Our data about doctors with a European primary medical qualification in Working paper 8 - October 2018

Transcription

1 Our data about doctors with a European primary medical qualification in 2018 Working paper 8 - October 2018

2 Our data about doctors with a European primary medical qualification in 2018 As we edge closer to the date that Britain will leave the European Union (EU), we ve been receiving large numbers of requests for data on the European medical workforce in the UK. We ve produced this report to make our data in this area as useful as possible to those who want to understand more about the makeup of this workforce. It is an update to two previous papers on the same topic 1,2 and summarises our latest data on doctors who gained their primary medical qualification (PMQ) in the European Economic Area (EEA) and who have a licence to practise medicine in the UK. In this paper we give updated data on the location, area of practice, and years of experience of EEA graduate doctors, and we highlight sections of the profession that have more EEA qualified doctors. We also present data on the profile of EEA graduates in each country of the UK, and look at how many EEA graduates are joining and leaving UK medical practice. Data are not directly comparable with the 2015 paper as we moved to using June 30 as the annual sample point for the number of doctors in a given year after that report was written. This change allowed us to report on data within the same calendar year rather than only presenting historical data. Figures are, however, highly consistent with the 2017 publication. 1 Our data about doctors with a European primary medical qualification in 2017, /media/documents/gmc-data-about-doctors-with-eea-pmq--november final_pdf _pdf pdf 2 Our data about doctors with a European primary medical qualification (2015),

3 Why do we report primary medical qualification? The data we hold by country of PMQ are completely accurate. A significant number of doctors qualify from a medical school in a country of which they are not a citizen, so their primary medical qualification is not a reliable proxy for their nationality. Although we collect data on doctors nationalities when they join the register, these data are not subsequently updated. In addition, we only have partial data on those who joined the register before Finally, we would not know if a doctor has an entitlement to a different nationality, other than the one they declared when they registered with us, which he or she has not yet claimed. What do we mean by EEA doctors? For the purposes of this analysis, we have defined EEA doctors as those who gained their PMQ from a medical school in the EEA or Switzerland but not the UK. It s important to note that the EEA is not the same thing as the European Union. To put it simply, the EEA includes all of the EU countries plus Iceland, Liechtenstein and Norway which are in the European Free Trade Area (EFTA). Although Switzerland is not a member of the EEA, it is a member of single market agreements and Swiss nationals have the same right to live and work in the UK as other EEA nationals. Figure 1: How we define the EEA UK EEA (excluding UK) Non EEA 2

4 The changing picture Doctors with a licence to practise In this paper, we focus on doctors with a licence to practise. To practise medicine in the UK, doctors must be licensed with us but not all licensed doctors are actually practising in the UK. Figure 2: The number of licensed and registered EEA graduates on the UK medical register as at June 30 each year 35,000 30,000 25,000 20,000 15,000 10,000 5,000 Since June 2014, EEA graduates must now show proof of their English language capability before they gain a licence to practise. This may help to explain why the number of registered EEA graduates has increased over time, yet the number of licensed doctors has decreased (Figure 2). It is important to note that there has been a consistent number of licensed EEA PMQ doctors since 2016 (that is, there has not, to date, been a reduction in the number of EEA doctors holding a UK license to practise following the June 2016 referendum). Table 1: The proportion of licensed doctors in the UK to hold an EEA PMQ Licensed EEA graduates 22,967 23,717 23,792 22,873 21,539 21,609 21,791 All licensed doctors 232, , , , , , ,433 % of all licensed doctors who are EEA graduates Registered EEA Licensed EEA % 10.1% 10.2% 9.8% 9.3% 9.1% 9.0% % of GPs who are EEA graduates 5.9% 5.8% 5.7% 5.5% 5.2% 5.2% 5.1% % of specialists who are EEA graduates % of doctors on neither register and in training who are EEA graduates % of doctors on neither register and not in training who are EEA graduates 14.8% 15.2% 15.3% 15% 14.4% 14.3% 14.0% 3.6% 3.6% 3.6% 3.5% 3.6% 3.7% 3.9% 15.3% 15.9% 16.1% 15.5% 13.9% 13.1% 12.2% 3

