As tighter immigration norms rub shine off UK, US for Indian MBBS grads, Australia, Germany, Middle East gain

Earlier this year, Apurva*, an Indian doctor working with the United Kingdom’s (UK) public healthcare system, the National Health Service (NHS), posted the email response to an application she had sent for a speciality training programme, equivalent to India’s postgraduation (PG) medical courses, such as MD and MS, on her LinkedIn page. NHS had informed that she couldn’t be called for an interview as she wasn’t in the “priority group”.

The response came shortly after the UK enacted a new law, the Medical Training (Prioritisation) Act 2026, which puts the country’s own graduates and those with substantial NHS experience ahead of international medical graduates (IMGs) for speciality training. Intensifying competition for UK’s speciality training had left many UK graduates waiting for PG training slots.

The law has been a blow to the aspirations of medical graduates from India, who were already struggling to find even non-training jobs in the UK, due to heightened competition and tightening of immigration norms. For Apurva, it strengthened her resolve to leave the NHS.

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“What it meant for me was that after four years of sheer hardwork, spending lakhs of fees on GMC's [General Medical Council] exams and securing a job in the NHS despite job saturation, I still stand with nothing but the same degree, just lesser hope. While I understand why the prioritisation would be legalised, what I don’t understand is how GMC is benefitting from IMGs, why the bill has to come into effect suddenly after a suspicious delay in training interviews (sic),” she wrote in her social media post.

The GMC is the UK’s medical licensing body.

The prioritisation law is the latest in a series of immigration reforms in the UK and the United States (US), the two preferred destinations for Indian medical graduates, brought in to limit the influx of international students and workers. Besides filling the aspirants with anxiety and confusion, the frequent policy changes have resulted in longer waiting time for job and training opportunities.

As per the latest figures, by 2025, there were at least 1.3 lakh Indian medical graduates practising or pursuing further training abroad, the vast majority of them in the UK and the US. However, the protectionist and anti-immigrant stance of the leaders in the two countries has also pushed some to consider other places, such as Australia, Germany and West Asian countries, or even returning home.

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Indian MBBS graduates in OECD countries

For a considerable period, India has been the biggest contributor of doctors across advanced economies. According to the International Migration Outlook 2025 report, released by the Organisation for Economic Co-operation and Development (OECD), there were 98,857 Indian-born doctors in 2020-21 in 38 OECD member countries – US, Canada, Australia and European countries – up by 76% compared to 2000-01. The expansion of the country’s medical education system, English-language training and bilateral recruitment by OECD countries have been credited for this dominance.

However, just two countries - US and UK - account for the lion’s share of Indian doctors abroad. Several thousand Indian-origin doctors also practice in the Gulf Cooperation Council (GCC), or Middle-Eastern countries, but there’s no consolidated data available for them.

Indian graduates seeking to work in US need to follow a straightforward path: clear the first two of the three steps of the country’s licensing exam, the United States Medical Licensing Examination (USMLE), and enrol in a three- to seven-year residency programme - comparable to the Indian PG medical course - in a specialisation of choice at a hospital. These graduates are typically admitted on J-1 (exchange visitor) visa or H1-B temporary worker visa. After completing the residency and clearing the third step, USMLE Step 3, one becomes eligible for the license of one of the US state boards and can work as a physician.

The UK, on the other hand, offers multiple routes for IMGs to enter its workforce, for training, non-training and speciality roles. The most common entry point for Indians passing MBBS is the two-part Professional and Linguistic Assessments Board (PLAB) exam, which makes one eligible for GMC registration and license to practise in the country. They can either opt for a non-training doctor’s job at an NHS Hospital or get enrolled in speciality training at a junior level, as ‘station house officers (SHOs)’. Prior NHS work experience helps increase one’s chances of finding a training slot.

A less-popular pathway is obtaining postgraduate medical qualifications awarded by the Royal Colleges of UK, namely the Membership of the Royal College of Surgeons (MRCS) and the Membership of the Royal Colleges of Physicians (MRCP). These are awarded through a three-tier exam, which assesses advanced clinical competence. Those who clear it can directly advance to higher levels of speciality training, as ‘registrars’.

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Indian Doctors in the UK: Shrinking share

In recent years, perhaps no other country’s immigration policies have been as volatile as the UK’s as the country seeks to strike a balance between plugging staff shortage in its public healthcare system and compulsion to accommodate its own medical graduates.

