The Savvy IMG

The best first job in the UK for overseas doctors

There are lots of different types of jobs in the UK for doctors and it’s hard to figure out where to start as an IMG. In this post, I’ll give you an in-depth walk-through of the possible jobs you can start with.

I’ll also make some recommendations depending on your background based on the level of support you’ll receive, and the expectations of you in that particular role.

Table of Contents

The best first job in the UK for overseas doctors

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Updated: April 19, 2020

Now remember, these are just my recommendations and not hard and fast rules. At the end of the day, you’ll have to conduct further research and use your own professional judgment, although I do hope that this article will give you a good background!

So if you want to work in the UK long-term, where should you start?

The best first job for most international doctors starting out in the UK, is as an employed non-training junior grade doctor in an NHS hospital.

Let’s break each term in that recommendation down and see whether it’s right for you.

NHS vs Private

The NHS is the public healthcare system in the UK. The vast majority of doctor jobs, including all training jobs, are in NHS hospitals. The NHS has very structured teams and support systems in place which will help you adjust to UK practice. Because of this, we generally recommend starting your UK career in an NHS hospital.

Jobs that are outside of the NHS are in the private sector. There is very little support for new doctors which can lead to a higher risk of litigation and complaints, which is why we don’t recommend starting your first job in a private hospital.

Recommendation: Start your first job in the NHS.

Employed vs Locum

When you are a direct employee of the hospital, the department tends to be more supportive and more understanding of the fact that you’re new to the UK. You are usually given an induction and an adjustment period.

If you work as a short-term locum, it means you have been placed in the hospital through a locum agency and you are not a direct employee. These jobs can be as short as a single shift, a couple of weeks, or up to 3 months. Sometimes you will not get a thorough induction, and you will certainly not have an adjustment period. With very short contracts, the rest of the medical team will not be invested in you professionally and you are unlikely to receive the support you need as a new doctor in the UK.

Recommendation: Start your first job as an employed doctor. Also be sure to ask about an initial adjustment period (see below).

Training vs Non-training

Training jobs are those that are part of a GMC-approved postgraduate specialist training programme. In these jobs, you need to meet all the numerous training requirements in order to progress from year to year. Once the programme is complete, you will be eligible for the GP or Specialist register and can apply for jobs as a GP or Consultant depending on your programme.

Related: The 4 types of GMC registration

We personally do not recommend starting in a training job at ST1/CT1 level or beyond as your first NHS post especially if you have not worked in a health system similar to the UK. Knowledge of how the NHS works is essential to succeed in a training job. Doctors in non-training jobs are often given an adjustment period so they can adapt to working in the NHS, this is not available in training jobs.

Making mistakes in a training job because you’re unfamiliar with the system can tarnish your reputation as a trainee, cause significant anxiety for yourself, and can even result in you getting kicked out of training. It also opens you up to complaints, investigations and medico-legal problems. All of this is completely avoidable by learning the system first in a non-training job.

Of course, there are IMGs who are suitable to start in a training job at ST1/CT1 level. We’ve listed the profiles of IMGs who may be suited for this below.

Related: What you need to know about specialty training in the UK

Most suitable first jobs if you plan to apply for UK specialty training

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 job depends on whether you are aiming for ST1/CT1 level, or ST3/ST4 level.

If you plan to apply for ST1/CT1 level

In this case, best first jobs can include non-training junior grade posts in an acute specialty, Standalone FY2, or WAST. Just make sure you do not make yourself overqualified for your target specialty.

Through these jobs, you can adjust to the NHS, complete the compulsory 12-month post-internship experience prior to starting ST1/CT1, and get your CREST signed. (CREST is not required for ST1/CT1 if you join Standalone FY2.

Related: Are you overqualified for UK specialty training?

If you plan to apply for ST3/ST4 level

Ideal first jobs include non-training junior grade jobs or non-training middle grade jobs with an adjustment period. Be sure that whatever job you choose, you will be able to fulfill all the eligibility requirements for your specialty including any core competency certificates.

What do I mean by junior grade and middle grade? Keep reading to find out.

Related: What IMGs need to know about applications to specialty training (residency) in the UK

Grade

There are 3 general grades of jobs in the UK: junior, middle and senior. I will include FY1 here as a separate grade since it is quite different from the rest. For each grade, I’ll discuss the role, expectations, and who it’s suitable for.

FY1

The role

FY1 stands for Foundation Year 1, it is for new medical graduates therefore it is an internship level post. Most FY1 jobs are based on the wards. There may be some opportunity to work in the emergency department (ED), but there is often little exposure to clinics and the operating theatre.

Expectations of you

Your colleagues will have the least expectations of you compared to anyone else on the medical team. Everyone will be aware that you need to be taught how things work in the NHS, and closely guided on management. They expect that you will ask lots of questions. 

Who it’s suitable for as a FIRST job in the UK

Training FY1 (UK Foundation Programme)

Suitable for you if youNot suitable for you if you

Have not completed internship overseas  AND

For this you would need to have provisional GMC registration.

