My journey started with a dream.
A dream to experience multifaceted healthcare systems and expose myself to risks outside my safety bubble. Anaesthetics was my first love during my internship. After a few gruelling months, I had locked it down as my first and only choice out of all the growing speciality training branches in India.
I finished my 3 years of postgraduate training at an internationally reputed tertiary care hospital. I then completed 2 years of senior resident-ship in another city.
The covid 19 pandemic exposed anaesthetists to a lot of poor public opinion. This left me wondering what to do: do I ignore my physical and mental health and burn the candle at both ends or have an experience outside the traditional system of work-life balance sacrifice?
I was naturally pushed towards the UK system, as the NHS is one of the oldest health care systems, celebrating its recent 75th anniversary. However, the entire process was daunting and complicated. I remember feeling like Dante in the Botticelli version of Dante’s Inferno.
To simplify the process for international medical graduates (IMGs), I will take you through the process from my experience. You can also check out alternatives such as the foundation programme or clinical fellow jobs.
The MTI Process
The MTI scheme is open to doctors working in various specialities, depending on which Royal Colleges are recruiting candidates.
As of August 2023, the following Royal Colleges are participating:
- Royal College of Anaesthetists
- Faculty of Dental Surgery
- Royal College of Emergency Medicine
- ENT UK
- Royal College of Obstetricians and Gynaecologists
- Royal College of Ophthalmologists
- Royal College of Paediatrics and Child Health
- Royal College of Pathologists
- Royal College of Physicians Edinburgh
- Royal College of Physicians
- Royal College of Physicians and Surgeons Glasgow
- Royal College of Psychiatrists
- Royal College of Radiologists (Oncology)
- Royal College of Radiologists (Radiology)
- Royal College of Surgeons of Edinburgh
- Royal College of Surgeons of England
Source: Academy of Medical Royal Colleges
Here is the guidance for the process I followed with the Royal College of Anaesthetists, translated into how I understood them:
Translation:
MTI posts are very rare owing to their competitive nature. This is due to many applicants from all over the world, and significant funding requirements from the Trust and the Government.
You need a bit of lady luck shining to get into this!
Translation:
Please do not quit your work when considering this post! Continue your work as usual, while applying for the post on the side. Plan accordingly as the process takes up to a year. Have a steady source of income to support your application.
Translation:
The post only offers employment for 24 months!
DO NOT set high expectations that you will be able to work for more than 24 months from the date of joining! You will be heavily penalised if you do so.
YOU MUST return to your home country after completing your placement.
Steps of the MTI Process
1. Get Your House in Order!
Once you read through the entire list of exhaustive requirements from the GMC and your royal college, you need to organise a portfolio of important documents – I would suggest keeping soft copies in high-quality PDF uploaded to your Google Drive Account, categorised.
What you need to organise before starting:
- Your updated Curriculum Vitae (CV).
Include an explanation of career gaps, especially gaps of more than a month, stating the reason.
- Your latest IELTS/OET English Exam Scores.
International English Language Testing System (IELTS).
Demonstrate knowledge of English by obtaining an overall score of 7.5. Aim for a score of at least 7.0 in each of speaking, listening, reading and writing.
Medicine Occupational English Test (OET).
Minimum grade 'B' in each testing area (speaking, listening, reading and writing). Please note IELTS online is not accepted and both the IELTS and OET certificates are valid for only two years.
- Your undergraduate (primary medical qualification) and postgraduate (M.D/D.N.B/D.A) course certificates, transcripts and degrees.
You will need to use EPIC ECFMG, an online degree verification tool to verify the authenticity of your degrees. I would suggest you do this as early as possible, as this is lifelong valid.
- Your valid passport (original), job experience history, and a timeline of your previous work experience with dates.
Provide evidence of at least three years within the last five years of speciality training outside of the UK and European Union.
- Your licensing from State/National Professional Medical Council.
For example, I had my Karnataka & Maharashtra – State Medical License details to hand.
Total Cost:
- Establish an EPIC Account and Confirm Your Identity - US$130 +
- Verification of Credential- US$100 per credential +
Some institutions charge a fee to verify credentials. You are, in most cases, responsible for paying these fees directly to the institution. If the Educational Commission for Foreign Medical Graduates (ECFMG) is aware that an institution charges such a fee, they will say this in the details for that credential within your EPIC Account.
