The Savvy IMG

Become a Paediatrician in the UK: A comprehensive guide for IMGs

Whether you are already a specialist overseas, or just starting out in your journey to a career in Paediatrics, there's a path to the UK for you here in this comprehensive IMG guide.

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A career in Paediatrics allows you to make real differences to children and adolescents that can impact the rest of their lives. It’s a widely varied field with a fulfilling subspecialty for all types of Paediatricians.

Here’s how you can work as a Paediatrician in the UK.

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 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:

  1. Become a recognised UK Consultant Paediatrician 
    • Whether you want to stay in the UK long-term or migrate elsewhere once you become a Consultant, is up to you.
  2. Work long-term in Paediatrics in the UK without becoming a recognised Consultant
  3. Complete a UK Paediatrics 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 Paediatrician

If you want to be recognised as a Paediatric Consultant 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 Paediatric residency programme (specialty training) you complete.

CCT route

This route involves completing the full 8-year UK Paediatric training programme. This means you start from specialty training year 1 (known as ST1).

Upon completion of the programme, you will be awarded a Certificate of Completion of Training (CCT) in Paediatrics.

The CCT route is best for new graduates or those who have not already completed postgraduate training in Paediatric.

Click image to enlarge

CCT route

This route involves completing the full 8-year UK Paediatric training programme. This means you start from specialty training year 1 (known as ST1).

Upon completion of the programme, you will be awarded a Certificate of Completion of Training (CCT) in Paediatrics.

The CCT route is best for new graduates or those who have not already completed postgraduate training in Paediatric.

Click image to enlarge

Before you can start UK Paediatric 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 experience 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 Paediatric 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 complete less than 8 years of the UK Paediatric training programme, then you are on the Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP) route.

The usual entry point into training is at ST3 (specialty training year 3) or ST4, so you would end up completing 5-6 years of the UK Paediatric training programme.

The CESR-CP route is best for IMGs who have already completed 2-3 years experience or training in Paediatrics.

According to new GMC rules, those on the CESR-CP route who complete at least 4 years of UK training in Paediatrics will still be awarded CCT. If you complete less than 4 years of UK training, you will be awarded CESR.

Related: CESR-CP now recognised as CCT

CESR-CP route

If you complete less than 8 years of the UK Paediatric training programme, then you are on the Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP) route.

The usual entry point into training is at ST3 (specialty training year 3) or ST4, so you would end up completing 5-6 years of the UK Paediatric training programme.

The CESR-CP route is best for IMGs who have already completed 2-3 years experience or training in Paediatrics.

According to new GMC rules, those on the CESR-CP route who complete at least 4 years of UK training in Paediatrics will still be awarded CCT. If you complete less than 4 years of UK training, you will be awarded CESR.

Related: CESR-CP now recognised as CCT

If you already have 2-3 years experience in Paediatrics, you can apply for junior-grade Paediatric positions such as CT1, SHO, or junior clinical fellow posts. Through these posts, you can work on the requirements needed to apply for ST3/ST4.

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 ST3/ST4.

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 Paediatric 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 Paediatric 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.

If you have already completed Paediatric 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 Paediatrics and Child Health (RCPCH) have specific guidance for the requirements for CESR. You can find the updated list of requirements here:

Equivalence

In the UK, all 3 routes CCT, CESR-CP and CESR, are seen as equivalent. You will be recognised as a UK Paediatrician 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 Paediatrics 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 Paediatrics 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 Doctors 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 ones available are:

  1. RCPCH MTI programme
  2. Oxford International Neonatal and Paediatric Fellowship Scheme.
  3. Great Ormond Street Hospital for Childen International Fellowship Program

The eligibility requirements for these programmes are different for each one, some even require you to secure funding from back home so be sure check these carefully.

You can review the application guidance here:

  1. RCPCH MTI programme
  2. Oxford International Neonatal and Paediatric Fellowship Scheme.
  3. Great Ormond Street Hospital for Childen International Fellowship Program

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:

  1. Visit the NHS Jobs website
  2. Search “paediatric fellow” or your preferred subspecialty like “neonatal fellow”
  3. Apply to jobs you like and are suitable for
  4. Once you have been accepted for a job, apply for GMC registration (please note, some jobs require you to have GMC registration before applying.)
There are numerous job titles for similar positions so if you’re confused, do check out our article UK doctor titles 101.

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 methods already mentioned above: PLAB, MRCPCH, or RCPCH sponsorship/MTI.

The registration you gain is permanent and will not be revoked after the fellowship.

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 RCPCH as part of the MTI scheme  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.

Paediatric residency in the UK

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

It is 8 years long in total. Each year is numbered starting from ST1 (specialty training year 1) up until ST8 (specialty training year 8).

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 Paediatric training programme is generally structured as follows:

YearStage
ST1-3Level 1 training
ST4-5Level 2 training
ST6-8Level 3 training including subspecialty 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 procedures on babies and children.

In most programmes, you will rotate to a new hospital every 6-12 months  (usually 12 months) throughout all 8 years.

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

Accelerated training

Although training is 8 years long, it is possible to complete training in a shorter time if you have experience outside of the training programme or you simply progress very quickly through all the requirements. However, you cannot complete training in less than 5 years. In order to receive a CCT, the absolute minimum time you must spend in the programme is 5 years.

So for example, if you have 12-months experience prior to starting ST1, then with the support of your supervisors and deanery, you can progress to ST3 the next year instead of ST2 as long as you meet all the requirements for ST3.

Or as another example, if you complete MRCPCH and all the other Level 1 requirements during by the end of ST2, you may be able to proceed directly to Level 2 training or ST4 instead of going through ST3. Again, this all needs to be approved in advance.