5 Whilst the total number of EEA graduates has remained consistent over the past three years, Table 1 shows the percentage of each register group that are EEA doctors has fallen slightly for each group except doctors in training. Joiners and leavers from the EEA Here, a doctor counts as joining the profession where they have a licence to practise in that year but did not have one the previous year. A doctor leaving the profession is one who was licensed, but has not held a licence for at least one year in this way, we do not count doctors who leave for short periods of time and re-join the profession the next year as a leaver. We don t have 2018 data for EEA graduates leaving the register or relinquishing their licence, as we count them here as leaving only if they ve left for a full year. From 2012 to 2014, the number of EEA graduates joining the profession increased. In the year following the introduction of English language requirements in 2014, the number of new joiners to the register dropped markedly. Since then fewer doctors than in 2012 have joined each year. Between 2012 and 2016, the number of EEA graduates leaving almost doubled but 2017 saw this trend reverse with a 39% reduction in EEA licensed doctors leaving. Figure 3: EEA graduates joining (gaining a licence for the first time) or leaving (relinquishing a licence to practise for at least one year) 3,037 3,213 3,397 2,398 2,048 2,057 2,021 Joiners Leavers 1,997 2,522 2,182 3,321 3,252 3,552 Figure 4 shows EEA doctors that relinquish a license to practise for at least one year, split by register type saw a considerable decline in EEA doctors choosing to leave across all register types in From 2016 to 2017, there was a decline of 36% in EEA doctors leaving the GP and specialist registers. There was a slightly steeper decline of EEA doctors leaving from neither register (who were not in training) at 41%. 4

6 Figure 4: EEA Doctors leaving (relinquishing a licence to practise for at least one year), by register group GP register Neither register and not in training Specialist register 1,019 1,176 1,486 1,459 1,471 1,421 1,623 1, ,033 1, *For presentational purposes, the small number of doctors on both the GP and specialist register have been omitted from the charts above. Doctors in training are discussed in a later section of this report. EEA doctors can join the GP or specialist registers via a number of routes. For instance, there are EEA doctors that only move to the GP or specialist registers after a period of work in the UK on neither the GP nor specialist registers. This means that looking into their register type at the point they join the UK workforce cannot give a fair indication of the volumes joining who become either GPs or specialists. However, we do have data showing how many EEA PMQ doctors join the GP register or the specialist register for the first time, though doctors can join both the GP and specialist registers at different points in time. Figure 5 shows there is a clear decline from 2014 to 2017 among EEA qualified doctors joining the specialist register for the first time. Figure 5: EEA doctors joining the GP register or specialist register for the first time by any route GP register Specialist register 1,484 1,658 1,814 1,292 1,299 1, *Please note doctors may first enter onto one register and then later join the other. 5

7 The plateau of licensed EEA doctors since 2016 (Figure 2) suggests the decline in EEA doctors joining the specialist register may be counter-balanced by an increase in those joining and remaining on neither register, whether in training or not. However, the types of work undertaken by these groups of doctors are wholly different and the decrease in specialist EEA doctors joining may be a concern. Of the EEA doctors joining each register shown in Figure 5, a large proportion do so via the automatic recognition of their professional qualifications (Figure 6). This is important to understand as this group would be particularly affected by changes to automatic recognition of professional qualification following Brexit. Figure 6: EEA Doctors joining the GP and/or specialist registers via the automatic recognition of professional qualification route only* Specialist register GP register Specialist and GP register 1,669 1,830 1,442 1,241 1,208 1, *Please note a small number of doctors may first enter onto one register and then later join the other. They are counted as Both GP and Specialist register if they joined both registers at the point of joining. 6

