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Guide for an Indian Dermatologist to Plan Their Future in the United Kingdom
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Received: ,
Accepted: ,
How to cite this article: Sehrawat M, Kumar R. Guide for an Indian dermatologist to plan their future in the United Kingdom. Indian J Postgrad Dermatol 2023;1:87-9.
Abstract
The United Kingdom (UK) is nowadays a sought-after destination to relocate for work. However, the path is confusing and unclear. This article aims to guide the Indian dermatologists who wish to work in the UK national health service.
Keywords
National health services
Consultant dermatologist
Specialist registration
Certificate of eligibility for specialist registration
Member of royal college of physician
INTRODUCTION
The Indian dermatology qualifications are not considered equivalent to that of the United Kingdom (UK) as it lacks the 2-year Internal Medicine training. However, practising dermatology is possible for Indian dermatologists with international experience.
How to proceed
To work in the UK, registration in the General Medical Council (GMC) is mandatory. To get GMC registered, the following steps are essential
Step 1 – English proficiency: There are two ways to show proficiency in the English language – the International English language testing system and Occupational English Test. The minimum scores needed in each of these to qualify can be found on the GMC website.[1]
Step 2: Licensing examinations, namely – Professional and Linguistic Assessments Board test (PLAB) or Member of Royal College of Physician (MRCP) exams.
The PLAB examination has two – parts 1 and 2. Part 1 is a multiple-choice question bases examination, while Part 2 is an Objective Structured Clinical Examination.[2]
Another way to get registered is by passing the MRCP examinations. MRCP examinations can be booked without an English proficiency examination also. However, one will have to show English proficiency to get GMC registered afterward.
CAREER OPTIONS
After GMC registration, as per your experience, you can start applying for jobs through various portals like national health service (NHS) Jobs, Indeed, Trac Jobs, and Oriel, or directly from a Hospital trust’s website.
The choice of job one should apply depends on their long-term plan and there are two main choices one can make:
To become a consultant dermatologist
Work long-term as a specialist dermatologist in the UK without becoming a recognised consultant.
We have detailed both of these prospects in sections below.
Consultant dermatologist
To become a substantive consultant dermatologist, one must get a specialist registration. There are three ways to get specialist registration
Certificate of completion of training (CCT)
CCT is the preferred route as it is a well-structured and supported program which is also recognised in many other countries apart from the UK. In this route, one must complete both medical core training (2–3 years) and dermatology training (4 years) in the UK.
In core training, there are three choices
2–3 years of internal medicine OR
3 years of acute care common stem programme OR
3 years of paediatric and 1 year of adult internal medicine.
After finishing core training, one needs to apply for dermatology speciality training again and compete nationally for this. The speciality training is for 4 years.
Certificate of eligibility for specialist registration combined programme (CESR-CP)
You will be awarded CESR-CP if you complete the 4-year UK dermatology training programme but did not complete Internal Medicine training in the UK. However, if you have an internationally accredited equivalent, then you can proceed through the CESR-CP pathway.
However, at the end of the training, you will still be awarded a completion of a training certificate in dermatology.
Certificate of eligibility for specialist registration (CESR)
In CESR process, one should collect and submit the evidence of equivalent knowledge and skills in dermatology as laid out in the UK dermatology curriculum, which also entails medicine competencies.[3] To improve their chances, one should also pass MRCP examinations and speciality certificate examinations which are not mandatory at the moment in the CESR route. The information about both these examinations can be found on the MRCP website.[4]
Documentation required to provide for CESR can be found on GMC speciality-specific guidance and British Association of Dermatology-specific guidance. The experience and training needed to show for the CESR can be from overseas, from the UK, or a combination of the two.
Specialist dermatologist as long-term plan
People do choose to work long-term as dermatologists in the UK without becoming recognised consultants as a consultant’s responsibilities are huge. One can apply for the job as per one’s previous experience, and the job description for the corresponding titles includes clinical fellow or speciality doctor. However, it is also possible to apply for locum consultant jobs which do not require you to be on the GMC Specialist Register.
MERITS AND DEMERITS OF WORKING IN THE UK
Working in the UK does come with merits and demerits and being aware of them is very crucial to decide one’s career journey in the UK. The work in the NHS is well structured and organised. Protocols and guidelines are set for every skin condition which is described in the National Institute of Health and Care Excellence guidelines and the British association of Dermatology guidelines. In addition, there is an opportunity to work less than full-time (e.g., 80%) for work life balance. Furthermore, there are opportunities to do locum work to earn extra money. Moreover, there is a huge backlog of patients waiting and so there are lots of vacancies for doctors at all levels. There is a good amount of annual leaves (25–34/year), sick leaves and study leaves (around 10) with a study budget of around £800–1000 depending on trust and grade. Other advantages of working in the UK are social safety, clean environment, living close to nature and good education.
After COVID pandemic, a huge burden of skin cancer has limited the variety of patients as skin cancers are a priority. The system demands lots of documentation and pressurised work. Moreover, the time is fixed for each consultation and may not be sufficient. This leads to a fear of missing important findings. In addition, the NHS does not fund cosmetic procedures, so if someone wishes for any cosmetic treatment, they would have to go private.
We have described major aspects of work and life in the UK below
Job plan
A full-time SAS doctor or a consultant works ten professional activities (PAs) of 4 h of sessions each. Out of ten PAs, seven are usually direct patient care, including general clinics, skin cancer clinics and special clinics (Paediatric, drug monitoring, or surgical lists). The remaining three sessions are for administration work, governance, multidisciplinary meetings and continuing professional development.[5]
One is also expected to provide advice on referrals from inpatients and general practitioners (GPs) a few times a week (till 5 o’clock except at weekends and bank holidays).
Work schedule
A typical day starts at 9 am until 5 pm. A clinic session is pre-booked and runs for around 3.5 h with 20 min, allotted for new patient and 10–15 min for a follow-up patient. After the consultation, a letter describing the diagnosis and management is dictated, which is electronically sent to the concerned GP.
Income and expenses
The starting annual salary of a consultant is around £80,000 which can go up to more than £100000 and with a pension scheme as well.[6]
The income tax is nearly 40%, and the living expenses are high. Parents must factor in childcare expenses aside from rental, council tax and utilities. The schools have holidays for 1–2 weeks every 6 weeks excluding the 6 weeks of summer vacations.
CONCLUSION
NHS is one of the several well-reputed health services with access to world-class health treatment including expensive medicines such as biologics and a huge scope to develop professionally as well. However, every system has its pros and cons and so one should be very clear about their choice of place they want to work in. This article is written with a hope to guide new dermatologists in India to plan their future.
Declaration of patient consent
Patient’s consent not required as there are no patients in this study.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The author(s) confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship
Nil.
References
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