Despite achieving A-grades in all three of his A-levels and securing interviews at two universities, Adnaan Patel could not win a place at a British medical school to pursue his ambition of becoming a doctor.
Instead, Patel swapped his northern English hometown of Blackburn for six years of study in the southern Bulgarian city of Plovdiv, following in the footsteps of a growing number of British-Asian students now seeking medical qualifications in Europe.
“I had a back-up offer to study optometry, but I just really wanted to do medicine. I had the grades and I already knew a couple of other people studying out here, so I thought, ‘why not? I’ll take the leap and go to Bulgaria myself,” he said.
Now 22 and in the third year of his medical degree, Patel is part of a growing pipeline of EU-trained talent entering the NHS, with Bulgaria the fastest-growing provider of overseas-trained UK graduates to the health service in 2023, according to data from the General Medical Council.
Other popular EU destinations include Poland and Romania, but the UK government estimates there are now more than 2,500 British students studying for medical and dental degrees across Bulgaria in cities including Plovdiv, Varna and Sofia.
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The UK health service is on a recruitment drive, with the number of places to study medicine at UK universities expanding by more than a third since 2017-18, rising from 7,660 to 10,415 in the current academic year, but demand still outstrips supply.
The NHS workforce plan, published in 2023, has set a target of 15,000 UK medical school places by 2031-32 but in the interim the health service has relied heavily on recruiting from abroad, including countries such as Pakistan and Ghana that are on the international ‘red list’ for doctor shortages.
However, health secretary Wes Streeting warned recently that the NHS had become “too reliant on pulling the immigration lever”, adding that too many “straight-A” British students were not getting places in UK medical schools.
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Until the new UK medical school capacity comes on stream, graduates from countries such as Bulgaria — which provided 435 British citizens with medical degrees in 2023 — can help boost the flow of doctors and dentists, and all at zero cost to the British state.
Mark Dayan, policy analyst at the Nuffield Trust think-tank, said the numbers of British students willing to leave home and train in Bulgaria “suggests there is pent-up demand in the UK for places.”
The British Medical Association, the doctors’ union, has called for more medical school places, as well as a commensurate expansion in training opportunities for newly qualified doctors.
“Those with the ability and desire to study to become a doctor in the UK should not be prevented from doing so due to a lack of places and high competition rates,” said Rob Tucker, chair of the BMA’s medical students committee.
Students at Plovdiv pay tuition fees of €9,000 a year, with living expenses typically taking annual costs to about €17,000 a year — or €100,000 for a six-year course — according to Adekunle Adetayo, a 2021 Plovdiv graduate now working in the accident and emergency department of Addenbrooke’s Hospital in Cambridge.
Adetayo, born in London and of Nigerian descent, was one of the early pioneers of studying in Bulgaria. But he found the transition so tough when he arrived in Plovdiv in 2015, that he later started an agency, MedConnect Europe, to help smooth the passage of others.
“I went through an agent and I was 18 years old. There were only 150 British students in the whole university back then, and there was no one there to help us when we arrived. They basically just left us to it,” he recalled.
The experience is much improved today, according to 19-year-old Merlin John, a first-year dentistry student who used another popular agency, InterHecs, to help her with the transition when she arrived last September, including the visa bureaucracy.
“We all met up beforehand online, which was very helpful, and they made us come out a week before term and arranged activities for us all to get to know each other,” said John, hanging out with a group of six fellow British students before class.
But there are still pressures. Many students were supported by family members working and sacrificing to meet the fees and living costs, said 21-year-old Hazrat Ali Khan, whose mother and sister have taken jobs in an online retail fulfilment centre to help pay his bills.
“I come from a low-income family. Sometimes it is a struggle to collect the money. I have debts with family and friends and I work in the summer, tutoring online. So I feel there is a financial pressure and a burden, but there’s also light at the end of the tunnel,” he said.
The challenge of moving to the Balkans to study in a city on the very edge of the European Union is partly softened by the sheer number of British students now obtaining medical degrees from Bulgaria.
The Medical University of Plovdiv, 150km south-east of the capital Sofia and a short bus ride away from Turkey, has more than 1,200 British students, roughly 80 per cent of whom — like Patel, whose grandparents came to the UK from the Indian state of Gujarat in the 1960s — are from South Asian backgrounds.
Around the campus, pockets of students with British regional accents from east London, Blackburn and Birmingham can be heard discussing their upcoming anatomy tests as well as the latest scores from the English Premier League.
Adjusting to Bulgaria’s language and cultural mannerisms was not easy at first, recalls 22-year-old Sumaiya Mahmood, now in her third year of dentistry, but she said the sacrifice of being away from home had been a valuable learning experience.
Mahmood, who grew up in Birmingham and is of Pakistani descent, achieved three Bs in her A-levels and revised hard to pass Plovdiv’s entrance exams in Biology and Chemistry, choosing dentistry in Bulgaria rather than accept a back-up offer to study pharmacy at Wolverhampton University.
“I feel blessed to be here. No schools in the UK were offering people in my position a place to study dentistry and Bulgaria has offered me that chance. So even if there are things we don’t like, Bulgaria has given us an opportunity the UK did not,” she said.
Those who win places are taught in English and receive a degree that is fully recognised in the UK. For clinical year students, the university boasts a state of the art simulation centre, with medical mannequins that can bleed, cry out in pain and even give birth.
Plovdiv, a city of nearly 400,000 people that combines ancient Roman ruins and Soviet-era industrial sprawl, has an Ottoman-era mosque where Muslim students can pray and a growing number of halal butchers to cater for their food needs.
Still, the students must get used to the no-nonsense approach of Bulgarian professors: when a group of British students arrive late for their anatomy class they are swiftly asked to leave. “No, go out please, you must be on time,” the teacher said before returning to teach the more punctual members of his class.
Veselina Goranova-Marinova, the vice-rector of educational activities at Plovdiv MU, said that UK students initially needed “more guidance” through the course materials than their Bulgarian counterparts, but then often did better in the exams.
“Come the end of the semester I’m often surprised by the results. The foreign students tend to be better prepared in the theoretical tests than the Bulgarians. The foreigners have difficulties to overcome, so perhaps they are more motivated to study hard,” she added.
For those who complete the course — and more than 90 per cent do, according to university data — a graduation ceremony takes place in Plovdiv’s spectacular Roman amphitheatre.
Muhammad Hamza, a 25-year-old from Blackburn who graduated from Plovdiv last summer and started work as a trainee dentist last month, has a video on his phone of the moment he strolled across the ancient stage, watched by his parents, to receive his graduation scroll.
“At the start I was apprehensive about studying dentistry abroad. I took it as a lifestyle choice, but then I came to love it,” he recalled. “And coming back to Plovdiv now, it feels like home. Looking back [at that video], it’s just pure happiness.”
Data visualisation by Amy Borrett