Assuming I pass the USMLAs, I am pretty sure I want to move straight to the USA after medical school. I want to eventually specialise in neonatology and I know how that will work here in the UK money and timescale-wise, but can't get a clear idea of the money situation in the US. Can anyone give me a rough idea of salaries from graduating med school to obtaining specialisation? This doesn't have to be very specific, rough estimates are fine. I am essentially trying to decide whether I should do some or all of the specialisation here or in the US.

Anything you do in the UK after med school won't be valid in the U.S. You will just have to do it all over again. (i.e. even if you finished all of your specialization and then came to the U.S., you wouldn't be able to practice until you repeated it all in the U.S.) You have to first finish med school, take the USMLEs, and apply for residency. To be a neonatologist, you would have to complete a three-year residency in Pediatrics, followed by a fellowship in neonatology (I'm not sure how long that is). I'm not sure how much it would cost you to take the USMLEs, but with test fees, study books, and travel, I would estimate at least $3000. While you are a resident, you will be paid somewhere between $38,000-$44,000 to start, with salary increases each year.

If you weren't in Scotland I'd know who you were (I've heard an SHO in Oxford is thinking along same lines as you) and could talk this over with you over a pint...

Basically, a fully trained attending in neonatology in US would earn about 170K pounds after training. So 1.5x-2.5x what a UK consultant would make.

An attending isn't the same as a UK consultant however. In terms of duties, hours, etc they are more like a (hardworking) senior reg (still do all the rubbish shifts, work 60hrs/wk etc, all sessions clinical!). Could also be a problem if you ever wanted to come back to UK - traditionally UK has been pretty rough on US trained attendings who want to practice in UK (making them go be regs for 2-4yrs etc) but this may change now that PMETB is up and running.

The training system in US is pretty restrictive in terms of being a normal human. Hours are typically 70-80+/wk in Peds/Neonates during training. 3-4 weeks/yr holidays at most. If you are young and have no family it is do-able, but think carefully otherwise.

If you can live with American lifestyle/"work ethic", coming from UK you'll have no real problems - especially if you want to go into academics (lower paid - many US students have huge loans,have come to medicine with high salary expectations, and think less than 120K pounds/yr means they will be poor!).

Finally, in reality, in contrast to what the previous poster said, UK training does give you credit/head start in US training. I've known a couple of SHOs who have started as PGY-2 (ie: missed intern year) thanks to their UK postgrad training. An example is internal medicine (which gives you 1yr credit for 3yrs of training): http://www.abim.org/cert/special.shtm

If you are still a student give some thought to doing F1 an F2 before you go, you'll have a couple of years of earning decent money for example (that is another thing - US training pay SUCKS) and you'll have a better chance of coming back if you don't like it in US then.

Best of luck,

I used to work with a guy who was a neonatology registrar in the UK before coming to the US. He started out as an intern in pediatrics but advanced to third year after about 6 months. From that point on, he staffed ICUs and NICUs and some of the US trained attendings consulted him on complicated issues.

In cases like this, the american board of pediatrics allows you to shorten the residency from 3 to 2 years (provided that you agree to pursue fellowship training or a 'chief resident year' for the third year).

Be sure to understand the differences between the systems. Unlike a consultant who can slack off and let the lower minions do his work, a neonatology attending (at least in private practice) will be required to take call and come in at ungodly hours to cover high-risk deliveries or 'attend' to sick kids under his service. The financial rewards are good, but the work is hard.

As for income during training:

Residency (year 1-3)

approx $40.000-$50.000 in first year, typically 2000 more per year of training. Depending on where you are in the country, this can be ok money or really little. Taxes are lower and cost of living can be controlled, but you have to anticipate that you can't build savings or buy a new car with cash during that time.

Fellowship (year 4-6)

depends. Some places just continue the 2000+ per year thing and you are looking at incomes somewhere in the 50s. At other fellowship programs income actually drops into the 30s (if there is a research component) But given that you are a board certified pediatrician at that point, you can make good money 'moonlighting' on the side (e.g. covering a community hospital NICU on your nights off).

Attending

According to the 2005 AMGA (american medical group association) survey, the average starting salary for a neonatologist is $165.000. Three years into practice, the average national income is $229.486 with some regional variation (AMGA data are representative of physicians in multispecialty groups and might not be representative of a single specialty neo group). Keep in mind that there is quite some variation. An academic neonatologists might only make 150k, someone in a private practice in a location with a good 'payor mix' might make 400k or more.