After largely unfettered access to PG training to non-European IMGs till 2005, UK introduced a slew of restrictions aimed at prioritising UK and European Union (EU) healthcare professionals. Doctors and nurses were relegated to the Tier-2 visa category – for skilled jobs with no takers among UK or European workers – and in 2010, the number of Tier-2 visas was capped. Doctors and nurses were exempted from this ceiling only in 2018.

While the count of IMGs in the UK medical workforce initially declined, it bounced back, surpassing previous levels in absolute terms. However, the proportional share of non-UK registered doctors in the overall workforce fell from 28.63% in 2006 to 25.94% in 2017.

The impact on Indians was more pronounced with a drop in their actual numbers as well as their share among IMGs and overall workforce. The presence of IMGs in PG training also declined dramatically – by around 40% for all nationalities between 2012 and 2017 and more than 60% for Indians.

The table below shows how many Indian doctors have worked and trained in the UK, from 2006 to 2025.

Indian doctors in the UK

Source: UK General Medical Council (GMC) Data Explorer

The UK’s decision to leave the EU in 2020 – the ‘Brexit’ – saw an exodus of European doctors from the UK, followed by a rise in demand for healthcare workers during COVID-19 pandemic. This led to a fresh influx of non-EU IMGs, including Indians. This was also aided by the introduction of a special, fast-tracked Health and Care Worker Visa. But in 2024, the government stopped care workers from bringing their immediate dependents to the country and raised the minimum salary threshold for skilled workers. The doctors and nurses were, however, exempted from these restrictions.

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In 2025, the UK framed a new set of rules for its indefinite leave to remain (ILR) or permanent residence programme, increasing the qualifying period from five to 10 years. While doctors and nurses were later exempted from these rules, following intense advocacy, it added to the expat healthcare workers’ anxieties.

Indian MBBS graduates among UK trainees

Source: UK General Medical Council (GMC) Data Explorer

Medical graduates surrendering licenses

Despite the recent policy changes, UK’s reliance on foreign doctors has grown, though the pace of their joining has slowed. According to GMC’s State of Medical Education and Practice in the UK 2025 report, following a substantial year-on-year increase in the last decade, the number of non-UK doctors taking up or returning to their license came to almost a standstill in 2024. As many as 20,060 doctors joined the UK workforce in that year, similar to the 19,629 entrants in 2023.

The report also suggests that the UK continues to be a favourable destination for aspirants, as indicated by the 27% increase in IMGs taking the PLAB exam. As a result, the number of doctors entering through the PLAB route has also increased, even as the MRCP/MRCS admissions remain virtually unchanged.

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The competition for speciality training has also intensified. The count of non-UK doctors applying for PG programmes has tripled, from 5,326 in 2018-19 to 18,857 in 2023-24, even as the acceptance rate has plummeted from 53% in 2019-20 to 23%.

At the same time, the UK is no longer an attractive destination for many among both UK and non-UK practitioners. According to the GMC report, 16,124 doctors gave up their licenses in 2024, many of them non-UK doctors who never got a job in the country. As many as 5,193 of them surrendered their license, up from 1,955 in 2023.

According to GMC’s 2024 workforce report, Australia is the most preferred destination for IMGs leaving the NHS, followed by Canada, United Arab Emirates (UAE), US, Ireland and New Zealand. The report also indicates that over 200 Indian doctors returned home in 2023.

One of the main drivers for these movements is better compensation. “Many Indians who come to the UK, end up moving to the Middle East due to its proximity to India. Also, once you’re trained in the UK, you can get a higher salary in the Middle East,” said Faisal Pokar, an Indian trainee in the UK.

UK immigration overhaul and doctors

Indian aspirants are particularly hit by the immigration overhaul. The share of Indian doctors among IMGs has gradually declined from over 40% two decades ago to a quarter. Indians account for only a little over 16% of all overseas trainees, a steep decline from 2006, when they were 46%.

Aman Sharma, an NHS trainee and founder of UK Dreamers, an online guidance platform for aspirants, suggests that one of the key challenges for Indian aspirants in the UK is that India doesn’t recognise dual citizenship, forcing them to make a choice. “Pakistani nationals, for instance, can have two passports after their training and can move between the countries,” he said, adding that by the time he finishes his training, he may not remain in the country.

UK demand for specialists

One category of physicians has witnessed a steady, if incremental, rise – the specialists – indicating continued demand for those possessing higher qualifications. “Now, it's very difficult to get ST1 level (the first level of speciality training) after PLAB, but you can get ST4 level,” said Asif Iqbal, a senior consultant at Apollo Hospitals Kolkata and founder of Farz Academy, a Kolkata-based training institute for MRCP candidates.

