EM docs practicing in UK/Europe?

[nowwhat]

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Curious to know if any other american trained EM physicians have made the jump across the pond? I know the pay is probably half as much so you have to be half crazy but anyone know someone who made it work?

It seems it might be a challenge for us to get them to accept our training as equivalent to theirs? For example looking at the UK pathway to EM the training takes 6 years after medical school. That is a lot of EM training. Most of us are done in 3 years. Maybe we could test out of these extra post grad years or simply take their board exams.

Thoughts or experience?

 

[gutonc]

Curious to know if any other american trained EM physicians have made the jump across the pond? I know the pay is probably half as much so you have to be half crazy but anyone know someone who made it work?

It seems it might be a challenge for us to get them to accept our training as equivalent to theirs? For example looking at the UK pathway to EM the training takes 6 years after medical school. That is a lot of EM training. Most of us are done in 3 years. Maybe we could test out of these extra post grad years or simply take their board exams.

Thoughts or experience?

Thoughts?

If you want to work in Europe, train in Europe. If you want to work in the US, train here.

"Testing out" doesn't really work after your sophomore year of college. If somebody with a PhD in biochemistry has to take the MS1 Biochem class, the chances of you being able to skip over 3 years of training in another country seems kind of crazy.

 

[anonymousEM]

You might be able to work on a US military base but there aren't a lot of opportunities for that either.

 

[leorl]

Their system is completely different. It would be country-dependent, and while they would value someone with US training, depending on how long you have been an attending you might have to repeat some european / UK training. Here's the breakdown:
US: medical school --> 3-4 year residency ---> attending.
UK/IRL: medical school --> intern year --> 2 years of general training either in surgery or medicine --> 3-5 years in the College of AE (accident and emergency) training scheme. --> possible consultant post not guaranteed.

So as you can see, they spend a lot more time with the training process, and if you are only just out of a residency, you will probably have to spend additional training time as a registar within the College, even though the skills you have as a graduate resident probably surpasses the skills of a registrar.

Also, non-EU or UK people do not get onto the scheme easily. You may be able to take 6 month registrar posts in an ER, but you would have to re-apply every 6 months - 1 year for either the same or a different posting, which may be in a different hospital.

It's a completely different system.

 

[energy_girl]

With all due respect to the previous posters, it is not entirely accurate that it's so hard to get into the UK/Europe systems. Our US medical training is recognized to similar in difficulty even if the length and pathway is different. We can get certified to practice as GPs by taking a test. Getting certified in EM is more difficult but not impossible and would be case by case. The main barriers would be language and citizenship, not training. This is not the case if you are UK/EU trained and want to come to the US to practice: you would have to redo a residency in the US in addition to passing tests.

Please PM me if you want specifics. I went to medical school in the US but also got part of my education in the UK and Europe. I chose to return to the US for graduate medical education because it is more portable than training from any other country. While I agree with one of the posters that if you intend to practice in the UK, train in the UK, etc, some may want to expand their options or have personal reasons why they want to be able to practice in both countries (i.e. SO's job, lifestyle, etc).

 

[nowwhat]

Thanks for the posts guys.

The way I am thinking about this is to first practice here in the US and pay off a good chunk of my student loans from med school. Then sometime down the road make the move. That would mean I make the transition as a seasoned EM attending. Which makes doing additional years of training not very practical at all.

It sounds like consultants there are attendings, registrars are like fellows?

Anyway, it is interesting that they train for 6 years. Would a first year EM consultant in the UK (PGY7) be better trained than an EM attending 4yrs out of residency (PGY7) here in the US? Seems like we should be just as good as them given an equal number of years experience.

 

[energy_girl]

Thanks for the posts guys.

It sounds like consultants there are attendings, registrars are like fellows?

Anyway, it is interesting that they train for 6 years. Would a first year EM consultant in the UK (PGY7) be better trained than an EM attending 4yrs out of residency (PGY7) here in the US? Seems like we should be just as good as them given an equal number of years experience.

Consultants = attendings with specialization in a field, like EM, surgery, etc.
Registrar = resident. Remember most in the UK will not complete specialty training and so have two intern years ("house officer" in their terminology). Registrar = resident in a specialty training program.

Their training is longer because they work far less (both UK and EU have very strict work hour regulations for something like 40-48 hours/week), and have far less well structured programs (these are apprentice-like programs, no RRC)! As much we may hate our hours or groan about our didactics, we do end up getting superior training in a shorter amount of time.

 

[gutonc]

Thanks for the posts guys.

The way I am thinking about this is to first practice here in the US and pay off a good chunk of my student loans from med school. Then sometime down the road make the move. That would mean I make the transition as a seasoned EM attending. Which makes doing additional years of training not very practical at all.

It sounds like consultants there are attendings, registrars are like fellows?

Anyway, it is interesting that they train for 6 years. Would a first year EM consultant in the UK (PGY7) be better trained than an EM attending 4yrs out of residency (PGY7) here in the US? Seems like we should be just as good as them given an equal number of years experience.

You can certainly make the claim that a "seasoned EM attending" would be as good as/better than a PGY-whatever registrar/consultant. But the argument is academic at best. Without their training, you're not getting a job there. Period.

Flip the scenario...is a UK A&E grad (PGY7+) going to waltz into the US and get a job in an ED here? No. Why not? Because s/he hasn't done the appropriate training. And if he could, how much holy hell would you be (rightly) raising? Same shoe, different foot.

 

[leorl]

There's pluses and minuses to each system. Right now for me anyway, a few people in the US (myself and obviously yourself included) are thinking of going elsewhere down the road after probably practicing here as an attending first. Quite a few are doing locums or moving permanently to Australia / NZ which operates like the UK system. The good thing about this is that there are bridging companies to go through that handle logistics for us. The same doesn't apply for the UK unfortunately, although that would be nice.

Whether our PGY4 is equal to their PGY7 you can't really say... it's like comparing between apples and oranges. They have seen more cases during their pre-consultant years than we have, just because of the number of years of their training. However, we operate under a very regulated and standardized residency program where we are given a lot of procedural skills early on in our careers. I'm not sure where that occurs in the scheme, although they do have College mandated procedural days (sim lab, which would not occur as much in their scheme as it does in ours). Also, other things which are standard here (ultrasound training) are only just now starting to be implemented into their training and are in infancy.

But at the end of the day, eventually the education and knowledge evens out. And even in terms of age, it evens out since they start medical school straight from high school. Over there, you will not encounter as much trauma or OBGYN or peds as you will in our academic hospitals as they still operate under the more traditional system.

Thanks for the posts guys.

The way I am thinking about this is to first practice here in the US and pay off a good chunk of my student loans from med school. Then sometime down the road make the move. That would mean I make the transition as a seasoned EM attending. Which makes doing additional years of training not very practical at all.

It sounds like consultants there are attendings, registrars are like fellows?

Anyway, it is interesting that they train for 6 years. Would a first year EM consultant in the UK (PGY7) be better trained than an EM attending 4yrs out of residency (PGY7) here in the US? Seems like we should be just as good as them given an equal number of years experience.