Introduction

The influx of foreign doctors into Britain was unprecedented in the post– World War II era. By 1955, overseas doctors—fully and temporarily registered— in aggregate far exceeded the annual production of domestic medical graduates. Their presence was no accident. The register continued to serve the national interest of Britain and British medicine even as the empire rapidly contracted. Technical assistance in the form of medical training constituted a major component in sustaining relations among member countries, including new Commonwealth countries in Africa and Asia that obtained their independence after the war. In addition to government-sponsored exchanges and training schemes abroad, domestic professional colleges and hospitals participated in the delivery of assistance to sponsored and unsponsored doctors. Indeed, overseas doctors who returned home with professional experience or additional qualifications advanced Britain's postwar vision of itself as a postimperial world power.

Besides buffing its image, technical assistance translated into an enormous transfer of wealth to Britain from donor countries. Indeed, the labor of overseas doctors was indispensable to the National Health Service (NHS). Launched in 1948, the NHS fulfilled a wartime pledge of comprehensive social security for all British citizens as outlined in the 1942 Beveridge report. Organizationally, the NHS consisted of a hospital service and a network of private practices that contracted with the government. But the delivery of medical care was ultimately dependent on a steady supply of doctors, especially in the hospital service. Even after mandating a preregistration yearlong hospital rotation for all medical graduates in 1952, growing use of services exposed the structural imbalance between the demand and supply of medical labor. Here overseas doctors supplemented the domestic profession. By 1960 they accounted for nearly 40 percent of the medical staff in the junior or training grades. In accommodating the training aspirations of overseas doctors, temporary registration afforded hospitals with an elastic supply of doctors to deliver health care to the public. These doctors provided care in underserved urban and rural hospitals. Their conditions of registration ensured that they would be under the supervision of a senior British member of the hospital staff and would not compete with domestic medical graduates who pursued career advancement in the service or practiced medicine privately.