I read with interest the debate about the International Fellowship Programme and the award of Membership without examination. As a psychiatrist returning to my home country I would like to share some views on these issues.

There is a shortage of psychiatrists in countries such as Pakistan and Sri Lanka but a large number of doctors trained in these countries work as psychiatrists in high-income countries. However, this situation existed long before the International Fellowship Programme came into being. As long as there is a shortage of psychiatrists in high-income countries and free movement of doctors for employment is permitted, this ‘exodus’ will continue.

The postgraduate training programme in Sri Lanka is unique in that it requires 1 year of compulsory senior registrar training overseas, prior to obtaining certification as a consultant. Of the trainees who passed the MD Psychiatry examination and proceeded overseas, only about a quarter have returned to Sri Lanka. Thus the larger loss in Sri Lanka is of trainees and not consultants.

Many accusations have been levelled at the Fellowship Programme for offering attractive packages to lure experienced psychiatrists to the UK. It could also be viewed as providing opportunities for those who choose to work under difficult circumstances in low- and middle-income countries to experience working in a different system and reap financial benefits.

The recognition of equivalent qualifications and the granting of membership of professional organisations occurs in many professions. This has enabled skilled professionals to work in different countries without having to repeat their basic training. The Royal College of Psychiatrists has been quite conservative in the recognition of equivalent qualifications compared with some of the other Colleges. For example, overseas graduates who hold a postgraduate diploma which is recognised by the Royal College of Physicians and which requires a comparable period of training may be permitted to enter the MRCP(UK) part 2 written examination with exemption from the MRCP(UK) part 1 examination and without the need for further training (http://www.mrcpuk.org). The Royal Australian and New Zealand College of Psychiatrists also grants exemption to psychiatrists who have qualified overseas, dependent on their training and experience (http://www.ranzcp.org).

Those who obtain the MRCPsych by examination do undergo good training and work very hard to obtain the qualification. However, this does not mean that training programmes in other countries are necessarily inferior in quality.

If the College decides to continue to award MRCPsych without examination, it needs to develop clear criteria on how applications are reviewed and publish these criteria so that applicants are clear about the expected standards. The equivalence guidelines of the Royal Australian and New Zealand College of Psychiatrists are ones that the College would do well to emulate (Royal Australian and New Zealand College of Psychiatrists, 2004).

Declaration of interest

V.d.S. worked as a consultant psychiatrist in the UK under the Fellowship Programme. She applied for MRCPsych under Bye-Law Section III 2(ii) in 2005.