BMA’s ARM did not just debate IMGs.

ARM exposed how the BMA treats IMGs.

For those who do not know, ARM is the Annual Representative Meeting of the British Medical Association.

It is one of the most important democratic meetings in the BMA. Doctors from across the UK attend, debate motions, vote on policy, and shape what the union will stand for.

This year, I attended ARM.

I left hurt, angry, and politically changed.

Here is my reflection after this year’s gruelling meeting.

BMA ARM 26, Brighton

1. I arrived feeling unseen. I left knowing we can no longer be ignored.

On the first evening, I attended the President’s installation ceremony.

I did not know many people. I could not see many IMGs around me. The room felt full of the old guard, prominent BMA figures, and medical students.

I felt like an outsider inside the institution.

Then the BMA President mentioned the international medical graduates in his one-hour-long speech. He acknowledged our contribution and recognised that many IMGs feel treated as second-class members of the profession.

That gave me goosebumps.

For a moment, I thought this ARM might be different.

By the end, that hope had been crushed.

IMG motions failed. IMG-led policy was defeated as our motion 59 was flipped ‘democratically 😉’ by a rider. IMG emergency motions were rejected. Many of us left feeling broken.

The President’s words made me feel seen.

The political process made me feel disposable.

2. Recognition is not representation.

IMGs were praised ceremonially but defeated politically.

We were recognised from the platform, but rejected on the conference floor.

That contradiction matters.

A union cannot build trust with IMGs by thanking us in speeches while rejecting our attempts to secure protection.

Gratitude is not protection.

Recognition is not representation.

IMG Voice is an advocacy group for IMGs inside the BMA

3. “IMG” has become a stigma:

ARM made something very clear.

“IMG” is no longer being treated as a neutral description of where someone qualified.

It has become a political mark.

Put “IMG” in a motion, and the motion becomes easier to defeat, which happened repeatedly this ARM.

Put “IMG” in an election statement, and the candidate becomes easier to dismiss, which manifested loudly in the election results.

Speak from an IMG perspective, and suddenly you are accused of threatening the future of UK graduates, which is how IMG activists are seen now!

That is deeply dangerous.

Some doctors carrying the IMG label are British-born UK citizens who studied medicine abroad. They are not “foreign doctors” in the lazy way some people imagine. They are British citizens, raised here, living here, committed here.

Yet the moment they carry the IMG label, they become politically marked as less legitimate.

That should trouble every doctor.

IMGs feel the stigma, UK IMGs feel it even deeper

4. “Deprioritisation” is sanitised exclusion.

The language matters.

“Prioritisation” and “deprioritisation” sound clean, technical, reasonable, and administrative.

But for the doctor at the bottom of that policy, it is not neutral.

It means:

Your labour is welcome, but your progression is conditional.

Your service counts when the NHS needs you, but counts less when you ask for a future.

You can staff the rota, but you cannot stand equally in the queue.

The political genius of “deprioritisation” is that it makes exclusion sound reasonable.

I do not experience this as deprioritisation.

I experience it as exclusion.

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5. Medical students deserved better than being placed against IMGs.

Medical students are afraid.

Their fear is real.

UK graduates deserve a future. They deserve fair access to training. They deserve serious advocacy.

But the debate should never have been allowed to become:

medical students versus IMGs.

It should have been:

medical students, resident doctors, locally employed doctors, and IMGs versus failed workforce planning.

The training crisis was not created by IMGs.

It was created by years of political failure, inadequate training expansion, poor workforce planning, over-reliance on locally employed doctors, and a system that keeps producing bottlenecks while asking doctors to fight each other for survival.

Medical students deserved serious advocacy.

They did not deserve to be placed on the emotional frontline of a political fight against IMGs.

6. The tyranny of the majority is real.

IMGs were an ineffective, and unrecognised minority inside this ARM.

That means the majority voted, amended, defeated, and moved on.

But for IMGs, these votes are not abstract. They affect training, visa security, career progression, family stability, a sense of belonging, and dignity.

Democracy is not only about whether the majority can win.

A union democracy is also judged by whether minorities can still trust the process when they lose.

At this ARM, many IMGs lost that trust.

The tyrrrranny! Auh

7. Motion 59 was designed as a bridge. The rider turned it into a gate.

Motion 59 was the clearest example of the ‘tyranny of the majority.’

Motion 59 was prepared by IMGs, during our dedicated time slot!

