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Second-class doctors? The impact of a professional career structure on the employment conditions of overseas- and UK-qualified doctors

Abstract:Career structures and their associated boundaries both offer and restrict careeropportunities and provide the potential to be sites of unfair discrimination. Yet theimpact of such structures is rarely explored. This article investigates the impact ofa career structure on the employment conditions of a Medical career grade in whichsome three-quarters of the doctors qualified overseas. The comparison of UK andoverseas qualified doctors in the Staff and Associate Specialist Group provides anunderexplored perspective on a professional career structure with a particularreference to reward, workload, autonomy and morale. The article draws on aquantitative study of 1,715 Staff and Associate Specialist doctors undertaken in2004. The findings demonstrate a complex comparative picture with overseas-qualified doctors earning more, working for longer hours, having less autonomy anda lower morale than their UK-qualified comparators. We conclude by pointing to thepotential for certain career structures to structurally and systematicallydisadvantage some groups.

CONTEXT OF THE STUDY
SAS GRADES
METHOD5
Characteristics of respondents
RESULTS
DISCUSSION
Acknowledgements
Notes
REFERENCES

Notes
1. OVQ medical practitioners tend to be referred to as International Medical
Graduates.
2. In order to undergo postgraduate medical training in the UK, a person has to
obtain a limited registration with the GMC in the UK. To obtain this limited
registration, one has to pass the PLAB test conducted by the GMC. Passing the
PLAB test allows a person to start the postgraduate training at the level of SHO
in a UK hospital. The GMC has been conducting the PLAB test in the UK for
over two decades now. Analysis of the percentage of doctors sitting the PLAB
test (Part 1) by country of attempt in 2003 revealed that 51 per cent sat the exam
in India. This compares with the 13 per cent who took the exam in Pakistan, 28
per cent in the UK and 8 per cent from other countries. Available from
www.gmc-uk.org
3. This work was undertaken by the National Institute of Careers Education and
Counselling who received funding from the DH. The research set out to develop
an understanding of the career support needs of doctors in training from the
doctors’ perspective. This was achieved through conducting a national survey of
final-year medical students and doctors in training. Questionnaires were sent to
final-year medical students, House Officers and three samples of doctors in
training (e.g. SHOs) and Specialist Registrars stratified by year of first registration.
The survey achieved a 42 per cent response rate with 1,740 questionnaires
returned. Both UK and overseas doctors working in England were included in
the sample that was taken from the BMA membership records. A number of
providers of career guidance and policy-makers in the field of medical education
were interviewed. This generated contextual information that could be used to
frame the survey findings and to understand the issues affecting the development
of existing career support.
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