaching sessions and conferences, and of course, performing surgery.
In most programmes, you will rotate to a new hospital every 6-12 months throughout all 8 years.
Related: How specialty training (residency) works in the UK: A complete beginner’s guide
Exams
The 2 official exams for UK Neurosurgical training are MRCS and FRCS Neurosurgery.
- MRCS – This exam has 2 parts, a written test (Part A) and a practical exam (Part B). Neurosurgery residents must pass both parts before progressing to ST3.
- Read about MRCS here
- FRCS Neurosurgery – This is the exit exam. It also has 2 parts, a written test (Section 1), and a practical/oral exam (Section 2). Neurosurgery residents must pass both parts by the end of ST8. Most trainees tend to take these exams around ST6.
- Read about FRCS Neurosurgery here
How to apply for UK Neurosurgery residency
Applications open once a year and are submitted through the website Oriel. The exact dates are released each year but the general timeline is as follows:
| November | Applications open |
| December/January | Multi-specialty recruitment assessment (MSRA test) |
| End of January | National interview + portfolio scoring |
| March | Results are released |
| August | Start of training |
Take note: in the UK residency application process, you make a single application for the whole UK. 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
The entry requirements for UK Neurosurgery specialist training
The requirements differ depending on whether you apply for ST1 or ST2. Starting training at either ST1 and ST2 should lead to a CCT.
ST1 Neurosurgery
ST1 - Entry requirements
- Full GMC registration by the time you start ST1
- 24 months clinical experience by the time you start ST1
- 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 ST1 Neurosurgery person specifications for the full requirements.
ST1 - Restrictions
If you have more than 24 months experience in any specialty after internship (meaning more than 36 months including internship) anywhere in the world, then you will be deemed overqualified for ST1.
You will also be deemed overqualified if you have more than 12 months combined experience after internship anywhere in the world in any of the following specialties : Neurosurgery, Neurology, Neuro-radiology and Neuro-intensive care.
ST1 - 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 50 posts for Neurosurgery, and 100 applicants, then the competition ratio is 2.
Here are the competition ratios for ST1 Neurosurgery over the past 5 years:
| 2015 | 2016 | 2017 | 2018 | 2019 | |
| Neurosurgery | 5.63 | 6.50 | 5.24 | 4.47 | 6.54 |
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.
ST2 Neurosurgery
ST2 - Entry requirements
- Validated logbook of surgical procedures
- Portfolio of assessments relevant to the ST1 Neurosurgery curriculum
- Neurosurgery ST2 Alternative Certificate of Core Competence
- Membership of Royal College of Surgeons (MRCS)
These are the basic requirements. Please see the ST2 Neurosurgery person specifications for the full requirements.
ST2 - Restrictions
Extensive previous surgical experience tends to be a negative factor when applying to surgical training in the UK. So if you already have extensive training and experience in Neurosurgery eg. more than 10 years, just be aware that there is a possibility that you may not get a place in ST2.
Also, be aware that the panel prefers recent graduates. If it has been more than 5 years since completing your foundation competences ie. internship, you may not get a place.
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 50 posts for Neurosurgery, and 100 applicants, then the competition ratio is 2.
2021 is first year that there are posts for ST2 so there are no competition ratios available yet. In the past, applications were for ST3, so here are the competition ratios for ST3 Neurosurgery over the past 4 years:
| 2016 | 2017 | 2018 | 2019 | |
| Neurosurgery | 3.67 | 2.11 | 6.00 | 7.00 |
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.
Neurosurgery at ST3 level is the most competitive surgical specialty.
Further information about applications
- Official website for information about Neurosurgery applications (ST1 & ST2)
- Oriel – Website where you apply including user guide and FAQs
If you have any questions about applying for Neurosurgery please contact the recruitment office via email: NeurosurgeryRec.YH@hee.nhs.uk.
Is it difficult to get into UK Neurosurgery training?
Neurosurgery is the second most competitive surgical specialty at ST1 level. There are approximately 20-30 vacancies throughout the UK for ST1 each year and around 150+ applicants.
At ST3 level, the competition is even more fierce with less than 10 places each year, sometimes as few as 2, and usually around 20 applicants making it the most competitive surgical specialty at ST3 level.
But that doesn’t mean that a determined accomplished doctor can’t succeed. Although you have to be realistic with the amount of work and sacrifice required to have a career in this specialty.
A golden opportunity for IMGs
In the past, Neusorugery was essentially closed to IMGs unless you found a way to work around the immigration rules. However, 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 equally alongside UK graduates, and the only determining factor of success is the application score.
No doubt it is still difficult, but now the doors are open for IMGs so it’s best to make the most of this golden opportunity while it lasts!
Related: 9 ways the new Shortage Occupation List affects IMGs dreaming of UK specialty training
How do I improve my chances of success?
Although Neurosurgery is competitive, of course, it’s not impossible. To succeed with your application, you’ll need to maximise your application score.
There are 3 components to the application score:
- 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 each of these areas and you will have a decent chance of landing a spot.
