We read with great interest the article “Insights into obtaining FRCR and beyond: Obstacles, opportunities and post-relocation dilemma - An Indian perspective” by Thaker et al.[1] The authors make pertinent points regarding push and pull factors which promote migration among Indian doctors, the pre- and post-FRCR (Fellowship of Royal College of Radiologists) difficulties which radiologists face, and the need for a clear vision before embarking upon FRCR.
Since the publication of the article, the Royal College of Radiology (RCR) has started conducting the FRCR examination in India. In recent years, there has been a significant increase in the number of Indian candidates applying for the FRCR examination as per feedback from candidates.
We conducted a cross-sectional survey of 326 Indian radiologists and radiology residents who have appeared for or plan to appear for FRCR examination. We asked the respondents what their reason was for appearing for or planning to appear for FRCR (single-response question) [Fig. 1]. Only 44% said it was with the intention of doing fellowship or practicing long term in the United Kingdom. Of these, 29% said they were appearing for FRCR to practice long term in the United Kingdom, and 15% said they were doing so for the purpose of pursuing a U.K. fellowship.
Fig. 1 Pie chart showing the responses to the question asking why the respondent appeared or plans to appear for Fellowship of Royal College of Radiologists (FRCR).
A large 27% said they were appearing for FRCR only to gain an additional degree with no plan to move abroad, and 12% were appearing to refresh their radiology knowledge. Remaining 17% said they were pursuing FRCR to do fellowship or work long term in Singapore/the Middle East.
Those radiologists planning to migrate or who have already migrated to the United Kingdom, Singapore, or the Middle East were asked their reasons for migration (multiple-response question) [Fig. 2]. The most common reason cited by majority of respondents (50%) was the lack of work-life balance in India. Other common reasons cited were better work and learning opportunities in the United Kingdom (37%) and prevalence of corruption and “cut practice” in India's private sector (30%). Other reasons were saturation of radiology private practice in India with excess competition, lack of academics and research opportunities in India, and better remuneration in the Middle East and Singapore (all 22% each).
The reason why candidates appear for a licensing examination is a personal choice. As per feedback from respondents, the inequality in radiology training standards with lack of infrastructure and academics across many places in India pushes some in tier 2 and tier 3 cities to pursue FRCR to validate their knowledge to globally recognized standards. Nevertheless, attaining an FRCR degree involves a substantial financial commitment, particularly in India where the FRCR fees are considerably higher compared to most other countries (except Singapore). Currently, there exist distinct examination fees for RCR members and nonmembers, with nonmembers incurring higher costs.[2]
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In the past, resources for FRCR preparation in India were limited; however, the landscape has changed significantly. Presently, there are few new websites and multiple social media groups that offer valuable guidance and support, catering even to those who have experienced initial examination failures or faced challenges in securing examination slots. Increased awareness and discussions resulting from these may also be contributing to increased applications from candidates.
The RCR has taken some steps to decrease the waiting time for examinations and increase examination slots, which may also be contributing to the surge in candidate numbers. The incorporation of more examination venues across the United Kingdom, such as Bridgend, Leeds, Crewe, Plymouth, and others, as well as the inclusion of international venues in countries like India, Pakistan, and Egypt, is aimed at diminishing the waiting period.[2]
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[4] Recently, RCR has introduced the RCR Exam Hub, a platform dedicated to exam applications which has brought greater transparency regarding the availability of exam slots and made the process more efficient.[5]
Considering the current situation, the RCR may take note that approximately 56% of Indian FRCR candidates have no intention of working in the United Kingdom, which means they will not be contributing to the United Kingdom health care workforce. To address the prolonged waiting times to appear for the exams and multiple exam application attempts, prioritizing the applications of candidates aspiring to work in the United Kingdom could help alleviate the radiology staff shortages the country is facing.
Fig. 2 Bar diagram showing the responses to the question asking the reason for migration among those radiologists who have migrated or planning to migrate outside India.
