UPDATED: October 24, 2019
As of October 6, 2019, all doctors coming from overseas and applying for work in the UK are automatically exempt from the Resident Labour Market Test (RLMT). This is because all jobs in the medical profession have been included in the UK Shortage Occupation List.
So now that all IMGs are exempt from RLMT, this means there are no more “IMG-friendly” specialties. Instead all specialties are now equally friendly to IMGs.
The exception to this is Public Health. Please be aware that Public Health is still subject to RLMT so the article below still applies.
This change may not last forever. You can read more about these changes and what it means for IMGs here.
Just for your reference, I have kept the old post below so you can see how things have changed.
Pre-October 6, 2019 article
A lot of people ask whether an IMG can apply to a particular specialty in the UK. The truth is, an IMG can apply to any specialty here. The more competitive specialties just involve taking additional steps. Nothing is impossible and if you’re dedicated and determined, you can get a training job in your dream specialty, even cardiothoracic surgery!
In this post I talk about how your immigration status affects your standing in applications to a first year training post, how open or “friendly” certain specialties are to IMGs in this regard, and what you can do to improve your situation.
This post is for doctors who have not completed a training programme (residency) in their home country and want to apply to a first year training job in the UK.
If you have already completed a training programme overseas and want to work in the UK long-term as a specialist (Consultant), you can follow the CESR-CP or CESR routes described here.
If you want to pursue a fellowship in the UK then return home, have a read of this article.
To understand how a specialty can be classed as IMG-friendly, you need to understand factors that affect how available that specialty is to IMGs.
Resident labour market test (RLMT)
The priority for specialty training jobs in the UK is based on immigration rules, not where you graduated. This means that as long as you have the right immigration status, you will be considered equally alongside UK applicants. This is the most crucial concept that you need to understand as an IMG applying to UK specialty training.
The immigration rule that’s relevant here is the RLMT. Essentially it says that a visa cannot be issued to a migrant worker if there is a suitable applicant from the UK or EU. In other words: the UK prioritises their own people and the EU (for the time being, this may change with Brexit). But as I mentioned earlier, if you have the right immigration status that makes you exempt from RLMT then you can be prioritised too.
Round 1 vs Round 2
Now for specialty recruitment to be compliant with the RLMT rule, there are 2 rounds. Round 1 is where those who are exempt from RLMT are given priority for training posts. If there are any jobs leftover from Round 1, they go to Round 1 re-advert aka Round 2. This is the round where those who are subject to RLMT are given consideration.
Therefore those who are subject to RLMT ie. those who need Tier 2 visas, can usually only apply in Round 2. This forms the basis of classifying a specialty as being IMG-friendly or not because IMGs generally apply in Round 2, and not all specialties have a Round 2 due to high levels of competition.
Most IMGs are subject to RLMT but not all!
Foreign nationals can also be eligible for Round 1 if they are in certain immigration categories that exempt them from RLMT. This means they will be considered equally alongside UK & EU graduates and can apply to any specialty without restriction.
Find out if you’re exempt by checking this list.
If you are not exempt then keep reading.
Competition ratios & fill rates
You can gauge how competitive a specialty is and therefore how likely it is to go to Round 2 by its competition ratio and fill rate.
The competition ratio is the number of applicants divided by the number of available jobs. So for example, if there are 100 doctors applying for Radiology and there are 50 jobs available, the competition ratio is 2. You can find all the competition ratios for the past 5 years on the HEE website.
The fill rate is the percentage of vacancies in Round 1 that were filled. For example if there are 100 jobs available in Round 1 and 95 of these are taken up, then the fill rate is 95%. It means that 5% of the jobs were left unfilled and are therefore likely to be advertised again in Round 1 re-advert or Round 2. You can find the fill rates for the last couple of years here. Take the fill rates published on this website with a grain of salt, sometimes these are inaccurate and in reality the fill rate is a lot lower.
Lower competition ratios translates to lower fill rates. Lower fill rates means Round 2 vacancies will arise. This gives IMGs who are subject to RLMT the chance to apply.
The opposite is true: high competition ratios translates to high fill rates. This means there are no Round 2 vacancies. Unfortunately for IMGs who are subject to RLMT, these specialties are essentially closed to them.
But don’t lose heart, there are ways around this obstacle. Keep reading till the end to find out how you can become exempt from RLMT.
Shortage occupation list
Specialties on the Shortage Occupation List (SOL) are open to IMGs because applicants are automatically exempt from RLMT and can therefore apply in Round 1.
The different groups of specialties according to IMG-friendliness
The 3 groups below are according to historical indicators of being open to IMGs such as those that have lower competition ratios, lower fill rates, and available Round 1 re-advert/Round 2 vacancies and the number of Tier 2 visas issued for training jobs in 2018.
All the specialties here are the ones that have openings for first year positions. Medical and surgical subspecialties eg. Cardiology, Orthopaedics, start from the third year (ST3) and are therefore excluded from this list. I’ll do a separate post about applying to ST3 positions.
