Leaving US

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its surreal..we were discussing safety and terrorism and in less than a week a terror strike takes place.. i had an eerie feeling when I read that post..i d knock on wood before saying anything good..

 

[WingedOx]

Dude, I understand you're a proud citizen of the US and it's fine but seriously, you need to adjust your view on the world. You can eat plenty of meat in Japan, French and Spanish people don't line up for soup kitchen and having a nice house with a big backyard and a green lawn is totally affordable for MD in most developped countries.





Not even one week later...

And yet the greatest threat to personal safety for those traveling to France this week has been...

...the English and Russians.

 

[Stagg737]

I've dabbled in Australia and the US. Multiple Sub-I's in both countries (speciality and primary care). Close mentors in both countries. Strong likelihood that I'll match okay in either country for my prefered specialities. That being said, for primary care...

Australia. It's unreal. ABFM Certification transfers. Here's my growing collection of Australia posts: http://forums.studentdoctor.net/threads/reciprocal-licensing-agreement-with-australia.1203527/

PCPs make about the same as the do in the US, much more if you're willing to practice rural or do some advanced procedural training. (And "rural" in Australia can literally be only 50 miles away from Sydney or Melbourne... or all the way up to Fly-In/Fly-Out outback clinics, which are a whole other level of awesome). Here's a calculator to play with: https://gpra.org.au/gp-earnings-calculator/

But this calculator is strictly for outpatient work.

One of my rural GP mentors rounded at hospital in the morning, did outpatient for 4 hours, went home for an hour or two to diddle around with his farm, and then came back for some surgeries/procedural stuff in the afternoon (cholyes, colonoscopies, tonsillectomies, etc.). He did admin on Fridays and saw private patients on Saturday. He also did a handful of shifts in the ED every month (in a country where people can see GPs for free--so no bogus nothing). Made a few nursing home visits too. Pulled in north of $700,000/year and skied all around the world Dec-Jan.

And don't forget: free healthcare for life, 8% of salary/year extra gets socked away in a pension fund, kids go to university for free, no insurance dramas, you can always do what's best for the patient (as long as it's reasonable and evidence-based), minimal paperwork, and Australians tend be very, very pragmatic people--even as patients, which I absolutely adore. "Why's my BP high"? "Cuz you're getting fat mate. Knock off the chips." "Yeah. Fair enough."

It's not all sunshine and puppies, but most of the discontent is over the length and availability of training (which can be 8-12 years for some specialities). But if you've already trained in the US and want to move... seems like a no-brainer (at least for FM).

Interesting. I've never heard heard of Australian docs making that much. Most of the numbers I've seen are similar to the ones quoted for "average" in this article:http://www.businessinsider.com.au/heres-how-much-money-australian-doctors-actually-earn-2014-5

Also, when I plug in what seems typical for a U.S. FM (10 shifts/wk + ten "extra" hours) puts the average non-rural physician around 125k pre-tax. I'm sure there are plenty of perks in Aus that we don't have in the U.S., but I'm not sure where you're getting these numbers that GPs (on average, not senior GPs) are rolling in the dough. If you've got other sources I'd be interested in seeing them, as I've legitimately looked into moving to Australia after paying back loans and building a bit of a nest egg.

 

[lymphocyte]

Interesting. I've never heard heard of Australian docs making that much. Most of the numbers I've seen are similar to the ones quoted for "average" in this article:http://www.businessinsider.com.au/heres-how-much-money-australian-doctors-actually-earn-2014-5

Also, when I plug in what seems typical for a U.S. FM (10 shifts/wk + ten "extra" hours) puts the average non-rural physician around 125k pre-tax. I'm sure there are plenty of perks in Aus that we don't have in the U.S., but I'm not sure where you're getting these numbers that GPs (on average, not senior GPs) are rolling in the dough. If you've got other sources I'd be interested in seeing them, as I've legitimately looked into moving to Australia after paying back loans and building a bit of a nest egg.

Mate that's why I started with:

PCPs make about the same as the do in the US, much more if you're willing to practice rural

The perks are definitely rural, where the need is greatest. My experience has been limited to that area of practice (as are my anecdotes) with heavy emphasis on procedural work (surgical skills, etc). It's the widest of wide-scope FM. That won't be reflected on this calculator. Also, ED shifts, administration, nursing home visits--it adds up.

Some of the calculator bits might be difficult to interpret. For example, Lvl B billing is what a patient would pay out of pocket (until some or most was reimbursed by private insurance). Bulk billing is completely free care. You can choose to bulk bill seniors and college students and people having a tough time and charge the rest $50 or 60. My mentor had a 40:60 split in favour of bulk billing with a $40 charge. It makes a huge difference to the bottom line and seems more equitable. I guess you guys would call that a sliding scale?

Urban means Sydney or Brisbane. It's like comparing a FM doctor in LA and... Walla Walla. Is that even a place? I dunno. Somewhere with low provider density. Salaries and opportunities will be skewed accordingly.

I think everyone should do a locums there first. It's a really lovely country. Good people. Laaaaaaaaidback. I wore shorts to clinic. You are appreciated as a generalist. Beautiful landscape. Beer and prawns and a country sunset.

