UK Graduates going to America

[harshanl]

Hi Everyone,
I'm a 5th year medic at Oxford, and am interested in doing a residency in the US when I qualify. From reading some of the threads on this forum, it seems that this is not a well trodden route. Is there anyone else out there who has/is interested in moving to the US after qualifying in the UK? Are UK graduates similarly disadvantaged to other FMG's in breaking into the US system?

Another question I have is to what extent one is disadvantaged as a FMG AFTER obtaining a residency. Are FMG's mistreated/exploited/abused compared to their US counterparts during the residency and afterwards (when applying for fellowships etc)? Or is everyone on an equal footing after getting past the residency application bottleneck?

I've been reading some of the residency reviews on scutwork.com, and most of the correspondents quote the number of FMG's on their program as if it were inversely proportional to the quality of the program (e.g. we have only x scum of the earth at our hospital). Is this representative of the general prevailing attitude towards FMG's?

So many questions, so few answers!
Any comments would be gratefully received.
Thanks,
Harshan

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[Jus]

Hey Harshan,

Like you I am contemplating the US route. I'm in my 2nd yr at Imperial, so I'll probably be taking the Step 1 sometime next year. Have you taken yours already? I'm afraid I don't know too much about the US system but the main reason I'm looking to cross the pond is cos the programmes there seem so much more organised. I've been speaking to some doctors over here, and you can literally languish for years and years here in an SHO or SpR posts waiting for a consultant to die...

Regards,

Jus

 

[Badkarma25]

I find this thread interesting...firstly, for the sake of accuracy, you can't really refer to North America collectively...you need to consider the U.S. and Canada separately, because frankly, they are two different worlds for FMG's. Having said that, I think that someone coming from Oxford would be well set up to get a residency and license in both countries, with the U.S. being easier. Oxford isn't exactly a fly by night operation, and assuming you do well on your USMLE's and your immigration issues can be swiftly resolved (visas and the like), you should have no major problems. The difficulty will lie in the experience (or rather, lack thereof) you have with American programs and residency directors. It is these connections that can really make all the difference in the world. Have either of you done any rotations or electives stateside? If not, I'm not really sure how much of a disadvantage you are at. Do well on your tests and go from there...and have confidence...you'll get something.

 

[Apollyon]

Being a USFMG, I've been at a lot of hospitals with graduates of programs based on the UK model (mostly Pakistan, India, and Nigeria). One recurring theme I've deduced (and had explicitly been told to me many times) is that the UK system is hardcore racist - without even a pretext, if you are from the subcontinent or Africa, you can linger for years (or your career) as a SHO or Senior Registrar; I have not heard if the same applies to "white" graduates. A cardiologist I know said that, "Anyone who says they like it in the UK is lying".

Ironically, though, I only know of one guy who graduated from a UK med school (Guy's Medical School) who did a residency in the US. He's an Indian guy, who has at least 2 brothers (maybe it's 3) that were already here. There's only one other guy NOT from India, Pakistan, or Nigeria, who is from NZ, did medicine at Charity in New Orleans, and is doing ID at Mount Sinai. Of course, I know that there are more than this, but I don't have experience with them.

One big problem with coming from the UK system is the transition to "multiple choice/multiple guess" exams, from the essay ones you're used to - you can't draw a picture of a renal calyx on Step II. There's one person I know from SDN only that went to school in Australia, failed Step I, and yet, even so, matched very well in a competitive residency.

And, here in the US, it's all your effort, and none of where you're from (after you get in). The current National Institutes of Health administrator is a radiologist from Algeria. One of the executive vice-presidents (maybe retired now) from UT-San Antonio went to school in his native Mexico (he tells a good story of his residency at "St. Mary's Lost-in-the-woods" in surgery, after finishing 1st in a class of 800). The only bummer is getting into a residency. It is illegal to discriminate by school, but no one (unless they are brain-damaged) will say "we don't take FMG's". However, if you speak English clearly, and have bulletproof numbers, you should do all right.

When you're an attending (say "consultant", and people will say, "Consulting what service?"), it's wherever you find a job - if you're trained and board certified/board eligible, only a fool wouldn't take a doc because of where they're from. When I was a student, one of my classmates said that studies preliminarily showed the FMG stigma follows you, but, if you get the job you want, how are you stigmatized?

 

[Vindaloo]

Originally posted by Apollyon
One big problem with coming from the UK system is the transition to "multiple choice/multiple guess" exams, from the essay ones you're used to - you can't draw a picture of a renal calyx on Step II.

This is completely inaccurate. Certainly not for the UK medical schools at least. I am studying for multiple choice (MCQ's) exams right now!!!

