Introduction 1.What is your name, speciality, grade and what hospital do you work at? My name is Dr Raja Adnan Ahmed and I am working as a Consultant Psychiatrist in       South Wales currently based in Ysbyty’r Tri Chwm Hospital which is part of the Aneurin Bevan University Health Board. I have been working on this substantive consultant post for over two years. 2.What country did you relocate from? I relocated from Pakistan having graduated in 2003 and I arrived in the UK in 2005. 3.Would you share with us your personal mission as a doctor? My mission is to raise awareness about mental illness amongst the general public as well as healthcare professionals and to reduce the stigma associated with mental health. I believe due to the lack of awareness many people, including doctors and allied health professionals, suffer in silence and treatable mental health conditions become disabling. I would like to see mental health receive the same attention and parity of funding as physical health. I would also like to see an improvement of training in Psychiatry as a discipline among medical students in the UK and in Pakistan.   4.At what point in your career did you decide you wanted to relocate to the UK? What were your motivations for wanting to do so? I moved to the UK following my house job (internship) in Pakistan. In fact, I started to plan during my final year of medical college. I was interested in Psychiatry and started to research the Royal College of Psychiatrist Training Curriculum and various training programmes within the UK. I undertook the necessary IELTS during my internship as well as studied for my PLAB1 exam. My main motivation to pursue training in the UK was the highly organised and carefully structured training programmes available in Psychiatry. There were excellent training opportunities, emphasis on a work life balance, a rewarding salary, recognition and clear pathway for progression of one's career, all of these factors contributed to my choice in migrating to the UK. The Relocation Process 5.How long did it take you to relocate, how difficult did you find the process, and do you recommend it to other IMGs? I relocated to the UK in 2005, at that time under the labour government, the visa regulations, especially for highly skilled migrants were quite straight forward. Unfortunately, this also meant that the job market became saturated quickly. A single non-training vacancy would attract hundreds of applications. It was not unusual at that time for IMGs to start with unpaid clinical attachment work for months whilst simultaneously applying for post across the country. The situation changed around 2006-2007 as many IMGs started to leave due to lack of posts. When I first moved to the UK within first few months of passing PLAB I was able to secure a clinical attachment and within 8 weeks of that I was able to secure first locum post in the same department which led to further short-term locum positions. However, it took me more than a year to secure my first training job as a foundation year two doctor. Certain specialities continue to have a chronic shortage of doctors, but I can see that the situation is improving, therefore, I advise young IMGs to pursue their ambitions at this current time. 6.Is there anything you would have liked to have known before deciding to relocate? And now once you live in the UK? When you move countries, you are leaving behind all the support networks, family and friends. It takes time to settle and for me at first it felt like I was starting my life from scratch. The initial months can be very anxiety provoking due to lots of uncertainties and challenges but as times goes on most of us adapt to the changes and the new cultures and working environment. Once a job is secure the rest comes naturally. You are never too far from a supporting figure, colleague or mentor. In my experience, Wales, has been a very welcoming and friendly place to live hence, I have chosen to stay and work here. I advise new IMGs to keep an open mind and be prepared to face the initial challenges. There is a lot to learn about British cultural norms, culture of NHS as a health service and British society in general. But once you start to settle the you will find British society and NHS is very welcoming and inclusive towards IMGs and you will get many of opportunities to grow.   Thoughts on the UK 7.For you, what are the key benefits of living in the UK? I see plenty of benefits living in the UK. The society in general is very liberal, inclusive and welcoming, people are very friendly and value your hard work, intelligence and dedication. The UK is at the cutting edge of medical research and innovation and there are excellent training opportunities which include training in the hospitals, Royal Colleges and opportunities with the local universities. The training and qualifications you gain in the UK are recognised globally. The NHS has the mechanisms to make you a well-rounded doctor. Our children also get better education via the school system here in the UK and hopefully will get excellent university education which will open opportunities for their future progress. The UK also offers you a very healthy work life balance and there is a lot to explore and enjoy as a family within the UK and also in Europe. 8.How do you feel you settled in your chosen location within the UK?  I grew up in a small town in Pakistan which was surrounded by beautiful countryside and mango farms. I think because of my upbringing and the lovely early childhood memories, I love the countryside. I remember my very first days in London when I was preparing for PLAB-2, visiting the city and travelling around on the London underground during the peak hours, as much as I enjoyed this experience my heart has always been drawn to the idyllic country atmosphere. Fortunately, I had the chance to work in the South Wales which offered me good balance or city and rural life with proximity of cities like Cardiff and Bristol along with the lovely countryside with rolling hills, peaks of Brecon Beacons and sandy beaches of the Welsh coastline. The cost of living is lower in Wales if you compare it with areas around London or the South West of England. 9.Have you applied for permanent residency in the UK? How did you find the process? The visa regulation has changed a lot since 2005, generally speaking, it was a lot easier 10 years ago. IMG doctors applied for a HSMP visa (highly skilled migrant programme) which lasted for certain number of years leading to ILR (indefinite leave to remain) and there was no need to change visas with every job.    