Exams

The official exams for UK Paediatrics are MRCPCH and RCPCHStart.

There are 4 parts of MRCPCH:

  • Foundation of Practice (FOP) – theory exam
  • Theory and Science (TAS) – theory exam
  • Applied Knowledge in Practice (AKP) – theory exam
  • MRCPCH Clinical exam
  • Residents must pass both 2 of the 3 theory exams before progressing to ST3, and they must pass all 4 exams before progressing to ST4.
  • You can read more about the exams here on the RCPCH website.
RCPCHStart is described as more of an assessment than an exam and is meant to guide senior trainees who are nearing the end of training and help prepare them to work as a new Consultant Paediatrician. It is compulsory for those on the CCT or CESR-CP route and is taken during Level 3 training, usually at ST7 but sometimes at ST6 or ST8.

Applying for UK Paediatric training

The requirements differ depending on whether you apply for ST1, ST3 or ST4. Starting training at any level should lead to a CCT.

Paediatrics ST1

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

Please note that according to the RCPCH website, it is no longer possible to enter training at ST2 level even though these person specification say ST1/ST2. Although it is possible to start at ST1 and be fast-tracked to ST3. Please see the section on accelerated training above.

There are no experience limits when applying for ST1.

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 450 posts for Paediatrics ST1, and 900 applicants, then the competition ratio is 2.

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

 20152016201720182019
Paeds ST11.801.651.331.301.18

(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.

There is usually 2 opportunities to apply for Paediatrics ST1 each year, these are called Round 1 and Round 1 re-advert.

The exact dates for each round are released each year but the general timeline is as follows:

Round 1

NovemberApplications open
Jan/FebInterview
MarchResults are released
AugustTraining starts

Round 1 re-advert

This is when the leftover jobs from Round 1 are opened again for applications.

Feb/MarchApplications open
AprilInterview
2-3 weeks laterResults are released
AugustTraining starts

You do not need to apply in Round 1 in order to apply in Round 1 re-advert.

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

Paediatrics ST3

  • Full GMC registration by the time you start
  • Minimum of 24 months experience in Paediatrics
  • Evidence of achievement of the ST1/ST2 curriculum – usually through a portfolio of assessments
  • A pass in 2 of the 3 MRCPCH theory papers 

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

There are no experience limits when applying for 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 30 posts for Paediatrics ST3, and 90 applicants, then the competition ratio is 3.

Here are the competition ratios for Paediatrics ST3 over the past 4 years:

 2016201720182019
Paeds ST32.241.521.503.15

(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.

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:

End of Jan – Mid FebApplications open
AprilInterview
2-3 week laterResults are released
AugustStart 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

Paediatrics ST4

These are the basic requirements. Please see the ST4 Paediatrics person specifications for the full requirements.

There are no experience limits when applying for ST4.

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 70 posts for Paediatrics ST4, and 140 applicants, then the competition ratio is 2.

Here are the competition ratios for Paediatrics ST4 over the past 4 years:

 2016201720182019
Paeds ST41.171.401.272.21

(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.

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:

End of Jan – Mid FebApplications open
AprilInterview
2-3 week laterResults are released
AugustStart 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

Is it difficult to get into UK Paediatrics?

Paediatrics is a specialty with low to moderate competition so the chances for an IMG to be successful with landing a training job are very good.

Of course, that doesn’t mean you will succeed as a slacker. This is still a specialty that requires a lot of hard work and dedication so you will still need a solid application and interview performance to succeed.

How do I improve my chances of success?

To succeed with your application, you’ll need to maximise your application score.

There are 2 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

GMC registration for Paediatricians

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 MRCPCH 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 established and future Paediatricians.

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.

If you pass all 4 MRCPCH exams, then you can bypass PLAB. The MRCPCH exams are aimed at doctors who have already completed their basic postgraduate training in Paediatrics.

You can gain GMC registration without PLAB if you obtain sponsorship through the UK Royal College of Paediatrics & Child Health (RCPCH).

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.

  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.
  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: 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.

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

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.

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.

free

24 Responses

  1. I have completed my fcps training I paediatrics in Pakistan.i want to get a job in UK…not very hectic but in paediatric field….what jobs should I target and what’s their pay package?

    1. Hi Sara,

      Thank you for reaching out. If you have completed your FCPS training in Pediatrics in Pakistan and want to work in the UK, there are several job options you can consider in the pediatric field.

      You can also explore non-training posts such as Trust Grade or Specialty Doctor positions in pediatric departments. These roles provide clinical experience and may have a more manageable workload compared to training posts.

      In terms of pay packages, the salary for doctors in the UK varies depending on factors such as experience, location, and grade. Specialty Doctors can earn between £41,000 to £76,000 per year, depending on the level of responsibility and experience.

      I hope this helps, and best of luck with your career in pediatrics!

  2. Hi Nick.
    this is the best website I have come across.
    I am presently working as a gp paediatric in my country. if I complete the mrcpch exams, what is the best way to apply for the paediatric cardiology? I heard that I should complete st1-st3 peads,? also can I apply for st3 Pediatrics or i should only be able to apply for st4 peads?

    1. Hi there! So sorry for the delayed response. It depends if you have already completed paediatrics training, I’m afraid I’m not sure what level of training you’ve had as “GP paediatric”. If you have not completed any formal paediatrics training, you’d need to apply for ST1 paeds. There is a lot to cover in your comment and I’m afraid I won’t be able to give you the detailed response you need to really develop a plan without further details.

      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).

      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. Wishing you the best!

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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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