BMJ 22nd September,2007

Following the resounding failure of the MTAS selection system for postgraduate medical training posts in the UK, there has been an inevitable outcry about the unemployment faced by UK medical graduates. To read about the debacle that is the MTAS, read Parashkhev Nachev's account in the BMJ. He explains how the system was flawed from the outset by ignoring evidence based practice in the design of the scheme. He also appropriates blame to the Royal College, who are meant to be the safeguards of the professions' interest.

There are many who blame the growing numbers of International Medical Graduates for robbing home graduates of their duly entitled jobs. This week's BMJ has a debate on the issue authored by two senior consultants who completed their undergraduate training outside the UK.

Dr. Edward Byrne, dean of biomedical training at UCL argues that training posts must go to UK graduates irrespective of merit and only in the event of a shortage (which did not happen this year) should other candidates be asked to fill these posts. Read the full article here. In response, Dr.Edwin Borman refutes this suggestion in the belief that restricting access would damage the future of the profession. Read his commentary here.

The most interesting article in this journal this week, perhaps published either because it reflects the sentiments of many UK graduates and citizens or because of its controversial direction is written by Graham Winyard, retired postgraduate dean of the Hull-York medical school.
The article condones the MTAS system and blames the british government for lacking a comprehensive and firm anti-migration policy for doctors. His suggestion would almost stop any IMG from going to the UK.
"The most obvious action would be to suspend the skilled migrant programme as it applies to doctors and establish a two stage recruitment process similar to that used in other countries,whereby overseas applications are considered after those of domestic graduates (which in our case would have to include Europe)."

I am utterly shocked that UK medical professionals are willing to insulate themselves from the world's medical community. There is no doubt that jobs are scarce and a combination of expanding medical schools, influx of IMG's, poor workforce planning and a non-functional computerised selection process has only highlighted the problem. However, the answer cannot be to cocoon yourself but rather to learn from other systems that have similar issues.

How would you expect to advance if you breed practices and knowledge incestuously? A closed,non-competitive system is bound to stagnate if not driven by a need to excel in a global setting. I can only presume that Dr. Winyard foresees and is content to herald the death of meritocracy (as little as it remains in the UK medical system today) and a multicultural NHS workforce in the near future if the government follows his suggestion.

On a personal note, I love the UK and foresaw myself as a medical professional in the NHS, but I am glad that I walked away from them this year. Although I did not predict such a catastrophe, I was convinced that IMG's would find it hard to work through the system to reach consultant positions. The prevailing antagonism towards IMG's from senior consultants, who are part of the selection panels, will only make it harder to find good training positions in the NHS in the near future. I would advise IMG's to look elsewhere for opportunities for the next couple of years