As the youngest daughter of two NHS nurses and with a resident doctor sister, Freya Mandapalli always knew she wanted to enter the medical profession.

Following her A-levels, and despite her best efforts, she struggled to secure an offer from a UK university and a medical education system that has struggled in recent years with the overwhelming numbers of applicants it receives.

Unable to pursue her ambitions in her home country, Freya instead opted for what is becoming an increasingly popular route into medicine by going abroad to study.

Having swapped her hometown of Preston for Bulgaria, Freya is now into her second year of her medical degree, a six-year course of study at the Medical University of Plovdiv.

Studying medicine in Bulgaria (Plovdiv pictured above) is not without its own unique challenges, with all students required to study and master a basic level of the Bulgarian language during the course of their degree. However, Freya feels she has adjusted well to her new environment.

‘I heard about Bulgaria through family, friends, initially,’ explains Freya. ‘I knew a few people in my peer group at college who were also going to Bulgaria, so I didn't feel like lonely.’

After starting her studies in September 2025 and having no real prior experience of Bulgaria, Freya admits the early weeks of the course were something of a ‘culture shock’ but that the supportive ethos of the university and others had helped ease the transition.

Studying abroad means Freya and other British students are not eligible for grants or financial support from UK sources, meaning the duration of the course must be entirely self-funded with tuition fees paid upfront.

Applications to medical schools can be undertaken directly by individuals. However, many students from the UK, such as Freya, opt to use the services of a recruitment agency.

These organisations provide assistance with navigating the admissions process, translation of documents, submission of applications and the arranging accommodation.

There is also the linguistic element of the course, with students receiving lessons in Bulgarian alongside their medical training, with meeting this language requirement essential if students hope to pass their one-year residency in Bulgaria’s health system later.

Freya admits that, while this aspect of the course has proved challenging, it does not prove insurmountable for most UK students.

‘We have to learn Bulgarian in our first and second year. It's obviously been difficult,’ she explains.

‘It has helped a lot of just like basic interactions, like shops and stuff and taxis [and] in some ways, it almost doesn’t feel like you are studying abroad, because you’re surrounded by so many people from your own country.’

Freya’s decision to study medicine abroad as a British national is one that has become increasingly commonplace in recent years, driven in large part by the well-documented shortage of training places at UK medical schools.

In its 2025 workforce report on the state of medical education, the GMC concludes that Bulgaria was one of the fastest growing sources of non-UK medical graduates into the NHS.

Specifically, the report found that in 2023, 70 per cent of the 622 doctors with primary medical qualifications gained in Bulgaria joining the NHS being British nationals, with between 2,000 and 5,000 UK citizens estimated to be studying medicine in Bulgaria.

The recent surge in the presence of British students in Bulgarian medical schools stands in stark contrast to the situation that existed just over a decade ago in which UK nationals were few and far between.

It was at that time that Ade Adetayo was one of the small handful of UK students making the journey to Bulgaria to study medicine.

Now an emergency medicine registrar at Addenbrooke’s Hospital in Cambridge, Dr Adetayo remembers how he decided to apply to study medicine at Plovdiv medical school and quickly found himself in at the deep end.

‘I remember going for my flight, my dad just sort of waving goodbye, and just not knowing what to expect,’ recalls Dr Adetayo.

‘At that time, I hadn’t even taken a flight before. I got to the airport at 1.45pm for a 2pm flight assuming it would be like boarding a bus. I missed that flight and I had to take the next available one that day to Bulgaria.

‘At the time the airport was in Sofia about an hour and a half from Plovdiv. I remember getting into a taxi very late at night and, as we were driving on the way, there was a car that was up in flames on the roadside, and I remember thinking, “where am I?”’

Although not the only British student studying at Plovdiv at that time, and despite the medical school and recruitment agency being understanding and helpful, Dr Adetayo says his experience as an international student at that time had been challenging.

In part because of his own experiences as a UK student training abroad, Dr Adetayo helped to co-found MedConnect Europe, a medical student recruitment agency that aims to support students from application stage to post graduation.

‘We got enrolled at the university, but again, we couldn’t speak a word of Bulgarian,’ he says.

‘We didn't know anything about the city, anything about the culture, anything about the life. It was sort of just: “You’re here now, you have to fend for yourself.”’

There are significant differences between UK and Bulgarian medical degrees with entry requirements and availability of course places more straightforward and plentiful in the case of the latter.

Course fees between the two countries also varies, with the typical cost of a medical degree at a Bulgarian university between £6,000 and £8,500 per year, compared with an average of just under £10,000 per year in the UK.

A medical degree in Bulgaria is a six-year course of study, with the final year of study consisting of a series of clinical placements within the Bulgarian health service, during which students will be required to observe and communicate with patients in Bulgarian.

The qualification is recognised by the GMC and confers a full medical licence thereby enabling graduates to access specialty training posts without having to complete the foundation programme.

One challenge facing students training in Bulgaria who then seek to return to work in the UK is a lack of exposure to and experience of working in the NHS, something Dr Adetayo sought to remedy by gaining work experience in UK hospitals when returning home during his summer breaks.

‘When I graduated, there wasn’t any support as to how to find jobs, how to do interviews, or even how to prepare yourself to make sure you’re in the best starting position,’ explains Dr Adetayo.

‘At that time there was no support with the GMC registration process, but now with Med Connect we’ve actually had representatives from the GMC, as well as Health Education England and the BMA, come out to Bulgaria to speak with the students.

‘We [Med Connect] also help to secure placements in UK hospitals, because a lot of the time it’s very difficult process in terms of the paperwork, the vaccinations, particularly if you are unfamiliar with the system.’

Support for graduates from EU medical schools – UK and non-UK citizens – looking to transition towards working in the NHS had previously been made available as part of the Doctors Gateway EU Programme.

Overseen by NHS Professionals, the programme provides doctors unfamiliar with the UK health service the chance to gain clinical and educational experience while working in posts equivalent to foundation year 1 or foundation year 2.

The programme has, however, temporarily suspended its applications process and it remains unclear when EU medical graduates will be able to again access the opportunities it provides.

This situation is further complicated by new laws introduced this year prioritising access to specialty and foundation training programmes to graduates of UK medical schools.

Under this legislation, however, British citizens graduating from EU medical schools, while precluded from being prioritised for access to the foundation programme, can still receive prioritised access to specialty (core and higher) training posts.

While the challenges of studying abroad and successfully managing a transition into medical practice in the NHS should not be underestimated, Dr Adetayo believes he and others serve as real-life examples of how this route into medicine can prove successful.

‘I would definitely encourage anyone considering studying overseas to think deeply about it.’ he says

‘A lot of the things I faced such as leaving my family, missing birthdays, weddings and family celebrations, even missing the births of my nephews and nieces means that you’re going to have to sacrifice a lot.

‘It’s becoming increasingly difficult to get a [training] place in the UK, but it is also a fact that there are success stories.

‘People have gone to Bulgaria, they’ve graduated and now they’re working in the NHS without any problems whatsoever. That, I think, has been one of the key driving factors in getting more students [to follow this route].’