Introduction
If you’ve heard that a surgical career in the UK is difficult, then you’ve heard right. But that’s no different to anywhere else.
In any country in the world, a surgical career is highly popular and therefore highly competitive. Nobody has ever said that a career in surgery was going to be easy, so if you chose this specialty, you already know this.
But competitive does not mean impossible. There is no reason why a hard-working and determined individual cannot succeed in this field in the UK!
So if you’re ready to pursue this long but fulfilling journey, then keep reading. I’ll give you an overview of what it takes to become a surgeon in the UK as an IMG.
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.
Are the steps different for each surgical specialty?
The steps and procedures for all the surgical specialties are essentially the same. The only exception is Oral and maxillo-facial surgery which requires both a dental and a medical degree.
To be clear, there are 9 surgical specialties in the UK: General surgery, Vascular surgery, Trauma & orthopaedics, Paediatric surgery, ENT, Plastic surgery, Neurosurgery, Cardio-thoracic surgery, and Oral and maxillo-facial surgery.
Ophthalmology and Obstetrics & Gynaecology are completely separate pathways that will not be covered in this guide.
What is 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:
- Become a recognised UK Consultant Surgeon in your surgical specialty of choice
- Whether you want to stay in the UK long-term or migrate elsewhere after, is up to you.
- Work long-term as a Surgeon in the UK without becoming a recognised Consultant
- Complete a UK surgical 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.
GMC registration
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 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 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 Surgery:
PLAB
The PLAB exam is set at the level of a doctor who has completed internship. The 2-part exam covers the basics in all specialties and is most suitable for IMGs who have not yet completed a surgical residency, however, it can also be taken by trained surgeons. In general, PLAB is the quickest and least expensive route.
MRCS
MRCS is 2-part postgraduate qualification aimed at doctors with at least 1-2 years experience in surgery, but it can also be taken by fresh graduates without any surgical experience. By passing both parts of MRCS, you can bypass PLAB.
FRCS
FRCS is a postgraduate qualification aimed at doctors who have completed a full surgical training programme ie. residency and are at the level of Consultant. Passing all parts of FRCS also means you can bypass PLAB.
MTI & Sponsorship
If you want to come to the UK for a short period of training (2 years max.) then return home, you may be able to obtain sponsorship for GMC registration thereby bypassing PLAB through one of the several international programmes. More on that below.
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 unless they depend solely on you to care for them both financially and for their health.
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.
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 Surgeon
If you want to be recognised as a Consultant Surgeon 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:
- CCT
- CESR-CP
- CESR
These 3 routes differ by how much of the 8-year UK Surgical residency programme (specialty training) you complete.
CCT route
If you complete all 8 years of UK surgical training in one of the 9 surgical specialties, then you will be awarded a Certificate of Completion of Training (CCT) in your chosen surgical specialty.
This means you must start surgical training from year 1*.
*If you have more than 18 months experience in Surgery, you are overqualified for year 1 of training and cannot pursue the CCT route. To become a Consultant, you must pursue either the CESR-CP or CESR routes described below.
CESR-CP route
If you complete less than 8 years of the UK surgical training programme training, you will be awarded a Certificate of Eligibility for Specialist Registration Combined Programme (CESR-CP).
The usual entry point after the first year, is in the third year known as ST3 (specialty training year 3), so you would end up completing 6 years of the training programme.
CESR stands for Certificate of Eligibility for Specialist Registration – Combined Programme.
CESR route (AKA Article 14)
If you do not complete any part of the official 8-year UK Surgical 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.
CCT vs CESR-CP vs CESR
In the UK, all 3 qualifications are seen as equivalent. You will be recognised as a UK Consultant Surgeon via any of these 3 routes.
But please be aware that this may not be the case overseas. Some countries do not accept CESR-CP or 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 Surgeon 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 Surgeon in the UK with decent pay and a good work-life balance.
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.
Related: UK doctor titles 101, The best first jobs for overseas doctors in the UK
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.
What if you want to become a Consultant eventually?
This is possible. Most Surgeons in this position go through the CESR route.