Have completed internship  OR

Have full GMC registration

Related: 

Non-training FY1 

Suitable for you if you Not suitable for you if you

Have completed internship overseas, have full GMC registration, and fit the following profiles:

Returning from a long career gap (more than 3 years)  OR

Have a nervous, extremely cautious, or anxious personality.

Have not completed internship  OR

Have provisional GMC registration  OR

You have completed internship overseas, and you are confident enough with your clinical skills to start in a junior grade job

Junior grade

The role

This grade is for those who have completed internship, have full GMC registration, and who may or may not have experience or training after internship. You will have:

  • Increased responsibility in managing patients
  • More shifts on weekends and nights
  • Responsibility for supervising those more junior to you

Job titles

SHO, non-training FY2, trust grade ST1/CT1, service post ST1/CT1, CT1/ST1 LAS, junior clinical fellow etc.

Expectations of you

As you have now completed internship, you will be expected to manage many scenarios initially before needing to ask for advice. However, since this is still a junior position, the senior members of your team will generally expect to guide you with most clinical decision-making. 

Who it’s suitable for as a FIRST job in the UK

Training Standalone FY2

Suitable for you ifNot suitable for you if you fit any of the following profiles

You have no other work experience after internship  OR

You have worked after internship but have not completed any postgraduate specialist training and you would like to start your UK career in structured junior level post

1. You have not completed internship OR

2. You have provisional GMC registration  OR

3. You have completed postgraduate specialist training  OR

4. You have worked as a specialist for several years.

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

WAST (Widening Access to Specialty Training) [CURRENTLY CLOSED]

Suitable for you ifNot suitable for you if you fit any of the following profiles

You have no other work experience after internship  OR

You have worked after internship but have not completed any postgraduate specialist training and you would like to start your UK career in structured junior level post  AND

You only want to be considered for jobs in England  AND

You are happy working in smaller towns and rural areas  AND

You are interested in applying for specialty training in Psychiatry, GP, or any medical specialty (although anyone can apply regardless of specialty interest)

1. You have not completed internship  OR

2. You have provisional GMC registration  OR

3. You have completed postgraduate specialist training  OR

4. You have worked as a specialist for several years  OR

5. You want a job in Scotland, Wales or Northern Ireland  OR

6. You are only interested in jobs in large cities.

Related: 10 reasons why you should apply for WAST

Training CT1 or ST1

Suitable for you if you fit the following profileNot suitable for you if you fit any of the following profiles

Have worked in a public healthcare system similar to the NHS and meet all of the following criteria:

  1. Valid Certificate of Readiness to Enter Specialty Training (CREST), and
  2. 12 months clinical experience in acute medical specialties after internship by the time they start ST1 or CT1
  3. Not overqualified

1. You have not worked in a public healthcare system similar to the NHS before, and do not meet all 3 criteria listed opposite OR

2. You have not completed internship OR

3. You have provisional GMC registration OR

4. You have completed postgraduate specialist training OR

5. You have worked as a specialist for several years

Related: Are you overqualified for UK specialty training?


Non-training jobs

Suitable for you if you have completed internship and fit any one of the following profilesNot suitable for you if

1. You have no other experience after internship but do not have a long career gap (less than 3 years) and feel confident with your clinical skills OR

2. You have worked after internship but have not completed any postgraduate specialty training OR

3. You have completed some postgraduate specialty training but didn’t finish it OR

4. You have completed all postgraduate specialty training but have a nervous, cautious or anxious personality

1. You have not completed internship OR

2. You have provisional GMC registration OR

3. You have completed internship but have a nervous, cautious or anxious personality OR

4. You have completed postgraduate specialist training and you are confident in your clinical skills OR

5. You have worked as a specialist for several years 

Middle grade

The role

This level is for those who have completed postgraduate specialty training or have several years of experience. As a middle grade doctor you will be:

  • The most senior decision maker for your specialty in the hospital, especially on nights or weekends. 
  • Responsible for leading and supervising your team including junior grade doctors and advanced nurses.

Job titles

Registrar, SpR, trust grade ST3+, service post ST3+, ST3 LAS, senior clinical fellow, specialty doctor, middle grade, staff grade etc.

Expectations of you

You will be expected to manage most simple and intermediate level cases independently without having to ask for advice. For complex patients and anything you’re unsure about, you will need to discuss it directly with the Consultant.

Who it’s suitable for as a FIRST job in the UK

Training jobs

We do not recommend an ST3 or ST4 training job as a first job for anybody. In fact, you’re unlikely to eligible since knowledge of how the NHS works is often a requirement for training jobs at this level. 

