Standing in the courtyard of the Sri Mahalakshmi Hindu temple in east London, a dozen jobless doctors are eating dhal, rice and potatoes off paper plates.
Wrapped against the cold in anoraks and sweaters, they come here each evening when the temple serves free food. They eat in the gloom before slipping away to damp, squalid lodgings where many sleep three to a room.
They are among thousands of overseas doctors who have flocked to Britain in the past five years in response to the NHS's global appeal for more staff. But instead of finding hospitals ready to welcome them, they face unemployment, poverty and discrimination.
A growing army of unemployed doctors, most from the Indian subcontinent, are living on the breadline in east London and other British cities while depriving their own countries of their desperately needed skills.
Their numbers have soared from 1,000 who passed the professional and linguistic assessment board (Plab) test - a requirement for all overseas doctors - in 1998 to 6,666 who passedin 2005 (up to 24 November).
Passing the test is the first of many hurdles this year's doctors must clear. All face months of hardship while they struggle to find work, and many never obtain jobs and return home broke.
A survey by the General Medical Council (GMC) shows that less than half of those who passed the Plab test in summer 2004 found work within six months, and a quarter were still unemployed a year later. The situation is likely to be worse this year.
The British International Doctors Association has accused the Government of exploiting the situation by charging doctors £500 each time they renew their visa. NHS trusts also charge doctors hundreds of pounds to take them on for a few weeks of work experience so they can improve their chances of getting a paying job.
Dr Prasada Rao, chairman of the association and a GP in Stoke-on-Trent, said: "It is absolutely diabolical. The numbers are unbelievable. These people have come to serve the NHS and there is chaos, confusion and a total lack of care. There is no co-ordination between the Department of Health, the Home Office and the General Medical Council. It is totally unacceptable."
Ramesh, aged 29, one of the doctors at the temple, qualified in Bangalore five years ago and arrived in the UK in August. He has applied for 100 jobs in anaesthetics, but has had no interviews since passing the Plab test in September. He said: "Everybody has the hope of a better career and a better life. But when we come here we are disappointed and get depressed. I have lost almost all my savings. I will stay one or two more months and see how things work out."
Ramesh paid £620 to take the Plab test. Each job application costs £5 for the five copies of his CV that he must include. He pays £160 a month to stay in a shared room and visits the temple every evening to eat. "I came because Britain was short of doctors and I wanted training," he said. "There was no indication it would be so tough to get a job."
Others nod in agreement. Rohid, 28, from Punjab, qualified as a doctor in 2002. He passed the Plab test a year ago and has made between 150 and 200 applications for clinical attachments - unpaid work experience. He has had one post - a three-week attachment which cost £100 (paid to the NHS trust), plus £50 for the medical tests he was required to take.
Nearby an unkempt terraced house functions as a temporary medical school, one of several which have sprung up to coach doctors through the Plab test. Young doctors learn how to adapt their training to a new culture for £150 for a 10-day course.
The GMC, which administers the test, said it had no control over the numbers applying. The GMC has posted details of the jobs market on its website, stressing that some posts attract more than 1,000 applications. There has been a sharp reduction in the numbers applying to take the test.
Hospital consultants and GPs are still needed but the expansion in UK medical school places and the influx from overseas has created a bottleneck, with too many junior doctors seeking too few training posts.
The health department said it was considering allowing overseas doctors to apply for jobs from their home countries.
'I saw a gap in the market for senior doctors and it went from there'
The 30 year old head of a recruitment agency that hires foreign doctors for the NHS is set to make £7m from the sale of the business that he launched three years ago.
Justyn Randall spotted a gap in the market in 2002, when the NHS was desperate to fill senior positions in British hospitals and primary care with consultants and GPs from overseas. He left his job in IT recruitment and he and a partner set up Global Medics, an agency specialising in the medical recruitment market.
The company has offices in Keighley, West Yorkshire, and London as well as bases in South Africa (where about 80 per cent of candidates are recruited), Australia, New Zealand, Germany and the Netherlands. More than 95 per cent of placements are for the NHS.
Under the terms of the deal, specialist recruitment firm Multi Group has agreed to buy Global Medics for £9.6m plus up to a further £4.1m depending on Global's performance for the current financial year. Mr Randall, who owns half of Global Medics, will receive up to £6.85m for his stake.
He said: "I saw a gap in the market for senior grade doctors and the business went from there. We're pleased with how it has developed."
The deal allows him to join the Multi board and oversee its medical businesses.
Jeremy LauranceReuse content