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According to Bhavesh Patel, director of Ahmedabad-based Medibridge Education Consultants, the NHS jobs have become hard to come by. “Earlier, it would take 1-2 years to get placed. Now the waiting period has increased to 2-3 years,” he said.

To maximise their chances of employment and training, some aspirants, especially those who aren’t particularly keen on staying in the UK, are opting for the MRCP/MRCS route over PLAB. Pokar is one of them.

Others, like Ankita Mishra, an Indian doctor, working as a research associate in London, seek additional qualifications before applying for speciality training. She recently completed a Master of Public Health (MPH) programme at Imperial College London. It also helps that she has done a six-month observership – hands-on training – in Atlanta, US.

“Since I want to work for the World Health Organisation (WHO), I decided to do MPH to improve my training chances. The UK really values if you’ve studied here, as it means you’ve interacted with their education system,” she said, adding, “The new immigration policies are quite stressful, and it's at this stage that I realise the value of my master’s. It will open up more opportunities.”

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Indian doctors in the US: H1B, J1 visa woes

While the situation isn’t as unpredictable in the US, the aspirants are still anxious due to the government’s recent moves to curb immigration, especially the steep annual $100,000 fees for the sought-after H1-B visa, which enables migrants to work while pursuing their training.

Many hospitals have already stopped sponsoring H1-Bs following funding cuts to the US’ Graduate Medical Education (GME) programme. As a result, a majority of the aspirants are now admitted through J-1 visa, sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG), which, until 2024, required the doctors to mandatorily spend two years in their home country after their training before applying for jobs through H-1B visas. In 2024, the US waived this home country requirement for 34 nations – including India and China – but the H-1B visa remains elusive.

“In the last two years, obtaining H-1B has become a nightmare,” said Abhishek Bavadhankar, medical director at Logiquest MedXpert Consultants, which trains aspirants for the USMLE exam.

According to Bavadhankar, while these changes haven’t affected training for IMGs, many candidates have put their ambitions on hold for more clarity. “The inclination for going to the US has increased, but there’s confusion among IMGs due to changes in policies,” he said.

Data from the US Federation of State Medical Boards (FSMB)’s biennial census of licensed physicians in the country shows the count of Indian doctors steadily increasing, though their share in the workforce has dipped slightly, from 23% in 2010 to 21% in 2024.

India is no longer the top source of foreign doctors in the US, having recently been overtaken by the Caribbean nations.

Share of Indian doctors in the US workforce

Source: Federation of State Medical Boards (FSMB)’s biennial census of licensed physicians in US

Indian Doctors Abroad: Australia, Germany gain

The OECD data shows that Australia and Germany have gained from the uncertainties in the UK and US’ immigration landscape. The former has almost doubled its intake of Indian doctors, while their presence in the latter has increased manifold. These figures, however, are still nowhere near the UK and US levels.

Indian Doctors in other countries

Source: Organisation for Economic Co-operation and Development (OECD) Data Explorer

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Medication Education and Training: Here vs there

Despite the hiccups, a sizeable chunk of Indian graduates continue to aim for opportunities to study, work and settle abroad.

Pokar, who studied till PG in India, noted stark differences in training and work cultures. “The Indian training is not very organised or streamlined. While in India a specialist doctor is expected to work on his own, over here, it’s more of a group practice where everyone, from microbiologists and pharmacists to physiotherapists and dieticians, works in tandem to provide care,” he said.

He also got lessons in other aspects of care work, including communication with patients

Mishra, on the other hand, found even the licensing exams to be instructive, as they tend to focus more on the application of medical knowledge rather than on inane information tested in the National Eligibility-cum-Entrance Tests (NEET). “The exams are broken up in parts to test different aspects. One actually has to do procedures - everything from ear exam to setting up an IV is tested,” she said.

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‘Brain drain’ concern

The outward migration of the highly-skilled medical practitioners continues to be a ‘brain drain’ concern for India, even as the country has significantly expanded domestic medical training capacity. While the Indian government boasts of surpassing the global standard of 1:1000 doctor to population ratio, these calculations include AYUSH doctors. Many of the country’s premier medical colleges face an acute shortage of faculty and doctors despite the expansion.

The aspirants believe that there needs to be substantially more public investment in the healthcare system and education if the country wishes to slow down the drain. They also wish for diverse career pathways for medical graduates, improved work-life balance and regulation on the cost of education in private institutes.

“There’s a stark disparity in how much the Indian and UK governments spend on public health. The expenditure on healthcare is key for people to come back,” said Pokar.

* Name changed to protect identity