If you are an international medical graduate planning to practise in the UK, the pathway involves multiple steps, multiple organisations, and multiple exams spread across 12-24 months. Each step has specific requirements, deadlines, and costs. Missing one deadline can delay your entire timeline by 6-12 months.
This guide covers every step — from initial eligibility through GMC registration to specialty training applications — with specific advice on preparation, costs, and common mistakes.
Eligibility
Before starting the PLAB pathway, confirm your eligibility with the GMC.
Primary medical qualification. Your medical degree must be from a medical school listed in the World Directory of Medical Schools (WDMS) and must include clinical training of at least 5,500 hours. The GMC uses the route finder tool on their website to confirm eligibility — check before paying any exam fees.
English language. IELTS Academic (minimum 7.0 in each component, 7.5 overall) or OET (minimum Grade B in each component). These must be current (within 2 years) at the time of GMC registration — not at the time of PLAB. Plan your language test early: booking, preparation, and results can take 3-6 months from decision to certificate.
Fitness to practise. The GMC requires a declaration of fitness to practise. Previous regulatory issues, criminal convictions, or health conditions that may affect practice must be disclosed.
PLAB 1
Format. 180 SBAs in 3 hours. The content is now aligned to the 2026 MLA Content Map — the same blueprint UK medical students follow. Questions test applied clinical knowledge with emphasis on NHS-specific management pathways, UK prescribing conventions, and NICE guideline-based decision-making.
Registration and booking. Register with the GMC and book through the PLAB booking portal. Exam windows are available at multiple international test centres and at the Manchester test centre. PLAB 1 fee: £283 (2026).
Pass mark. Set by Angoff methodology — varies by sitting but historically around 60-65%.
How to prepare. iatroX provides a free PLAB 1 Q-bank with AI-adaptive learning — the engine targets your weakest clinical domains based on your performance. The UKMLA Academy provides 402 structured condition pages covering the MLA Content Map. The AI study planner generates a daily revision schedule calibrated to your exam date. Mock exams simulate the real format — 180 questions, 3 hours, deferred explanations.
Start preparation 6-12 months before your target sitting. The adaptive engine and spaced repetition need time to work — a 12-week preparation timeline produces better outcomes than a 4-week cram.
PLAB 2
Format. OSCE (Objective Structured Clinical Examination) — 16 stations, 8 minutes each. Stations test history taking, clinical examination, communication skills, and practical procedures. Conducted at the GMC's Manchester Clinical Assessment Centre.
PLAB 2 fee: £1,036 (2026). This is a significant cost — especially combined with travel and accommodation for international candidates.
Preparation. PLAB 2 tests clinical skills rather than knowledge. Preparation requires structured OSCE practice with clinical examination stations, communication scenarios, and procedural skills. Peer practice groups, OSCE preparation courses (face-to-face in Manchester, or online), and clinical attachments provide the practice environment that textbook study cannot.
Clinical attachments. 4-12 weeks of supervised NHS placement. Not formally required for PLAB 2 but strongly recommended — they provide exposure to UK clinical systems, NHS documentation, and the communication style the OSCE expects. They also provide UK references for training applications. Arranging a clinical attachment requires contacting NHS trusts directly — most have a formal application process. Apply 3-6 months in advance. Some trusts charge an administrative fee.
Life in the UK: What IMGs Should Know
The NHS is different from most health systems. General practice is the front door — not the emergency department. Most patients are managed entirely in primary care. Hospital referrals require specific criteria. The GP gatekeeping model means hospital specialists see pre-selected patients, not walk-in presentations. This is clinically different from systems where patients self-refer to specialists.
Working patterns. The NHS uses a rota system. European Working Time Directive (EWTD) limits working hours to 48 hours per week averaged over a reference period. Night shifts, weekend shifts, and bank holidays are part of most training rotas. Pay is determined by the national pay scale with additional payments for unsociable hours.
Indemnity. You need medical indemnity before starting clinical work. The MDU, MPS, and MDDUS are the main providers. NHS Resolution provides state-backed clinical negligence indemnity for NHS work, but personal indemnity for GMC fitness-to-practise proceedings requires defence union membership.
BMA membership. Not mandatory but strongly recommended. The BMA provides employment advice, contract reviews, pay dispute support, and professional guidance — particularly valuable for IMGs navigating their first UK employment contracts.
GMC Registration
After passing both PLAB 1 and PLAB 2, you apply for GMC registration.
Full registration with a licence to practise requires passing PLAB 1 and 2, current English language evidence, identity verification, fitness to practise declaration, and payment of the registration fee.
Provisional registration is available for IMGs entering an approved Foundation Year 1 programme.
Timeline. Registration processing takes 4-8 weeks. Do not leave this until the last moment before a job start date — delays in document verification can push registration past your intended start.
Fees. GMC registration fee (annual), plus the one-time registration processing fee. Check the GMC website for current figures.
Foundation Programme and Specialty Training
Foundation programme. Some IMGs enter the UK through Foundation Programme posts — particularly the standalone Foundation Year 2 programme. Applications are through the UKFPO.
