Most international medical graduates arrive at the same fork in the road: sit PLAB, or apply through the Portfolio Pathway. Both lead to full registration with a licence to practise. They are not interchangeable, and picking the wrong one can cost you a year and several thousand pounds.
The short version
- PLAB is an exam route. Two parts, no seniority requirement, predictable process. Best if you are early in your career or your postgraduate qualification is not GMC-accepted.
- Portfolio Pathway (formerly CESR) is an evidence route. No exam, but you must demonstrate that your training and experience are equivalent to a UK certificate of completion of training, or to the standard of a specialist or GP.
- If you already hold an accepted postgraduate qualification such as MRCP(UK), MRCS or MRCGP, you may not need PLAB at all.
Route 1: PLAB
PLAB 1 is a 180-question single-best-answer paper, sat in the UK and at overseas centres. PLAB 2 is a 16-station OSCE, sat only in Manchester. You must pass PLAB 2 within two years of passing PLAB 1, and you must apply for registration within two years of passing PLAB 2.
What it costs. PLAB 1 is £283 and PLAB 2 is £1,036. Registration after passing is £481, or £184 if you qualified recently enough to qualify for the reduced rate. Add flights, a UK visitor visa, and around a week of accommodation in Manchester for PLAB 2.
How long it takes. Realistically 9 to 18 months from starting revision to holding registration, with the bottleneck almost always PLAB 2 seat availability rather than your own readiness.
Who it suits. Doctors within a few years of graduation, doctors whose postgraduate training is not recognised, and anyone who wants a first NHS job at trust grade or core level rather than direct entry to the specialist register.
Route 2: Portfolio Pathway
The Portfolio Pathway is an assessment of evidence, not an exam. You compile documentation covering every capability in the relevant UK curriculum: clinical knowledge and skills, teaching, audit and quality improvement, leadership and management, research, and continuing professional development.
What it demands. Typically six or more years of postgraduate practice, with a substantial part at senior level in the specialty you are applying in. The evidence bundle is large: logbooks, workplace-based assessments, structured reports from named referees, appraisal documentation and evidence spanning your recent practice.
How long it takes. Preparation usually runs 12 to 24 months alongside a full-time job, and the GMC assessment itself takes several months after submission.
Who it suits. Experienced specialists and senior GPs who want to enter the UK at consultant or GP level rather than restart training.
The questions that actually decide it
1. Where do you want your first NHS job to be?
If your goal is a consultant post, the Portfolio Pathway takes you there directly. If your goal is simply to get working in the NHS this year and build from there, PLAB is faster and far less administratively painful.
2. Do you already hold an accepted postgraduate qualification?
Check the GMC's list before you book anything. Holding MRCP(UK), MRCS, MRCOG, FRCA, MRCPCH or MRCGP can remove the PLAB requirement entirely, which changes the maths completely.
3. Is your evidence contemporaneous?
Portfolio Pathway evidence must reflect your recent practice. If your senior experience was five years ago and you have been in a service post since, you will spend a long time rebuilding a bundle that a panel will accept.
4. What can you afford to have go wrong?
PLAB has one failure mode: you resit. The Portfolio Pathway has many, and each one is measured in months.
A useful rule of thumb: if you can list your evidence against every curriculum domain from memory, the Portfolio Pathway is realistic. If you cannot, PLAB will get you into the NHS sooner, and you can build the portfolio here.
A hybrid strategy most people miss
Many successful IMGs do both, in sequence. They pass PLAB, take a trust-grade or specialty doctor post, and use two or three years of NHS practice — with UK appraisals, UK audits and UK referees — to build a Portfolio Pathway application that is far stronger than anything they could have assembled from abroad. UK-based evidence is easier for an assessor to interpret, and your referees are already familiar with the standard.
What to do this week
- Check whether your postgraduate qualification is GMC-accepted.
- Confirm your English language evidence is valid and in date.
- If you are leaning towards PLAB, look at real PLAB 2 seat availability, not the theoretical calendar.
- If you are leaning towards the Portfolio Pathway, map your existing evidence against the specialty curriculum and be honest about the gaps.
Take the pathway quiz for a personalised route, or read our PLAB vs MRCP comparison if the exam route is where you are heading.