IMGs form the backbone of the NHS, with their numbers steadily increasing and playing a crucial role in delivering patient care. However, a recent analysis from NHS Resolution's Practitioner Performance Advice service casts a revealing light on concerning patterns: IMGs are disproportionately represented in cases where concerns about individual practice are raised. This disparity isn't just a statistic; it speaks to systemic challenges, ranging from inadequate induction processes to potential biases in how performance issues are managed.
Understanding these trends is crucial for IMGs navigating the UK healthcare landscape, as they offer valuable insights into potential pitfalls and highlight the need for a more equitable and supportive environment.
Understanding Disproportionate Representation in Performance Concerns
IMGs in the UK find themselves significantly overrepresented in concerns reported to NHS Resolution's Practitioner Performance Advice service. Specifically, practitioners who qualified outside the UK had 1.6 times the rate of cases per 1,000 practitioners compared to those who qualified in the UK. This issue is further compounded by the fact that ethnic minority practitioners also face higher case rates (1.3 times more likely than white practitioners), and given that a significant proportion of IMGs are from ethnic minority groups, this overlap exacerbates the issue. Doctors and dentists are statistically more likely to face exclusion if they are from Asian or Asian British, Mixed, or 'Any Other Ethnic Group'.
These disparities are particularly stark in particular roles and at specific career stages. IMGs appear to be overrepresented in GP training grades, accounting for 61% of cases in this group, despite comprising only 23% of those on the General Practitioner Register in 2023. Furthermore, IMGs are disproportionately represented in cases involving practitioners who have been in a role for less than one year, with 70% of such cases involving IMGs. This percentage falls to 43% for practitioners who had been in post for more than 10 years, suggesting that the initial period of adjustment is particularly challenging for IMGs.
Common Themes and Underlying Factors
A significant majority (73%) of all cases, including those involving IMGs, feature behaviour/misconduct concerns. This broad category encompasses issues like poor communication with colleagues, teamwork problems, breaches of confidentiality, and even incidents of theft or fraud. An analysis of behavioural assessments of doctors, which would include IMGs, found an overarching theme of a lack of self-awareness and insight.
The article points to several potential contributing factors and systemic issues:
Poorer Inductions and Support: The report states that "‘Outsiders’ have poorer inductions, feedback and ongoing support, are more likely to work in isolated roles and are more vulnerable when things go wrong in cultures that focus on blame rather than learning." This is particularly relevant for IMGs navigating a new healthcare system.
Lack of Access to "Informal Rules of the NHS": IMGs are often impacted by insufficient inductions and a lack of access to "the informal rules of the NHS," as well as challenges navigating new social, cultural, and professional environments.
Discrimination and Negative Lived Experiences: Research into the lived experience of ethnic minority and IMG practitioners revealed that most participants described feeling discriminated against, leading to long-term impacts such as trauma, stress, and anxiety.
Increasing Numbers of IMGs: The growing number of IMGs joining the workforce (over half of doctors joining in 2022 were IMGs; the number of GP Register IMGs almost tripled from 2018 to 2022) underscores the urgency of addressing these disparities.
What IMGs Can Learn and Actions to Consider
For IMGs in the UK, these findings offer crucial lessons and highlight areas for proactive engagement:
Be Aware of the Statistics: Understand that, as an IMG, you statistically face a higher likelihood of having performance concerns raised. This awareness should prompt proactive measures, not fear.
Prioritize Effective Induction and Integration: The initial period in a new role is critical. Actively seek comprehensive inductions, ask clarifying questions about the nuances of NHS practices, and proactively work to integrate into your team and the wider professional culture.
Focus on Communication and Teamwork: Given the prevalence of behaviour/misconduct concerns, hone your communication and teamwork skills. Seek regular feedback, clarify expectations, and invest in building positive professional relationships.
Develop Self-Awareness and Insight: Engage in self-reflection and actively seek constructive feedback from peers and supervisors to enhance your understanding of yourself. Being open to understanding your impact on others can help address potential issues before they escalate.
Understand Your Rights and Available Support: Be aware that NHS Resolution is committed to improving fairness. If concerns are raised about your practice, understand your organization's local procedures and consider seeking impartial advice from services like NHS Resolution’s Advice.
Advocate for Better Support Systems: Recognize that systemic issues contribute to these disparities. While individual responsibility is essential, IMGs can also advocate for more equitable and supportive systems within their workplaces and through professional bodies.
Address Potential Discrimination: If you experience or witness discrimination, understand the appropriate channels for reporting and seeking support. Your voice is crucial in highlighting these issues.
Seek Feedback Regularly: Proactively seeking feedback, especially in the early stages of a new role, can help identify and address potential issues before they become formal concerns.
Engage with EDI Initiatives: Support and engage with Equality, Diversity, and Inclusion initiatives within your workplace. These efforts are crucial for fostering a more equitable and supportive environment for all practitioners.
The insights from this report are a stark reminder that while IMGs are vital to the NHS, they often face unique challenges that can lead to disproportionate scrutiny. By understanding these patterns and taking proactive steps, IMGs can better navigate their careers in the UK. Moreover, this analysis should serve as a powerful call to action for healthcare organizations to critically examine their practices, ensuring fairness and equity for all their staff. Are we, as a healthcare system, truly doing enough to support every medical professional, regardless of their qualifications?
Read the full report: https://resolution.nhs.uk/learning-resources/demographics-professions-and-concerns-patterns-in-practitioner-performance-advice-cases-with-a-focus-on-international-medical-graduates-imgs/Â