How are UK graduates viewed in the USA for residency?

[siddesh]

hi,

May I ask how favourably UK graduates are held in the United States in terms of residency applications? Ok there may be a lot of Bush/Blair buddies but how does this translate in the medical world?!

Regards
Siddesh

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[johnny_blaze]

Really? I constantly hear the opposite. Every single Consultant I’ve been under always asks me the same question when they find out I’m Canadian “Why the hell did you come over here?”

I think the British undergraduate system is very good. However, I have my own doubts about postgraduate training. I’m not looking forward to spending 10-15 years to become a consultant in something I can do half the time in the U.S/CAN.

I think money is also an issue for many consultants. Consultants don’t make as much money as US/CAN counterparts without doing private work on the side. That means bye bye to weekends and even less family time. This isn’t even a possibility for some specialties that are purely hospital based (ie. EM, transplant surg. Ect) and some specialties cant afford to do private work because of NHS demand (ie. Head and neck surgery… imaging arranging private practice when a flap that took 10 hours to put in fails and you have to do it again!).

However, some consultants do receive salary benefits after years of commitment to the NHS and some decide to go fully private… I dunno, I guess it just depends which situation you are in.

 

[siddesh]

Hi,

W4G have written a PM. Grateful for yr response.

Siddesh

 

[johnny_blaze]

I don’t think orthopods make avg. 200k/year. Most consultants w/ minor private work earn around 100k pounds/year, probably more if they have an A or A+ rating with the NHS. It really depends which subspecialty you’re in (ie. Hand/Ankle surgeons have much less private opportunities as knee/spine orthopods). Also, most private work is done in areas that have lots of money rather than poorer cities or towns, so location is also a factor.

I think General Practice is a brilliant specialty to do in the U.K. You make just as much (if not more) than US/CAN counterparts and have the opportunity to do staff grade work in almost any other specialty your interested in. You can even do minor surgery. My sis is a GP and is thinking of moving to the U.S. After looking over her options again I think she’s changed her mind because she’s got it good over here.

I do agree that there are some benefits to working here. I personally think the plastic surgeons working in Harley st. in London are earning much more cash than their US “nip-tuck” counterparts. ENT is another biggie here.

 

[f_w]

I think the basic questions you have to answer first are:

Do you want to live in the US or the UK ?

Do you want to practice medicine in the US or the UK ?

There are considerable differences in daily life and medical practice, look at them first before you get into the financial side.

Kicking around numbers, is not going to help you too much. In both countries, there will be high-earners in some specialties such as plastics, CT surgery or interventional cardiology. The relation of their income between the two countries has nothing to do with the average physicians income and lifestyle. On average, US docs probably come out ahead of most other countries. Otoh, in the US you have to make allowances for items less important in most european countries: Retirement, your kids education and disability coverage. After all these are taken care of, the amount of money you have available to spend on your lifestyle might not be all so different.

One aspect: If you do your training in the US and are anal about documenting everything, you can get it credited towards a CCST in the UK. If you do your training in the UK, if you are lucky you get a year off some of the residencies here.

Coming back to the original question: With a UK medical school education and maybe some experience at the PRHO and SHO level, you have a good shot at getting a residency in a moderately competitive specialty. The top competitive specialties such as neurosurg, optho and derm are quite inaccessible for non-citizen FMG's, no matter how well qualified they are.

 

[f_w]

I am actually at work, so my reply will grow later.

- you quote that 9% of the NS residents are FMG's. This number includes US citizens that went overseas for their medical education. Look at the number of non-citizen FMG's to get an idea whether you can match into these specialties, and it does look pretty dark there. The few 'true FMG's' that make it into competitive specialties these days have put in a couple of years worth of research time and pre-residency fellowships. Others were fully trained specialists in their home countries before they came to the states.

- the 200 residents in the top-notch specialties are out of a population of 96.000 physicians in training and something like 24.000 FMG's in training. I am glad you are so optimistic, but I have to disappoint you here.

- canadian graduates are commonly not counted as FMG.

- Your hope about the FMG's in competitive specialties beeing brits is probably unfounded. In my humble opinion, most of them are graduates of Indias and Pakistans top medical schools (incidentally, a good number of them went to the UK or IRL first, only after they hit the 'glass ceiling' of being stuck at the registrar level, they decided to move on to greener pastures.)

- getting your CCST through a US residency will only help you into a consultant position in specialties the NHS is shorthanded in. (There are folks who managed to get their radiology CCST with training in india, worked as a consultant in some 'district general hospital' for a year or two and moved on to the US afterwards.)

