Place of medical qualification and outcomes of UK General Medical Council "fitness to practise" process: cohort study

Abstract

Objectives To evaluate whether country of medical qualification is associated with "higher impact" decisions at different stages of the UK General Medical Council's (GMC's) "fitness to practise" process after allowing for other characteristics of doctors and inquiries. Design Retrospective cohort study. Setting Medical practice in the United Kingdom. Participants 7526 inquiries to the GMC concerning 6954 doctors. Main outcome measures Proportion of inquiries referred for further investigation at initial triage by the GMC, proportion of inquiries investigated that were subsequently referred for adjudication, and proportion of inquiries resulting in doctors being erased or suspended from the medical register; relative odds of higher impact decisions, by country of qualification, adjusted for doctors' sex, years since primary medical qualification, medical specialty, source and type of inquiry, and nature of allegations. Results Of 7526 inquiries, 4702 concerned doctors who qualified in the UK, 624 concerned doctors who qualified elsewhere in the European Union (EU), and 2190 concerned doctors who qualified outside the EU. At the initial triage, 30% (n=1398) of inquiries concerning doctors who qualified in the UK had a high impact decision, compared with 43% (267) for doctors who qualified elsewhere in the EU and 46% (998) for those who qualified outside the EU. The adjusted relative odds of an inquiry being referred for further investigation were 1.67 (95% confidence interval 1.28 to 2.17) for doctors who qualified elsewhere in the EU and 1.61 (1.38 to 1.88) for those who qualified outside the EU, compared with doctors who qualified in the UK. At the investigation stage, 5% (228) of inquiries received concerning UK qualified doctors were referred for adjudication, compared with 10% for EU (63) or non-EU (221) qualified doctors. The adjusted relative odds of referral for adjudication were 2.14 (1.46 to 3.16) for doctors who qualified elsewhere in the EU and 1.68 (1.31 to 2.16) for those who qualified outside the EU. At the adjudication stage, 1% (69) of inquiries received concerning UK qualified doctors led to erasure or suspension, compared with 4% (24) for doctors who qualified elsewhere in the EU and 3% (71) for non-EU qualified doctors. The adjusted relative odds of erasure or suspension were 2.16 (1.22 to 3.80) for doctors who qualified elsewhere in the EU and 1.48 (1.00 to 2.19) for those who qualified outside the EU. Conclusions Inquiries to the GMC concerning doctors qualified outside the UK are more likely to be associated with higher impact decisions at each stage of the fitness to practice process. These associations were not explained by measured inquiry related and doctor related characteristics, but residual confounding cannot be excluded.

Disciplined doctors: Does the sex of a doctor matter? A cross-sectional study examining the association between a doctor's sex and receiving sanctions against their medical registration

“…The findings of this study are in agreement with previous research that has shown that older doctors,8 doctors who qualified outside of the country in which they are practising11 14 and doctors of certain specialties7 are more likely to be subjected to disciplinary action by a medical regulatory board. It has also been demonstrated in previous studies that female doctors are more likely to have qualified more recently than male doctors,3 are more likely to have qualified in the country in which they are practising19 and choose different specialties to male doctors 20…”

International Medical Graduates (IMGs) in the UK—a Systematic Review of Their Acculturation and Adaptation

“…An assessment procedure to gain entry and get registration from a professional body like GMC in itself is a long and demanding process; although it is necessary for the receiving country to be sure of the capabilities of IMGs and their suitability to work, it is hard for IMGs to get the registration process sorted, get shortlisted for a job and have smooth career progression (Stewart 2003). Disciplinary actions and GMC hearings are twice as high for IMGs compared to UK doctors and it has been implicated that this is because of the lack of knowledge and guidance about legal and ethical issues among IMGs (Slowther et al 2009;Humphrey et al 2011). Training issues have been a difficult for IMGs and they have used clinical attachments as a method of gaining entry into the training schemes but there have been problems getting the funding to support the professionals who are willing to support these candidates during their clinical attachments (Malik et al 2007).…”

“…It has been reported that non-UK doctors lack relevant information about legal, ethical and professional standards and guidance prior to registration; the training and support available especially in the area of communication and ethical decision-making is variable and isolation in non-training posts further complicates the situation (Slowther et al 2009). Data from hearings conducted by GMC found that doctors who qualified outside Britain were twice as likely to face a disciplinary hearing compared to doctors trained in Britain (Humphrey et al 2011). Berry (1997) describes diversity in society as one of the spices of life, in addition to providing competitive advantages in international diplomacy and trade.…”

Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia

“…Other variables—including, patient characteristics,41–44 case-type and outcomes,39 45 doctors’ ethnicity and country of training,46 47 the practice setting, and aspects of the patient-doctor relationship48—may also predict complaint risk. However, because these variables are usually more difficult to measure at the population level, their suitability for large-scale predictive modelling is questionable.…”