International medical graduates: a workforce at a crossroad?

How do changing workforce policies shape the experiences, opportunities, and wellbeing of doctors who form a vital part of the NHS?

A new editorial by researchers from the NIHR ARC NWL and Imperial College London Ethnicity and Health Unit (EHU), published in the Journal of the Royal Society of Medicine, explores the evolving policy landscape affecting international medical graduates (IMGs) and considers the implications for workforce stability, equity, and patient care within the NHS.

The paper reflects on proposals announced in December 2025 to expand speciality training places while prioritising United Kingdom medical graduates. Although the proposal was later rejected in a doctors’ ballot, it signalled a broader strategic direction towards strengthening domestic training routes and reducing reliance on overseas recruitment. Such developments have important consequences for workforce composition and career progression.

Drawing on General Medical Council workforce data, the article highlights the scale of IMGs’ contribution to UK healthcare. In 2024, more than 20,000 IMGs joined the medical register, accounting for 42 per cent of the licensed medical workforce. At the same time, the data show increasing exits from practice, with 4,880 IMGs relinquishing their licence in 2024, a 26 per cent increase compared with the previous year.

Our researchers suggest these trends do not occur in isolation but reflect wider challenges in how the workforce is organised and supported. Many IMGs are recruited into locally employed doctor roles. While these posts are essential for service delivery, they may offer limited opportunities to enter formal training pathways and inconsistent access to pastoral or career support.

Beyond workforce data, the article highlights the lived realities of migration and professional transition. The authors describe challenges associated with adapting to unfamiliar clinical norms, communication expectations, regulatory requirements, financial pressures, and experiences of social isolation or discrimination. These factors can shape both wellbeing and retention, particularly during the earliest stages of practice in the UK.

While recognising policy efforts to improve recruitment and retention of UK graduates, the authors emphasise the need for workforce strategies that also account for fairness, inclusion, and long-term sustainability. IMGs remain integral to NHS functioning and should be supported as valued members of the workforce rather than viewed solely through the lens of short-term staffing pressures. Our researchers propose a fivefold framework for action encompassing recruitment equity, structured welfare support, retention through belonging, ethical leadership, and improved workforce planning. Together, these measures aim to strengthen both doctors' experiences and the system's effectiveness.

The article "International medical graduates: a workforce at a crossroad?" is published in the Journal of the Royal Society of Medicine.