Your First NHS Job as an IMG

Your First NHS Job as an IMG: What to Know and Where to Start 

Starting your career as a doctor in the UK is an exciting yet challenging step, especially if you're an International Medical Graduate (IMG). With a wide range of roles available, it’s easy to feel overwhelmed by options. What kind of hospital should you choose? Should you aim for a training or non-training post? What grade is right for your level of experience? 

In this guide, we’ll break it all down to help you make the best possible choice for your first NHS job, avoid common mistakes, and set yourself up for long-term success. 

Why Your First Job in the NHS Matters 

Your first role in the NHS isn’t just another job—it's a critical foundation for your future in UK medicine. It influences everything from your confidence and clinical competence, to your eligibility for future training programmes and your long-term career satisfaction. 

Many IMGs have struggled after jumping into a role that was too advanced or lacked proper support. Others have flourished after taking a more measured approach. The key difference? Choosing a job that suits your background, clinical experience, and familiarity with the UK healthcare system. 

The Best First Job for Most IMGs 

For most overseas doctors, the best first NHS job is an employed, non-training, junior grade position in an NHS hospital. 

Let’s explore why this specific combination works well: 

NHS vs. Private Sector 

The NHS (National Health Service) is the UK’s public healthcare system, and the primary employer of doctors in the UK. NHS hospitals are structured with clear hierarchies and robust support systems. These offer better supervision, induction programmes, and team support—essential elements for someone new to the UK system. 

In contrast, private hospitals tend to be less structured and offer minimal support, making them high-risk environments for new IMGs. Starting your career there could leave you vulnerable to litigation or complaints due to unfamiliarity with protocols. 

Recommendation: Always choose an NHS setting for your first job. 

Employed vs. Locum Roles 

As an employed doctor, you become part of the hospital’s permanent or long-term team. This status comes with formal induction, a clearer understanding of expectations, and often, an adjustment period—a valuable opportunity to learn without pressure. 

Locum jobs, on the other hand, are temporary and often lack induction or support. You’re expected to hit the ground running, which can be overwhelming for IMGs unfamiliar with the NHS. 

Recommendation: Choose an employed position and clarify if an adjustment period is offered before accepting the role. 

Training vs. Non-Training Jobs 

Training jobs are part of formal specialty training programmes (e.g., ST1/CT1 or higher). While these jobs offer career progression, they come with high expectations, tight timelines, and little tolerance for mistakes—making them risky as a first job if you haven’t worked in a system like the NHS before. 

Non-training jobs, on the other hand, allow more flexibility. You can build your confidence, adapt to NHS systems, and gather necessary documents (like the Certificate of Readiness to Enter Specialty Training – CREST) for future training applications. 

Recommendation: Start with a non-training role unless you already have experience in a similar healthcare system and meet all specialty training eligibility criteria. 

Which Grade Should You Choose? 

Jobs in the NHS are categorised into several grades. Here's what you need to know about them: 

FY1 (Foundation Year 1) 

This is an internship-level post, suitable for doctors who have not yet completed internship abroad and hold provisional GMC registration. It comes with the lowest expectations and high levels of supervision. 

Not suitable if you’ve already completed your internship and hold full GMC registration. 

Junior Grade 

This includes roles like SHO, non-training FY2, or clinical fellow ST1/CT1. Suitable for IMGs who’ve completed internship and have little or no experience post-internship, or who are cautious and want strong supervision. 

Jobs such as Standalone FY2 or WAST (if available) fall into this category. Both offer excellent structure, making them ideal first steps into the NHS. 

Middle Grade 

Jobs like Registrar or Specialty Doctor fit here. Suitable for IMGs who have completed postgraduate specialty training or have at least 3 years’ experience in their specialty. If you're coming from a similar healthcare system—or you negotiate an adjustment period—this could be a good fit. 

However, taking a middle-grade job without adequate support can be risky. You’re expected to supervise junior doctors and manage emergencies independently. 

Senior Grade 

These roles are reserved for highly experienced doctors—typically those who’ve worked over a decade in their specialty. Most require being on the GMC Specialist or GP Register. While some IMGs manage direct entry, it’s uncommon as a first UK job. 

Why the Right Fit Matters 

Starting in the wrong job can lead to serious consequences, such as: 

• Being demoted or removed from your role 

• Facing GMC investigations or license suspension 

• Losing confidence and returning home demoralised 

These risks are entirely avoidable. By choosing a role that matches your background and offers support, you give yourself the best possible start in the UK. 

Adjustment Periods: A Hidden Lifeline 

Many non-training roles include a structured adjustment period, where you can observe, shadow colleagues, and ease into on-call shifts. This can make a massive difference to your early experiences. Always ask during interviews whether this is offered. 

Final Thoughts and 3 Key Tips for IMGs Starting in the NHS 

Starting your medical career in the UK is an exciting journey. Here are three final tips to help you make the most of your first NHS job: 

1. Choose Support Over Prestige 

A job that gives you time to learn, adjust, and grow is far more valuable than a prestigious title or location. Prioritise supervision and structure. 

2. Ask the Right Questions at Interview 

Find out if the role includes induction, shadowing, and team support. Make sure the hospital understands that you are new to the NHS and will need guidance. 

3. Don’t Rush into Training 

Unless you’re 100% sure you're ready, start with a non-training job. You’ll build UK experience, avoid risks, and increase your chances of succeeding in future training posts. 

In Summary 

The best first job for most IMGs is a non-training, employed, junior grade role in an NHS hospital. It’s the safest, most supportive, and most effective way to transition into UK medical practice. Use your first job to build confidence, learn the NHS system, and prepare for a successful career ahead. 

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