Several NHS hospitals have been accused of exploiting foreign doctors as “cheap labour”, after it emerged they can be paid less than UK staff.
The British Medical Journal investigated the treatment of doctors taking part in a fellowship scheme that allows them to work at English hospital trusts for two years to gain experience, before returning to practise in their home countries.
This revealed that foreign trainees can be paid several thousand pounds less than UK-trained junior doctors employed by the NHS, and they miss out on overtime pay.
The Medical Training Initiative (MTI) scheme is run by the Academy of Medical Royal Colleges. Since it began in 2009 there have been almost 7,000 trainees from countries such as Pakistan, India, Sri Lanka, Egypt, Nigeria and Saudi Arabia.
In some NHS trusts the foreign doctors receive the same pay and benefits as trust-employed doctors of the same level, but in others they are not paid equally.
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This includes at University Hospitals Birmingham (UHB), Dudley Group NHS Foundation Trust, and Walsall Healthcare, which have an specific agreement in place with the College of Physicians and Surgeons Pakistan, allowing them to pay fellows from Pakistan less than the going rate.
For example, doctors from Pakistan who worked at the Birmingham trust as grade three specialty trainee registrars or above were paid the equivalent of £32,400 to £43,200 tax-free a year.
This is less than doctors at the same level employed by the trust, who were paid £51,017 in 2022-23 and £55,328 a year in 2023-24 as a basic gross salary, excluding any overtime or enhanced hours payments.
Under the agreement with the Birmingham trust, foreign fellows also do not receive paid parental leave. In 2017 UHB terminated the contract of a fellow who became pregnant. The urologist, who wanted to remain anonymous, told the BMJ that the experience was “traumatic”.
“I was not the priority and that the trust’s trainees and trust grade doctors were the priority. I was told, you are just to cover the clinics and on calls”, she said.
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“One lady from the international team seemed angry and said “we don’t expect you guys to get pregnant while you’re here” and that my fellowship would be terminated. It was a shock to me how she spoke.
One consultant said UHB was using fellows as “cheap labour”, although another senior medic at the trust praised the scheme for its training opportunities, but highlighted a lack of equal pay and rights.
A spokesman for the Academy of Medical Royal Colleges said: “The issues the BMJ is raising here are very concerning. All doctors should be paid the correct rate for their work, regardless of whether they are on the MTI scheme or not. But this is a matter between the doctor and the NHS organisation that employs them.”
Michael Newman, an employment lawyer at law firm Leigh Day, described the scheme as “exploitative” and said every worker was by law entitled to maternity leave after they began employment.
UHB said the programme “undoubtedly benefits the NHS system, but in return it benefits the overseas healthcare structure”.
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They added: “Programmes which encourage the upskilling of medical practitioners from countries with less-developed healthcare systems have been described by the WHO as a ‘brain gain and not a brain drain’.”
An NHS spokesperson said: “While the salary of these positions is agreed between the individual trust and their international partner, fellows play an important role in treating NHS patients at the same time as learning new advanced clinical skills in a high-quality and fair learning environment, before returning to their home countries.”