However, ECFMG may not be aware of all fees charged by institutions. So, it is recommended that you check with the institution in advance regarding fees for verifying your credentials. In some cases, the institution will require that ECFMG pay this fee at the time the verification is requested. In this case, ECFMG will pay the fee and place a corresponding charge on your EPIC Account. They will advise you of this in advance of assessing the fee to your account.
2. Application & Communication
There are two routes which you can take to obtain an MTI post.
Option 1
The first route is to find a post by contacting different hospital trusts that are advertising eligible jobs postings. Here are a few websites that might help:
If you have been appointed to an approved MTI post, please contact the appropriate Royal College with the details.
Option 2
The Royal College in your speciality may have a matching scheme, which means they can match you to an appropriate MTI post. You will need to meet the eligibility criteria.
For example, if you want to be enrolled in the RcoAs Matching Scheme, complete and return the following documents to the Global Partnerships department. Please be aware that enrolling in the College’s Matching Scheme does not guarantee that they will find a post for you.
The Royal College will review this information and may request more details before proceeding. They will then send your details to hospitals looking to recruit MTI doctors. It will be individual hospitals deciding whether they wish to interview you. Should this be the case, they will contact you directly to arrange the interview.
I opted for the matching scheme checklist route, whilst searching for possible jobs on the sites mentioned above. It helps to create mail alerts for jobs as an anaesthesiologist, which leads to a daily review of possible options from your mailbox!
I also contacted multiple personnel listed on the job recruitment posts with a brief statement of my requirements. This helped me network through various ads.
The following helps you to understand the basic salary you will be offered as an MTI fellow. This is on par with the British trainees (NHS 2016 Contract Pay scales).
| Grade | Nodal Point | Basic Pay | On-Call Allowance* | Weekend Allowance** |
|---|---|---|---|---|
| ST1 - ST2 | 3 | £43,923 | £3,514 | Up to £6,589 |
| ST3 - ST5 | 4 | £55,329 | £4,427 | Up to £8,300 |
| ST6 - ST8 | 5 | £63,152 | £5,053 | Up to £9,473 |
I joined at the ST4 level (3 years of postgraduation in Anaesthetics + 1 year of training) as per my application.
3. Interview
Once I had completed the previous steps, I got listed for an online Zoom interview with the Head of the Trust, the HR department of the Trust, and the Royal College of Anaesthetists MTI manager along with 1-2 consultants. They mailed me the interview timings and confirmed my availability.
I recommend resting well one day prior to the interview, clearing off your schedule for 3-4 hours at minimum to enable you to be completely relaxed during the process.
Questions they asked me in the MTI interview:
Anaesthesia-specific Communication Scenario.
In-depth questions regarding communication with the matron.
The scenario was that I had to request an urgent ICU bed for a critically ill patient in septic shock, with a shortage of ICU beds
Anaesthesia-specific Clinical Scenario.
Question on the management of an intraoperative anaphylactic reaction to antibiotics.
I was also asked about the management of a patient in diabetic ketoacidosis posted for emergency debridement.
Assessment of Professionalism and Values
Question on relating NHS Trust values to my work practice.
They wanted to know how I would incorporate these principles into everyday life.
Research a bit about your trust beforehand!
CV and Clinical Skills Review
They asked me to go through my experiences in Anaesthesia while looking at my CV for reference.
Additional Questions
Queries on job expectations from my end.
They were also interested in research potential, audits, and prior experience in US-guided blocks
4. Job Offer
If you have made it this far, without having a panic attack or throwing something at the wall, I would urge you to keep on going. You are doing perfectly fine!
The trust confirmed my success at the interview and contacted me via email to confirm my interest in their offered post. Once I confirmed the same, they sent me a contract/job offer letter outlining the post details.
I would advise you to go through this document as if you were holding your own life in your hands.
Once you have been approved for an MTI post, you may have to supply the following documents:
- Certified copy of primary medical degree and any further qualifications
- Verification by the Education Commission for Foreign Medical Graduates (ECFMG) of these qualifications
- Job offer letter from the UK employing authority
- Certified IELTS or OET Certificate
- Certificate of Good Medical Standing from your national medical council (valid)
- Confirmation of payment of £120 fee
- Scanned copy of your passport
- Names and contact details of your nominated referees
Your application will be checked, and your trust will pay a fee to the Royal College. Following this, you should receive an MTI scheme acceptance letter.