Gahhh... I'm torn to stay or leave but clinical training is out of this world amazing in the US...

 

[Giovanotto]

I'd like to get out of here after graduating. I'm not as worried about my pay as I am quality of life for myself and my family. My paycheck is one thing, but then y ou have to consider the cost of health care for a family, the cost of higher education, so on and so forth. Plus, I'd much rather practice in a country that views health care as a right and provides it for its citizens.

Ding ding ding, we have a winner. Please brace yourself for the hoard of naysayers that your post will attract. Ignore them is my advice.

 

[Stagg737]

Mate that's why I started with:



The perks are definitely rural, where the need is greatest. My experience has been limited to that area of practice (as are my anecdotes) with heavy emphasis on procedural work (surgical skills, etc). It's the widest of wide-scope FM. That won't be reflected on this calculator. Also, ED shifts, administration, nursing home visits--it adds up.

Some of the calculator bits might be difficult to interpret. For example, Lvl B billing is what a patient would pay out of pocket (until some or most was reimbursed by private insurance). Bulk billing is completely free care. You can choose to bulk bill seniors and college students and people having a tough time and charge the rest $50 or 60. My mentor had a 40:60 split in favour of bulk billing with a $40 charge. It makes a huge difference to the bottom line and seems more equitable. I guess you guys would call that a sliding scale?

Urban means Sydney or Brisbane. It's like comparing a FM doctor in LA and... Walla Walla. Is that even a place? I dunno. Somewhere with low provider density. Salaries and opportunities will be skewed accordingly.

I think everyone should do a locums there first. It's a really lovely country. Good people. Laaaaaaaaidback. I wore shorts to clinic. You are appreciated as a generalist. Beautiful landscape. Beer and prawns and a country sunset.

Gahhh... I'm torn to stay or leave but clinical training is out of this world amazing in the US...

Thanks for the clarification. I'm not overly familiar with the intricacies of their reimbursement system, just that it's two-tiered and the basics behind it. I saw that you were talking about rural early on, but didn't realize the entire post was referring to rural medicine. It also sounds like 'rural' there can be suburban in the U.S. What are the populations of the rural locations near the big cities down there? I ask because there are many places in the U.S. where you can go 50 miles outside (I think you mentioned that was rural there in a previous post) of a city and most of the towns will still have populations around 50k.

Also, what do you think average pay is for an urban or more suburban type of physician? In the U.S. average can easily be 200k+ when you included bonus and benefits, so I'm wondering how Australia stacks up there.

 

[Lee Ik-jun MD]

Hi there,

With all the bull**** that physicians have to deal with (government limiting how much you can earn, nurses who think they are equal or better than you, everyone thinking you're rich and should earn less, declining reimbursement, confusing coding for reimbursement, turf wars, people with less training getting more autonomy (NPs and CRNAs), and politicians screwing you financially), would you think about leaving US and practice in another more physician-friendly country? If yes, where would you move to?

My mother in law is Canadian.
So we spent a lot of times visiting her, 5-6 times/ year
i can tell you, from conversations with her primary care doc as well as other MDs
that the US is more physician friendly, in terms of compensation.

You can always volunteer in places outside the US to get a first hand feel of how it is.
my friend who's an ophtho resident is also a member of ORBIS.
and he says he wouldn't want to practice anywhere else.

and btw, they ( ORBIS) have a flying eye hospital.. isn't that cool?

 

[DynamicMD]

Also, be aware that DOs in Europe are very, very different from DO's in the U.S. In Europe, they ONLY learn OMM and do not go to actual medical school like DO's in the U.S., which is why some European countries like Norway or France have restrictions against them.

So even if the DO degree is recognized in Europe, you can't do anything but OMM??

 

[Stagg737]

So even if the DO degree is recognized in Europe, you can't do anything but OMM??

It depends on the country. In some countries, like France, that's true. In a lot of countries if you complete a residency in the U.S. as a DO (sometimes it has to be an ACGME program) you have full practice rights as a U.S. DO.

The problem is that the European DO degree is essentially the same thing as a chiropractor in the U.S. They don't go to med school, so they aren't trained in medications, physiology, etc. They only learn about the musculoskeletal system and OMM. In the U.S., DOs learn everything that MDs do + OMM and must complete training in residency, so the degrees are considered equivalent in terms of legal practice rights here. If a DO from Europe came to the U.S. they would not have full practice rights either, because they were not trained in medicine. The issue is that in the U.S. and Europe, there are people called "DOs", but their training is vastly different.

 

[fancymylotus]

Hi there,

With all the bull**** that physicians have to deal with (government limiting how much you can earn, nurses who think they are equal or better than you, everyone thinking you're rich and should earn less, declining reimbursement, confusing coding for reimbursement, turf wars, people with less training getting more autonomy (NPs and CRNAs), and politicians screwing you financially), would you think about leaving US and practice in another more physician-friendly country? If yes, where would you move to?

My fiancé would relocate to tangier in a heartbeat if we could. I just don't know that I'd want to practice dentistry there...


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