8 EEA graduates in each UK country in 2017 We have allocated doctors to a country based on a combination of their workplace address, training records, the organisation they are linked to for revalidation and, where these are not available, their correspondence address. 97% of all doctors and 89% of EEA doctors could be allocated to a country in this way. Figure 7: Characteristics of licensed EEA graduates by UK country in 2018 EEA graduates in Northern Ireland Number 544 % of Northern Ireland s doctors 8.7% % Male 56.4% % BME 4.0% Average age 47.5 Average UK experience 18.3 years EEA graduates in Scotland Number 1,174 % of Scotland s doctors 5.8% % Male 55.1% % BME 6.5% Average age 44.8 Average UK experience 13.2 years EEA graduates in England Number 17,004 % of England s doctors 8.5% % Male 52.5% % BME 13.9% Average age 43.2 Average UK experience 11.4 years EEA graduates in Wales Number 656 % of Wales doctors 6.5% % Male 56.6% % BME 12.7% Average age 45.9 Average experience in the UK 14.1 years EEA graduates in other locations or not located* Number 2,413 % of other/not located doctors 39.7% % Male 62.9% % BME 6.6% Average age 42.5 Average experience in the UK 5.9 years *This includes 1,358 doctors who are linked to a UK designated body for revalidation but who could not be linked to a specific region. The remaining 1,055 doctors may not have given a valid postcode for their address, or did not have a UK address or a designated body in the UK for revalidation, and their correspondence address was not in the UK. 385 out of 544 EEA graduates in Northern Ireland gained their primary medical qualification in the Republic of Ireland 71%. 7

9 Regional breakdown of the EEA We define Central Europe, Eastern Europe and Baltic countries, North-western Europe and Southern Europe as groupings of the following countries: Figure 8: A regional breakdown of the EEA UK North-western Europe Central Europe, Eastern Europe and Baltic Countries Southern Europe Non EEA Central Europe, Eastern Europe and Baltic countries: Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia. North-western Europe: Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Ireland, Netherlands, Norway, Sweden and Switzerland. Southern Europe: Bulgaria, Croatia, Greece, Italy, Malta, Portugal, Slovenia and Spain. Where in the EEA did our doctors qualify? Between 2014 and 2016, the number of licensed EEA graduates from each region of the EEA declined. Since then, the number of licensed EEA graduates from the Central Europe, Eastern Europe and Baltic countries group has increased from 2016 to the point where there are now more of these doctors than those from North-western Europe for the first time. The peak in Southern European graduates happened in 2014, at the same time as the introduction of new English language requirements for all doctors coming to practise in the UK. Since then, this group has at a broadly consistent figure, as has the North-western Europe group. 8

10 Figure 9: Number of licensed doctors on the medical register from each European region 9,121 9,011 8,681 7,974 8,544 8,345 8,153 7,625 Southern Europe North-western Europe Central Europe, Eastern Europe, Baltic countries 7,588 7,530 7,522 6,614 7,030 6,926 7,062 7,095 6,903 7,227 7,205 7,131 7,138 6,874 6,724 6, EEA graduates by country of qualification and area of practice As in 2017, Ireland remains the most common PMQ country for EEA graduates whilst the least common is Norway (Table 2). There are over 10,000 licensed doctors on the Specialist Register (only) that are EEA graduates, over half (5,467) of whom graduated from just four countries Ireland, Greece, Italy and Germany. EFTA Doctors Doctors from the EFTA countries may be subject to a unique policy context once the UK has left the EU. However, it is important to note that EFTA doctors are a very small part of the UK workforce. On June 30 th 2018, there were 153 such doctors (0.06% of all licensed doctors). Table 2 showed 75% (114) of the EFTA doctors received their PMQ from Switzerland, whilst 14 % (22) qualified in Iceland and 11% (17) in Norway. We found that 77% (118) of the 153 EFTA doctors licensed in 2018 were based in England and that 5% (8) worked in Scotland. There were no licensed EFTA doctors working in Wales or Northern Ireland in Just over half of the EFTA doctors were on the specialist register and a little over a third were on neither the GP or specialist register and were not in training. The remaining 19 doctors were split between those in training and those on the GP register. 9

