“Is it IMG friendly?”: Facing the truths you won’t want to hear by Kim Nurse

This last month, thousands of hardworking junior doctors across the country found out whether they had secured national training numbers. Now understandably, trainees have many questions; where’s good for training, teaching or social life, yet surprisingly the question seen all too commonly across numerous social media channels was:

“Which hospitals are IMG friendly?”

International Medical Graduates (IMG’s) undeniably play a hugely important role in the NHS, representing one third of the total number of UK doctors yet, they face a number of hurdles in order to practice in the UK. For example, those from outside of the European Union have to pass the Professional and Linguistic Assessment Board Test and the International English Language Test System, before facing the cultural and healthcare system differences that one can only learn about by working within a healthcare system, for example, the UK 1.

None can dispute that the NHS is a challenging environment to work within. Standards and regulation are high, culture is sometimes challenging and those who have attended a UK medical school are comparatively more familiar with the NHS, an advantage overseas doctors simply do not have.

Overseas doctors are vital to the functioning of the NHS and without them, in my view, the system would collapse. Yet IMG’s report countless stories of bullying, harassment and being made to feel unwelcome, and evidence shows they are also less likely to report it, due to fear of repercussions 2.

Within an increasingly international work force, how have we got to a point where deaneries and hospitals are labelled “IMG friendly”…or not? This last year in particular, society has spoken out against racial discrimination, yet the most recent NHS Staff Survey demonstrates that, compared with white staff, people from ethnic minority backgrounds continue to face discrimination and higher levels of bullying, harassment and abuse from other staff 3. In addition, they are often subjected to racial abuse from members of the public whilst at work, which has significant impacts upon their health and wellbeing and daily working lives.

So, what can hospitals do? Do research, enable the conversation, hear the stories you do not want to hear and face up to the truths and reality of your work-place environment 4. Ask yourself, “are we IMG friendly?” And if not, “why not?”  Be prepared to have the difficult conversations .

IMG’s face many challenges; visa issues, distance from family and loved ones, cultural barriers, language barriers and countless stressors that many of us don’t have to deal with. Progress is slowly being made at various levels, within society and the NHS, and every hospital within the UK will say they don’t tolerate racial discrimination, but if trainees are asking “is this hospital IMG friendly?”, this is indicative of a fear of racial discrimination, which needs identifying, addressing and eradicating now, not in years to come.

Whatever your role in the NHS, it is everyone’s responsibility 5 to work towards ensuring that there is no such thing as ‘IMG friendly’ and that this is a given, regardless of which area of the UK you find yourself in.


  1. Jalal, M. Bardhan, KD. Sanders, D. Illing, J. Overseas doctors of the NHS: migration, transition, challenges and towards resolution. Future Healthcare Journal. 2019;Vol 6:76-81
  2. Hoosen I, Callaghan R. A survey of workplace bullying of psychiatric trainees in the West Midlands. Psychiatry Bull2004;28:3.
  3. NHS England. 2020 National NHS Staff Survey. Available at: https://www.nhsstaffsurveyresults.com/homepage/results-2020/ [Accessed 22.04.21]
  4. Kline R, Leadership in the NHS,
  5. https://blogs.bmj.com/bmjleader/2020/09/12/healer-heal-thyself-by-roger-kline/

Dr Kim Nurse

Kim Nurse is a GPST2 at King’s College Hospital London and the London representative for the FMLM Trainee Steering Group.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

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