Are we missing great talent because we focus too much on system familiarity?

Why an over-reliance on local-system experience may be quietly screening out some of the best clinicians available to us.

When a service is under pressure, there is a natural instinct to hire someone who can "hit the ground running". Usually that means someone who already knows the system: the same IT, the same pathways, the same way of working. It feels like the safe choice. But I have come to believe that an over-reliance on system familiarity is one of the quietest ways we miss great talent.

During my years in NHS transformation, I watched outstanding clinicians be overlooked, not because they lacked skill, but because their experience came from a different system. And I watched international professionals, once given the chance, become some of the most committed and capable members of a team.

The comfort of familiarity

Familiarity is reassuring. A candidate who already knows the local system needs less induction, asks fewer questions, and looks like less of a risk on paper. None of that is wrong. The problem is when familiarity becomes the primary filter: when "have they worked in our system before?" quietly outweighs "are they an excellent clinician who will grow and stay?"

What familiarity does and doesn’t predict

System familiarity predicts how quickly someone settles into the mechanics of a role: the login, the referral form, the local protocol. Those things are learnable, usually within weeks. What it does not predict is clinical excellence, resilience, how someone behaves under pressure, or whether they will still be with you in three years. Those are the things that determine whether a hire was a good one.

What we screen out

Every time we treat unfamiliarity as risk, we narrow the pool. We screen out the radiographer trained to an excellent standard overseas. The clinician returning after time abroad. The professional whose system worked differently but whose skills transfer completely. In a workforce shortage, that is a luxury none of us can afford.

England’s NHS Long Term Workforce Plan is explicit that international recruitment will remain part of the solution for years to come, and health systems in New Zealand and Australia rely heavily on overseas-trained professionals. These are not fallback hires. In many services they are the backbone.

Comparable systems, recognised training

It is worth remembering how much structure already exists to support this. Regulators such as the Medical Council of New Zealand recognise training from comparable health systems precisely because excellent clinical standards travel well across borders. The frameworks already say what experience sometimes forgets: a different system does not mean a lesser clinician.

Assessing potential, not just pedigree

The shift I would encourage is from screening for familiarity to assessing for potential. That means asking different questions: How strong is the underlying clinical skill? How quickly does this person learn? How do they work within a team? What support would help them succeed, and can we provide it? Good international recruitment is built around exactly this kind of support: registration, orientation, mentoring and time.

What would I do?

If I were reviewing how a service hires, I would ask three honest questions. Are we confusing "familiar" with "good"? Are our job criteria describing the skills the role needs, or simply the system we happen to use? And are we set up to support someone excellent through their first few months, because if we are, familiarity matters far less than we think.

Final thoughts

None of this is an argument against valuing experience. It is an argument for being honest about which kind of experience matters. The systems people know can be taught. The clinical judgement, the character and the commitment they bring cannot. In a world short of healthcare professionals, the organisations that thrive will be the ones willing to look past the familiar, and see the talent that was there all along.