Debating weather to do my residency in US or Ireland, thoughts and advice appreciated

[MoeC]

I hope everyone is doing well

I am a Canadian, who graduated from Europe a few months ago. I applied to the Irish medical council and waiting for the process to hopefully apply for an SHO job and later for a residency in Family medicine/GP when applications are open. I am also thinking of applying to the UK medical council (GMC) since for now, it doesn't require the PLAB exam. My sister is near the end of her residency in the US and everyone (who's in the medical field) I talked to about my decision is telling me to reconsider and do the USMLE and go to the US instead and that the US residency is number one in the world and I would have better opportunities worldwide and it's better than UK and Ireland especially in the long run..etc..etc..
My main issue with going to the US is the time I will need to prepare for the exams when I could be already working as an SHO and later do my residency directly.

Do you agree with the US being the best in the world and a huge difference compared to Ireland?
Would a doctor with an American Board have better opportunities and salary compared to a doctor with an Irish board where ever they go?
Will I regret not doing my residency in the US instead?

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[RangerBob]

Where do you want to work? I would do your residency wherever you want to work/live.

Otherwise I really can’t comment as I don’t know anything about international training/degree/licensing reciprocity/portability, etc. But I can’t imagine there’s a significant difference between being a US grad or Irish grad if you want to work in a non-western country. The bigger issue will be whether you know the language/customs/local healthcare policies.

Maybe if you want to stay in Europe the Irish degree is preferred since you’d have a better understanding (presumably) of European healthcare?

 

[MoeC]

Living in Europe for so long and the comfort it gives me compared to Canada and the US makes me say Europe. But if I want to later move to the middle east or come back to Canada or even move to Oceania, then maybe a US residency degree would be better?

 

[RangerBob]

Living in Europe for so long and the comfort it gives me compared to Canada and the US makes me say Europe. But if I want to later move to the middle east or come back to Canada or even move to Oceania, then maybe a US residency degree would be better?

I really don't know--this isn't an area I have any experience in. I just know it's best to train where you'd like to practice.

The US system is quite different from Canada, so I don't think it's a given that the US degree has a meaningful edge over Ireland there. More important, I suspect, is that you can learn the Canadian system.

I know essentially zero about the Middle East or Oceania's healthcare systems.

If you think you're likely to stay in Europe for a while, I'd probably do your training there. Unless another country's healthcare system is based off ours, I can't see the US having a big/meaningful edge over Ireland when it comes to job prospects. The US and Ireland both have modern healthcare systems, great education, and speak English.

I suspect what is more important is whether you have enough language/cultural competency to practice in the countires in the Middle East/Oceania that you're interested in. And if you have ties to those countries.

Once again, these are all my opinions. I am not knowledgeable about oversees training. I'm not sure how many people here will have expert knowledge in this area, but hopfully someone will chime in and confirm/refute if my opinions above are accurate.

 

[MoeC]

I really don't know--this isn't an area I have any experience in. I just know it's best to train where you'd like to practice.

The US system is quite different from Canada, so I don't think it's a given that the US degree has a meaningful edge over Ireland there. More important, I suspect, is that you can learn the Canadian system.

I know essentially zero about the Middle East or Oceania's healthcare systems.

If you think you're likely to stay in Europe for a while, I'd probably do your training there. Unless another country's healthcare system is based off ours, I can't see the US having a big/meaningful edge over Ireland when it comes to job prospects. The US and Ireland both have modern healthcare systems, great education, and speak English.

I suspect what is more important is whether you have enough language/cultural competency to practice in the countires in the Middle East/Oceania that you're interested in. And if you have ties to those countries.

Once again, these are all my opinions. I am not knowledgeable about oversees training. I'm not sure how many people here will have expert knowledge in this area, but hopfully someone will chime in and confirm/refute if my opinions above are accurate.

Thank you, I appreciate it. Yeah hopefully someone comes along and sheds some more light. Maybe I am in the wrong section tho?

 

[Crayola227]

If you train outside the US, it is almost nearly impossible to end up practicing in the US without redoing residency pretty much entirely.

My understanding is that with US training, it is somewhat easier to go and practice outside the US.

Only you can know which will work better for you.

 

[MoeC]

If you train outside the US, it is almost nearly impossible to end up practicing in the US without redoing residency pretty much entirely.

My understanding is that with US training, it is somewhat easier to go and practice outside the US.

Only you can know which will work better for you.

Gotcha, so yeah what i am wondering is that US training would be stronger worldwide than Irish training. This is sad because family medicine in Ireland is around 4 years compared to US where it's 3 years. It seems that it's just the reputation that America is the leading in medical advancment

 

[Crayola227]

Gotcha, so yeah what i am wondering is that US training would be stronger worldwide than Irish training. This is sad because family medicine in Ireland is around 4 years compared to US where it's 3 years. It seems that it's just the reputation that America is the leading in medical advancment

Well I wouldn't just compare # of years to decide that. The programs have rigorous standards and they definitely fit many hours of quality exposure in that time at most.

