What matters to the GMC is whether you qualified in the UK, or one of a defined list of overseas hospitals in Australia, New Zealand, Malaya, Singapore, Hong Kong, South Africa and the West Indies. If so, you are eligible for provisional and full registration as normal, though graduates from overseas hospitals in this category need to pass the IELTS English exam.

Otherwise, usually after the equivalent of a house year overseas, you are eligible for limited registration of five years maximum. It is for this that you need to have passed, or be exempt from, the Plab test (see Hospital Doctor's passim for the controversy over Plab). To be eligible for Plab, you need to have passed the IELTS.

Overseas doctors' immigration requirements

What matters to the Home Office is that you have the right of indefinite residence in the UK (that is, you are a national of a country in the European Economic Area). If not, and you wish to train in the UK, you need permit-free training (PFT) status. To qualify, you must intend to do postgraduate hospital training; intend to leave the UK afterwards; be eligible for GMC registration; and be able to support yourself 'without recourse to public funds'.

You may be granted visitor status to the UK for a period of up to six months to sit the Plab test, extendable for a further six months to resit. On passing you can apply to switch to PFT; UK graduates on a student visa will also need to switch to PFT.

You are allowed 12 months of PFT for a PRHO year. As an SHO you then get three years, extendable for a further year (on application to the Home Office with references and support from your postgraduate dean). In an SpR post, you get three years, similarly extendable to a date six months after CCST.

An alternative to an SpR post is an FTTA (fixed term training appointment), usually shorter, in which you are not eligible for a CCST. Only doctors without indefinite right of residence are eligible.

Training numbers

Overseas doctors in SpR posts are awarded a VTN (visiting training number). Those in FTTA posts are awarded an FTN (fixed training number).

Work permits

The apprehension and fear of the unknown experienced by an overseas (non-EC) doctor is no different today than it was 38 years ago when I arrived in the UK - except that we then had far less pounds in our pockets when setting out on the expedition of job hunting.

To get going is still difficult until success smiles in the form of a locum position, which will not necessarily be in the doctor's desired specialty.

All available 'helpful' guidelines do not, in my opinion, address the initial psychological discomfort (including depression) most overseas doctors go through. This in turn tends to have an impact on performance, leading to loss of confidence and consequent failures.

These young colleagues do face a huge obstacle in finding their first jobs. But it is important for them to relax before they start job-hunting.

Success in the PLAB is the first step. Matters have been made easier by the GMC, which holds the test in centres abroad. This certainly saves permit-free training time.

An attachment is needed to get accepted in the chosen specialty. This helps the doctor to learn the ropes, paving the way to a proper job. Clinical attachment should be regarded as a period to prove one's ability and should be taken seriously, as the consultant's reference invariably works as a turning point. It works well if the consultant's help is sought in adhering to a strict learning timetable. Time should be spent on strengthening the basic skills of history-taking, examining, writing up and presenting.

It is best to ask the consultant's advice when applying for the first job. The application and CV should always be well laid out and type-written. It should be realised that overseas doctors invariably compete with one another in most of the junior positions in the district hospitals. It is essential to turn out in proper attire and with the intention of earning the job rather than being given it. I strongly advise that the interviewee visits the hospital prior to the interview to enhance the chances of success.

It is a good idea to ask a senior colleague to offer a mock interview, so that the interviewee can focus on improving body language as well as learning how to answer questions at the interview. The interview should be a two-way process between the candidate and the committee and answers should be succinct.

Once in the job, it is always helpful to start from the basics, seeking advice as required and not taking undue responsibility without consulting a senior. Attendance at postgraduate meetings is a must.

All regions have excellent postgraduate training facilities and tutors are dedicated and helpful. They should be approached for the entitled study leave and courses. I strongly discourage anyone from taking an examination without adequate preparation, as failure will result in losing the permit-free training period.