Passing PLAB and landing a job is the part everyone prepares for. The first six months on the ward is the part that decides whether you settle or burn out.
Week one: paperwork before medicine
Your induction will involve more administration than clinical teaching. Expect ID badges, IT accounts, e-learning modules, mandatory training, occupational health, and a payroll form that will determine whether your first payslip is correct. Two practical points:
- Bring your passport, biometric residence permit or share code, GMC certificate and P45 if you have one.
- Register with a GP and open a UK bank account in the first fortnight. Many things downstream, from credit checks to tenancy references, depend on both.
The biggest clinical adjustment is not clinical
Most IMGs arrive competent. What changes is how you work:
Documentation is the record of your thinking
UK notes are expected to show your reasoning, your differential, your plan and your safety-netting, not just your findings. "Chest clear, continue" is not a defensible entry. Write as if a coroner and a colleague will both read it, because sometimes they do.
Escalation is expected, not weak
In many health systems, calling your senior at 2am signals that you cannot cope. In the NHS it signals that you are safe. Nobody criticises the registrar who was called; they criticise the one who was not. Learn your department's escalation ladder in week one and use it.
The multidisciplinary team has real authority
Nurses, pharmacists, physiotherapists and specialist nurses will challenge your decisions, and they are frequently right. Doctors who treat that as insubordination struggle. Doctors who treat it as free senior review thrive.
Consent, capacity and safeguarding are legal, not cultural
Mental capacity assessment, DNACPR conversations, and safeguarding referrals follow specific UK frameworks. Read your trust's policies early rather than improvising from experience elsewhere.
Money in the first three months
Your first payslip may be taxed on an emergency code, and it may be smaller than you expected. Budget for a gap: many trusts pay a month in arrears, so if you start mid-month your first payment can be six or seven weeks after arrival.
Recurring costs to plan for: GMC annual retention, medical indemnity where required, royal college membership, exam fees, professional subscriptions, and the immigration health surcharge if it was not paid upfront. Several of these attract tax relief through professional expenses — keep the receipts.
The part people do not say out loud
The loneliness is real, and it peaks around month two or three, once the novelty has gone and before you have friends. It is worse if you came alone, worse again on nights.
What helps, consistently:
- Say yes to the first three social invitations, even when you are tired.
- Find one person in the department who arrived from abroad recently. They remember the map.
- Keep one non-medical routine — gym, faith group, football, cooking on Sundays.
- Talk to your family on a schedule, not at random. Random calls become no calls.
If you are struggling, your trust has a free confidential staff support service, and the NHS Practitioner Health service exists specifically for doctors. Using them is not a mark against your record.
Build the record from day one
Your future self, applying for training or the Portfolio Pathway, will need evidence you cannot backdate:
- Start a portfolio in month one, not month ten.
- Get workplace-based assessments signed on the day, while the case is fresh.
- Register an audit or quality improvement project by month three.
- Teach something — students, foundation doctors, a nursing session — and collect feedback forms.
- Book your first appraisal early and keep the outputs.
The six-month marker
By month six, most doctors report the same three things: the clinical work feels ordinary, the documentation is automatic, and they have stopped rehearsing phone calls before making them. That is what settling looks like. It arrives later for some people, and that is normal too.
Track everything in the portfolio builder, and see what the whole move costs in our cost calculator.