The Savvy IMG

Become an Ophthalmologist in the UK: A comprehensive guide for IMGs

Ophthalmology is in huge demand in the UK. Specialists are needed faster than the UK can produce them, so there are many opportunities for an Ophthalmologist trained overseas to work here.

Table of Contents

How international overseas medical graduates can pursue ophthalmology in the UK

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Introduction

Ophthalmology is in huge demand in the UK. Specialists are needed faster than the UK can produce them, so there are many opportunities for an Ophthalmologist trained overseas to work here.

If you are interested in entering Ophthalmology residency in the UK, be aware that it is highly competitive. However, with hard work and a clear strategy, it is certainly possible for an IMG to get a place in the UK Ophthalmology residency programme (speaking from my own personal experience!)

The steps to work in the UK

These are the general steps for any IMG to work in the UK:

  1. Determine your long-term goal
  2. Get registered with the GMC
  3. Find a suitable job
  4. Obtain a work visa
  5. 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 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:

  1. Become a recognised UK Consultant Ophthalmologist 
    • Whether you want to stay in the UK long-term or migrate elsewhere after, is up to you.
  2. Work long-term as an Ophthalmologist in the UK without becoming a recognised Consultant
  3. Complete a UK Ophthalmology 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 Ophthalmologist

If you want to be recognised as a Consultant Ophthalmologist 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:

  1. CCT
  2. CESR-CP
  3. CESR

These 3 routes differ by how much of the UK Ophthalmology residency programme (specialty training) you complete.

CCT routeCCT Ophtha IMGs

If you complete the full 7-year UK Ophthalmology training programme, you will be awarded a Certificate of Completion of Training (CCT) in Ophthalmology. This means you start from specialty training year 1 (known as ST1)*.

*If you have more than 18 months experience in Ophthalmology after internship anywhere in the world, you are overqualified for ST1 and cannot pursue the CCT route. To become a Consultant, you must pursue either the CESR-CP or CESR routes described below.

Related: Are you overqualified for UK specialty training?

Please take note, you do not need to have any work experience in Ophthalmology in order to apply for ST1 Ophthalmology. Besides, there are rarely any Ophthalmology jobs for those without prior experience.

Before you can start UK Ophthalmology 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.

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 Ophthalmology.

CESR-CP route

CESR-CP Ophtha IMGsIf you complete less than 7 years of the UK Ophthalmology training, then this is the Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP) route.

The usual entry point after ST1 is ST3 (specialty training year 3), so you would end up completing 5 years of the training programme.

According to new GMC rules, those on the CESR-CP route who complete at least 3 years of UK training in Ophthalmology will still be awarded CCT.

Related: CESR-CP will soon be recognised as CCT

If you already have more than 18 months of experience in Ophthalmology, you can apply for non-training ST1, SHO, or junior clinical fellow posts.

If you have more than 3 years of experience, you could apply for specialty doctor, senior clinical fellow, and registrar posts.

Through any of these posts, you can work on the requirements needed to apply for ST3.

CESR route (AKA Article 14)

CESR Ophtha IMGsIf you do not complete any part of the official 7-year UK Ophthalmology 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.

CESR stands for Certificate of Eligibility for Specialist Registration.

If you have already completed Ophthalmology 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.

The GMC and Royal College of Ophthalmology (RCOphth) 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 are seen as equivalent. You will be recognised as a UK Consultant Ophthalmologist 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 an Ophthalmologist 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 an Ophthalmologist 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.

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:

UK doctor titles 101

The best first jobs for overseas doctors in the UK

This is possible. Most Ophthalmologists 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 couple of ways to do this.

  1. Visit the NHS Jobs website
  2. Search “Ophthalmology fellow”
  3. Apply to jobs you like and are suitable for

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 for a fellowship, you can use any of the methods mentioned above: PLAB, MRCS/FRCS, ICO, FRANZCO or RCOphth Dual 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:

  1. Tier 5 temporary work visa (maximum 24 months in the UK on this type of visa) – this is done through RCOphth OR
  2. 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.

Ophthalmology residency in the UK

Let’s talk a bit more about the UK Ophthalmology training programme.

Officially, it’s called Ophthalmic Specialist Training (OST). It is 7 years in duration and each year is numbered. The first year is termed ST1/OST1, each year the number goes up until the final year ST7/OST7. 

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 first 2 years cover basic Ophthalmic training, the next 3.5-4 years cover higher Ophthalmic training, and the last 1-1.5 years are spent in a subspecialty.

Throughout the 7 years you will be seeing patients in clinics, managing with emergencies overnight and on weekends, attending teaching sessions and conferences, and performing surgery.

In some programmes, you will stay in the same hospital for ST1 & ST2. You will then rotate to a new hospital in your region every year until ST7. In most programmes, you will rotate to a new hospital every year for all 7 years.