 

[MoeC]

Well I wouldn't just compare # of years to decide that. The programs have rigorous standards and they definitely fit many hours of quality exposure in that time at most.

Yeah of course, I just meant one of the things to consider before painting all other countries with one brush. It just feels that America has such a strong title that it overshadows many other countries which is honestly isn't fair.

 

[Crayola227]

Yeah of course, I just meant one of the things to consider before painting all other countries with one brush. It just feels that America has such a strong title that it overshadows many other countries which is honestly isn't fair.

Oh, I would definitely agree with that. Been arguing for years that countries with more humane work hours and are more years (and often graduates have less educational debt so it matters less they are in training more years) are fully capable of training competent and excellent physicians.

Just saying that the US is able to keep the # of years less by making up for it by requiring more hours worked in a given timeframe. It's brutal but it does work, quickly.

 

[guytakingboards]

Gotcha, so yeah what i am wondering is that US training would be stronger worldwide than Irish training. This is sad because family medicine in Ireland is around 4 years compared to US where it's 3 years. It seems that it's just the reputation that America is the leading in medical advancement

Pure anecdote but one of the people I knew who did training in Ireland just had phenomenal physical exam skills. Well beyond the average American trainee at the time. The idea is that there's much more limited access to imaging/laboratory studies in Ireland so they have to really knock out the H&P portion of the workup.

The US may lead the world in medical advancement but the random individual family med program might not be all that great. There's plenty of crap programs in crap locations. Family med isn't typically something that needs leading edge training (to my understanding). Most family med in the states don't even practice the full spectrum (i.e. OB, procedures, minor surgery, etc...).

I wouldn't necessary put the American family med programs on a pedestal, but then again I don't know much about the Irish programs either.

 

[MoeC]

Pure anecdote but one of the people I knew who did training in Ireland just had phenomenal physical exam skills. Well beyond the average American trainee at the time. The idea is that there's much more limited access to imaging/laboratory studies in Ireland so they have to really knock out the H&P portion of the workup.

The US may lead the world in medical advancement but the random individual family med program might not be all that great. There's plenty of crap programs in crap locations. Family med isn't typically something that needs leading edge training (to my understanding). Most family med in the states don't even practice the full spectrum (i.e. OB, procedures, minor surgery, etc...).

I wouldn't necessary put the American family med programs on a pedestal, but then again I don't know much about the Irish programs either.

I am really glad to hear that and this is what I aspire for. I even want rural medicine and to be very independent and know so much and do so much. Of course, I would also know my limitations and refer to specialists but as a last resort. I don't want to be a gatekeeper that sends patients here and there, dusting his hands from all the hard work. So hopefully Ireland is the way

 

[lymphocyte]

I am really glad to hear that and this is what I aspire for. I even want rural medicine and to be very independent and know so much and do so much. Of course, I would also know my limitations and refer to specialists but as a last resort. I don't want to be a gatekeeper that sends patients here and there, dusting his hands from all the hard work. So hopefully Ireland is the way

The opinion of your sister and her colleagues don't matter at all and are clouding your judgement. You talk a lot about reputation and opinions. If it's validation you're seeking, good luck, but you won't find it, and you'll end up miserable pursuing what other people think are important. I would recommend you figure out where you want to live and then train there. It'll be good enough, I promise.

Having said that, would you ever consider Australia? I think it has the best working conditions for doctors in the world. Standards of training are very high. And you can work in Canada, the US, or Ireland after you complete the FRACGP (which is the fellowship in general practice). I think we do rural healthcare better than any country in the world out of sheer necessity.

I am Currently Certified in a Country Outside the United States | ABFM | American Board of Family Medicine

If you have received training and certification in Australia, Canada, Great Britain or New Zealand you may be eligible to receive initial board certification through ABFM if:

www.theabfm.org

 

[MoeC]

The opinion of your sister and her colleagues don't matter at all and are clouding your judgement. You talk a lot about reputation and opinions. If it's validation you're seeking, good luck, but you won't find it, and you'll end up miserable pursuing what other people think are important. I would recommend you figure out where you want to live and then train there. It'll be good enough, I promise.

Having said that, would you ever consider Australia? I think it has the best working conditions for doctors in the world. Standards of training are very high. And you can work in Canada, the US, or Ireland after you complete the FRACGP (which is the fellowship in general practice). I think we do rural healthcare better than any country in the world out of sheer necessity.