Unfortunately, I don't understand the current visa rules so well as so much has changed but I believe the UK government should make it easier for highly skilled professionals to acquire British visa’s and provide them a clear pathway to permanent residency. The NHS 10.How did you feel on your first day of working within the NHS, your first week, month and then how do you feel now compared to when you first started? My very first experience of working in the UK was clinical attachment which led to a locum SHO job in the same hospital. I was very excited and nervous at the same time. I met very helpful experienced seniors to guide me through that period and I slowly gained experience and confidence. There is no doubt that the first few weeks or months in the NHS can be difficult as there is a lot to learn about the system and functions of the multi-disciplinary teams. I advise doctors to be honest about their skill level and do not ever hesitate to ask for help when you are unsure. Also, do not feel ashamed to ask plenty of questions and identify areas of your weakness, reflect upon them, discuss them with your supervisors and develop a personal development plan (PDP)  to constantly learn and improve your skills. 11.How would you describe the support you received from your hospital after starting your new position? I received good support from seniors in the Royal Gwent Hospital, Newport when I was doing both my clinical attachment and during my locum SHO position in medicine. I was lucky to work with the seniors who understood that IMGs require periods of induction into the NHS system and require extra support and supervision at the start.    My first training post was in Yeovil, Somerset as and FY2 in 2007, again I was warmly welcomed by the staff and received appropriate support in settling in and achieving my required foundation competences and application process for the core psychiatry training. I think all departments in NHS are familiar with new IMGs starting their first job in the NHS and they are usually very helpful. I also advise IMGs to look out for mentors both at a peer level and senior levels who can guide and support you during the initial years. 12.What were your thoughts on the UK/NHS System in 2005, do you think either has changed much over the last 13 years? This is an interesting question. Certainly, a lot has changed within the NHS and as an organisation NHS is constantly evolving as it is trying to improve and find more effective ways to perform. Although we use word NHS as if this is a single organisation but in reality, the NHS is formed by lot of different bodies and as doctors we experience interactions with various different trusts, hospitals, training schemes, royal colleges, deaneries and universities. Since I started working in the NHS I have noticed there are certain negative streams of media that denigrate the health service and portray it to be unsustainable. I remember IMGs back in 2005 were worrying if the NHS would survive another 5 years. It is true that certain Trust services and hospitals struggle to manage safely but on the other hand there is a lot more positivity about the NHS and its excellent performance which is not reflected fully in the media. I now advise my colleagues and new IMGs to avoid concentrating on all the negative media coverage about the NHS and focus on all the positives NHS offer you. By working within the NHS, you become part of a diverse multicultural workforce and get exposure to excellent training opportunities, cutting edge techniques, chance to work with worlds experts in certain fields, frontline academics and mentors. I believe NHS will continue to offer excellent training despite the austerity measures.    13.What is your opinion on the NHS? Working within it and as a patient receiving care? NHS is an excellent health system and simply one of the best in the world. The staff show real compassion and commitment and generally the training of the staff along with safety standards are exceptional. I believe your hard work and dedication are recognised and commended within the NHS and you are given opportunities to bring about the change. 14.What pathway did you use to become a UK Consultant? I have a CCT in Old Age Psychiatry which I achieved in 2016. I started the training pathway in 2007 with a Foundation Year 2 job in Somerset, which led to core psychiatry training. I finished my membership exam, core and specialist training within Wales Deanery. For IMGs who are interested in psychiatry training, I always advise them to consider the proper training pathway with membership exams and aim for the CCT. Given the shortage of applications on core training jobs, the core training places have been under filled for the last 10 years (although in 2018 we had a much better year for recruitment). Similarly, when core trainees are finishing their membership exams, they are getting specialist training posts fairly easily leading to CCT. Although I have nothing against CESR pathway, generally speaking in Psychiatry it is easier to get a CCT with better exposure to training which helps you to become a confident consultant.     15.How do you find working in the UK compared to your home country? When I left Pakistan in2005, the life of a trainee doctor in Pakistan was very difficult due to shortage of training places, shortage of supervisors and very low salaries. But above all, I was most concerned with the lack of training opportunities. In comparison to Pakistan, I felt the training in the UK offered a better structured and clear pathway to progress along with several excellent opportunities to refine my skills as educator and leader. Working and training in the UK also gives you financial independence and a peace of mind so you can focus your energies on training needs, membership exams and clinical skills. When I was working in Pakistan, I knew I would have been financially dependent on my parents, but in the UK, my wife and I moved into our first house in Wales when we were both Foundation Year 2 doctors. The Future 16.What are your hopes for the future? I am currently working on a Consultant Psychiatrist post with NHS Wales and pursuing a Master’s in medical education with Cardiff University. I would like to develop myself as an experienced educator, I am already involved with Cardiff University Medical School, the Welsh Deanery and my local health board in teaching and examining roles but I would like to expand my involvement and improve my own experience as an educator. I am interested in raising awareness about mental illness in general public and healthcare professionals and improve recruitment into psychiatry. I am also interested in Qualitative research methods and currently exploring and learning more about qualitative research and designing my first Qualitative research project. In the future, I like to establish myself as an experienced researcher with publications in reputed psychiatry journals along with my clinical and educational role. In my personal life, I am blessed with an extremely supportive wife, who is a GP herself and we have three lovely energetic children. I always try and find ways to spend quality time with my family and maintain a healthy work life balance. We enjoy hobbies such as cycling, hiking, running and swimming. The future holds so much more! Thank you for reading! Join our Facebook Group IMG Advisor! Here you will have access to regular relocation blog posts, the opportunity to ask questions and receive professional support and the chance to meet other IMGs!