It was written to reinforce that significant NHS/HSC experience should mean 24 months of NHS/HSC service, which has been agreed last year as formal policy by the BMA.

That was not extreme.

It was a compromise.

Then came the rider.

Pushed in forcefully by the ARM’s top table, saying loudly ‘We need a policy’, although many of us believed the BMA already had one.

The rider changed the meaning.

A 24-month proposal became a five-year barrier.

A motion designed by IMGs as a bridge was turned into a gate.

That is why Motion 59 hurt so much.

Lost by only four votes in favour of the five-year rider.

Four.

It was not simply that IMGs lost a vote.

It felt as though the democratic process was used to invert the purpose of an IMG-led motion.

This is the part I will not forget.

We were not defeated by an overwhelming moral consensus.

Not crushed by logic.

Not buried by a united profession.

We were four votes away.

The argument landed.

And the room was divided, so as the union now!

8. The emergency motions showed the cost of procedural exclusion.

On the final day, IMG groups submitted multiple emergency motions.

Many of us prepared speeches.

I barely slept.

We believed there might still be a chance to speak, to challenge what had happened, and to put IMG pain directly before the Representative Body.

Then the emergency motions came out.

None of ours had been selected.

No debate.

No speech.

No vote.

No chance to make the case.

When a motion is debated and lost, at least the room has heard you.

When a motion is rejected before debate, it feels like being excluded before reaching the microphone.

That was crushing.

9. I felt more excluded by the union than by my hospital.

One of the strangest moments was being asked whether I felt bullied or excluded in my workplace.

The answer is no.

I do not feel excluded by my hospital.

I feel excluded by my union.

That is the contradiction.

The BMA speaks about fighting bullying, exclusion, and discrimination. Yet many IMGs felt excluded, dismissed, and politically marginalised inside the BMA itself.

That should trigger serious institutional reflection.

10. The old guard is complicated.

Some established IMGs have been in the system for years.

They survived.

They built careers.

They gained influence.

Some now have children in UK medical schools or are entering medicine.

Their fear is understandable.

One side fears permanent exclusion.

The other fears intergenerational loss.

But fear cannot be allowed to become policy that excludes newer IMGs.

Immigrant survival politics is complicated. But established IMGs cannot use IMG identity when it gives them legitimacy, then disappear when newer IMGs need protection.

11. Symbolic representation is not enough.

Representation is not just having someone with an IMG background in the room.

Is not a surname.

Is not biography.

Representation is what you do when the room turns against the people you claim to represent.

If IMG-background leaders cannot guide the community, explain the process, defend IMG-led motions, challenge procedural harm, and be accountable to IMGs, then that is not representation.

That is presence without power.

12. The next phase must be strategic.

ARM taught me a hard lesson.

Being right, being harmed and morally clear is not enough.

In union politics, you need organisation.

The next phase of IMG advocacy cannot be built on pain alone.

It has to become disciplined, strategic, organised, and impossible to ignore.

It must convert pain into organisation.

Visibility into votes.

Exclusion into political leverage.

We need to know who is hostile, who is persuadable, who is opportunistic, and who can be worked with.

We need alliances where possible.

Confrontation where necessary.

Accountable IMG leadership.

Procedural literacy.

IMG advocacy cannot rely on goodwill, last-minute motions, emotional speeches, or symbolic allies.

Organise, Vote, and Speak!

13. ARM broke something in me, but it also taught me how power works.

I left ARM hurt.

But I did not leave naïve.

I learned that recognition is not representation.

Gratitude is not protection.

I learned that IMG exclusion is not only a government policy problem.

It is also a BMA democracy problem.

A language,

A representation

A culture,

And a power problem.

14. Final message to ARM attendees, and the wider BMA community:

To everyone who was in that room:

We saw what happened.

And felt it.

And we will not forget it.

We were crushed by the union that claims it supports us!

You praised us ceremonially, then defeated us politically.

We designed a motion as a bridge; you turned it into a gate.

A 24-month compromise became a five-year barrier.

Emergency motions were rejected before we reached the microphone.

So do not mistake our pain for weakness.

Or our disappointment for defeat.

Or our exclusion for silence.

ARM did not end IMG advocacy.

ARM explained why IMG advocacy must become stronger.

The task now is clear:

Convert pain into organisation,

Visibility into votes,

And exclusion into a political force the BMA can no longer ignore.

We are coming!