- You mention that you are interested in IM and EM. IM is wide open for FMG's of all origins, the top programs are a bit more selective.
The craze of people streaming into EM has ebbed off a bit since 'ER' is starting to go into reruns.

 

[johnny_blaze]

Having a CCST doesn’t guarantee you a consultant spot, nor does having your fellowship. I know plenty of surgeons who trained a heck of a long time before even getting close to attaining consultant posts. Most of these guys have taken years out to attain higher degrees (i.e MD, PhD, MS, ect) and some from very prestigious U.K universities. There’s no way doing a 5 year residency in Surg. (for example) In the U.S will make you equivalent to their level of experience. Even if you are eligible for getting a CCST and a FRCS/FRCP does that necessarily mean that you’ll get the job over the competition who has the same letters that you do (probably even more) and more years of experience.

I hope I don’t sound sarcastic and I’m not implying that what I hear is BS… its just that I speak to a lot of consultants about US/CAN medicine (the topic always comes up because I’m Canadian) and they don’t seem at all that impressed with north American training. The one benefit I can see is that you can probably work as an attending for a couple years (and earn good $$) and then comeback to the U.K for a consultant job… if you really wanted too

 

[Miklos]

As for that old b*llocks about FMGs not getting top competitive specialties - it is just not true. Check the Freida site for the actual numbers - 9.1% of trainee neurosurgeons in the US are FMGs - that is 70 out of 775. Pretty high level considering only a small fraction of the real superstars from non-US schools go to US for residency. Similar high representation in Ophthalmology (6.9%) and Derm (3.6%). So that is almost 200 FMGs currently training in the very most competitive of the specialties in the US (70 neurosurgery FMG residents + 87 Ophthalmology FMG residents and 36 derm FMG residents) who didn't listen to the "oh, it is impossible for FMGs to get into XYZ in the US" nonsense. These people had to come from somewhere. I willing to bet a LARGE number of them came from UK and Canadian Medical Schools.

For the record, Canadian grads are not considered IMGs. Their med schools are indirectly part of the LCME.

Regarding numbers (also from FREIDA), take a look at the selected specialities below.

Col1 = % of IMGs, Col2 = total # of res. in that specialty, Col3= absolute # of IMGs in that specialty

ENT 1.9% 1071 20
Ortho 2.0% 3024 60
Derm 3.6% 994 36
EM 4.4% 3909 172
Urology 5.1% 1038 53
Plastics 5.8% 556 32
Ophth. 6.9% 1260 87
Rad-Onc 8.0% 494 40
Neurosurg 9.1% 775 71
Transition 9.2% 1183 109
Rad-Diag 9.8% 4044 396
Ob/Gyn 21.0% 4681 983
Surg 21.5% 7623 1639
Anesth. 26.7% 4719 1260
Peds 29.5% 7773 2293
FP 33.5% 9529 3192
PM&R 34.90% 1120 391
Neuro 38.0% 1339 509
Psych 42.0% 4522 1899
IM 48.9% 21351 10441

Totals 29% 81005 23683

So:

There are 571 IMGs training in the very competitive specialties (ENT to Neurosurg) out of a population of 23,683 IMG residents. This means that 2.4% of all IMG residents (in our sample) are in these residencies.

I'll let those numbers speak for themselves.

Residency directors can work out the difference between a US student who got rejected from every US medical school and ended up with an MD from Grenada say, and the British lad who got AAAAA at A-level and won all the prizes and the academic firm housejobs at Cambridge Medical School.

Perhaps, if the British grad beat the SGU grad's USMLE scores.

 

[Miklos]

I hope I don’t sound sarcastic and I’m not implying that what I hear is BS… its just that I speak to a lot of consultants about US/CAN medicine (the topic always comes up because I’m Canadian) and they don’t seem at all that impressed with north American training. The one benefit I can see is that you can probably work as an attending for a couple years (and earn good $$) and then comeback to the U.K for a consultant job… if you really wanted too

I have no desire to start a useless flame war, but having seen a bit of both as a medical student, I have a different opinion. North American training seemed far more intensive and focused (perhaps it is due to the hours). When I compared North American PGY1s (and highly motivated MS4s) to UK SHOs, I felt that the North Americans beat the British hands down.

 

[f_w]

I risk repeating myself here.

> That to me means if you are good, there are places available.

No matter how 'good' you are, if you are in a competitive specialty, PD's don't even look at FMG applications. Unless you have toiled in the labs of one of the faculty for a couple of years and managed to get your application read through the intervention of your PI, you don't even appear on the radar screen of the PD.

