The Savvy IMG

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

Table of Contents

psychiatry guide imgs PLAB MRCPsych

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Introduction

Psychiatry is a popular field for IMGs wanting to pursue a career in the UK. It’s a wonderful specialty that allows you to combine medicine, neuro-science, behavioural science, high-level communication skills to make a real difference people’s lives.

The career of Psychiatrist is diverse and flexible with lots of different sub-specialties and great scope to work part-time for those who have commitments outside of medicine.

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

The steps to work in the UK

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

  1. Understand the UK Psychiatry training pathway
  2. Determine your long-term goal
  3. Get registered with the GMC
  4. Find a suitable job
  5. Obtain a work visa
  6. Start work

It is possible to do steps 2 & 3 simultaneously depending on the type of job. It is also possible to interchange steps 2 and 3 by finding a job first, and obtaining GMC registration after you’ve received a job offer as long as the employer agrees to this in advance.

We also have a short course where we explain how it is possible to get into UK training in 2 years time. Enrol now for free.

The UK Psychiatry training pathway

Whether you plan to enter the UK training pathway or not, it’s important to understand the pathway so you have an idea of what it takes to become a recognised UK Consultant Psychiatrist.

Psychiatry training for UK medical graduates is currently 8 years long in total after medical school and consists of the following stages:

For UK doctors, this consists of the following:

  • 2 years UK Foundation Programme
  • 3 years in core Psychiatry training + Membership of the Royal Colleges of Psychiatrists (MRCPsych)
    • These years are designated CT1, CT2 and CT3.
  • 3 years in higher specialty training in a subspecialty
    • These years are designated ST4, ST5 and ST6. 
    • The main subspecialties are: child and adolescent, forensic, general adult, old age, psychotherapy or psychiatry of learning disabilities.
    • Other subspecialties that can be included in the training are: addictions, eating disorders, neuro psychiatry, perinatal and social & rehabilitation psychiatry.

For IMGs, it can look a little different. We’ll go into the possible alternatives a bit later.

Because the application process for core training and higher specialty training is separate, Psychiatry training is what’s called an “uncoupled” training programme.

When core training and high specialty training are combined into a single programme with one application, this is known as “run-through” training. Child and Adolescent mental health is currently being trialled as run-through programmes but it’s not yet widely available.

Overview of the UK Psychiatry training pathway

Determining your long-term goal

Now, before you can set out on our journey, you really need to determine your long-term goal. This is the step that many IMGs skip and as a result, they end up taking a sad long winding road.

So before you continue reading, pause for a minute to answer this question: what do you want to get out of coming to the UK?

There are 3 main choices when it comes to clinical work:

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

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

CCT route

This route involves completing both the UK core Pyschiatry training and higher specialty training (all 6 years). Upon completion of the programme, you will be awarded a Certificate of Completion of Training (CCT) in Psychiatry. The CCT route is best for new graduates or those who have not already completed postgraduate training in Psychiatry. Click image to enlarge

CCT route

This route involves completing both the UK core Pyschiatry training and higher specialty training (all 6 years).

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

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

Click image to enlarge

Before you can start UK Psychiatry training, you need 24 months clinical experience. This includes 12 months of internship, and 12 months post-internship.

If you have not completed internship overseas, then your only option is to join the 2-year UK Foundation Programme as a first job.

If you have already completed internship overseas, the most suitable first jobs for this route include non-training FY2, Standalone FY2, WAST, or any SHO level post in any specialty with acute medical responsibilities. Any of these jobs will help you gain the 12-months post-internship experience required before starting Psychiatry specialty training.

Related:

UK internship (Foundation Programme) open to all IMGs for 2020

10 reasons why you should apply to WAST

Standalone FY2: Your chances as an IMG and how to optimise your application

CESR-CP route

If you don’t complete the 3-year UK core Psychiatry training programme but you do complete the 3-year higher specialty training, then you are on the Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP) route.

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

CESR-CP route

If you don’t complete the 3-year UK core Psychiatry training programme but you do complete the 3-year higher specialty training, then you are on the Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP) route.

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

If you already have 2-3 years experience in Psychiatry, you can apply for junior-grade Psychiatry positions such as CT1, SHO, or junior clinical fellow posts. Through these posts, you can work on the requirements needed to apply for higher specialty training.

