Poaching doctors from abroad is unethical

Abstract

Recruiting an ever-increasing number of doctors from low-income countries to plug staff gaps in the UK National Health Service (NHS) is unethical. These doctors are needed to maintain essential services in their own countries. Based on WHO recommendations of doctor-to-patient ratios, India had a shortage of about 600 000 doctors in 2020,1JournomedShortage of doctors in India; a hard reality.https://journomed.com/shortage-of-doctors-india-a-hard-reality/Date: Aug 18, 2020Date accessed: March 18, 2022Google Scholar and Pakistan had a shortage of 200 000 doctors in 2019.2Hussain S Pakistan facing acute shortage of doctors.https://tribune.com.pk/story/1975950/1-pakistan-facing-acute-shortage-doctorsDate: May 19, 2019Date accessed: March 18, 2022Google Scholar Guidance is enshrined in the WHO code of practice,3WHOWHO global code of practice on international recruitment of health personnel.https://www.who.int/hrh/migration/code/WHO_global_code_of_practice_EN.pdfDate: May 30, 2010Date accessed: February 14, 2022Google Scholar which states that “Member states should discourage active recruitment of health professionals from developing countries facing critical shortages of health workers.” A similar code of practice, listing 47 countries, was published by NHS Employers.4NHS EmployersCode of practice for international recruitment.https://www.nhsemployers.org/articles/code-practice-international-recruitmentDate: Nov 11, 2018Date accessed: February 14, 2022Google Scholar This guidance from WHO and NHS Employers has been ignored. In 2018, 53% of new doctors registering with the UK General Medical Council (GMC) had been trained abroad. In 2019, this trend increased to 60%—7343 doctors were trained in the UK and 10 966 outside of the UK.4NHS EmployersCode of practice for international recruitment.https://www.nhsemployers.org/articles/code-practice-international-recruitmentDate: Nov 11, 2018Date accessed: February 14, 2022Google Scholar Of these 10 966 doctors, 2461 came from the European Economic Area and were able to register directly with the GMC. Few doctors came from affluent western European countries. The other 8505 were international medical graduates from outside the European Economic Area, who had passed the GMC's Professional and Linguistic Assessment Board (PLAB) tests. In 2021, the GMC registered almost 13 000 foreign graduates, accounting for 64% of the total number of graduates. Meanwhile, thousands of eligible British students had not gained places in medical school because student numbers are controlled by cost. There is convincing evidence that PLAB is too easy. The examination is pitched at the level of skill a British doctor would reach within a year of graduation (aged about 25 years). GMC data support that 70% of PLAB graduates are aged 30–49 years.5UK General Medical CouncilGMC annual report.https://www.gmc-uk.org/-/media/documents/annual-report-2018-english_pdf-80413921.pdfDate: Oct 1, 2019Date accessed: February 14, 2022Google Scholar Most of these graduates would be too old to train in major hospital specialities. Two bodies of work6McManus IC Wakeford R PLAB and UK graduate's performance on MRCP(UK) and MRCGP examinations.BMJ. 2014; 348g2621Google Scholar, 7Tiffin PA Illing J Kasim AS McLachlan JC Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study.BMJ. 2014; 348g2622Google Scholar published in 2014 led to the conclusion that the pass mark of PLAB needed to be raised substantially to reduce the difference in performance between international medical graduates and UK graduates. However, this increase in pass mark has not happened. Increasing the pass mark would inevitably reduce the pass rate, which would have implications for workforce planning in the NHS. The five new medical schools announced in 2018 will only produce an extra 1500 graduates per year, the first in 2023.8BBCUnder-doctored areas to get new medical schools.https://www.bbc.co.uk/news/health-43463358Date: March 20, 2018Date accessed: March 23, 2022Google Scholar In August, 2019, the GMC industrialised its PLAB facility in Manchester by doubling the examining capacity to 11 000 candidates per year. Furthermore, the GMC encourages recruitment from abroad, by arranging PLAB1 examinations in 24 centres in 15 countries outside the UK. This moral and ethical dilemma should be addressed. We should train more British doctors as a matter of urgency. Recruitment from abroad on this scale is not in the best interests of the NHS or the donor countries. I declare no competing interests.