Related: 8 tips to succeed when applying for UK specialty training
GMC registration for Neurosurgeons
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 FRCS/MRCS certificate (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 4 options to do this for Neurosurgery.
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 Psychiatrists, however, it can also be taken by those who are already specialists. In most cases, it is the quickest and least expensive route.
MRCS
The MRCS exams are aimed at doctors who have completed junior surgical residency (usually 1-2 years), although it’s possible to pass MRCS with just internship experience. If you pass MRCS, then you can bypass PLAB.
FRCS/JSCFE
The FRCS and JSCFE exams are aimed at doctors who have completed a full surgical training programme and are ready to be Consultants. This exam will allow you to bypass PLAB.
RCS Sponsorship/MTI
You can gain GMC registration without PLAB, MRCS, FRCS of JSCFE if you can obtain sponsorship through the Royal College of Surgeons.
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:
- The best first job in the UK for overseas doctors
- 10 ways to prepare for your first job in the NHS as an IMG
- 12 essential items for IMGs working in the NHS
You can also identify the most suitable first job by considering which route you are pursuing.
CCT Route
You need to make sure you meet the requirement for 24 months clinical experience in order to apply for surgical training. Options to achieve this are Standalone FY2, or a non-training job in any specialty. Just be sure not to exceed the Neurosurgery experience limits otherwise you become ineligible for the CCT route.
CESR-CP Route
Middle grade posts including registrar, specialty doctor, and senior clinical fellow are helpful for this route provided you are given an adjustment period so you can gradually settle into your role.
CESR Route
You can apply for locum consultant or specialty doctor posts in departments that are supportive of your plans to pursue CESR.
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.
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.
Recommended books
Day-to-day clinical reference
Interview preparation
For both training and non-training jobs.
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.
29 Responses
Hy there, thanks for this update it’s been really helpful especially seeing your replies to the questions ask
My question goes.
Am a final year medical student in Nigeria with interest in Neurosurgery
But due to some challenges I would like to start my residency in neurosurgery before moving to UK to continue from where I left off is this possible?
Hi Abel, unfortunately no, it’s not that straightforward. Entry to Neurosurgery in the UK is highly competitive and once you have exceeded 12 months experience in Neurosurgery, it then becomes near impossible to enter UK Neurosurgical training.
Soooo I’m finishing my 6 years general physician training in early 2025 in BSMU (Belarusian state medical university) is it possible to get a degree in neurology and then proceed into neurosurgery? and will i be able to work while getting my degrees?
Hi there, I’m not sure what you mean by “degree in neurology”. Do you mean like a Masters degree, PhD or something else? There might be some confusion about how UK training works. This free course might help make things clearer https://thesavvyimg.teachable.com/p/img-shortcut Hope it helps! It can get confusing so if you’re looking for one-to-one guidance for your specific personal circumstances, I would recommend booking a general guidance session (40 mins) or even specialty guidance session (60 mins). For more details, please visit our page here.
https://thesavvyimg.co.uk/img-coaching
I hope to speak to you soon so we can come up with a plan and timeline that works for you!
I graduated in 2015 and did 24months internship in my home country (that’s the normal duration of internship over there). I then became an SHO in general surgery for 41 months. I then decided to move to the UK. I understand that length of time in general surgery already excludes me from ST1. I was just an SHO doing house-keeping so I do not have a logbook for that time. Does than then mean all pathways are inaccessible for me and I just need to forget about that since ST2 would need a logbook
Hi there, if you are planning to apply to training, then yes you would need to provide a log book of your surgical experience. If you’re unable to obtain this in your home country then you can do this in the UK instead.
Hello, first of all thanks for your information.
I’m from Latin-America. I’m already a neurosurgeon consultant with internship completed:
– 2 years medical internship completed
– 5 years neurosurgery residency completed
– 2 years experience as neurosurgeon consultant (during pandemic outbreak, this is why I had to stop my road to UK)
I’m wondering if do I apply to entry UK-training at ST2 or ST3-4? What do you recommend would be my best route?
Kind regards
Hi there, ST3-4 entry has been closed so ST2 is the only option at this stage. If you are already a consultant then you will likely be considered overqualified for training but you can always try. There is currently no strict experience cutoff for ST2 applications although the person specifications do state “Applicants must… Not already hold, nor be eligible to hold, a CCT/CESR in the specialty they are applying for and/or must not currently be eligible for the specialist register for the specialty to which they are applying”
Alternatively you can get GMC registration via MRCS and just start applying for neurosurgery jobs. Once you start working in the UK you’ll probably get a better idea of whether you really need to aim to repeat UK training or you can become a Consultant through the CESR route.
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
Best of luck!
I am currently pursuing my undergraduation from india in medicine and I want to become a neuro surgeon in uk. Which courses should I choose while applying in uk universities for post graduation to become a practicing neurosurgeon?
Hi there! Neurosurgical training in the UK doesn’t involve applying for courses or applying to universities. Definitely check out this article https://thesavvyimg.co.uk/specialty-training-residency-in-the-uk/ Good luck!