From all corners

For core surgical trainee Marvee Zakaria, her first day as a doctor in the NHS saw her forced to confront a startling reality.

‘I walked in, and I was like, “Oh my god, we don’t wear lab coats”,’ recalls Dr Zakaria, who arrived in the UK from Pakistan in 2019.

‘To me my lab coat used to literally be that layer that was separating me from my clinical environment.’ 

As is common practice in many countries, Dr Zakaria (above, pictured right) had received the iconic white lab coat from her medical school upon graduation and had faithfully brought it with her to the UK, fully assuming her new colleagues in the NHS would be sporting similar workplace attire.

While in many ways a minor detail, Dr Zakaria’s lab-coat experience is perhaps symbolic of the kinds of cultural differences and personal and professional challenges commonly encountered by IMG (international medical graduate) doctors arriving in this country.

These can range from acclimatising to British weather and slang and the emotional effect of being separated from friends and family, to working through the process of obtaining a licence to practise and navigating an unfamiliar and complex health system.

Trinidad-born vascular surgery specialty trainee 5 Lisa Rampersad knows the realities of navigating these kinds of challenges.

Having now worked as a doctor exclusively in the NHS for more than a decade, Dr Rampersad admits she had never imagined coming to the UK but this all changed after meeting her partner, a UK national, while at medical school in Guyana.

‘I [had] had no intention of leaving the Caribbean at all, and in med school I met a boy,’ she reflects.

‘My first experience of the UK was during a lovely heat wave … two weeks of sunshine and lovely blue skies,’ she says.

‘I finished medical school at the end of 2014 [and] came over to the UK on 20 December, landed at Gatwick Airport and immediately started complaining to my partner who was outside waiting for me about how cold it was, about how this is not what I signed up for.’

Despite arriving in the UK in 2014, Dr Rampersad was forced to endure a two-year legal battle over the status of her visa before she was finally allowed to go to work in the NHS.

During her first week, she discovered what it was like to be ‘thrown in at the deep end’ as an IMG utterly unfamiliar with the structure, working practices and even the jargon used within the health service.

‘I was really naive, I came from medical school, I knew nothing, I didn’t know anything about the UK,’ says Dr Rampersad.

‘I started as a foundation year one doctor and had the induction week. Somebody stood at the front talking about making sure to fill in your CBDs and CEXs and your TABs.

‘I’m sat there looking around [and] nobody else looks confused about this, so I can't ask "what do you mean". I did my whole first rotation without one form filled in because I didn’t know how to do these things.’

While many trusts and workplaces are able to offer support to IMG staff, there is no single national organisation providing comprehensive help and advice.

Fortunately for Dr Rampersad, she found that joining the BMA and having access to the knowledge and guidance of fellow members and member relations staff made an enormous difference.

She adds that the launch of the association’s international affiliate membership scheme back in 2022, has further built on the kind of support available to help IMG doctors make a successful transition to life and work in the UK.

‘Where I come from, we don't have a doctors’ union, so knowing what a union actually is was actually one of the biggest things for me,’ she says.

‘The BMA have got ways of helping before you get [to the UK], they can check rotas, they can check contracts, they can help you and support you in so many ways before you even get into the country.’

This month sees the UK observe Overseas NHS Workers Day, an event which aims to recognise and celebrate the contributions of international staff to the NHS.

Despite being a relatively new addition to the health service’s celebratory calendar, Nigerian-born Somto Ogbuagu welcomes its inclusion as a means of hopefully raising greater awareness and appreciation of the role that IMGs play in the health service.

‘No one should ever feel that they are less than they are, ever, which is why I like the IMG day,’ says Dr Ogbuagu who is now a ST5 paediatric registrar based in Liverpool.

As the daughter of two doctors, Dr Ogbuagu knew from early on in her life that she was destined for a career in medicine and even has fond memories of being picked up from school by ambulance.

She remembers well, however, how hard the early years of life in an unfamiliar country were.

Unable to work as a doctor while awaiting her licence to practise from the GMC, Dr Ogbuagu spent two years being financially dependent on her husband while also finding her feet in a very different society and culture.

‘Nigeria is a very outgoing country,’ explains Dr Ogbuagu.

‘We’re very bubbly people back home, and it was a very rude cultural shock to come to a country where people like to keep to themselves.

‘I just couldn’t understand it – that I think for me was just different, completely different. And it did affect my mood for a while because I came in winter, and people are extra moody in winter.’

Upon starting work in the NHS, Dr Ogbuagu says she found the support and advice of her supervisor invaluable to contending with the steep learning curve facing her.

‘The first supervisor you get when you come into the UK is very, very important,’ she says.

‘It’s [the NHS] a completely different world. The actual theory of medicine itself is the same, but the practice is completely different.’

Though now on the specialty training pathway, Dr Ogbuagu began her clinical career in the NHS as a trust grade doctor, also known as LED (locally employed doctor).

With these posts overwhelmingly filled by IMG doctors, LEDs work in non-permanent roles without the protection of national terms and conditions for employment and pay or guaranteed access to training.

While the BMA has, in recent years, sought to increase awareness of and support for LEDs, Dr Ogbuagu warns the plight of many these staff continues to go under the radar.

‘It does irk me quite a lot when I see trust grades who have no protections, no career path [and] no support to get a career path at all,’ she says.

‘I feel trust grades are in the position where a lot of things are going to be not known to them. A lot of the system and the way things are set up means they're already at a disadvantage.

‘Starting a job as a trust grade doctor, I think you absolutely need to have the support of the BMA.’

Insufficient access to specialty training places has, in recent years, become an increasingly acute and pressing issue for all resident doctors both UK-trained and IMGs.

The failure of successive governments to address bottlenecks within the system by increasing funding and implementing better workforce planning, has resulted in many doctors unable progress their careers and even forced some to reconsider their futures in the NHS.

In response to the rising crisis, the BMA resident doctors committee outlined a proposal which called for access to training places to be prioritised for UK medical graduates, with the committee later amending its position insisting that it is committed to engaging with all resident doctors over finding a way forward.

‘I don’t think it should be an us versus them. I think it should be us as doctors saying to the Government, our population is growing, our population is getting older and we need more doctors,’ says Dr Rampersad.

‘Every single day that you come to work should be a training day, and this artificial creation of training numbers or only being allowed this number of people shouldn’t stop anyone else from being trained in that specialty.’

Starting a new life and career in a new place far from home is never straightforward.

While many of the challenges facing IMG doctors have remained stubbornly persistent for decades, Dr Zakaria says solidarity with those in similar positions and who made the journey before you, has never been more important.

‘If you can find somebody who is [also] an IMG, who understands where you’re coming from. Just align yourself with like-minded people early so you have a clear sense of your direction for your career.

‘If you find these people early on, just work towards that goal because it is so easy to get lost in the job, and it is so easy to get lost in who you are as well.’

To hear Dr Zakaria, Rampersad and Ogbuagu’s stories in full please listen to episode three of The Doctor podcast

(Image credits: Matthew Saywell)