5. GMC Registration
All doctors treating patients in the UK need to be registered with the General Medical Council (GMC). Doctors successfully appointed through the MTI will receive GMC registration sponsored by the College.
This is the most crucial step, so I would suggest you take some time out from your busy day to sit down and put on your thinking hat! This is the cheese to the pizza you are cooking. The application needs to be primed and shaped properly to avoid undue delays.
You will not receive guidance from the college or your trust to complete this step.
You will need to make a GMC Online account and start an application for an MTI post. They will ask you to fill in your details – keep all your documents at hand for ease. Scan through the entire application prior to submission for errors.
You will need to provide a reasonable explanation of your career gaps too.
The GMC will scrutinise your application and ask you for recommendations from your existing council. I had to inform the Maharashtra Medical Council of the same, and they replied to the GMC within 2-3 working days stating that their good standing certificate was valid and I was never involved in any medicolegal issues during my tenure.
There was a considerable delay as my application had one shortcoming. I was not registered in my current state as an anaesthesiologist when I started my post. I was only registered in my previous state. I had to offer a lengthy detailed explanation for the same (contact me if you need help with this!).
Be prepared mentally for an exhaustive run, as the GMC tends to only reply on Fridays. The rest of the working days are spent in regret, frantically questioning your decision!
Once your application is completed, the GMC will contact you to attend an identity check online or upon your arrival in the UK. I finished my online within an hour. Once this is completed, you will have your GMC registration approved and your name will be placed onto the GMC register. You will then be able to start your clinical work.
6. Letter of Sponsorship (Tier 5 Visa):
Now that you are licensed to practice in the UK, you will need to be in possession of your WORK VISA.
This is a Tier 5 UK visa, as a part of Government Authorised Exchange (GAE) – ensure you select the same.
As an MTI candidate, you will receive a Certificate, which you will need in order to apply for your Tier 5 visa from UK Visa and Immigration (UKVI).
To get this, the following requisites need to be matched:
The HR department of your UK employing Trust will need to complete the Academy's (AoMRC) online MTI application form. The form will be approved by your Royal College and the Academy (who are the visa sponsors for the MTI scheme).
You need to have proof that your GMC application is completed, pending an ID Check either online or on arrival to the UK. I had a screenshot stating the same. You will also need to also complete and sign any further documents required by your Royal College.
7. Visa Application
If you ever have completed a UK / Schengen visa application, you will know that it's an arduous process going to a VFS centre abroad and standing in the queue.
However, there is good news! They fast-track all work visa applications in order to expedite your arrival to the UK!
I completed my UK GOV Visa application – Tier 5 Government Authorised Exchange (GAE) stating my intentions to return to my home country after 2 years. You will need your certificate of sponsorship (CoS) issued by the Royal College to complete this step.
Arrange your biometrics appointment as early as possible and you will receive your vignette in the passport within 1-2 weeks.
This is the point where you will need to resign from your current workplace and collect all the documents. Make sure you liaise with your hospital trust and the College to confirm your start date.
Pros and Cons of the MTI Scheme
Pros:
- You are getting speciality training for 2 years under a qualified NHS consultant.
On top of that, you will get a diploma. The Diploma in UK Medical Practice (DipUKMP) will be awarded after the completion if you are sponsored by Royal Colleges.
- In addition to receiving up to 24 months of specialised medical training, there are MTI-specific resources.
Doctors on the MTI can attend a variety of workshops and seminars, gain fellowship to their relevant medical college and in some instances, sit their Medical Royal College Part 2/final examination.
- You will get a sponsored GMC registration
Technically won’t have to go through any hoops of examinations just for GMC registration (like PLAB and MRCP).
- The salary is great, on par with UK graduates.
Cons:
- This visa does not count towards your British Citizenship or Indefinite Leave to Remain.
- Time-consuming with the paperwork involved.
- Very few posts compared to the number of applicants.
Conclusion
The MTI scheme is a great, albeit temporary, way to gain access to UK speciality medical training. There are several hoops to jump through, but with good preparation, you can overcome these easily.
Look carefully at the eligibility requirements for MTI jobs, and make sure you avoid quitting your job before you know your start date!
This was just a brief overview of the entire process from my perspective. I would like to help all prospective applicants in whatever way I can, please feel free to contact me by mail ([email protected]).
I will respond as soon as I can!