11 Table 2: Licensed doctors from each EEA country by register type in 2018 Rank PMQ Country Licensed Doctors GP (only) Specialist (only) Register type GP and specialist Neither and not in training Neither and in training 1 Ireland 3, , Greece 2, , Romania 2, Italy 2, , Germany 2, , Poland 1, Spain 1, Czech Republic 1, Hungary 1, Bulgaria Netherlands Malta Slovakia France Lithuania Portugal Belgium Latvia Austria Croatia Sweden Switzerland* Denmark Slovenia Estonia Finland Iceland* Norway* Total 21,791 3,075 10, ,613 2,306 *EFTA country or Switzerland. There are currently no licensed doctors with a Liechtenstein PMQ. Please also note that there were no licensed doctors working in England in 2018 that had a PMQ from two EEA countries, Cyprus and Luxembourg. 10

12 Areas of practice of EEA graduates Figure 10 shows the division of doctors among the register types with a black line at 9% to reflect the proportion of EEA graduates across all register types. From this we can see the GP and doctors in training areas of practice are comparatively underrepresented whilst the Specialist, GP and Specialist and Neither (not in training) registers are overrepresented. Figure 10: All licensed EEA graduate doctors by register type, showing % of each register type that are EEA graduates in 2018 Neither and in training GP Neither and not in training Specialist GP and specialist 3.9% 5.1% 9% 12.2% 14.0% 14.5% Figure 11 shows that certain specialities have greater proportions of EEA graduates than others. The red line denotes the average across all specialties (14%) whilst the black line is the average across all registers (9% also shown in Figure 10). Almost a quarter of all ophthalmology specialists are EEA graduates and most specialities have a greater proportion of EEA graduates than the average across all registers. Only the emergency medicine and public health specialties bucked that trend with emergency medicine having only one in fifteen (6.7%) holding an EEA PMQ. In short, the acute sector of the NHS is particularly reliant on EEA doctors and they make up 14% of hospital consultants. But certain specialties such as ophthalmology (24%) and surgery (18%) are even more reliant on this group. 11

13 Figure 11: Percentage of each specialty group that were EEA graduates in 2018 Other or multiple speciality groups Ophthalmology Surgery Pathology Obstetrics and Gynaecology Radiology Paediatrics Medicine Anaesthetics and Intensive Care Psychiatry Occupational medicine Public Health Emergency Medicine 9% 14% 13.9% 13.9% 13.8% 12.9% 12.8% 12.4% 11.9% 11.1% 8.6% 6.7% 18.4% 25.3% 24.4% Four country data on EEA graduates by area of practice Our data shows that EEA graduate specialists are overrepresented across all four UK countries when compared to the average proportion that are EEA qualified across all registers (9%). GPs are generally underrepresented by EEA graduates in all UK countries except for Northern Ireland, where 9.9% (170) of GPs are EEA graduates with 86.5% (147) of those having qualified in Ireland. Scotland, Wales and England have relatively low reliance on EEA GPs with 3.7% to 4.9% of their GPs qualified in the EEA (Figure 12). Figure 12: Number and proportion of licensed EEA graduates by UK country, by register type* in 2018 EEA graduates in Northern Ireland GP only 170 (9.9%) Specialist only 216 (11.4%) Neither and not in training 75 (8.3%) Neither and in training 76 (4.4%) EEA graduates in Scotland GP only 218 (3.7%) Specialist only 572 (9.1%) Neither and not in training 193 (7.9%) Neither and in training 174 (3.2%) EEA graduates in England GP only 2,463 (4.9%) Specialist only 8,293 (13.3%) Neither and not in training 4,136 (11.2%) Neither and in training 1,970 (4.0%) 12

14 EEA graduates in Wales GP only 99 (4.0%) Specialist only 342 (10.7%) Neither and not in training 139 (7.0%) Neither and in training 72 (3.0%) *This graphic excludes doctors who are on both the GP and Specialist Registers. The data presented show, for example, there are 50,805 doctors who are on the GP register only in England in total and of those, 2,463 were EEA graduates. Therefore, the percentage of GPs in England that are EEA graduates is 4.9%. 385 of 544 (71%) EEA graduates in Northern Ireland gained their PMQ in the Republic of Ireland. The differences between the four countries EEA graduates in other locations or not located GP only 125 (32.7%) Specialist only 1,195 (64.1%) Neither and not in training 1,070 (28.9%) Neither and in training 4 (0.1%) As previously reported, there are a similar proportion of EEA graduates in each broad area of practice in Scotland and Wales. Northern Ireland has the greatest proportion of EEA graduates who are GPs. England has the most EEA graduates who are specialists or on neither register and not in training. It is difficult to make comparisons about the numbers of doctors within each speciality group in the four countries of the UK due to the small numbers of EEA graduates involved but Table 3 has been included to show this. 13