 

[Apollyon]

Originally posted by Vindaloo
This is completely inaccurate. Certainly not for the UK medical schools at least. I am studying for multiple choice (MCQ's) exams right now!!!

Chill out, dude! All I know is that people in the "UK system" have to draw pictures, and that the Nigerian, Indian, Pakistani, and Sri Lankans can diagram something infinitely superior than most US docs (ask a US EM doc to draw a hand on the chart, and you'll see).

Moreover, the UK med students I dealt with in Grenada COMPLETELY derided the "MCQ" format; this was 6 years ago, so maybe there's been a sea change.

And, as for "completely inaccurate", you are saying that ALL your exams are multiple guess, and there are NO essays or diagrams? Ever?

 

[Vindaloo]

Originally posted by Apollyon
Chill out, dude! All I know is that people in the "UK system" have to draw pictures, and that the Nigerian, Indian, Pakistani, and Sri Lankans can diagram something infinitely superior than most US docs (ask a US EM doc to draw a hand on the chart, and you'll see).

Moreover, the UK med students I dealt with in Grenada COMPLETELY derided the "MCQ" format; this was 6 years ago, so maybe there's been a sea change.

And, as for "completely inaccurate", you are saying that ALL your exams are multiple guess, and there are NO essays or diagrams? Ever?

Ok, I am chilled but was chilled before when I wrote it. When you said UK SYSTEM, I read it as medical schools in the UK. I think a more accurate phrase would be UK based model or UK model.

The MCQ format is very similar to US multiple choice exams. Not sure why they derided it. Furthermore, I meant that your statement was inaccurate. I think overall the exams are very similar to the US. I've never written an essay for an exam or have been asked to draw anything. I have written short answer/fill in the blanks in addition to MCQ's. Is every exam at medical schools in the US multiple choice?

Out of curiosity what were UK students doing in Grenada? Rotating through the hospitals or attending the medical school as students?

 

[harshanl]

Thank you for all the replies, all of which were helpful.

Apollyon Wrote -

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Being a USFMG, I've been at a lot of hospitals with graduates of programs based on the UK model (mostly Pakistan, India, and Nigeria). One recurring theme I've deduced (and had explicitly been told to me many times) is that the UK system is hardcore racist - without even a pretext, if you are from the subcontinent or Africa, you can linger for years (or your career) as a SHO or Senior Registrar; I have not heard if the same applies to "white" graduates. A cardiologist I know said that, "Anyone who says they like it in the UK is lying".
------------------------------------------------------------------------------------



This is only partly accurate - the system here is "Nationalistic", and not strictly racist; i.e. the in discrimmination occurs against FMG's, as opposed to UK graduates who belong to an ethnic minority. I too have come across many disillusioned FMG's who have been stuck at a junior grade without hope of further progress. I suppose the situation is similar to what is found in the US, except that the training here is more highly stratified (e.g. House officer->Senior House Officer->registar->consultant), and discrimmination occurs at each stage. The consensus seems to be that breaking into the US system at the residency level is harder, but things are relatively straightforward thereafter.


I'm a Sri Lankan citizen who is (shortly) going to graduate with an Oxbridge degree, so am in an intermediate position. Paediatrics at the top of my speciality wish list, so hopefully getting a decent residency in the US would not be too hard (I hope!).

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[harshanl]

Jus Wrote
----------------------------------------------------------------------
Hey Harshan,

Like you I am contemplating the US route. I'm in my 2nd yr at Imperial, so I'll probably be taking the Step 1 sometime next year. Have you taken yours already? I'm afraid I don't know too much about the US system but the main reason I'm looking to cross the pond is cos the programmes there seem so much more organised. I've been speaking to some doctors over here, and you can literally languish for years and years here in an SHO or SpR posts waiting for a consultant to die...

Regards,

Jus
------------------------------------------------------

Hi Jus,
I'm taking my STEP 1 in September, and STEP 2 after Finals next Summer. The plan is to keep the US option open if I decide to make the switch. At least 5 other people in my year at Oxford are doing/have done the USMLE's. Do you know of anyone who's actually gone down the UK->US route? Seems not many people go down that road.

Good luck in your studies.

Harshan

 

[Apollyon]

Originally posted by Vindaloo
Is every exam at medical schools in the US multiple choice?

Out of curiosity what were UK students doing in Grenada? Rotating through the hospitals or attending the medical school as students?

To my knowledge, if everyone is sitting the exam, yes. Questions have to be objective, without ambiguity. They need to be scored quickly. This lends itself to machine scoring, and, ergo, multiple guess. Quizzes in small groups can be fill in the blank, but, if the whole class is there, no. But, then again, you put the modifier of "completely" on it - which is why I enquired as to the entirety.