I am Currently Certified in a Country Outside the United States | ABFM | American Board of Family Medicine

If you have received training and certification in Australia, Canada, Great Britain or New Zealand you may be eligible to receive initial board certification through ABFM if:

www.theabfm.org

Thank you

For the first part, I definitely agree, and I definitely am not looking for validation. Maybe they are and want a better "title" for me, which really annoys me, because it may not really be the case. But no I am looking for what's best overall and that is useful anywhere I go.

As for Australia, I did consider it for a long time but the same issue for me is that I need to spend time preparing for the exams, and I really want to start training already. And another small issue is that it would really far from my family.

 

[Old_Mil]

I talked to about my decision is telling me to reconsider and do the USMLE and go to the US instead and that the US residency is number one in the world and I would have better opportunities worldwide and it's better than UK and Ireland especially in the long run..etc..etc..

My main issue with going to the US is the time I will need to prepare for the exams when I could be already working as an SHO and later do my residency directly.

Do you agree with the US being the best in the world and a huge difference compared to Ireland?
Would a doctor with an American Board have better opportunities and salary compared to a doctor with an Irish board where ever they go?
Will I regret not doing my residency in the US instead?

Having worked both in the US and overseas after going to a US medical school and non-FP US residency, I'll disagree with those who suggested you go to the US. There was an era where doctors flocked from the UK and Canada to private practices in the United States. That era is largely over, and what you see now is FMGs from less desirable locations coming to the US to bolster their earning potential.

In my opinion the postgraduate training system in the UK, Canada, Australia, and New Zealand produces better FM physicians than in the United States. It's not because US grads are dumb, but it's because the medicolegal system here has slowly restricted the training and practice opportunities of general practitioners to the general medicine/clinic setting. Even the FPs that graduate from so called "full spectrum" residencies in the US find that in many locations they won't be credentialed to do the things that they trained to do.

As far as salaries go, while the salaries of specialists and specialist surgeons are higher in the US than in the UK system the salaries of generalists (FM, IM, Peds and EM) are not.

As far as geographical flexibility, training in the British System gives you a lot of flexibility to go back to Canada, stay in the UK, go to Australia or New Zealand, or even practice in what was once called the commonwealth.

You'll practice in a better medmal environment when you're done. You won't have wage, training, and other pressures from midlevels which are relatively rare outside the US.

Finally, you get authentic, fresh Guiness.

So facing the same decision you have to make, I'd go to Ireland.

Good luck

 

[dozitgetchahi]

Having worked both in the US and overseas after going to a US medical school and non-FP US residency, I'll disagree with those who suggested you go to the US. There was an era where doctors flocked from the UK and Canada to private practices in the United States. That era is largely over, and what you see now is FMGs from less desirable locations coming to the US to bolster their earning potential.

In my opinion the postgraduate training system in the UK, Canada, Australia, and New Zealand produces better FM physicians than in the United States. It's not because US grads are dumb, but it's because the medicolegal system here has slowly restricted the training and practice opportunities of general practitioners to the general medicine/clinic setting. Even the FPs that graduate from so called "full spectrum" residencies in the US find that in many locations they won't be credentialed to do the things that they trained to do.

As far as salaries go, while the salaries of specialists and specialist surgeons are higher in the US than in the UK system the salaries of generalists (FM, IM, Peds and EM) are not.

As far as geographical flexibility, training in the British System gives you a lot of flexibility to go back to Canada, stay in the UK, go to Australia or New Zealand, or even practice in what was once called the commonwealth.

You'll practice in a better medmal environment when you're done. You won't have wage, training, and other pressures from midlevels which are relatively rare outside the US.

Finally, you get authentic, fresh Guiness.

So facing the same decision you have to make, I'd go to Ireland.

Good luck

I think it all depends on where you want to work, but I agree that if you want to work anywhere in the Commonwealth (and perhaps some other countries elsewhere too), Irish training may actually be an advantage because of its portability. It seems like a lot of docs living out there elsewhere in the world have trained somewhere in the British system.

If you want to live in the US, train in the US unless you want to have to start residency over.

 

[Splenda88]

Pure anecdote but one of the people I knew who did training in Ireland just had phenomenal physical exam skills. Well beyond the average American trainee at the time. The idea is that there's much more limited access to imaging/laboratory studies in Ireland so they have to really knock out the H&P portion of the workup.

The US may lead the world in medical advancement but the random individual family med program might not be all that great. There's plenty of crap programs in crap locations. Family med isn't typically something that needs leading edge training (to my understanding). Most family med in the states don't even practice the full spectrum (i.e. OB, procedures, minor surgery, etc...).

I wouldn't necessary put the American family med programs on a pedestal, but then again I don't know much about the Irish programs either.

I am not a FM doc, so I am not defending FM here.

We rely on imaging and laboratory studies a lot here because we have these damn lawyers breathing down our neck.