After many young doctors failed to get NHS jobs this summer, two experts in this week's BMJ debate whether training posts should be reserved for UK graduates.
Society has a moral obligation to ensure that young people who successfully complete a demanding primary medical course have the opportunity to complete their training and enter medical practice, argues Edward Byrne, Dean at the Faculty of Biomedical Sciences, University College London.
He acknowledges that we live in a global world and free exchange of expertise is clearly desirable. However, this needs to be balanced against the training needs of UK graduates. One possible solution, he says, would be to encourage a period of work in other countries towards the end of specialty or family medicine training.
Medical training in the UK is among the best in the world and it is appropriate that a country with the wealth and stature of the United Kingdom cover its medical workforce needs without drawing doctors from less well advantaged countries in Europe or elsewhere, he writes.
If the UK can contribute a relatively small number of fully trained doctors to work in other countries, that would be a useful contribution to international health. But, he argues, a failure to provide training opportunities for the great majority of UK graduates and enable them to enter practice would represent a waste of human potential and a failure of care for young doctors.
Restricting access would damage the profession, argues Edwin Borman, Consultant Anaesthetist at Coventry and Warwickshire NHS Trust and Chairman of the BMA's International Committee.
For most of the lifespan of the NHS, the UK has had an implicit policy to rely on international medical graduates to "top up" the number of UK graduates, he writes. Currently, 36% of doctors registered to practise in the NHS qualified abroad.
It is to the credit of the medical profession that during the crisis of the medical training application service (MTAS), all eligible applicants have been treated equally and posts have been allocated according to merit, he says.
The good name of the medical profession in the UK already has been damaged by the Home Office which introduced changes, without notice, to the immigration rules. It would be a tragedy for the profession itself to sully its reputation by abandoning the principle of solidarity that goes back as far as the Hippocratic Oath.
And he suggests that the blame for the chaos that is MTAS should be placed with those in the Department of Health who decided that medical staffing no longer needed to be planned centrally. Instead, he argues that training places should be limited to numbers that reflect the projected future need for consultants and general practice principals.
The anger of those caught up in the MTAS debacle is expressed in a personal view by Parashkev Nachev, a clinical research fellow at Imperial College London. He argues that the system has damaged professional standards and blames the royal colleges for "failing to act when there was still time to do so."