Interesting discussion. I guess I have no idea what you guys are talking about except that your medical training system seems incredibly complex.
I guess while we're on the subject, would one of you two like to outline the pros and cons of the british vs. the american system. Being members of this forum, I'm sure that you understand the american system quite well (and it's simple enough).
I can give you a few points, what you consider to be pros and cons is up to you!
We do 2 general years straight from med school which involves a mixture of 6 different surgical and medical jobs so we are better generalists. In our system though we are expected to take care of minor things outside of our specialty that you would refer out.
We are expected to do minor procedures that your nurses seem to do, bloods, catheters etc at least at the very junior levels.
Our neurosurgery training is broader. You seem to do some neurology with neurosurgery but we do that, neuro HDU/ITU, some emergency med, some other surgical specialties and neuro-radiology within our neurosurgery training. We have a national neurosurgery curriculum, training will be very similar regardless of where you go. Also we move around a bit. We will spend a few months as the junior of a particular consultant rather than a junior on the service in general. Then after about 6 months you will switch to another consultant. This might be at the same or a different hospital, in most other specialties people move hospitals every 6 months to a year but there aren't that many neurosurgery centres so people tend to just switch to a different consultant within the same hospital.
Our training is longer. 2 general years then 8 years of neurosurgery +/- a few extra years for PhDs, fellowships, not getting a job etc.
We don't apply to a specific hospital. Neurosurgery has a national selection process. The whole thing is run out of one place, somewhere in Yorkshire I think. Those offered jobs put in preferences for where they want to be placed and then that, along with the applicants overall score from application, interviews etc determine where everybody ends up.
We have far less jobs. 18 is the number I have seen though I don't know if this is accurate. That's 18 training posts (residency) each year for the whole of the UK.
We struggle to get jobs at the end of training because there are just so few of them. All the NS attendings I know got several job offers with no problems.
The environment is different. We are quieter and can be snobby, but once you get to a certain level people will outright scream in your face if you mess up. In the US, at least where I have been people are louder, pushy and backstabbing rather than confrontational.
We are more protected at a very junior level in terms of how seniors will treat us. You basically have to be nice to students and those in their first 2 postgrad years here whereas I have seen people being absolutely awful to those of the equivalent level in the US.
We can be on call from home in the 3rd year of specialist training. However, due to the nature of the specialty most actually stay on site at this level. You have to be on site until a more senior level in the US.
The attitude to education seems different. In the US we were told that if your senior doesn't know the answer to something and you do you keep your mouth shut. In the UK you say the answer if you know it so everyone can benefit. You seem to stress research at a more junior level which is great in some ways but in my experience takes time away from other things and basic knowledge suffers for it. Teaching also seems to be stressed more in the UK. If you want to get a specialist job at all some evidence of teaching is expected. I started doing formal teaching back when I was a 4th year student which isn't our final year.
Our juniors can operate without supervision once they reach a certain level. A consultant does not have to be present if something comes in in the middle of the night that they can handle. That obviously gives our consultants a better lifestyle than your attendings. Some Americans seem to find this dodgy but bear in mind the length of our training, our "juniors" can have been neurosurgeons, and certainly doctors for longer than your very junior attendings. Juniors being allowed to operate alone essentially means that as a consultant if there is a simple surgery you hate you never have to do it!
Career progression is more closely supervised in the UK, from what I have seen anyway. In the US I was told that a couple of times a year you get a bit of feedback on your progress but it's not super formal. We have extensive reviews twice a year where you have to present your portfolio to a panel and discuss it. You need to show evidence of teaching, research and practical skill. You have a list of all the surgeries you have performed or assisted on and will have been marked on how competent you are at doing them all and if you don't reach a high enough number or sufficient skill level you may have to repeat a year. There is a bunch of other stuff in the review but you get the gist.
Our hours are shorter but busier. The working day is different too, you start earlier but finish earlier. Our hours are a bit more sociable.
The NHS is awful. If you want a scan, anytime, day or night, you get it, we might, we might not. We usually will but might have to fight for it. Your nurses are far better and more respectful. Here if a nurse doesn't want to do something, they often just wont. Most of them can't/wont take blood, do cannulas, catheters etc. They are also incredibly rude and will bitch to your face even if you are a consultant. Obviously not all are like that but it certainly isn't uncommon.
We are paid slightly more as juniors from what I gather but once fully qualified you will easily earn 4 times what we do.
Our neurosurgeons also seem to have a lot more kids than yours! A lot of our consultants will have 3-5 kids and most juniors seem to have 1 or 2, at least at my hospital which is one of the bigger centres. Your neurosurgeons at most seem to have 1 kid. Again that is just what I saw where I have been.