Goal #3 – Complete a Surgical fellowship training / gain UK experience then return home
Many doctors wish to gain experience and training in the UK in order to better serve their patients back home, or gain a UK qualification that will boost their career overseas. If this is something you’re interested in, there are several programmes you can look into
Royal College International Fellowships
The Royal Colleges of Surgery organise international fellowship programmes which allow overseas surgical residents (those already in training), to gain some UK work experience (up to 2 years max.). These programmes allow surgeons to bypass PLAB but usually require that you have passed exams in your home country.
The specific requirements for each programme can be found on the website.
- Royal College of Surgeons, England
- Royal College of Surgeons of Edinburgh
- Royal College of Physicians and Surgeons of Glasgow
University-linked degrees
There are many UK universities offering a Master’s or MD in a surgical field. (search UK Masters Surgery)
While you do gain training through one of these programmes, and you can use it to boost your career prospects overseas, just bear in mind that these University-linked degrees, have no place in the UK surgical training pathway. On their own, they will not lead to recognition as a UK Consultant.
Fellow jobs
Other than these programmes, you can also simply apply for surgical jobs on the NHS jobs website. The steps are pretty simple:
- Visit the NHS Jobs website
- Search “surgery fellow”
- Apply to jobs you like and are suitable for
Work visas
There are 2 options for work visas:
- Tier 5 temporary work visa (maximum 24 months in the UK on this type of visa) – this is relevant for the Royal College programmes OR
- Tier 2 standard work visa (no maximum period) – leads to permanent residence after 5 years, and British citizenship a year later.
After completing your fellowship training and gaining UK experience, you simply return home after the job contract ends.
Surgical residency in the UK
If you’re interested in entering the official UK surgical residency, here’s what you need to know.
Surgical training in the UK is 8 years long. To enter surgical training you must first have 24 months clinical experience so altogether it’s 10 years long after completion of medical school.
You will be paid a salary while you are training. There is no tuition fee for this.
Related: How much do doctors in specialty training (residency) earn in the UK?
Programme structure
There are 2 types of training programmes: uncoupled, and run-through.
Uncoupled
This is the typical type of surgical programme. It involves 2 years of Core Surgical Training (CST), and 6 years in Higher Surgical Training which can be one of the following specialties:
- General surgery
- Vascular surgery
- Trauma & orthopaedics
- Paediatric surgery
- ENT
- Plastic surgery
- Urology
So for these specialties, you need to apply for CST, then later apply for your higher surgical specialty – that’s 2 separate applications.
The first year of Core Surgical Training is called CT1, the second year is called CT2. Once you reach higher surgical training, the letter changes to S but the numbers continue.
So for example, ST3 Urology is the 3rd year of surgical training. The numbers continue up until ST8 – the final year.
Run-through
In run-through training, all 8 years are combined into one programme. You apply for the first year, and then no longer need to apply for the higher years – so it only involves one application.
The run-through programmes are:
- Neurosurgery
- Cardio-thoracic surgery
- Oral and maxillo-facial surgery
The first year of a run-through programme is called ST1, it continues until ST8 – the final year.
Many of the uncoupled surgical specialties are starting to pilot run-through programmes too. This includes General surgery, Vascular surgery, Trauma & orthopaedics, ENT, and Urology.
Rotations
For all types of training programmes, you will rotate between different departments and hospitals every 6-12 months.
Related: How specialty training (residency) works in the UK: A complete beginner’s guide
This training is NOT a university degree
Although training is organised by several institutions including the Royal College of Surgeons, don’t confuse it for a university degree. It’s not.
You will not finish with an MD or Masters in Surgery. Your final qualification is the CCT which will allow you to be recognised as a Consultant in the UK.
Exams
The official exams for Surgery in the UK are MRCS and FRCS.
MRCS must be completed by the end of year 2. It is required in order for you to progress to ST3 in any surgical specialty. The exam is the same for all surgical specialties.
FRCS must be completed by the end of year 8. The exam is different for each of the 9 surgical specialties.
How to apply for UK Surgical residency
Applications to training are made through the website Oriel. There are 2 timelines for applications: Round 1 is for applications to CT1 or ST1. Round 2 is for applications to ST3.