Related: How specialty training (residency) works in the UK: A complete beginner’s guide

Exams

The official exam for Ophthalmology in the UK is the FRCOphth. There are 4 parts to this exam. All parts must be passed by the end of the 7-year training programme.

  • Part 1 – This is a written exam about basic Ophthalmic sciences. iIt is a requirement for ST3 applications, but not for entry to ST1. However, if you do pass this exam before ST1, you get extra points in the ST1 application. Ophthalmology residents must pass Part 1 before progressing to ST3.
  • Refraction exam – This must be passed by the end of ST3.
  • Part 2 – Part 2 is actually a 2-part exam with a multiple choice exam, and an oral exam. The exams are taken on different dates. Ophthalmology trainees must pass these exams by the end of ST7.
Please take note that ICO and MRCS/FRCS Ophthalmology are NOT accepted as alternatives to FRCOphth when it comes to specialty training

How to apply for UK Ophthalmology 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:

NovemberApplications open
December/JanuaryMulti-specialty recruitment assessment (MSRA test) Required for ST1 only, not ST3
FebruaryNational interview + Portfolio scoring
1-2 weeks after interviewPreferencing (ranking of preferred locations to work in the UK)
2-3 weeks after interviewResults are released
AugustStart of training

After the interview, you select which regions of the UK you want to be considered for and rank them in order of preference. If accepted, you will be assigned to a region based on your rank and preference (ie. the higher your rank, the higher your chance of getting your top preference) and allocated to a hospital within that region. The job then starts in August.

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 Ophthalmology specialist training

The requirements differ depending on whether you apply for ST1 or ST3. Starting training at either ST1 and ST3 should lead to a CCT.

ST1

  • 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.
    • You do not need to have any work experience in Ophthalmology in order to apply.
  • F2 competences or CREST (Certificate of Readiness to Enter Specialty Training)

These are the basic requirements. Please see the ST1 Ophthalmology person specifications for the full requirements.

If you have more than 18-months experience in Ophthalmology after internship anywhere in the world, you are considered overqualified for ST1 and will not be eligible to apply.

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 100 posts for Opthalmology, and 400 applicants, then the competition ratio is 4.

Here are the competition ratios for Ophthalmology ST1 over the past 5 years:

 20152016201720182019
Ophthalmology3.944.845.263.743.24

(Source)

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

  • 24 months experience in Ophthalmology by the time you start ST3 (August)
  • FRCOphth Part 1
    • FRCS/MRCS/ICO are NOT accepted
  • A valid certificate confirming completion of UK ST1/ST2 competences outside of the training programme

These are the basic requirements. Please see the ST3 Ophthalmology person specifications for the full requirements.

At present, FRCS and ICO are not accepted for entry ST3. Only FRCOphth is accepted.

If the panel feel you are eligible for CESR and therefore overqualified for training, you may be deemed ineligible for ST3. So if you already have extensive training and experience in Ophthalmology eg. more than 10 years, just be aware that there is a possibility that you may not get a place in ST3.

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 10 posts for Ophthalmology, and 40 applicants, then the competition ratio is 4.

Here are the competition ratios for Ophthalmology ST3 over the past 5 years:

 20152016201720182019
Core Surgery3.073.562.33N/A

(Source)

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.

Is it difficult to get into UK Ophthalmology training?

Ophthalmology is considered highly to extremely competitive and used to be 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 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?

Although Ophthalmology is competitive, it’s not impossible. I applied for ST1 as an IMG and ranked 96th percentile of all applicants nationwide on my first application. 

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)
  • 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

Further information about applications

If you have any questions about applying for ophthalmology please email the recruitment office – SEVRecruitment.SW@hee.nhs.uk

GMC registration for Ophthalmology

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 is no exemption 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 (Ophth) 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 several options to do this for Ophthalmology:

The PLAB exam is set at the level of a doctor who has completed internship. It covers the basics in all specialties and is most suitable for IMGs who have not yet completed an Ophthalmology residency, however it can also be taken by trained Ophthalmologists. In general, PLAB is the quickest and least expensive route.

These exams are aimed at doctors who have completed a residency or specialist training in Ophthalmology. If you pass either FRCS Glasgow (Ophth) or FRCS Ed (Ophth), then you can bypass PLAB.

If you obtained MRCS Ophth prior to Sep 2018, you can use this to bypass PLAB and gain GMC registration. If you obtained MRCS Ophth after Sep 2018, then you also need to pass the FRCS Ophth OSCE to gain GMC registration.

You can gain GMC registration without PLAB, ICO or MRCS/FRCS if you can obtain sponsorship through RCOphth. It’s a lengthy process which you can read more about on the RCOphth website.

