NHS trusts have been accused of using foreign doctors as “cheap labour” following an investigation.
Doctors can work in English hospitals for two years as fellows to gain experience to implement in practice in their home countries.
But a British Medical Journal (BMJ) investigation claims some are paid less than other employees, and have fewer benefits.
The NHS said the fellows played an important role.
About 7,000 trainees have taken part in the Academy of Medical Royal Colleges’ (AoMRC) Medical Training Initiative (MTI) scheme from countries including Pakistan, India, Sri Lanka, Egypt, Nigeria and Saudi Arabia since it began in 2009.
The BMJ found an agreement between the College of Physicians and Surgeons Pakistan (CPSP) with University Hospitals Birmingham NHS Foundation Trust (UHB), Dudley Group NHS Foundation Trust, and Walsall Healthcare NHS Trust led to trainees being paid less than trust-employed workers.
It claims senior fellows from Pakistan who worked at UHB as grade three specialty trainee (ST3) registrars or above were paid a stipend of between £2,700 and £3,600 a month by CPSP, which is the equivalent of £32,400 to £43,200 tax-free a year.
They are not guaranteed overtime pay or pay for on-call work.
The BMJ said UHB would not confirm the exact equivalent salary details, but according to NHS payscales, ST3 doctors employed by the trust were paid £51,017 in 2022-23 and £55,328 a year in 2023-24 as a basic gross salary, excluding any overtime or enhanced hours payments.
However, UHB said that it was not representative to compare the two pay scales.
One consultant, who spoke to the BMJ anonymously, claimed UHB was using fellows as “cheap labour”, although another senior medic at the trust praised the scheme for its training opportunities, but highlighted a lack of equal pay and rights.
An AoMRC spokesperson said the issues raised were “concerning” and doctors should be paid the “correct rate for their work” but that it was a matter between the doctor and the NHS organisation that employs them.
In light of the BMJ investigation, CPSP is set to review and overhaul some guidelines, but said the scheme had improved healthcare in Pakistan.
A spokesperson for UHB said the programme “undoubtedly benefits the NHS system, but in return it benefits the overseas healthcare structure”.
Diane Wake, chief executive of the Dudley Group NHS Foundation Trust, said it did not directly employ staff who are part of the trainee scheme so is “not responsible for their remuneration”.
She said it had not received concerns from colleagues but would look into any that were raised.
Walsall Healthcare NHS Trust said it has recruited three MTI fellows under the CPSP scheme, who are due to start in November, but does not have any in post at present.
The CPSP has been approached by the BBC for comment.
An NHS spokesperson said salaries are agreed “between the individual trust and their international partner” and fellows play an important role in treating patients while learning “advanced clinical skills”.