UK students in Grenada were ostensibly rotating at the General Hospital - the condemned-by-WHO hospital, but it was more a busman's holiday. Sometimes, the students would extend the stay to Tobago. We had a visiting student from Oxford in New York City a month ago, and she was going from New York to Western Samoa for her next rotation.

 

[geezer]

Vindaloo,

I think the only way in which you have never had to write an essay or draw a diagram in an exam at med school will be if you are a fresher and have actually not sat an exam yet. What school do you go to?

Yes it is true that we take MCQs in the UK but tis accounts for relatively little here in the UK compared to the US. Also, our mcq's are negatively marked!!!

 

[Digi]

Perhaps Im a bit off topic, but the search function is disabled for me. Are there any threads that talk about American students going to the UK to get their medical degree? For me it's a family issue. I see people talking about Ireland, Australia and the Caribbean, but not much about the UK. I appreciate any input.

 

[PTCA]

Harshan,

This is only partly accurate - the system here is "Nationalistic", and not strictly racist; i.e. the in discrimmination occurs against FMG's, as opposed to UK graduates who belong to an ethnic minority. I too have come across many disillusioned FMG's who have been stuck at a junior grade without hope of further progress. I suppose the situation is similar to what is found in the US, except that the training here is more highly stratified (e.g. House officer->Senior House Officer->registar->consultant), and discrimmination occurs at each stage. The consensus seems to be that breaking into the US system at the residency level is harder, but things are relatively straightforward thereafter.

What do you think are the advantages of doing a residency in the us vs doing a residency in the uk since you are a uk graduate and the discrimination issue does not apply to you? Is it something about peds in particular or does it concern all specialties? Can anyone elaborate on the discrimination? At what stage of your training-career can you be halted being a EU graduate (before or after doing a specialty) in the UK? I am not really familiar with the ranks you mentioned (SHO ect.) so I can?t figure out if you are only delayed professionally after residency or if the delay can influence your specialty training (since I am considering returning in my country after specializing in the UK}? Does this trend appear in all specialties, or are there fields where uk and non uk graduates could be jugged by their performance alone (perhaps certain less competitive fields)?
Thanks in advance for any info.

 

[MacGyver]

There's one person I know from SDN only that went to school in Australia, failed Step I, and yet, even so, matched very well in a competitive residency.

Huh? How is it possible to get a residency if you fail Step I?

 

[leorl]

At my university, although not strictly based off the UK system, yes...we had to draw diagrams. I actually liked it very much, although I would have preferred some MCQs as well. We do have MCQs in most subjects, but the Anatomy department actually chose to do away with them since they found out that students whose native language was not English were having difficulties understanding some of the questions correctly. Also for some reason, they found that North Americans were having trouble with the MCQs...maybe because they weren't exactly the straightforward type of MCQs that we are used to having. Instead, most MCQs are (choose a or b, just b, or none of the above, all of the above), that kind of thing...which can get tricky. Some courses even try to mimic USMLE0-type MCQs, even though the USMLE isn't prevalent in these countries. So I really don't think the differences in "the system" center around MCQ vs. essay/diagrams, because we get both.

Also, MCQ negative marking is a pain in the ass.

 

[Vindaloo]

Originally posted by geezer
Vindaloo,

I think the only way in which you have never had to write an essay or draw a diagram in an exam at med school will be if you are a fresher and have actually not sat an exam yet. What school do you go to?

Yes it is true that we take MCQs in the UK but tis accounts for relatively little here in the UK compared to the US. Also, our mcq's are negatively marked!!!

you're wrong. MCQ's account for 1/3 of all of our exams. I haven't had to draw a diagram all year and I don't think I will ever have to.

Furthermore MCQ's account for a fairly significant part of exams later in your medical education (for example MRCS, FRCA).

 

[Lexmark]

Your biggest single problem is immigration. If you've got the visa issue sorted then you'll want to take USMLE step 1 and 2 and I think IMG's do a clinical exam as well.

As a grad from England you'll find positive discrimination and especially with a degree from Oxford Uni. The American medical profession can be just as snobby as the UK one given the chance.

 

[geezer]

Are USMLE scores only valid for a limited period of time? The reason I ask is that I intend to take both step 1 and step 2 by this time next year however I want to take the MRCP/MRCS before I leave the UK. This means that I will be applying for US residencies in about 3 years time.

 

[Winged Scapula]

The only time restriction I am aware of in regards to USMLE is that all 3 steps must be taken within 7 years. If you apply to US residencies within 3 years, you will still have some time before being required to finish Step 3.