This is the second in a two-part series where we hear from International Medical Graduates (IMGs) who have relocated from Nigeria to the UK to work for the NHS.
Moving to a new country can no doubt be a bewildering experience for doctors. With different ways of working, unfamiliar equipment, colloquialisms – all challenges for the IMG.
The General Medical Council (GMC) is aware of these challenges and offers a free online course, Welcome to UK Practice. We encourage all doctors new to the UK to attend.
The course gives practical guidance on ethical scenarios that doctors may encounter at work, while giving them the opportunity to connect virtually with other international doctors.
Nigerian national Dr Olujinmi Adetutu, a GP trainee working in Greater Manchester, reflects on how he followed his dreams to work as a doctor in the UK and how those dreams compare with reality.
I emigrated to the United Kingdom on a cold February morning. I remember the fear and a certain degree of apprehension; what would happen in a place I knew no one and had no family? How would I blend and fit in? Will I stick out like a sore thumb? Will it just be like another job in my medical career? However, as all these thoughts whizzed through my mind, a flame of hope, excitement and joy rose in me. I was moving to the UK.
I had a plan—everything was going well post-medical school. Even though the idea to practise in the UK started in medical school, I was comfortable. Then a classmate sat the PLAB exams and emigrated within eight months after we first had the conversation. Soon after, I jumped on the process myself.
Taking the PLAB exams was capital intensive. The exchange rate, when I converted my salary from Nigerian Naira to British Pounds to pay for the exams, was high. I had to save for about six months before I could even start the process of applying. I was, however, driven by one goal, I would begin to work in the UK and make so much money that I will not know what to do with it.
Dreamily, I would convert the salary in Pounds back into to Naira. I thought that I had found the proverbial money tree, and all my troubles were about to be over. I imagined being able to buy a Porsche in my first six months and a house in my first year. The sweet bliss of ignorance!
No one told me that I had to pay monthly rent (you pay annually in Nigeria). I did not know that getting a car was hard, or that your first insurance will probably cost as much as the car you’ve bought. Of course, I could not and still cannot afford a Porsche. You will need a solid credit history to qualify for monthly payments. No one told me that buying a house outright was just a dream
Getting into the NHS for me was the goal. And so, I focused on getting a job after my PLAB exams. I applied to numerous hospitals and had to wait a couple of months before securing a job. I learned how to write a CV and shape it to the person specification. I finally got a job in the NHS—in a trust that was instrumental to my development.
Starting work was scary. On my first day on the ward, I was asked to review a patient scoring a four (huh?) in the National Early Warning Score*, and the patient was ‘poorly’. Of course, I ran to the person I was shadowing for help as I had no idea what was going on. I was then told to take a blood sample from a patient who missed the morning phlebotomy rounds.
This was a job I was so glad to do—at least I knew what to do. I took the sample and sent it off. I remember being awed when I was asked by a nurse about two hours later if the results were back. My look must have said ‘how can it be back so quickly’. But alas, it was back. Yes, the results back home are not returned so quickly…
Another funny interaction I had was the way I addressed everyone I spoke to. I called them Ma or Sir. I remember one of my consultants, who was in his 60s, asking me to call him by his name. To me, as an African man, doing that seemed the height of disrespect. Nurses I worked with thought I was from another planet when I kept saying ‘yes ma’ to them.
After a couple of months, I settled in. I became so comfortable doing on-calls that I was picking up numerous extra shifts. No one told me anything about the tax system in the UK – and that the more you earned, the more tax you paid. Before long, I was paying 40% tax. My dreams of buying a Porsche were getting ever more distant.
Working in the NHS has shown me that, although the system is not perfect, you get to work with people keen on getting the job done. People care for the patients and, in most places, the patient is the goal, the reason why we are all at work daily. People often work with limited resources but do the best with what they have at hand. Now, in my final few months of GP training, I have come to see the United Kingdom and the NHS as my place. A place I can do my best and contribute. A system where I can learn and teach—where I can effect changes in my own way.
It is not a perfect system. However, as an IMG, I feel there is even more pressure to blend in seamlessly, so you do not stand out as an outsider- from patients asking you to repeat yourself to the pressure to prove you are knowledgeable to your team (especially the nurses who are watching you closely) and to yourself as a doctor.
However, I am happy there are more IMGs in the system now. There is now a mentorship programme, run by Nigerian Doctors in the UK, in place to help newcomers find their feet and to teach them things we did not know or were unaware of when we came here.
My advice for doctors wanting to work in the UK would be that it is rewarding in the long run and you will get there. The processes you must go through may seem tedious, but you will get through it. Once you are working you will feel proud of yourself and see the effect of your hard work.
I benefitted from attending the GMC’s Welcome to UK Practice workshop. Beforehand, I was unaware of patient autonomy before moving to England. But the session explored how over here your job is to present patients with the best options for their health and respect their decision. Back home we told a patient which option would be best and didn’t have the same discussion about the different options. The workshop wasn’t overwhelming at all, it made me feel more prepared for scenarios I would be likely to encounter day-to-day in the UK and I left feeling more prepared.
For more information about Welcome to UK Practice visit this page – places can be booked via a doctor’s GMC Online account.
*National Early Warning Score is a system for scoring the physiological measurements that are routinely recorded at the patient’s bedside. Its purpose is to identify acutely ill patients, including those with sepsis, in hospitals in England.