 

[Miklos]

I think these 200 (or 571) out of 24,000 stats aren't useful. The budding neurosurgeon from the UK is never going to turn down a place at Queens Square to do a Family Practice Residency in Anytown, USA. What matters is how many spots in the competitive programs are taken up by FMGs. From the figures Miklos has kindly provided us I'd ballpark it at a median percentage of about 5%. That to me means if you are good, there are places available. Which is fair. Of course some boardline candidates will get spaces if they come from US schools while they would not match with the small scores/skills as a FMG - but so what, that seems fair and proper.

4.3% based on my spreadsheet, but close enough.

However, as f_w points out, the problem for FMGs is that unless they have connections to a given program, they are highly unlikely to have their application reviewed. Why? Because most PDs in highly competitive specialties will filter out (literally on the computer) everyone but LCME grads. The only way to argue with the PDs computer apart from connections is to achieve stellar scores on the USMLEs.

(It is for this reason that very highly motivated US students from Grenada for instance on occasion, though admittedly rarely, achieve highly competitive residencies. In contrast to the UK grads, they are more easily able to network during their two US clinical years, gaining recognition for their efforts from the people that count.)

Regarding the number of UK grads who do make it to the US, please see http://www.ecfmg.org/annuals/2002/certstan.html Exhibit 4 (it is the latest that the ECFMG has made public). It shows that a total of 44 UK grads and 60 with UK citizenship received ECFMG standard certifications in 2002. It seems highly unlikely to me that all of them achieved residencies in highly competitive programs. Contrast this to the number of students from Grenada (384) or India (1,180).

 

[siddesh]

As W4G says I think PDs look more favourably at a UK/European grad than an Indian or maybe a Caribbean grad. Hey a lot of Indians dont get visa for Step2 CS, never mind get an ECFMG certificate!!! I guess because in UK you cant pay to get into a GMC recognised UK grad schools. Forget about all these private ventures here, they are a joke and are mostly caribbean off shoots.

Maybe there are similarities in cultural background between the USA and UK? 60 people from the UK getting ECFMG is tiny! A few senior UK graduates above me have had no problem getting residency even in compet. specialities. Naturally board scores etc count, cant get round the usual hurdles.

Hey I've seen a couple of adverts in the Brit Med Journal where American programs come to the UK to interview Uk grads. Naturally may not be the best places but it does say something.

Cheers

 

[johnny_blaze]

I have no desire to start a useless flame war, but having seen a bit of both as a medical student, I have a different opinion. North American training seemed far more intensive and focused (perhaps it is due to the hours). When I compared North American PGY1s (and highly motivated MS4s) to UK SHOs, I felt that the North Americans beat the British hands down.

I’m sorry if I gave the impression that I was interested in getting into a debate about the quality of US vs UK training… I assure everyone that I wasn’t. I was just stating ideas I had based on what some consultants told me about US docs they had work with/for them.

I personally respect the fact that you’ve had exposure to both US and UK training and highly value your opinion. I’ll be doing an elective in Ontario at the end of this year and probably then I’ll see if a difference really even exists at all.

 

[f_w]

You are entertaining. Why am I getting this vibe of post-colonial british arrogance, every time I read your posts.

- Neurology is not a competitive specialty (JHM is a competitive program though)

- Pediatrics is not a competitive specialty, even at 'Mans Greatest Hospital'.

- You are pointing to folks that came in the 70s ! Most did a good deal of clinical training in the UK before they came to the states.

- Some of the folks you are pointing to where researchers before they came to the US. They did their groundwork before they made the move. This is a far cry from thinking that you can breeze into an ENT residency spot through the match, just because you are from the 'motherland'.

- The fact that there are FMG's in leading positions in US medicine prooves the point that ONCE you have made your entrance at the residency level, your FMG status in fact doesn't hinder you from getting far (Elias Zerhouni, the chief of the NIH is Algerian. When he came, radiology was competitive. His Algerian professor hooked him up with a residency position in the US, he freely admits that his entry was based on patronage. Nepotism is alive and kicking, in the past couple of years most of the FMG's in my specialty had some inside track.)

 

[OzDDS]

Regarding the number of UK grads who do make it to the US, please see http://www.ecfmg.org/annuals/2002/certstan.html Exhibit 4 (it is the latest that the ECFMG has made public). It shows that a total of 44 UK grads and 60 with UK citizenship received ECFMG standard certifications in 2002. It seems highly unlikely to me that all of them achieved residencies in highly competitive programs. Contrast this to the number of students from Grenada (384) or India (1,180).