Specialty training. Applications through Oriel (the national recruitment portal). Most specialty training programmes require the MSRA (Multi-Specialty Recruitment Assessment) as part of the selection process. The MSRA tests clinical problem-solving (SJT-style questions about clinical scenarios) and professional dilemmas (situational judgment on workplace scenarios). MSRA scores are ranked nationally — a strong MSRA score is essential for competitive specialties. iatroX provides a free MSRA Q-bank with adaptive practice and mock exams.
Specialty competitiveness for IMGs. Some specialties are more accessible to IMGs than others. General practice, psychiatry, and emergency medicine historically have higher competition ratios that still allow IMG entry. Highly competitive specialties (dermatology, ophthalmology, plastic surgery, radiology) have very few IMG appointments at the training level. Understanding the competition landscape before applying prevents wasted applications and disappointment.
Portfolio requirements. Specialty training applications are scored on portfolio evidence — WPBAs, audit, teaching, research, quality improvement projects, and postgraduate qualifications. Building a competitive portfolio takes 12-24 months of deliberate evidence collection. Start from your first UK clinical post. Use iatroX CPD tools to capture clinical learning events, clinical AI queries, and reflective entries that satisfy portfolio domain requirements.
Alternative career paths. Not all IMGs pursue specialty training. Some build rewarding careers in SAS roles, locum work, GP partnerships, or portfolio careers combining clinical work with education, management, or research. The UK medical workforce is increasingly diverse in career structures — training is not the only valued pathway.
SAS and locally employed doctor posts. Many IMGs initially work in SAS (Specialty and Specialist) or locally employed doctor (LED) positions while preparing for specialty training applications. These posts provide clinical experience, NHS references, and the opportunity to build a portfolio for competitive applications. SAS posts are increasingly valued — the 2021 SAS contract reform improved pay, career progression, and professional development opportunities. Some IMGs build long-term careers in SAS roles rather than entering training programmes.
Costs: The Full Financial Picture
The UK IMG pathway involves significant cumulative costs. Planning for these in advance prevents financial stress during the process.
IELTS/OET: approximately £200-300 per sitting. PLAB 1: £283 per attempt. PLAB 2: £1,036 per attempt. GMC registration: annual retention fee (check GMC website for current rate). Clinical attachment: variable (some trusts charge £200-500, others are free). Travel and accommodation for PLAB 2 (Manchester): variable. Visa fees: Health and Care Worker Visa is the most common route — reduced fees and no Immigration Health Surcharge for healthcare workers. Defence union membership: approximately £500-800/year for the first year.
Total estimated cost from decision to first NHS post: £2,500-5,000+ depending on the number of exam attempts, visa route, and clinical attachment arrangements.
How to minimise costs. Use free preparation resources where available — iatroX provides a free PLAB 1 Q-bank with adaptive learning, eliminating the need for paid Q-bank subscriptions for the knowledge component. Pass first time — every re-sit adds the full exam fee plus potentially additional accommodation costs. Apply for NHS-funded clinical attachments where available.
Common Mistakes and Timeline Planning
Mistake 1: Not checking eligibility first. Some medical degrees are not recognised by the GMC. Verify eligibility using the GMC's route finder tool before investing in IELTS/OET preparation and PLAB registration. Discovering ineligibility after paying for IELTS and PLAB 1 registration wastes both money and time.
Mistake 2: Taking IELTS/OET too early. Results expire after 2 years. If you take IELTS 3 years before GMC registration, you will need to retake it. Time your language test so the result is current at the point of registration — not at the point of PLAB 1 booking.
Mistake 3: Underestimating PLAB 2 preparation. PLAB 1 tests knowledge (which you can build alone with a Q-bank). PLAB 2 tests skills (which require practice with partners, stations, and ideally a clinical attachment). Budget 3-4 months of dedicated PLAB 2 preparation, including peer practice groups and ideally a clinical attachment or OSCE preparation course.
Mistake 4: Not starting the portfolio early. If you plan to apply for specialty training, you need a portfolio with WPBAs, audit, teaching, and reflections. Start building this from your first UK clinical post — not the month before applications open. The strongest IMG training applications have 12-18 months of documented UK clinical experience, completed audit cycles, teaching evidence, and structured reflective entries. iatroX CPD tools help capture this evidence from day one.
Mistake 5: Applying only to London and the South East. Competition for posts in London is significantly higher than in other regions. IMGs who restrict their job search to London and the home counties may wait months for a suitable post. Trusts in the Midlands, North West, North East, Wales, Scotland, and Northern Ireland are often actively recruiting IMGs and may offer better training opportunities, lower cost of living, and a more supportive environment for newly arrived international doctors.
Typical timeline. IELTS/OET (3-6 months) → PLAB 1 preparation and exam (3-12 months) → PLAB 2 preparation and exam (3-6 months) → GMC registration (1-2 months) → first UK post. Total: 12-24 months from decision to practise. The fastest realistic timeline (for a candidate who passes everything first time with no delays) is approximately 12 months. Most IMGs will realistically take 18-24 months due to exam scheduling, visa processing, and job search timelines.
Start your PLAB 1 preparation with iatroX's free Q-bank and AI study planner at iatrox.com/quiz-landing.