A. Specialties that accept IMGs in Round 1
(Most IMG friendly)
|B. Specialties that tend to have Round 1 re-advert/ Round 2 vacancies||
C. Specialties that tend not to have Round 1 re-advert / Round 2 vacancies
(Least IMG friendly)
For Scotland only:
Obstetrics & Gynaecology
Internal Medicine (previously called Core Medicine)
Emergency Medicine (few spaces)
Obstetrics & Gynaecology (few spaces)
Oral and Maxillo-facial Surgery
Community Sexual and Reproductive Healthcare (CSRH)
Child and Adolescent Mental Health Services (CAMHS)
A. Specialties that accept IMGs in Round 1
GP and Core Psychiatry services are severely short staffed in the UK. Because of this, both specialties accept IMGs in Round 1 and may even accept applicants without any UK experience.
In GP recruitment, IMGs in Round 1 are still subject to RLMT so they have to wait for RLMT-exempt applicants to be placed first, but this shouldn’t phase IMG applicants too much. Because of the high number of vacancies there tends to be enough jobs to go around although you may not be allocated to your preferred geographic region.
Core Psychiatry is a little different. IMG applicants are actually exempt from RLMT as Psychiatry is currently on the UK Shortage Occupation List (SOL). For Scotland only, IMGs are also exempt from RLMT in Paediatrics, Anaesthetics, and Obstetrics & Gynaecology.
You may not need UK experience to be successful for these specialties as they are in such shortage, but it is always beneficial to have UK experience prior to starting a training job.
B. Specialties that tend to have Round 1 re-advert/Round 2 vacancies
The fact that the specialties in this group often go to Round 2 indicates that there is a good chance for IMGs to get a spot. Competition can still be tough though so you can’t slack off with your CV. You can always try to submit your application in Round 1, but just be aware that most specialties will reject your application even before reaching interview stage if you are subject to RLMT.
Although it is possible to successfully land a job without UK experience if you have a good CV and do well at interview, I think you’ll find it beneficial to work in the UK first before applying. This will help you adjust to working in the NHS; it will also give you time to build up your CV so you have a higher chance of getting a job in a location you prefer.
Also you do not have to apply only in Round 2. You can always try to be in Round 1 by becoming exempt from RLMT. This increases your chances of not just getting a job, but getting one in your preferred location. Read the advice below to find out how.
C. Specialties that tend not to have Round 1 re-advert/Round 2 vacancies
These are the most difficult specialties for IMGs to enter. If a specialty fills all their vacancies in Round 1 with doctors who are exempt from RLMT, then that’s really the end for IMGs.
Or is it?
Remember I mentioned earlier that IMGs can also be considered in Round 1 if they become exempt from RLMT? There are 7 ways an IMG can gain exemption from RLMT in order to be considered equally alongside UK graduates.
If I’m in Round 1 will I definitely get a training job?
No, of course not. Nothing in life is guaranteed. You still have to compete against other applicants so build up your CV and don’t waste this opportunity!
But if you are in Round 1, you are on level playing field with UK graduates and you will not be discriminated against as an IMG. This situation is the best you can hope for, it really is an incredible opportunity that you just don’t get in the US. If you are unsuccessful in Round 1, at least you know it won’t be because you graduated overseas.
Here are some ways we can help with that:
- Read this article for tips on improving your application to specialty training.
- To improve your interview skills, I highly recommend this book. Without it, I wouldn’t have gotten my Standalone FY2 job.
- If you want a more detailed walkthrough, be sure to check out our masterclass.
- How IMG-friendly a specialty is has to do with how open it is to applicants who are subject to RLMT.
- The Resident Labour Market Test (RLMT) is an immigration rule to allow jobs to be filled by UK/EU applicants first.
- Priority for training jobs is given to those who are exempt from RLMT, not necessarily UK graduates. Some overseas graduates can be exempt from RLMT too.
- All RLMT-exempt doctors will be considered equally for jobs.
- Those who are exempt from RLMT are given jobs first in Round 1, if there are any jobs left vacant they go to Round 1 re-advert aka Round 2. Applicants who are subject to RLMT can apply in Round 2. Whether a specialty has a Round 2 can be gauged by the level of competition.
- Indicators of competition include the competition ratio and the fill rate.
- Competition ratio – number of applicants divided by number of available jobs.
- Fill rate – percentage of jobs in Round 1 that are filled.
- Jobs on the Shortage Occupation List (SOL) are exempt from RLMT.
- Specialties can be grouped according to how open they are to IMGs from most open to least open
- A. Specialties that accept IMGs in Round 1
- B. Specialties that tend to have Round 2 vacancies
- C. Specialties that tend not to have Round 2 vacancies
- Being in Round 1 does not guarantee you a job, you still need to build up your CV and perform well on interview to compete with other applicants. The book Medical Interviews is essential for a good interview performance.
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