You don't think has anything to do with the fact that there are a number of actual High quality postgraduate training positions and medical jobs in the UK as compared with the carribean and india? You know those low numbers for UK grads receiving ECMFG certs might possibly be because most UK grads finish and work in the UK not even considering applying for a cert to work in the US. In contrast to Caribbean grads where for 99% of them their sole purpose for existance is to take students who couldnt get into US schools give them a degree and get them back to the US to practice.

A better study would be to take the total number of UK grads who actually applied to competitive residency programs and got accepted, compared with carribean grads who actually applied for competitive residency programs and were accepted. I think you'll find there is an actual difference.

 

[OzDDS]

What about Australia?

Actually did you know the cheif of ped neurosurg at Yale is a med grad from Australia and got into neurosurg residency at Yale only after her Australian 1-year internship (required for medical registration in australia) and one year as a house officer in the UK.

http://info.med.yale.edu/neurosur/faculty/chiang.html

Speaking of Neurosurgery.. What do you think of Ben Carson at Hopkins? Did you know he did his fellowship training in Perth, Western Australia?

 

[f_w]

There are indeed not many UK colleagues looking for residencies in the US. Probably for the same reasons that we don't see many french or swiss physicians in the US. The general economic conditions in these countries as well as the medical environment just don't create too much of a pressure to look elsewhere .

Btw, the lady at Yale did a pre-residency fellowship in addition to her basic training in AU and the UK. Foreign grads just don't walk into neurosurg spots fresh off the boat.
Also, there was a bit of a dip in the competitiveness of referral based specialties in the early to mid nineties. Everybody was wetting their pants over the prospect of Hillary Clintons system of socialized medicine. Everyone tried to fashion themselves as 'primary care', as this was considered to be the only safe haven. Back then, medschool advisors would deliberately sabotage their students plans to get into the 'small surgical specialties', radiology or anesthesia (talk about getting screwed). Things today are different.

And Carson is a nice guy. Met him at a Orioles game once.

 

[Insider]

For the record, Canadian grads are not considered IMGs. Their med schools are indirectly part of the LCME.

Regarding numbers (also from FREIDA), take a look at the selected specialities below.

Col1 = % of IMGs, Col2 = total # of res. in that specialty, Col3= absolute # of IMGs in that specialty

ENT 1.9% 1071 20
Ortho 2.0% 3024 60
Derm 3.6% 994 36
EM 4.4% 3909 172
Urology 5.1% 1038 53
Plastics 5.8% 556 32
Ophth. 6.9% 1260 87
Rad-Onc 8.0% 494 40
Neurosurg 9.1% 775 71
Transition 9.2% 1183 109
Rad-Diag 9.8% 4044 396
Ob/Gyn 21.0% 4681 983
Surg 21.5% 7623 1639
Anesth. 26.7% 4719 1260
Peds 29.5% 7773 2293
FP 33.5% 9529 3192
PM&R 34.90% 1120 391
Neuro 38.0% 1339 509
Psych 42.0% 4522 1899
IM 48.9% 21351 10441

Totals 29% 81005 23683

So:

There are 571 IMGs training in the very competitive specialties (ENT to Neurosurg) out of a population of 23,683 IMG residents. This means that 2.4% of all IMG residents (in our sample) are in these residencies.

I'll let those numbers speak for themselves.



Perhaps, if the British grad beat the SGU grad's USMLE scores.

Most of those IMGs are US Citizens who graduated from off shore schools!

 

[Miklos]

Most of those IMGs are US Citizens who graduated from off shore schools!

If you are referring to IMG residents that are in competitive programs, that point has been made by f_w.

Regarding the overall population of IMGs, the ECFMG says that about 6,000 total IMGs attain residency positions in the US each year. For a numerical discussion about this and the distribution of IMGs, see http://forums.studentdoctor.net/showthread.php?t=148928

 

[Insider]

If you are referring to IMG residents that are in competitive programs, that point has been made by f_w.

Regarding the overall population of IMGs, the ECFMG says that about 6,000 total IMGs attain residency positions in the US each year. For a numerical discussion about this and the distribution of IMGs, see http://forums.studentdoctor.net/showthread.php?t=148928

You're either an IMG or you're not! Within the IMG lot, you are either American or you aren't.

 

[Miklos]

I think that we've come to the point where we are now moving in circles. I think that I'll try to retire from this discussion as well.

Miklos

 

[f_w]

We all got your point: All animals are equal, but some animals are more equal than others.

