The UK’s National Health Service (NHS) is heavily reliant on migrant labour to deliver essential services. While evidence indicates that overseas doctors have less positive career outcomes that may result in pay gaps in comparison to UK-trained counterparts, extant theoretical explanations have been slow to consider the crucial role of workplace practices, and the degree to which pay gaps differ between multiple identity sub-groups. Adopting an intercategorical approach to analyse statistical survey data from 5,753 NHS doctors, we examine how pay gaps stem from career barriers and management support in male and female International Medical Graduate, European Economic Area and UK doctors. Our findings provide insights into intersectional variations in career barriers and pay gaps for skilled medical migrants which point to penalties for migrants, especially migrant ethnicized women. Based on our findings we extend the literature in two ways. First, we extend theoretical explanations of pay gaps by conceptualizing pay differences as a complex multi-layered concept that embrace workplace practices as well as intersecting demographic identities. Second, we contribute to theory on skilled migration by highlighting the counter-intuitive shape of management support on migrants’ careers and diversifying extant understandings of constraint and enablement in migrant careers.