The exact dates are released each year, but the general timeline is as follows:
Round 1 (ST1/CT1 )
| November | Applications open |
| January | Interviews |
| February/March | Results are released |
| August | Job starts |
Round 2 (ST3)
| January/February | Applications open |
| March-April | Interviews |
| April | Results are released |
| August | Job starts |
National recruitment
In the UK, applications to training are known as national recruitment. As the name says, it is a national process. So you make one application to each specialty you want to apply for – you can apply to as many as you want without prejudice.
After the interview, you select which regions of the UK or which specific job placements you want to be considered for, and rank them in order of preference. If accepted, you will be assigned to a region/job based on your rank and preference (ie. the higher your rank, the higher your chance of getting your top preference).
Take note that in UK residency application process, you do not apply separately 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 Surgical training
The requirements differ depending on whether you apply for CT1/ST1 or ST3.
Remember, entry to CT1/ST1 leads to CCT while entry to ST3 leads to CESR-CP.
Entry requirements for CT1/ST1
- Full GMC registration by the time you start CT1/ST1
- 24 months clinical experience by the time you start CT1/ST1
- This includes 12 months of internship + 12 months after internship.
- F2 competences or CREST (Certificate of Readiness to Enter Specialty Training)
- Competitive portfolio
- To be shortlisted for interview, you need to have a good portfolio score.
These are the basic requirements. Please see the ST1 person specifications for the full requirements.
Restrictions for CT1/ST1
It is possible to be considered overqualified for a first year surgical training post.
See the table below for the current restrictions.
| Surgical specialty | Maximum experience permitted for CT1/ST1 |
| Neurosurgery | 24 months clinical experience (in any specialties) with no more than 12 months combined experience in Neurosurgery, Neurology, Neuro-radiology, and Neuro-intensive care |
| All other surgical specialties | 18 months in surgical specialties (Ophthalmology and Obstetrics & Gynaecology not included) |
Any clinical experience as a doctor after internship up until the start date of ST1/CT1 is counted. This includes both training or non-training experience, whether in the UK or overseas.
Competition for ST1
There are approximately 80-100 vacancies throughout the UK for ST1 each year and around 430+ applicants.
Further information about ST1 applications
- Official website for information about ST1 applications
- Website where you apply (Oriel) including user guide and FAQs
If you have any questions about applying for ophthalmology please email the recruitment office – SEVRecruitment.SW@hee.nhs.uk
Entry requirements for ST3 Ophthalmology
- 24 months experience in Ophthalmology by the time you start ST3 (August)
- FRCOphth Part 1
- 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.
Restrictions for ST3 Ophthalmology
At present, FRCS and ICO are not accepted for entry ST3. Only FRCOphth is accepted.
You cannot apply for ST3 if the panel feel you are eligible for CESR and therefore overqualified for training. So if you already have extensive training and experience in Ophthalmology eg. more than 10 years, you are unlikely to get a place in ST3.
Competition for ST3
There are usually less than 20 vacancies throughout the UK for ST3 each year and around 40+ applicants.
Further information about ST3 applications
- Official website for information about ST3 applications
- Website where you apply (Oriel) including user guide and FAQs
If you have any questions about applying for ophthalmology please email the recruitment office – SEVRecruitment.SW@hee.nhs.uk
Is it difficult to get into UK Surgical training?
Surgical is considered competitive, no surprise there. But even though it’s competitive, it’s not impossible.
There are many IMGs in surgical training despite the previous immigration rules that favoured UK graduates. With those rules now reversed, there is really nothing to stop you from getting your spot in training too.
Related: 9 ways the new Shortage Occupation List affects IMGs dreaming of UK specialty training
To succeed with your application, you’ll need to maximise your application score.
There are 2 main components to the application score:
- Your CV/portfolio
- Your interview performance
Related: 8 tips to succeed when applying for UK specialty training
Do well in each of these 2 areas, and you will have a decent chance of landing a spot.
Need more guidance?
If you’re looking for step-by-step strategy to succeed with your application to ST1 or CT1 in a surgical field as an IMG, don’t forget to check out our IMG Masterclass.
