The view from the bottom of the NHS ladder can feel endless. A clinical fellow post. Then an LAS. Then another LAS. A year later, the rota changes, the trust changes, but the badge stays the same. No national training number. No progress. Just a growing CV of service jobs and the quiet question building in the background — is this it?
For many international medical graduates (IMGs), this is not just a phase. It becomes a pattern. One year in a non-training role becomes two. Then three. Suddenly, applying for specialty training feels like aiming for something out of reach. Confidence dips. Applications are delayed. And slowly, the system shapes the doctor more than the doctor shapes their path.
But it doesn’t have to stay this way. This isn’t a blame story. It’s an untangling of what causes the cycle — and how IMGs can rise out of it.
The System Wasn’t Built for You
That’s the first truth to face. The UK medical training pathway is designed with homegrown graduates in mind. From the moment they start medical school, UK students are coached, mentored, and funnelled toward training applications. They know what a “portfolio” means by the second year of university. They are taught how to speak the language of evidence, reflection, and competencies before they ever set foot in a hospital job.
IMGs arrive with degrees, experience, and motivation. But not the same map. They enter the workforce with clinical knowledge, but without guidance on what’s actually being assessed when applying for training. And so, the first job — often a non-training role — is taken as a temporary step. A way to “get used to the NHS.” But then the contract ends. The next job is another non-training post. The next rota. The next hospital. No guidance. No mentorship. Just work.
Without structured feedback or strategic planning, many IMGs end up working hard, learning fast — but standing still.
The Real Cost of “Service Jobs”
Non-training posts in the NHS come in many titles: LAS (Locum Appointment for Service), Clinical Fellow, Trust Grade, SHO, or even “Junior Doctor (Non-Training).” They often pay more than training jobs. They may come with fewer assessments and offer more flexibility. But they lack one thing — career momentum.
In these roles, doctors are expected to fill rota gaps. Clinics get cancelled. Teaching is inconsistent. Supervision is informal. And because there’s no ePortfolio or ARCP review, there’s no system in place to push development. The doctor becomes functional — useful to the department, dependable, but rarely challenged to grow in a targeted way.
This stagnation happens quietly. There’s no moment where the path clearly ends. But slowly, the line between “I’m getting NHS experience” and “I’m stuck” begins to blur.
Why IMGs Hesitate to Apply for Training
Fear is one reason. After years of being in a non-training post, some IMGs begin to feel like outsiders. They worry their experience won’t match up. That they’ll be rejected. That they don’t know how to “sell themselves” the way UK grads do. They hear about competition ratios and feel intimidated. Or they simply don’t have time — long shifts, visa issues, family pressures — it all delays the moment of application.
Some have been given the wrong advice. Others don’t even know what counts in an application. Teaching experience? Audits? Courses? Publications? It’s overwhelming. And without guidance, many choose the safer route: another Trust Grade job, another six-month contract, another line on a CV that still doesn’t lead to a training number.
Climbing Out of the Cycle Starts with Clarity
There’s no single solution — but there is a shift. A decision to stop treating the job as a holding space and start treating it as a launchpad. That begins with learning what the specialty training pathway actually demands.
Every specialty has published person specifications. These documents spell out exactly what they’re looking for — from clinical skills to commitment to specialty, from teaching to leadership. Reading them is not optional. It’s foundational. Because once you know what the selectors value, you can start building backwards.
Teaching doesn’t have to mean lecturing at a conference. It can mean organising a small session for juniors and collecting feedback. Leadership isn’t just being president of a society — it’s volunteering to lead an audit, or improving a local pathway. Commitment to specialty isn’t proven through years of service alone — it’s shown through structured reflection, relevant courses, and evidence of proactive engagement.
The climb starts when experience stops being passive — and starts being documented, reflected, and aligned with training values.
Networking Isn’t Optional — It’s Strategy
Many IMGs underestimate the power of connection. Specialty applications in the UK are designed to be fair — blind scoring, standardised interviews — but access to knowledge is still unequal. Those who speak to current trainees, who attend webinars, who join support groups, consistently perform better. Not because they’re smarter — but because they’re more informed.
Joining a Facebook group for IMG applicants. Reaching out to someone on LinkedIn. Attending a Royal College event. These aren’t just side steps. They’re ladders. Conversations spark clarity. Clarity builds confidence. And confidence fuels applications.
No one climbs alone. Not in a system this complex.
Visa Status Can’t Be the Excuse Forever
Yes, it matters. It shapes job offers, post availability, and sometimes discourages applications altogether. But it’s not a life sentence. Many training programmes now sponsor visas. Even competitive specialties like radiology, paediatrics, and psychiatry offer posts with sponsorship built in.
Avoiding training applications “because of visa issues” may be valid once. Maybe even twice. But in the long run, it becomes a way of staying stuck. Instead, start planning. Know when your visa expires. Research which training posts offer sponsorship. Prepare in advance.
A stable visa begins with a bold application.
The End of Waiting
No one will tap your shoulder and tell you it’s time to apply. NHS Trusts won’t advise you to leave their rota. Some supervisors may even suggest “another year in the department to build your skills.” But the system doesn’t reward waiting. It rewards alignment with criteria.
So if the goal is specialty training, the waiting ends now. Choose a specialty. Read the person specification. Join a forum. Book a course. Start your ePortfolio even if you're not required to. Ask a supervisor for a teaching opportunity. Write a reflection after your next night shift. Apply for a training post — even if you're scared.
Because climbing the NHS ladder isn’t about permission. It’s about momentum.