Non-training jobs

Suitable for you if you fit one of the following profilesNot suitable for you if you fit any of the following profiles

You have completed postgraduate specialty training or have worked at least 3 years in the relevant specialty AND

  • You work in acute inpatient-based specialty, ie. you will be on call with work in the evenings, nights and weekends eg. any surgical or medical field, AND you have worked in a health system similar to the UK OR have negotiated an adjustment period (see below) OR
  • You work in a non-acute outpatient-based specialty that does not manage acutely unwell patients, eg. Dermatology, Genitourinary Medicine, Pathology etc

1. You have not completed internship OR

2. You have provisional GMC registration OR

3. You have completed internship but have no other experience or training OR

4. You have not completed postgraduate training or worked at least 3 years in the relevant specialty OR

5. You have completed postgraduate training or worked at least 3 years in you will be working in an acute inpatient-based specialty but you have not worked in a health system similar to the UK and will not be given an adjustment period

Related: 10 ways to prepare for your first job in the NHS as an IMG

Senior grade

Senior grade doctors include GPs and Consultants. In order to apply for permanent GP or Consultant jobs then you need to be on the GMC GP or Specialist Register, respectively. 

It may be possible to get on the GP or Specialist Register as an IMG without any UK experience so you can apply for these roles as a first job. However this is quite difficult, so if you are unable to gain direct entry to the GP or Specialist Register, then you can still work as a locum GP or locum Consultant.

The role

This level is for those who have completed postgraduate specialty training and have worked for several years in their specialty overseas – usually over a decade. As a senior doctor, you will work largely independently in terms of clinical decision-making, and you will be responsible for supervising all junior and middle grade doctors in your team.

Expectations of you

You may need to ask about how things are done, but you will be expected to manage the vast majority of patients without the need to ask for advice on how to manage them. 

Of course, if you have a highly complex patient then you should discuss their case with other GPs or Consultants – either in the same specialty or other specialties as appropriate.

Who it’s suitable for as a FIRST job in the UK

This job is really only suitable for those who have already worked for over a decade in their specialty.

Related: How to become a UK Consultant without entering a UK training programme

The adjustment period

Most hospitals will give you some time to adjust to the new system by giving you a period of shadowing/observation (this can be paid or unpaid) or taking you off night and weekend shifts initially. This is only available in non-training jobs.

For middle grade jobs, some hospitals will allow you to work as a junior grade for a few weeks or months before working as a middle grade. Again, this is only available in non-training jobs.

Take advantage of these opportunities because once the adjustment period ends, you will be expected to get on with work like the rest of the team.

Related: 5 feelings you’ll experience as a new IMG in the NHS

The consequences of starting in the wrong job

Starting in the wrong job for can be devastating. If you’re overconfident and take on a job that is too senior or unsuitable for you, it can have dire consequences for your career, your UK license, and your morale and well-being.

Here are some examples of actual situations that have happened to IMGs over the years:

  • Demoted from junior grade to FY1
  • Demoted from middle grade to junior grade
  • Taken off the on-call rota
  • Removed from a training post
  • Reported to the GMC for incompetence
  • Reported to the GMC for clinical mistakes made
  • Investigated by the GMC
  • GMC licensed revoked
  • Demoralised and returned home

All of this is easily avoidable by starting in a job that is suitable for your background. It is also important to clarify what support you’ll be given before you actually accept a job. It’s really good to do this during the interview.

We’ll write another post in the future on how to evaluate whether a job has enough support for IMGs before you accept it. We’ll also publish all our tips on how to adjust to the UK system, so you can avoid these devastating situations and thrive instead in your UK career.

Related: Can you reject a job offer you’ve previously accepted?

Summary

The best first job for IMGs in the UK, is the one that will provide support for new UK doctors and is suited to the background experience. For most IMGs, this means an employed non-training junior grade role in an NHS hospital.
Starting in a training job at ST1/CT1 level is generally not recommended, but this is possible for IMGs with a suitable background.

  • Starting in a training job at ST3/ST4 level is not recommended. It’s also very unlikely due to eligibility requirements.
  • Starting in a non-training middle-grade job in an acute specialty may be suitable with an appropriate adjustment period.
  • Starting in a non-training middle-grade job in a non-acute specialty may be suitable even without an adjustment period.
  • Starting in a senior role may be suitable for those with over a decade of experience.

These are just general recommendations. For any job, always check the job description and profile to see whether you are suitable. Good luck in your first job!

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

61 Responses

  1. I am last year medical student from somalia i want to finish internship here in Africa so how can reach UK and can i apply UK jobs while i am here in Africa ? Thank you for your help

  2. Im a recent US IMG graduate looking to do my residency in the UK. What is the best way for me to proceed and get additional information?
    Thank you,
    Aaron Corbin

  3. Hi Nick, this was a wonderful post and truly a great help. I have finished my residency for obstetrics and gynecology in my home country and been working as a junior consultant for over two years now. I would like to work in the UK seeing as I might be moving there with my fiance. May I ask what path or process must I do?

    Kind regards

    1. Hi there! We have some guides for each specialty on our website here:
      https://thesavvyimg.co.uk/category/specialty-guides/

      You can find information about GMC registration, fellowships, and UK training. I’d definitely recommend checking it out as we cover your specialty there 🙂
      But I do understand that this whole UK journey can all be quite confusing at first, I’ve definitely felt that way when I first started!

      If you are finding the information too overwhelming and you are looking for individual guidance for your personal circumstances, we offer IMG coaching sessions that you can book here.

      https://calendly.com/drkimberlytan

      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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