If you have more than 3 years of experience, you could apply for non-training middle-grade positions such as specialty doctor, senior clinical fellow, and registrar posts. Again, through these posts, you can work on the requirements needed to apply for higher specialty training.

Just a word of caution, if you start your first job at middle-grade level, it is recommended that you arrange an adjustment period of working at a junior level for a short period before stepping up to middle-grade responsibilities.

Related:

CESR route (AKA Article 14)

If you do not complete any part of the official UK Psychiatry 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 Psychiatry 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 Psychiatry 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 Psychiatrists (RCPsych) 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 Psychiatrist 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 Psychiatry 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 Psychiatry in the UK with decent pay and a good work-life balance.

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 UK fellowship training/gain experience in Psychiatry 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 is the RCPsych MTI programme.You can review the application guidance 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:

  1. Visit the NHS Jobs website
  2. Search “Psychiatry fellow” or your preferred subspecialty like “forensic psychaitry 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, MRCPsych, or RCPsych 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.

Psychiatry residency in the UK

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

It is 6 years long in total with 3 years in core training (designated CT1, CT2 and CT3), and 3 years in higher specialty training (designated ST4, ST5, and ST6). You have to apply seperately for core training and then higher specialty training.

Throughout the 6 years you will be seeing patients in clinics, consulting with other medical and surgical teams on the wards, managing emergencies overnight and on weekends, and attending teaching sessions and conferences.

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

You will be paid a salary while you are training.

Related: How much do doctors in specialty training (residency) earn in the UK?

Programme structure

The Psychiatry training programme is generally structured as follows:

YearStage
CT1-3Core Psychiatry training – you will rotate through various Psychiatry specialites with at least 1 year in General Adult Psychiatry
ST4-6

Higher specialty training – you will specialise in 1-2 of the main Psychiatry subspecialties: child and adolescent, forensic, general adult, old age, psychotherapy or psychiatry of learning disabilities.

You can also develop a “special interest” in other subspecialties bu including it in your training. These include: addictions, eating disorders, neuro psychiatry, perinatal and social & rehabilitation psychiatry.

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

Exams

The official exam for UK Psychiatry is MRCPsych. There are 3 parts of MRCPsych:

  • Paper A – written test on the scientific and theoretical basis of Psychiatry.
  • Paper B – written test on clinical aspects of psychiatry.
  • Clinical Assessment of Skills and Competencies (CASC) – Clinical Assessment of Skills and Competencies (CASC) – a practical exam to test your skills

Psychiatry trainees must pass all 3 exams before they can start higher specialty training.

You can read more about the exams on the RCPsych website.

Applying for UK Psychiatry training

The requirements differ depending on whether you apply for core training, or higher specialty training.

Psychiatry CT1

These are the basic requirements. Please see the CT1 Paediatrics person specifications for the full requirements. 

There are no experience limits when applying for CT1, however, as with all specialties, those who have enough experience and training to be eligible for recognition as a Consultant may be deemed overqualified.

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 Psychiatry CT1, and 900 applicants, then the competition ratio is 2.

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

  2015 2016 2017 2018 2019
Psychiatry CT1 1.42 1.50 1.26 1.48 1.78

(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 3 opportunities to apply for Psychiatry ST1 each year, these are called Round 1, Round 1 re-advert, and Round 2.

Jobs that are available in Round 1 and Round 1 re-advert start in August, while those in Round 2 start in February. The highest number of jobs will be available in Round 1.

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

Round 1

NovemberApplications open
JanuaryMulti-specialty Recruitment Assessment (MSRA) – entrance test
FebInterview
2-3 weeks laterResults 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
April/MayMulti-specialty Recruitment Assessment (MSRA) – entrance test
AprilInterview
2-3 weeks laterResults are released
AugustTraining starts

Round 2

This is when jobs that start in February instead of August are open for applications.

JulyApplications open
SeptMulti-specialty Recruitment Assessment (MSRA) – entrance test
Sept/OctInterview
2-3 weeks laterResults are released
FebTraining starts

You do not need to apply in Round 1 in order to apply in Round 1 re-advert or Round 2.

Take note: in the UK residency application process, you make a single application for England, Wales and Scotland, and another application for Northern Ireland if you wish. You do not apply to individual hospitals.

If you want to learn more about how residency applications work in the UK, check out this essential guide: What IMGs need to know about applications to specialty training in the UK

Higher specialty training ST4

There are 6 Psychiatry subspecialties that you can apply for when it comes to higher specialty training.