This pathway is not yet totally clear. When you have ICO, you will be eligible for MRCS Ed (Ophth), in the past this could be used for GMC registration instead of PLAB, but now it seems you also need to pass the FRCS Ophth OSCE. We recommend contacting the GMC directly about this if you want to pursue this route.

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 options for IMGs without PLAB, FRCS, or sponsorship. You can read more about it below under the section “Become a recognised UK Consultant Ophthalmologist”

If you have obtained Fellowship of the Royal Australian and New Zealand College of Ophthalmologists (FRANZCO) awarded since January 2010, then it can be used to bypass PLAB and gain GMC registration.

Finding a suitable first job

There are 2 main questions to consider when looking for a suitable first job.

  1. 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.
    • Most Ophthalmology jobs require previous training and experience.
  2. 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 best first job depending on the route you wish to pursue.

You need to make sure you meet the requirement for 24 months clinical experience in order to apply for surgical training. If you haven’t completed internship overseas, then you need to apply for 2-year UK Foundation Programme starting with FY1.

If you have already completed internship overseas, you can apply for either Standalone FY2 or a non-training job in any specialty.

Just be sure not to exceed the experience limits for your target specialty, otherwise you become ineligible for the CCT 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. 

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 Health and care worker visa. 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.

In short, the majority of IMGs who come to work in the UK, can gain British citizenship within 6 years.

Recommended books

Click on the images to check the price on Amazon.

Day-to-day clinical references

FRCOphth Part 1 preparation

Interview preparation

For both training and non-training jobs.

For the critical appraisal station of the training job interview.

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.

You might also like

Looking for a step-by-step guide?

Subscribe to the Savvy IMG and grab your FREE 2-year roadmap to UK residency as an IMG.

free

Looking for a step-by-step guide?

Subscribe to the Savvy IMG and grab your FREE 2-year roadmap to UK residency as an IMG.

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45 Responses

  1. Hello,

    I want to ask in the structure of training it says you will spend 1-1.5 year in subspecialty training does that mean that the 7 year training program includes a fellowship? Or do I need to get that after I get my CCT?

    Also can I finish my training in less than 7 years if I meet all the requirements or do I need to finish the 7 year anyway?

    Thank you

    1. Hi there, in essence, yes, the 7 years will include a “fellowship”. For more surgical and competitive specialties though, like cornea and vitreoretinal surgery, it is often expected that you do additional fellowships after the 7 years.
      It is possible to finish earlier than 7 years but the so far the shortest time that will be allowed is 6 years.

  2. Hi. I want to get GMC registration via Royal College of PS(FRCSOphth/Glasgow) so it will be a full registration with licence to practice. Therefore, which pathway should I follow for being consultant after commencing working in NHS?

    1. Hi there, you can apply for middle grade posts and work on the portfolio/CESR pathway to be recognised as a consultant. If you have less than 30 months experience in Ophthalmology, you can apply for the training programme. It’s 7 years long but if you have previous experience, you may be able to skip 1-2 years.

  3. Hello,
    I am a fifth year medical student in Rome. And I’m studying in english. I would like to apply for ophthalmology residency in uk. I read everything in your website but still i am so confused.
    Could you please help me with this? What is the first step exactly?

    Thank you so much

    1. Hi Ala, great to hear from you!
      The first step is really understanding how everything works otherwise you might start taking action and find out later on that you’ve made some big mistakes.
      I would highly recommend our free online course IMG Shortcut to get a good overview. It’s a lot easier to understand in video format than text!
      https://thesavvyimg.co.uk/img-shortcut
      Hope you find it helpful!

  4. Hi!
    I’m an IMG from India. I’d completed my post graduation in Ophthalmology last year.
    I wanted to know about how to show the Foundation year and ST1/ST3 competences.

    1. Hi there, if you’re applying for ST3, you don’t need to show foundation competences as long as you have the ST1/ST2 competences. The form for those competences is on the Severn deanery website here https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-ST3-23/applicant-guide-lib

      It can get quite confusing so if you are looking for one-to-one guidance for your specific personal circumstances, you can book a session to discuss your options here:
      https://thesavvyimg.co.uk/img-coaching

      Good luck!

      1. Thank you for the reply.
        I just read that the ST3 entry point for Speciality Training is going to be stopped after this year. I had just started on building my portfolio for ST3 applications and I don’t have a strong portfolio yet to apply for ST3 applications this month. I’m disheartened as an IMG who’s got more than 24 months experience in Ophthalmology, the only option now is the CESR Pathway.

        1. Hi there, I don’t know if ST3 is being closed next year or the year after but yes those are the plans unfortunately. I would say to apply this year anyway, you never know you might get the job! What you’ve done has not gone to waste, when you apply for CESR you’ll need all of those achievements as well. Good luck!

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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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