‘Brexit’ and electives: An uncertain future
Each year, many of the 6,000 or more medical students from faculties across the UK set out on their electives (1), spending several weeks in medical settings ranging from a tiny district hospital on the island of Fiji to a huge teaching hospital in the heart of London. The opportunity to experience healthcare systems across the world is arguably invaluable, especially considering that medical students in the UK are privileged to study within a technologically advanced and free at the point of use NHS. However, during the past couple of months, young people across the UK have been expressing concerns regarding the future of freedom to travel, down to the UK voting to leave the European Union (EU) on the 23rd June 2016 (2). Faced with having their EU citizenship removed, many medical students may be wondering what consequences this will have when planning their elective or travelling to practise medicine internationally.
Travel and residence in the EU
First and foremost, holding EU citizenship brings with it the “right to move and reside freely within the territory of the EU” (3). Simply put, a medical student undertaking their elective within the EU has the right to travel or live there within the period of their elective placement, so long as this is less than three months in duration. A visa is therefore not required.
It is not yet clear as to how these rights will change once the UK enacts Article 50 of the Lisbon Treaty, however it must be assumed that as current non-EU citizens are not entitled to these rights (3), British citizens could lose these rights once the UK leaves the EU. Although needing a visa for travel in the EU in the future is unlikely, there are worries that EU member states may impose restrictions on British citizens residing and working within the EU, just as one of the key arguments for ‘Brexit’ was to impose similar restrictions for non-British citizens to reside and work within the UK (2).
However, due to the short-term nature of a medical elective, alongside the fact that an elective is not truly paid work in another country, these restrictions if imposed should not have an extremely adverse effect on the right to reside within the EU during an elective.
Planning a medical elective can pose a huge financial challenge for some students. Before even leaving the country, there are a range of costs to consider, including visas, flights, travel and medico-legal insurance, and fees charged by the host institution. There may be worries that these costs could increase when the UK leaves the EU, for example the cost of currency. The value of sterling fell dramatically on the evening of the EU referendum, leading to a rise in the cost of purchasing euros (4). Although some predict this to recover, the future of the cost of travel looks uncertain for the time being.
Insurance and protection
Most host institutions require proof of professional medical indemnity insurance in order for students to attend their elective placement. Currently there is good legal representation for UK medical students abroad, for example, membership with the Medical Defence Union currently covers medical student electives in other countries including those in the EU (5). Changes in law and policy once the UK does indeed leave the EU could threaten indemnity abroad, and since there is no known date for the UK to actually leave the EU, medical students may be wondering when and where their indemnity will be valid.
Attitudes to British citizens abroad in the EU
In the aftermath of the EU referendum, reports surfaced of a surge in hate crimes against minorities in the UK (6). It is inaccurate to say that the attitudes behind these crimes are representative of the entire population of the UK, but nevertheless these events may have painted the UK in a bad light. Many UK medical students may worry that they will not be as readily accepted on their electives in the EU as a result of the referendum. An elective is often a huge challenge in itself, fitting in to culture and the way of life of a new country, and there could be concerns that Britons will not be as welcome in the EU as they once were.
It is clear that there will be changes for the UK when it eventually leaves the EU, however what is less clear are the implications for planning electives. Travel restrictions and financial challenges will of course be a barrier for UK medical students abroad, but probably the most serious concern is whether they will be accepted in an organisation their country has decided to leave. This may well lead to more students opting to travel to a non-EU country to undertake their elective and travelling further afield may increase costs to students. Moreover, medical students may simply remain in the UK to undertake their electives, to avoid complications of planning an elective within the EU and to bypass the cost of travelling to non-EU countries.
Despite these concerns, it remains important to remember the reasons behind an elective: to widen medical and cultural experiences, and to make a difference to the lives of others, whether that be halfway across the world or much closer to home.
1. Banerjee, A. Medical electives: a chance for international health. Journal of the Royal Society of Medicine. 2010, 103, pp.6-8.
2. The Guardian. Britain has voted to leave the EU – what happens next? [Online]. 2016. [Accessed 29 August 2016]. Available from: http://www.theguardian.com/politics/
3. Treaty on the Functioning of the European Union, 13 December 2007. [Online]. 2007/C 306/01. [Accessed 11 July 2016]. Available from: http://eur-lex.europa.eu/
4. The Guardian. The post-Brexit pound – how sterling’s fall affects you and the UK economy. [Online]. 2016. [Accessed 29 August 2016]. Available from: https://www.theguardian.com/business/
5. The MDU. Indemnity for your elective. [Online]. 2016. [Accessed 29 August 2016]. Available from: http://www.themdu.com/for-students/your-elective/...
6. The Guardian. Police blame worst rise in recorded hate crime on EU referendum. [Online]. 2016. [Accessed 11 July 2016]. Available from: https://www.theguardian.com/society/