A controversial scheme in English hospital trusts has resulted in overseas doctors receiving lower pay and reduced benefits compared to their counterparts, an investigation has exposed.
Doctors from abroad arrive at NHS trusts as ‘fellows’ under the Academy of Medical Royal Colleges’ medical training initiative (MTI) scheme, spending two-years in the NHS to acquire experience that they’ll later apply in their home countries.
However, a British Medical Journal (BMJ) investigation claims that they might receive lower compensation than doctors hired by trusts and can be returned to their home country if they get pregnant.
At certain NHS trusts, fellows are provided with identical compensation and advantages as doctors who are formally employed.
But, the University Hospitals Birmingham NHS Foundation Trust, Dudley Group NHS Foundation Trust, and Walsall Healthcare NHS Trust have an exclusive arrangement with the College of Physicians and Surgeons Pakistan (CPSP). As discovered by The BMJ, this agreement enables fellows to receive lower pay than the trainees employed by these trusts and also experience reduced benefits.
Critics, including employment lawyers, doctors, and the fellows themselves, have condemned this arrangement as exploitative.
“Since the scheme, the mortality rates for pregnant women in Pakistan have decreased, and there’s been an improvement in medical oncology care and paediatric care, which are demonstrable in the data,” said Asad Rahim, a consultant endocrinologist at Birmingham Heartlands Hospital and regional director of the CPSP’s centre in Birmingham responsible for trainees in the UK.
He added that lack of maternity pay needed to be balanced against the greater good the scheme was having in terms of improving healthcare in Pakistan.
Since its commencement in 2009, approximately 7,000 participants from countries such as Pakistan, India, Sri Lanka, Egypt, Nigeria, and Saudi Arabia have engaged in the programme led by the Academy of Medical Royal Colleges (AoMRC).
An internal document obtained by The BMJ revealed that fellows save the trust money, as their remuneration is lower than the standard pay for junior doctor posts. Despite claims that fellows do not pay income tax or national insurance on their stipend, HM Revenue and Customs insists they should be taxed according to UK laws.
Further investigation highlighted that fellows under the CPSP’s agreement received a stipend ranging from £32,400 to £43,200 a year, significantly less than the equivalent pay of ST3 doctors employed by the trust, which ranged from £51,017 to £55,328 a year, excluding additional or enhanced hours, on-call work, or pension deductions.
The report revealed that in 2017 the Birmingham trust terminated the contract of a fellow who became pregnant.
“I informed my department about my pregnancy at around 20 to 24 weeks. They asked me to tell the international team so that, if there was a maternity package, I could get one. The moment I involved the international team, doctors at the trust who ran the scheme arranged for a meeting. I have tried to forget the way it was all dealt with, but I still get flashes of how rude and inconsiderate they were and the remarks they made,” she described her ordeal to BMJ.
“The international team told me that they would terminate my fellowship and my contract would end on 30 June. My baby was born on 27 of June, only eight weeks before the end of the fellowship.
“The mental stress had an effect on my physical health. So after my baby was born I just let it go. My husband got a job in the UK and could sponsor us on his visa. The whole thing was a traumatic experience, and it shook my trust on so many levels.”
Hassan Bin Ajmal, a fellow at University Hospitals Birmingham NHS Foundation Trust, revealed that he had to use two weeks of annual leave when his daughter was born because paid parental leave was not available.
The CPSP has promised to review and restructure its guidelines after criticisms emerged regarding the harsh conditions imposed on the fellows.
Rahim mentioned that fellows receive 25 days of yearly leave and an additional 10 days that can be used for unforeseen situations, such as family emergencies. If they take more time off, it could affect their two-year training term.
They are advised to return to their home country, pause their training duration, and resume in the UK when feasible. Depending on specific circumstances, the CPSP might consent to continue paying the fellows their stipend during leave. For instance, there was an instance where a fellow was given their stipend for four months while caring for their ailing father in Pakistan.
The Ceylon College of Physicians informed BMJ that in the past, some trusts collaborated with Sri Lankan trainees as honorary fellows. These trainees received a £2000 monthly stipend from the Sri Lankan health ministry.
Unfortunately, due to economic challenges in Sri Lanka, this funding was discontinued for new fellows, although existing trainees in the UK continued to receive their stipends.
In the east of England, Sri Lankan trainees are currently paid by the trust, with additional payments formerly provided by the Sri Lankan government for on-call and weekend work.
Meanwhile, the British Association of Physicians of Indian Origin (BAPIO) established its own training programme due to concerns about the misuse of fellows to cover staff shortages in some NHS trusts. The organization’s aim was to treat international medical graduates as trainees rather than just additional staff.
“I think what we really wanted to create is a system whereby all these international medical graduates are treated as trainees rather than as pairs of hands,” said Parag Singhal, executive director of BAPIO Training Academy, an organisation in the UK that recruits Indian doctors on behalf of trusts and manages their training.
A representative from the Academy of Medical Royal Colleges expressed concern about the issues highlighted by BMJ. They emphasised the importance of all doctors receiving fair compensation for their work, whether they are part of the MTI scheme or not. However, they noted that this matter pertains to the doctor’s agreement with the NHS trusts that employ them.