15 Table 3: EEA graduates in the four UK countries and those with an unknown location by area of practice Northern Ireland Scotland England EEA doctors % of all that are EEA EEA doctors % of all that are EEA EEA doctors % of all that are EEA GP % 225 4% 2,605 5% Specialist % 579 9% 8,435 13% Medicine 39 8% 117 7% 2,135 13% Emergency medicine 7 9% 13 5% 122 7% Anaesthetics and intensive care medicine 27 10% 77 15% 1,003 12% Obstetrics and gynaecology 18 15% 20 6% % Occupational medicine 1 6% 4 6% 38 8% Ophthalmology 7 17% 15 10% % Paediatrics 18 15% 38 10% % Pathology 7 9% 38 13% % Psychiatry 19 9% 49 7% % Public Health 7 21% 6 5% 49 6% Radiology 25 14% 51 11% % Surgery 47 16% % 1,931 17% Other or multiple specialities 1 33% 2 33% 31 23% Neither and not in training 75 8% 193 8% 4,136 11% Neither and in training 76 4% 184 3% 1,970 4% EEA doctors Wales % of all that are EEA EEA doctors Other % of all that are EEA GP 103 4% % Specialist % 1,214 64% Medicine 61 7% % Emergency medicine 2 2% 10 34% Anaesthetics and intensive care medicine 75 14% % Obstetrics and gynaecology 24 14% 73 72% Occupational medicine 0 0% 9 41% Ophthalmology 10 13% % Paediatrics 27 11% 47 45% Pathology 11 9% 39 53% Psychiatry 29 9% 46 38% Public Health 8 16% 8 27% Radiology 22 9% % Surgery 76 13% % Other or multiple specialities 1 17% 4 100% Neither and not in training 139 7% 144 4% Neither and in training 72 3% 4 4% 14

16 To present a complete picture, Table 3 includes doctors who are on both the GP and specialist registers and so will not match Figure 12. There is a relatively high proportion of EEA licensed graduates who have a location outside the four countries of the UK or who we cannot locate (11%). Given that there are 2,413 licensed doctors in this group, it is highly likely that these numbers of located doctors are underestimates. EEA doctors in training Our data shows that there were 2,306 EEA doctors in training in Table 4 breaks this population down by training stage, showing that EEA doctors are a small minority at each stage. This trend is consistent across all years since 2012 although the percentage of CT3 trainees that held an EEA PMQ in 2018 was abnormally low. Table 4: Numbers of EEA doctors at each stage of training in 2018 along with the percentage of each stage that were EEA doctors Training Stage EEA doctors % EEA F % F % CT % CT % CT % ST % ST % ST % ST % ST % ST % ST % ST % It is also important to consider the areas in which EEA doctors are training. Whilst the greatest percentage shown in Table 5 was in occupational medicine, there were only 31 trainees in this area in total in 2018 and so this percentage should be treated with caution. Psychiatry had the second largest proportion EEA doctors whilst General Practice accounted for the largest number of EEA trainees. 15

