The first few months in the UK can be a steep learning curve with lots of new processes to learn and adapt to. Dr Omar Alam, ST5 trainee in acute internal medicine at Hull Royal Infirmary, shares why he believes taking an SHO role for just a few months will give you the best start working in the UK.
My view is that starting as an SHO, even if it feels like a step backwards, is often the best start for your career in the UK. But why?
I get messages from IMGs on a regular basis telling me that they took a registrar post in medicine in haste as their first job in the NHS and are now struggling. Luckily, we have colleagues who flag this up to consultants and the directorate who then make amends (ie put them on the SHO rota, etc), but sometimes mistakes happen - and the GMC doesn't take this lightly.
I do know IMGs who started as registrars and have been comfortable working in that position from the first day. This could be because they were well supported and asked everyone around them for help, and found they did get help, but quite a few are not this lucky.
So for the sake of your sanity and patient safety, please do not start as a registrar as your first job in the NHS. Even though you meet the qualification criteria on paper (that is given by MRCP), things are a bit different in reality, it takes time to understand how the NHS works. Clinical knowledge is never an issue, it’s the "logistical" angle which people struggle with.
Trusts are desperate for registrars in every specialty. They will do a quick interview and select you (everyone can tell the management of MI, PE, and the typical interview questions); however, when you start work, it is a whirlwind unless you know the system well.
I have tried my best to support as many people as I can but unfortunately, a few of them were referred to the GMC for being unsafe (when facing the MPTS panel and when in court, it is you and your documentation - registrars are expected to run the hospital at night).
So please be cautious, the registrar pay does appeal to many, however a lot of people struggle, and some unlucky ones suffer long term.
Here is my advice for people who are overqualified for SHO posts:
1. Apply for registrar level posts.
2. Request that they pay you as an SHO for the first few months.
3. Shadow on-call registrars.
4. Do a registrar shift with an on-call registrar supervising you.
5. Then request them to put you on the registrar rota once you are more confident.
OR
1. Apply for SHO posts and start working as an SHO on the SHO rota.
2. Shadow on-call registrars once you feel settled.
3. Do a registrar shift with an on-call registrar supervising you.
4. Then request to be put on the registrar rota with registrar pay once you are more confident.
I know my IMG colleagues are very highly qualified and just as knowledgeable as my UK trained colleagues, so I am in no way suggesting that they are incompetent. I am simply saying, give yourself a little bit of time to understand the NHS systems and get to know the differences in the UK before taking on the registrar role.
If you are working as a registrar already and are struggling, I have more information and support including template letters available on my blog.
About the author
Dr Omar Alam is a specialty trainee registrar in acute internal medicine. Omar came to the UK in 2016 from Pakistan and has a blog sharing some of his experiences, focusing particularly on International Medical Graduates. Omar also provides mentoring to International medical graduates, local UK graduates and advanced care practitioners in his workplace.