The high levels of unemployment among international medical graduates (IMGs) in the UK and the skewed career structure of the NHS may stem from the 1930 withdrawal of General Medical Council recognition for Indian degrees forcing Indian colleges to align more closely with Western medical practices. From 2001 emigration to the UK surged just when UK medical schools were increasing their output. The result was severe unemployment among IMGs. The visa restrictions put in place to correct this make it difficult for IMGs to come to the UK even for short periods of experience. However, the Medical Training Initiative visa category offers an alternative and allows them the opportunity to gain up to two years' UK experience. The NHS has been in debt to IMGs and the countries that trained them since its inception. We must look for new ways to maintain international links and for the NHS to play a positive role in the global health economy.