In this issue’s Advocacy feature, Aska Leslie takes a look at another perspective of the ‘brain drain:’ the problems faced by doctors who have been forced to flee their home and their jobs to seek asylum in the UK and their struggle for professional recognition…and employment.

Introduction

According to a recent article in the Lancet, almost half of the 16000 staff expansion of the NHS came from the recruitment of health professionals trained outside the UK and Europe [1]. A third of practising doctors have been trained overseas. This of course brings up issues related to the impact of such a ‘brain drain’ on the countries that these staff originate from, many of these countries being resource-poor anyway. However, it is also worth considering that a proportion of overseas qualified doctors come to the UK out of necessity, rather than choice i.e. to escape conflict and persecution. These doctors are often met with difficulties in accessing employment, despite having considerable clinical experience in their home countries.

CASE STUDIES (provided by Refugee Women's Association)

Case Study 1
Medical Doctor from Bulgaria

• Arrived as a refugee 7 years ago (1998)
• 8 years’ experience as a physician
• Found employment as a GP in 2004

Case Study 2
Medical Doctor from Afghanistan

• Arrived as a refugee in 2001
• 5 years’ experience in Obstetrics & Gynaecology
• Found employment as an SHO this year (2005)

These doctors face a number of barriers to employment:

• Process of re-qualification
  The process of re-qualification is made up of a number of steps. All non-EEA /Swiss nationals or those not married to an to an EEA national are required to obtain the International English Language Testing System (IELTS) exam certificate, at the levels required by the GMC before they can register with the GMC.

  Refugee doctors must also pass the PLAB exam [2] (unless they are exempt). PLAB 1 is a three-hour written exam which tests medical theory as applied in the UK ethical, cultural and legal setting, and it can be taken before entry into the UK in some countries. PLAB 2 consists of a 14-station objective structured clinical examination (OSCE) and must be taken in the UK.

  The cost of re-qualification is often a problem for refugee doctors. As of January 2005 the fees were as follows:
  £145 for each attempt at PLAB 1, and £430 for each PLAB 2 sitting [3].

  Refugee doctors may also have difficulties with the PLAB 2 because of differences in clinical practices due to cultural/social factors e.g. how doctors interact with patients. PLAB 2 requires doctors to be fully assimilated into UK culture and society.

• Difficulty in getting clinical attachments, supernumerary/honorary posts

  Undertaking clinical attachments or working in a supernumerary/honorary post is a way for refugee doctors to gain the experience necessary to pass the PLAB 2 exam. It is also the only way that overseas qualified doctors can get a UK consultant reference [4] (this is almost essential for getting a job, and particularly vital for refugees who may not be able to provide a Certificate of Good Standing from the country where they obtained their primary medical qualification). It is often very difficult for refugee doctors to gain such experience.

• Lack of UK work experience
  Because these individuals lack UK work experience, it is much more of a challenge to obtain employment.

• Lack of confidence
  Understandably, many refugee doctors feel a lack of confidence, and it is therefore important that they are adequately supported through the re-qualification process, as well as once they have obtained employment.

• Childcare and family responsibilities
• Prejudices and lack of awareness of the skills, potential and contribution of refugee doctors

  Refugee doctors may experience prejudice by NHS staff and patients.

Available resources

There are resources available to help refugee doctors overcome these difficulties. For example, the Refugee Women’s Association works with female refugee doctors, supporting them through the re-qualification process and providing mentoring (where employed refugees mentor those who are unemployed). They run Accelerated English training courses (unfortunately only in London at the present time) and are able to provide travel expenses and contribute towards childcare costs. They also provide a crèche, thereby helping to increase access.

The North East London Strategic Health Authority maintains a website (supported by the NHS) which aims to assist refugee and overseas qualified health professionals to find employment in the health and social care sector.

What can Alma Mata and its members do?

• Provide clinical attachment or supernumerary/honorary posts

• Provide mentoring support to help refugee doctors gain employment
• Raise awareness of refugee health professionals’ skills and contribution to the medical field
• Get involved with organisations that work in this area:

  STAR (Student Action for Refugees) offers university students and young people the opportunity to support refugees in a practical way in their local communities through volunteering (e.g. running after-school clubs for the children of refugee families; acting as an advocate by accompanying individuals to register with their GP, to job interviews).

• Improve our own understanding of complex issues surrounding refugees:

  The Refugee Council run a wide range of courses [5] for those wanting to learn more about supporting refugees and understanding their needs (e.g. ‘Cultural aspects of working with refugees and asylum seekers’; ‘Understanding health needs of refugees and asylum seekers’)

Aska Leslie
Postgraduate Education Editor

[1] Eastwood J, Conroy R, Naicker S, West P, Tutt R, Plange-Rhule J (2005) Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK. Lancet. Vol. 365, Issue 9474 (May) pages 1893-1900

[2] Professional and Linguistic Assessment Board

[3] Refugee doctors can apply for exemption from the £145 fees for their first two attempts at PLAB 1 if they obtain a letter from the Home Office confirming that they have exceptional leave to remain or refugee status in the UK.

[4] Cheeroth S, Berlin A. (2001) Guidelines for Clinical Attachment for Overseas Qualified Doctors. BMA. (December) Page 1.

[5] For further enquiries about Refugee Council courses, call Anna Lodge, Training and Events Officer on 020 7346 6739 or email marketing@refugeecouncil.org.uk.