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Career Progression and Grades for UK Doctors

  • November 18, 2016

One of the most frequent and important questions we get asked by international doctors is where they fit into the UK system and what grade they can expect to work at.

It is important to note that medical terminology is different from country to country, so this brief guide aims to clearly explain the UK system and give you a better idea of what grade you can expect to start at.

Foundation Training

In the UK the Foundation Programme is a two-year generic training programme which forms a bridge between medical school and specialist/general practice training.

Foundation Year 1 (FY1 or Trust grade equivalent)

FY1 enables medical graduates to begin to take supervised responsibility for patient care and consolidate the skills they have learned at medical school.  At this stage, the doctor will have provisional GMC Registration.

Satisfactory completion of F1 allows the relevant university to recommend to the GMC that the foundation doctor can be granted full registration.

As most IMG’s come to us after they have completed their internship year, it is rare we use this grade to employ doctors into.

Foundation Year 2 (FY2 or Trust grade equivalent)

FY2 doctors remain under clinical supervision (as do all doctors in training) but take on increasing responsibility for patient care. In particular, they begin to make management decisions as part of their progress towards independent practice.

FY2 doctors further develop their core skills and contribute more to the education and training of the wider healthcare workforce, such as nurses and medical students. A big part of this year is determining your chosen specialist interest area upon completion.

At the end of FY2, doctors will have begun to demonstrate clinical leadership and decision-making responsibilities that are essential for hospital and general practice specialty training.

Satisfactory completion of FY2 will lead to the award of a Foundation Achievement of Competence Document (FACD) which indicates that the foundation doctor is ready to enter a core, specialty or general practice training programme.

Most of the posts that we recruit to, at this level, are for doctors who have completed their internship year overseas and ideally have a few months of additional second-year experience. You should note that Trust grade posts are not training posts, however, most departments will sign off equivalent competency certificates to ensure that you can still apply to the next stage in their medical career.

Junior Middle Grade (CMT1/2, ST1/2, Junior Clinical Fellow and SHO)

At this stage, doctors have usually started to get an idea of the area that they will eventually go on to specialise in.

This phase of a doctor’s career is about expanding on foundation training and moving towards specialist training. To exemplify, a General Medicine doctor will spend these two years of their career in longer rotations between several general medicine specialism’s whilst studying towards their MRCP exam. Once complete they will usually elect to continue with one specialist interest, such as Cardiology, right the way through to Consultant level.

Junior Clinical Fellow and SHO equivalent positions are an excellent starting place for international doctors with a small amount of specialist training who are perhaps looking to study towards a Royal College qualification.

Senior Middle Grade (ST3-8, GP Trainee, Senior Clinical Fellow and Staff Grade Equivalent, Speciality Doctor)

Once a doctor has made it to this stage in their career they should have developed all the skills necessary to be ready to fully immerse themselves in specialist training for the next four to six years (depending on the length of training for the chosen specialism).

Each year of progression will involve more advanced practice and autonomous working, with the emphasis moving away from training and towards becoming fully independent – and will eventually become a trainer of the next generation. Please note those who choose a career in General Practice will go through fewer years of training (typically three).

Once training years are complete, doctors receive a Certificate of Completion of Training (CCT) and gain entry to either the GMC Specialist Register or GP Register.

Equivalent Senior Clinical Fellow and Staff Grade vacancies are often the best starting point for international doctors who are looking to join at this level.

Consultant or GP

Once a doctor has completed their specialist training they will be free to work independently as Consultants or General Practitioners.

For international doctors, it is worth noting that the CESR route recognises equivalent specialist training and without this, it will be impossible to enter the UK system as a permanent Consultant straight away. Thus, the most popular route is for IMG’s who do not hold CESR or CCT they will act down to a Senior Middle Grade whilst they work towards their specialist registration or alternatively take up a temporary post which will allow Consultants to work for a fixed-term without their CESR or CCT.

The NHS has many different variations and it can seem quite complicated for those who are not working within the healthcare system every day. We have tried to simplify things in this article, but if you have any specific questions relating to your circumstances or would like further advice – please email us on [email protected].

And if you are an international doctor who is interested in relocating to the UK and working within the NHS send your CV to [email protected] and one of our Specialist Advisers will be in touch.

Come and say hello! Join our Facebook Group IMG Advisor – here you will be able to ask questions, receive access to frequent blog posts and meet other IMG’s!

Journey through Medical Training


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