If it helps you to keep your mental balance, so be it. I wish you the best of luck in your quest for an IM residency that fulfills your name recognition needs.

 

[C. Ronaldo]

Waiting4Ganong, dont you think it is unethical to be trained in the UK for "free" as you claim (but apparently it isnt actually free), but then jump ship over to the US? I remember you thought it would be unethical of me to move back to the UK to get EU fees for medical training but then returning to practice in the US. You would be doing the same thing, no?

 

[johnny_blaze]

I think W4G and I are on the same page. I also think postgrad training in the US is very attractive because there are lots of changes being made in the U.K system. I personally can’t see myself having a comfortable ride to a consultant post here.

There are indeed not many UK colleagues looking for residencies in the US. Probably for the same reasons that we don't see many french or swiss physicians in the US. The general economic conditions in these countries as well as the medical environment just don't create too much of a pressure to look elsewhere .

This is very true. I am the only person I know in my medical school actually thinking about leaving the country to go to US/CAN for training. The British medical system does have its flaws (in my opinion) but does also have advantages that keeps majority of its graduates in the country. I think the main reason its so easy for me to consider leaving is due to the fact that I don’t have any British ties and there’s really no reason for me to stay.

I do see how it can be difficult to match into really competitive specialties in the US as a UK grad but I’d say that goes the same for competitive specialties here with US grads. That’s simple because there’s limited spaces and priority definitely goes to the home grown. But second place would probably go the English training countries (US, CAN, UK, AUS, ect).

Now if it was only easy matching in Ontario… geesh!!

 

[f_w]

Why I changed the post ? I was on call, waiting for some study to be finished so I could read it and get some breakfast. While scrolling through the thread, somehow your arrogance got to me. I figured, a slightly less concilliatory post would be in order and edited it to what it is now...

No, I am not a medstudent. Do I have to be one ? I don't have a 'vested interest' in keeping anyone out, but as a FMG in a competitive specialty, I do see how hard the folks who came after me have it (irrespective of the world acclaim of their medical school).

(But maybe you are really better off staying in the UK. The glimpses of your personality this thread offers make me believe that you wouldn't fit in well in a US training program.)

 

[nanosomic]

w4g, if you so believe in the UK medical training stay the hell in the Uk. Why the worry to come to America? Is the UK boring or what?

 

[nanosomic]

w4g, you have issues my friend. Stay the hell in the UK!

 

[f_w]

What happened to w4g ? All his posts disappeared from the thread (at least on my PC).

Did he implode into a wath of foaming protoplasm, or did a moderator put an end to his name calling ?

I just sat down to craft a rhetorically flawless reply to his false allegations, but now I can't even use his posts for raw material :-(((

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Anyway, to come back to siddesh's question:

- Just as any foreign grad in the US, you are free to compete for any residency position, competitive specialty or not.

- While the lack of a language barrier and the fairly well organized british medical school education, give you a leg up on many of the other foreign grads, PD's will only rarely prefer you over their local crop.

- The US goverment subsidizes every residency position with $80.000 to $140.000 per year. Many people here feel that this subsidy should benefit people who stay in the US to serve medicare patients after they graduate (not my personal opinion, but somehow quite rational).

- Do anything you can during medical school to beef up your CV. Do research, volunteer in the homeless asylum, do outreach work.

- If your school has US connections, use them. Do an elective or some research time in the US. Letters of recommendation from US faculty are very valuable in the residency selection process.

- If you have a channel to make use of nepotism, do it. In highly competitive specialties, this might be your only way to get your CV even looked at.

- Ace the USMLE's, particularly step1.


This, and what I have said in the above posts, are the 5 cents I can contribute.
I am
-- 'foreign' medical graduate in the US
-- not a US citizen
-- 'senior resident' in a specialty currently very competitive (radiology)

It is up to you whether you want to:
a) listen to the experience of someone who has been here for a while and has seen how things have changed for FMG's.
b) listen to some UK medstudent whoose experience with the US GME system is based on having received 'positive' replies from IM residency directors.

Make up your mind. Everyone who has the necessary credentials is welcome in the US medical system. Compared with the hoops other 'physician immigration' countries put up for people who want to get in (e.g. the UK, CA or AU), the system here is fairly predictable and bottom-line fair. The 'bottle neck' is the step of getting into a residency program, after that your opportunities to make it in private practice or academia are not limited by your FMG status, your skin color or your national heritage.

And with this, I think it is time to retire (from) this thread. It is interesting how in an anonymous forum like this, seemingly educated people can engage in a virtual screaming match at the drop of a hat.