17 Table 5: EEA doctors in each area of training in 2018 and the percentage of that area that were EEA doctors Area of Training EEAs in 2018 %EEA Foundation % Core Elements of Specialty Training % Anaesthetics 53 2% Emergency medicine % General Practice % Intensive care medicine 8 3.4% Medicine % Obstetrics and Gynaecology % Occupational Medicine % Ophthalmology % Paediatrics and Child Health % Pathology % Psychiatry % Public Health 2 1.1% Radiology % Sexual and reproductive health 0 0% Surgery % Years of UK experience Experience is defined here as the number of years that a doctor has had a UK licence to practise (for those joining before 2009, we use the date they joined the medical register). About a third of (31%) of EEA graduates located in the UK have 0 to 5 years of experience of working here; over half (55%) have fewer than ten years of experience. Northern Ireland has a comparatively even distribution of doctors across all experience levels, and has a higher proportion of EEA graduates who have over ten years of experience than any other country of the UK. This is likely to be a result of doctors who qualified in the Republic of Ireland practising in Northern Ireland. In locating doctors, we use a combination of data about where they are practising. We couldn t assign a UK location to 11% of EEA doctors these doctors may be overseas, or may not have given a valid UK postcode. 57% of these doctors have between 0 and 5 years of UK experience. 16

18 Figure 13: Years of UK experience of EEA graduates in each UK country in % 30% 20% 10% England 25% 20% 15% 10% 5% Scotland 0% 0% 20% 15% NI 25% 20% Wales 10% 15% 10% 5% 5% 0% 0% 80% 60% Other 40% 20% 0% Limitations of our analysis This paper has looked at doctors with a primary medical qualification in the EEA, but this does not mean these doctors are EEA nationals. We only have partial data on the nationality of doctors at the time of their registration. 17

19 Conclusion 9% of all licensed doctors in 2018 were EEA graduates but this figure was 14% for hospital consultants and was higher still for some specialties. The number of licensed EEA graduates has remained fairly constant over the last three years and we have data to show that fewer EEA graduates left the register last year than in any year since The mix of doctors joining our registers from the EEA has changed in recent years saw the number of graduates from Central and Eastern Europe and Baltic countries exceed those from North-western Europe for the first time. We have seen a marked decline in EEA doctors joining our specialist register since 2014 which is a concern because of the large proportion of certain specialties that are currently EEA doctors. However, 2017 did show the number of EEA specialists leaving fell by over a third compared to When the four countries were compared, Northern Ireland had the largest percentage of its workforce holding an EEA PMQ, with 71% of those graduating in the Republic of Ireland. Also, Northern Ireland s EEA graduates had the greatest average age and average years of UK experience among the four countries, underlining the particular importance of EEA doctors to the medical workforce in Northern Ireland. EEA doctors and leaving the European Union This report shows that the number of EEA qualified doctors licensed to practise in the UK has remained fairly constant since the June 2016 referendum. Similarly, the number of doctors joining the register from the EEA has been relatively steady over the last two years despite continuing uncertainty about whether current registration arrangements for EEA doctors (which are based on the principle of mutual recognition by member states of each other s qualifications and enables registration to be granted very quickly) will continue after the UK leaves the EU in March The status of doctors already registered in the UK is guaranteed. While it s clear that EEA doctors currently see the UK as an attractive place to work, this could change rapidly depending on the outcome of the negotiations to leave the European Union. In turn, the UK s medical workforce could be significantly impacted. Anecdotal evidence from our own frontline engagement, and insight from other organisations such as the British Medical Association and regulators from other European countries, suggests that EEA doctors are growing increasingly nervous about the post-brexit landscape. As the UK medical regulator we are doing all that we can to prepare for the various scenarios that we may face in March 2019, while we await the outcome of the negotiations and confirmation from Government on how EEA qualified doctors will be able to join the UK medical register. What is clear is that the UK continues to value this important cohort of EEA qualified doctors and must work to ensure that the current uncertainty does not deter them from coming to the UK and contributing to our NHS. 18

20 Website: Telephone: General Medical Council, 3 Hardman Street, Manchester M3 3AW Textphone: please dial the prefix then to use the Text Relay service Join the facebook.com/gmcuk linkd.in/gmcuk youtube.com/gmcuktv This information can be made available in alternative formats or languages. To request an alternative format, please call us on or us at publications@gmc-uk.org. Published October General Medical Council The text of this document may be reproduced free of charge in any format or medium providing it is reproduced accurately and not in a misleading context. The material must be acknowledged as GMC copyright and the document title specified. The GMC is a charity registered in England and Wales ( ) and Scotland (SC037750) Code: GMC/DADEPMQ/1018