Negative and often biased media reports about foreign-trained doctors in the UK are harmful to the doctors and damaging to the NHS, argue JS Bamrah and Joydeep Grover of the British Association of Physicians of Indian Origin in an opinion piece in The BMJ.
They write:
There has been sustained public and political scrutiny of foreign trained doctors over many years, revived recently by a Telegraph report with the headline “Foreign trained doctors responsible for majority of misconduct cases”.
We believe that the issue is not whether misconduct by any doctor should be scrutinised, it is whether Medical Practitioners Tribunal Service outcomes can be reported as though they prove a problem with foreign trained doctors, when the path to a tribunal is shaped by a range of factors that are often not related to a doctor’s competence.
The Telegraph is not an outlier in taking a swipe at migrant doctors: MPs and other newspapers have also had a go over many years. Provocative and sensationalised headlines simply add to the negative narrative about foreign doctors, such as The Independent’s “Foreign doctors’ poor English is killing patients, say MPs”2 and the Sun’s “SEX SCANDAL: Foreign doctors behind 60% of sex assaults on patients despite only making up a third of NHS medics”.
Even the BMA has not been entirely supportive, arguing earlier this year that new international medical graduate (IMG) recruits should gain five years’ NHS experience before being considered eligible for NHS training opportunities. This is despite the consensus among medical royal colleges that two to three years is sufficient.
While some of the tabloid press simply report factual news about foreign doctors, others sensationalise, frame statistics selectively, and invite unsupported, racialised, and anti-migrant inferences.
Let us put into context the role and numbers of foreign doctors practising in the UK. There are presently 422 048 doctors registered with the General Medical Council. Of these, 229 770 are UK trained while the remaining 192 278 were trained overseas. IMGs are not a homogenous group; they differ by geography, culture, race, religion, gender, medical education, and regulatory background.
And when does an IMG cease to be an IMG? Media coverage suggests that once a foreigner, always a foreigner.
Many IMGs join the NHS with substantial professional experience and a strong commitment to patient care, but encounter avoidable barriers early in their UK careers. Reported disadvantages include differential treatment in GMC processes, royal college examinations, trust procedures, employment, career progression, leadership opportunities, and pay.
In a GMC report earlier this year chief executive Charlie Massey stated: “Deep-rooted inequalities in medicine continue to impact careers and opportunities for ethnic minority and non-UK qualified doctors working in the NHS.”
The GMC has acknowledged that IMGs account for a disproportionately high percentage of fitness-to-practise concerns raised by employers, and has sought to address this, saying that “the quality of registrants isn’t the issue – it’s deficits in the system”.
These deficits include inadequate induction, limited early supportive feedback, professional isolation, and the persistent treatment of IMGs as outsiders, despite their contributions to the NHS.
In recent years there has been a distinct change of tone and openness from the NHS and the GMC. Where previously there had been no acknowledgment of discrimination, they have belatedly and repeatedly highlighted disproportionality and discrimination affecting doctors based on race, ethnicity, and place of primary medical qualification, particularly in referrals made by employers and healthcare organisations.
By contrast, concerns raised by the public appear more similar between UK qualified and ethnic doctors, most of whom are internationally qualified doctors.
This distinction is key: as public complaints are broadly similar but institutional referrals are disproportionate, the pattern reflects organisational decision-making. It would therefore be unsafe to treat the final tribunal population as a simple reflection of underlying misconduct in the medical workforce.
A proven sanction is, of course, serious; but aggregate figures are also shaped by who is complained about, who is referred externally, what is managed locally, and how much support or remediation is offered before formal escalation.
A recent report by the all-party parliamentary group on global health and security emphasises that the contributions of the NHS’s international doctors and nurses have been vital for years, describing them as a pillar of global health security.
On a conservative estimate, the all-party parliamentary group concludes that approximately £14bn has been saved in training costs across NHS doctors and nurses, with £1.1bn saved in the past year alone.
The NHS benefits from the skills of many doctors whose core education and training were funded outside the UK.
IMGs are not a marginal presence in the NHS medical workforce: they are essential. Recent GMC workforce reporting indicates that doctors who qualified outside the UK make up around 42% of licensed doctors in the UK, with particularly high representation in locally employed, specialty, associate specialist and specialist, and other non-consultant roles.
These roles often sit closer to service pressure, rota gaps, and local employment structures, which may themselves affect exposure to complaints, escalation, and regulatory referral.
Negative publicity can harm the IMG workforce and public confidence in it. The contributions and achievements of IMGs rarely receive the same prominence as individual cases of misconduct.
We recognise that where harm has occurred it should be properly investigated and subject to appropriate sanctions – but what should be avoided are sensational headlines that invite broad conclusions from small or inadequately contextualised numbers.
Such reporting risks damaging the NHS at a time when it depends on the skills and experience of internationally trained doctors.
JS Bamrah, trustee and past chair, Joydeep Grover, president: British Association of Physicians of Indian Origin, UK.
The BMJ article – Foreign trained doctors, misconduct, and misleading headlines (Open access)
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