Overseas doctors more likely to face serious GMC action

General Medical Council (GMC) decisions about doctors who qualified outside the UK are more likely to have far reaching consequences (high impact decisions), finds research published on bmj.com today.

The authors, led by Professor Charlotte Humphrey from King's College London, say there is no clear reason why overseas doctors do worse in GMC fitness to practise processes than their UK-trained peers.

Humphrey argues that perhaps 'real differences exist in fitness to practise between groups of doctors who are referred to the GMC' or 'that the GMC processes tend to discriminate against certain groups of doctors.'

However, the authors stress that their research makes it 'difficult to reach a conclusion that clearly supports either of these potential explanations and both might be valid.'

The study looked at GMC cases between 1 April 2006 and 31 March 2008. The researchers reviewed the background to 7,526 inquiries to the GMC concerning 6,954 doctors. They assessed how many inquiries were referred for further investigation, how many were investigated and then referred for adjudication, and how many resulted in doctors being erased or suspended from the medical register.

The results show that of the 7,526 inquiries, 4,702 related to doctors who had qualified in the UK, 624 in the European Union (EU) and 2,190 who had qualified outside the EU. At the initial GMC stage (triage) 29% of inquiries concerning UK qualified doctors had a high impact decision compared with 43% for EU doctors and 46% for non-EU doctors.

At the adjudication stage 1% of UK qualified doctors were erased or suspended from the medical register compared to 4% of EU doctors and 3% of non-EU doctors.

The authors conclude that their research raises questions about the GMC fitness to practise processes. They speculate that perhaps inquiries involving UK-qualified doctors are being assessed less seriously than those involving non-UK qualified doctors.

Humphrey and colleagues also question whether some non-UK qualified doctors may not be well placed to defend themselves or challenge decisions compared to their UK-trained colleagues.

In an accompanying editorial, Marcella Nunez-Smith, Assistant Professor at Yale University School of Medicine, says that given the rise in the dependence on foreign-trained doctors in countries like the UK and US, it is essential to determine 'whether international medical graduates offer the same quality of care as doctors who train and practise in destination countries.'

Nunez-Smith argues that Humphrey's research is a critical contribution to the debate but that 'additional research on the association between other doctor related characteristics, such as ethnicity, and the fitness to practise process is needed.'