IMG Doctors in Emergency Medicine UK 2025: Your Complete Step-by-Step Career Guide

Why Emergency Medicine in the UK?

The NHS is one of the largest employers of international medical graduates in the world. Emergency Medicine in particular has historically welcomed overseas doctors — IMGs make up a significant proportion of the emergency medicine workforce at all grades, from junior clinical fellows to consultants.

For doctors trained outside the UK, Emergency Medicine offers a clear, structured training pathway, globally respected qualifications (MRCEM and FRCEM), competitive salaries, and the opportunity to work in one of the highest-acuity clinical environments in the world.

That said, the pathway is not simple. It requires careful planning across GMC registration, English language testing, examinations, visa sponsorship, and building a competitive training portfolio. This guide walks you through every step in the right order.

Step 1: English Language Test

Before you can register with the GMC, you must demonstrate that your English language skills meet the required standard. This applies to all doctors from outside the UK, regardless of country of origin — unless English is your first language and you trained in certain approved countries.

There are two accepted tests:

Step 2: GMC Registration

GMC registration is mandatory before you can legally work as a doctor anywhere in the UK, including NHS Emergency Departments. There are several routes to GMC registration depending on your existing qualifications and experience.

The MyIntealth System (New from 2024)

Since 2024, overseas doctors must verify their medical qualifications through MyIntealth — the new platform run by Intealth, which has replaced the old EPIC system. If you previously verified documents through EPIC, your credentials remain valid and have been migrated to MyIntealth automatically.

Step 3: Demonstrating Foundation Competencies

To enter Emergency Medicine specialty training in the UK, you must demonstrate that you have the equivalent of UK Foundation Year 1 and Year 2 competencies. There are two main ways to do this as an IMG:

• 1
  Apply for UK Foundation Training

  IMGs can apply to join the UK Foundation Programme directly. Applications require eligibility checking one year in advance. This is highly competitive but gives you structured, recognised training from the outset.

  Structured
• 2
  Take a Trust Grade (Non-Training) Post and get a CREST Form

  Most IMG doctors take a service post (Clinical Fellow, Trust Grade SHO, or Junior Doctor) in an NHS Emergency Department first. During this time, you work towards having a Consultant sign your CREST form (Certificate of Readiness to Enter Specialty Training). This confirms you have the equivalent of F1/F2 competencies and makes you eligible to apply for ACCS-EM training.

  Most common route

Step 4: The MRCEM Exam — The Key Qualification for IMG EM Doctors

The MRCEM (Membership of the Royal College of Emergency Medicine) is the essential postgraduate examination for any doctor pursuing Emergency Medicine in the UK. For IMG doctors, passing the MRCEM is one of the most important steps in your career — it demonstrates clinical knowledge, supports your training application, and in some cases enables direct GMC registration.

The MRCEM has three parts, which must be passed in order:

• 1
  MRCEM Primary

  180 Single Best Answer (SBA) MCQs in 3 hours. Tests basic sciences — anatomy, physiology, pharmacology, microbiology, pathology, and evidence-based medicine. Available at Surpass Test Centres internationally.

  Theory — 3 hours
• 2
  MRCEM Intermediate SBA

  180 SBAs across two 2-hour papers (90 questions each) with a 1-hour break. Tests the full range of emergency presentations and clinical decision-making. Available at Surpass Test Centres internationally.

  Theory — 4 hours
• 3
  MRCEM OSCE

  16 clinical stations of 8 minutes each, plus 1 minute reading time per station. Tests clinical and communication skills in a simulated emergency setting. Held in London, Kuala Lumpur, Chennai and Hyderabad — making it accessible internationally.

  Clinical — 2h 42min

Step 5: ACCS Training & Higher Specialty Training

The formal training pathway for Emergency Medicine in the UK is structured as follows:

Acute Care Common Stem (ACCS) — Core Training (CT1–CT3)

ACCS is a 3-year core training programme and the only route into Higher Emergency Medicine Specialty Training in the UK. During ACCS-EM training:

• Years 1–2 (CT1–CT2): Rotations through Emergency Medicine, Acute Internal Medicine (AIM), Anaesthetics, and Intensive Care Medicine (ICM)
• Year 3 (CT3): Focused Emergency Medicine training to ensure readiness for ST4 entry

IMG doctors can enter ACCS at three different levels depending on their experience:

Higher Specialty Training (ST4–ST6)

Following successful completion of ACCS, doctors enter Higher Emergency Medicine Specialty Training for 3 years (ST4–ST6). This culminates in the FRCEM (Fellowship of the Royal College of Emergency Medicine) examination and the award of a Certificate of Completion of Training (CCT) — the qualification needed to work as a Consultant in Emergency Medicine.

Alternative Route: CESR Portfolio Pathway (For Senior IMGs)

Not every IMG doctor wants to re-enter the training grade structure from the bottom. For more senior doctors with substantial Emergency Medicine experience, the CESR Portfolio Pathway (formerly known simply as CESR) offers an alternative route directly to specialist registration.

What is the Portfolio Pathway?

The Portfolio Pathway is the GMC's route to specialist registration for doctors who have not completed a GMC-approved training programme. Instead of going through ACCS and higher training, you compile a comprehensive body of evidence demonstrating that you have achieved the same competencies as a CCT-trained specialist.

CESR Requirements for Emergency Medicine

• Full GMC registration with a licence to practise
• Completion of Foundation Programme Year 1 and Year 2 (or equivalent)
• Minimum of 4 years postgraduate experience, including at least 2 years in Emergency Medicine
• Evidence portfolio demonstrating all RCEM curriculum competencies (CiPs)
• Multi-source feedback (MSF/360° feedback) from colleagues
• Annual NHS appraisals signed by your Responsible Officer
• Workplace-based assessments (CBDs, Mini-CEX, DOPs)

Visa & Immigration for IMG Doctors in the UK

Most international doctors working in the NHS require a Skilled Worker Visa (previously Tier 2). The good news is that NHS jobs are on the UK's Shortage Occupation List, which simplifies the process significantly.

Key Requirements

• Certificate of Sponsorship (CoS) — your NHS employer will provide this once you have a confirmed job offer
• GMC registration — you must be GMC registered before your visa can be processed
• English language evidence — your IELTS or OET results will be required
• Salary threshold — NHS medical salaries comfortably exceed the Skilled Worker Visa minimum

Medical Training Initiative (MTI)

The MTI is a sponsored scheme that allows junior doctors who qualified overseas to work and train in the NHS for up to 24 months. It is an excellent option for doctors who want to gain UK NHS experience before committing to the full training pathway.

NHS Salary for Emergency Medicine Doctors

NHS salaries are standardised and transparent. Here are the approximate salary bands for Emergency Medicine doctors at different grades:

* Figures are approximate basic salaries excluding supplements, on-call payments, and London weighting. NHS pay scales are subject to annual review.

Frequently Asked Questions — IMG Doctors & Emergency Medicine UK