  • Child and Adolescent Psychiatry
  • Forensic Psychiatry
  • General Adult Psychiatry
  • Old Age Psychiatry
  • Psychiatry of Learning Disability

The entry requirements and process for applying are essentially the same for all 6. See below for more details.

  • Full GMC registration by the time you start

CCT route

  • You must be in your third year (CT3) of UK core Psychiatry training or you have already completed UK core Psychiatry training.

CESR-CP route

There are 3 main eligibility requirements:

  1. Experience (one of the following)
    • Minimum 3 years Psychiatry OR
    • 2 years Psychiatry + 1 year in UK training for Internal Medicine, GP or Paediatrics with approved transfer of credits
  2. Competence (one of the following)
  3. MRCPsych

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

There are no experience limits when applying for ST4, however, as with all specialties, those who have enough experience and training to be eligible for recognition as a Consultant can potentially be deemed overqualified for training but I’ve not yet seen this happen.

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 Psychiatry ST4, and 90 applicants, then the competition ratio is 3.

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

 2016201720182019
General ST41.301.071.020.99
Child and Adolescent ST41.091.110.770.96
Forensic ST41.921.021.291.13
Medical Psychotherapy ST44.003.003.002.67
Old Age ST40.900.880.791.09
Learning Disability ST40.760.860.350.45

(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 are usually 2 opportunities to apply for Psychiatry ST4 level – Round 2 and Round 2 re-advert. Applications are submitted through the website Oriel. The exact dates are released each year but the general timeline is as follows:

Round 2

Jobs that are open during Round 2 start in August. This is when the majority of posts are available. 

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

Round 2 re-advert

Jobs that are open during Round 2 re-advert start in February. There are usually less posts for this round compared to Round 2. 

Jul-AugApplications open
Aug-OctInterview
2-3 week laterResults are released
FebruaryStart of training

Take note: in the UK residency application process, you make a single application for England, Wales aand Scotland, and another application to Northern Ireland if you wish to train there. 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 Psychiatry?

Psychiatry training is a specialty with relatively low 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 to core Psychiatry training, you’ll need to maximise your application score.

The application score is equally split into 3 components:

  • 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.

In fact, if you do really well in the MSRA, you can even skip the interview and CV/portfolio bit and get a job offer for core training directly. The cut off score for this great opportunity changes each year so you’ll need to check the latest application guideline to find out what it is.

Related: 8 tips to succeed when applying for UK specialty training

Further information about training and applications

If you have any questions about applying for Psychiatry, you can email psychiatryrecruitment.nw@hee.nhs.uk.

GMC registration for Psychiatrists

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 MRCPysch 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 Psychiatrists.

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.

If you pass all 3 MRCPsych exams, then you can bypass PLAB. The MRCPsych exams are aimed at doctors who have already completed their basic postgraduate training in Psychiatry.

You can gain GMC registration without PLAB if you obtain sponsorship through the UK Royal College of Psychiatrists (RCPysch) via the Medical Training Initiative (MTI).

You can gain GMC registration without PLAB if you passed were awarded the Fellowship of The Royal Australian and New Zealand College of Psychiatrists after January 2012.

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 without PLAB, MRCPsych or sponsorship. You can read more about it below under the section “Become a recognised UK Consultant Psychiatrist”

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

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

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16 Responses

  1. This is very informative, thank you. I have completed a 3 year post graduate specialization in psychiatry. Do you have information about MRCPsych exam?

  2. hi dr tan,

    how does one work long term in the UK without being a consultant? i have a spouse visa and right to work in the UK.
    i am an IMG , and i have completed my postgraduate degree in my home country.

    1. Hi there, you can just start applying for jobs in your specialty. You can search for relevant job titles mentioned in this article UK doctor titles 101
      You’d only become a consultant if you either complete UK specialty training, or go through the CESR route. Both are active processes that you can pursue if you wish, but ultimately, neither are required to work in the UK long-term. Good luck!

      If you’re looking one-to-one guidance for your specific personal circumstances, I would recommend booking a general guidance session (40 mins). For more details, please visit our page here.
      https://thesavvyimg.co.uk/img-coaching

  3. In the very last option you mentioned CESR without MRCPsy. Can you explain how it works and where to get more information about it?

    1. Hi there, yes the links are provided above under “What documentation do you need to provide for CESR?” All 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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