So what's wrong with practicing in Irel, UK, or Aus ?!??

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eg77

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So this issue has been killing me for a while and I've been skeptical to ask it. Everytime I check out forums for international schools it seems that the main question is regarding writing licensing exams for US and/or Canada to practice there. I understand that people want to return to their home country and live there but I can't help but question if there is something terribly wrong about the practice of medicine in Aus, Irel, or the UK. Or is it simply the difficulty of obtaining citizenship and opening a practice in these countries that is an issue?!? Do immigrants to these countries have to go through hell to practice there even if they graduate from the respective med schools?

Curious to hear your guys' thoughts on this issue
 
I think the main reason is that it is so hard for a foreign student to get a job after medical school, since the employers have to prove they couldn't fill the spot with an EU citizen before it will get approved. And, from what I understand, you can't become a citizen during or immediately after medical school, as you can't have spent your required stay in Ireland as a student.

So, I think the security of being able to find posts in the US is greater than in Ireland IF you are from the US (Canada if you are from Canada, etc.).

Take this with a grain of salt, and please correct me if I'm wrong.
 
there's nothing wrong with it. A few NA people each year stay on and go through the training schemes (especially those ones with Irish significant others).

Most of the NAers in my class are staying to do an intern year here. There's a number of reasons:
1) not ready to leave just yet (ie. great friends here, although out of Dublin might be nice)

2) want to recoup some of the money we've poured into this system (as a junior doctor working craploads of overtime, you can earn a LOT of money. This might change in the future if EUWTD is ever enforced). Also, I've heard 6 weeks vacation (when in your life esp. in the US will you ever get 6 wks vacation?) plus bonus (for laptop, etc) when you first sign on.

3) Want more time to fulfill US requirements (ie taking USMLE steps, doing electives in final year)

However, we probably won't stay here after intern year:
1) You'll learn on US electives that there's more of a team feel in the US, the junior doctor does a lot of scutwork but also some medicine. Whereas junior doctors here don't do that much medicine. That's not bad, it's just a different system
2) It takes longer to progress through the UK system. And most likely will be even longer taking into account non-EU status.
3) Although Ireland is an enjoyable place, there are things you might like better elsewhere. I'm not sure if it's different in the UK/Oz. I personally think Oz would be awesome, but I don't know too much about the system there.
 
I forgot to add that even if you don't want to live all your life in the US in the future, in order to go back for any stage, it is much more favorable if you've done your training in the US. So those of us who want to go home at some point and don't want to potentially deal with hoops, might as well just do training in the US.
 
2) want to recoup some of the money we've poured into this system (as a junior doctor working craploads of overtime, you can earn a LOT of money. This might change in the future if EUWTD is ever enforced). Also, I've heard 6 weeks vacation (when in your life esp. in the US will you ever get 6 wks vacation?) plus bonus (for laptop, etc) when you first sign on.

I just wanted to point out that what appears as "a lot of money" during your first year in Ireland really isn't -- consider:

1st year in Ireland... $100, 000K USD (not unreasonable)
1st year resident U.S. ... $42 000K USD

Ok, so it looks like you've just gained nearly $60 000 dollars, right?

Well, the problem is that by staying in Ireland, you've just cost yourself a year of your working life before starting residency. So you are, in effect, short-changing yourself on the backend of your career... when you're probably making at least $200 000! So what looks like a $60 000 gain is more likely at least a $100 000 LOSS in the long run! ($200 000 / year at age 55, say, vs. the $100 K you made as an intern). And that's assuming no increase in salaries over 30 years.

Admittedly, it's probably not that much of a gap since if you have loans, etc. the $60 000 up front can be used to offset principal of your loan reducing interest, etc. but the point is that at best it is probably a financial wash, and at worst, a financial misstep, to stay and do intern year just for the sake of earning a little extra dosh.

This is not to argue that there aren't plenty of other reasons to stay, tho 🙂
 
nah, people don't stay just cuz of the money. It's in combination with the other factors. Personally, I don't think I'm hindering my career too much by delaying a year in US residency. Also, it's more like 60k+ euro if you're motivated enough to work overtime. Some people with smaller debts to pay who want to pay more of it off in the beginning choose this option too.
 
So it isn't that difficult for NAs to get spots in Ireland? For some reason, I was under the impression that it was extremely difficult for us to get jobs. I'm not second-guessing you, just trying to confirm, because if I'm wrong, I will be very happy. 🙂
 
internship posts shouldn't be too hard (depending on class size, etc.). This might be harder in the future, will have to see. Probably can progress to SHO spots too. However, further progression through the ranks may be a different matter.
 
Ah, yeah. If you can't get higher training or consultant spots, it doesn't seem to make much sense to go through the basic training. I'll just have to wait and see, I guess.
 
I can answer the U.K part of the question as I am studying in England rather than Ireland. I’ve met a few Canadians in schools here in Europe and the main reason they want to go back home is because Canada is where they always saw themselves practicing as a doctor. For them, Canada is home and that’s where they want to be. The new immigration/visa work laws are having a massive influence but this issue is still fairly new.

All the other stuff about money and career progression don’t make much sense. British docs make good money here and thanks to the whole MMC scheme, it’s much quicker to become a consultant. There are so many different angles to look at this from.
 
Yeah, but I was kind of hoping to just stay over there permanently. I still plan on going, whether that is possible or not, but it doesn't seem like anyone can really say for sure if it's a realistic goal to stay in Ireland permanently after med school.
 
no one's saying it can't be done, and I do know Americans who have stayed on here. It's just most people prefer to do residency training at least back in the US, before moving on elsewhere (if they don't have a burning desire to stay home)
 
It's definitely feasible to stay here. Loads of Americans in my class stayed for internship - the hospitals are dependent on a certain proportion of non-Irish staying. For SHO schemes, it all depends on your internship year - and who you know... Getting into specialist registrar schemes is hard, but I have Pakistani and Indian friends who have done so, so it must be possible for North Americans as well. Finally, getting a consultancy post is the big challenge... Maybe if the Hanly solution goes through, with consultant-delivered health care, it may be possible. Otherwise, it might be hard, but not impossible!
 
What if you get nationalised? If I really want to move there, I'm going to try and become a citizen. Would that make things easier?
 
Well, it's less about nationality, and more about who you know when it comes to consultancy. Nationality doesn't really play into it at all, as far as my friends' experience is. But at the higher levels, you may be at a disadvantage if you haven't built the same social network as your Irish peers. But we had a recent appointment of a consultant of non-European origin in my hospital, which is a major Dublin teaching hospital, so it's definitely possible! Just make sure you make friends in your specialty of choice.
 
Good point. That makes it seem a bit more realistic to me, especially since I'm very good at making--and keeping--connections. I was under the assumption that it was generally close to impossible to "go all the way" in Ireland if you aren't Irish. But, the posts on this thread have cleared things up a bit. Now, I just have to get in. 😛 My final requirement was sent out today, so hopefully I'll get my "complete" email soon.
 
Yeah, but I was kind of hoping to just stay over there permanently. I still plan on going, whether that is possible or not, but it doesn't seem like anyone can really say for sure if it's a realistic goal to stay in Ireland permanently after med school.

I never met anyone who continued to want to stay there permanently after being there a few years. Several thought they wanted to stay at first, but it never lasted in the people I knew. Well, maybe some Malasians. Did any others of you older bunch know of people choosing to stay long-term?
 
I know 4 - 1 Canadian and 3 Americans who've stayed long term. At least 2 because of significant others (1 of them went to the UK to do internship/residency and is now in Belfast). The other stayed because of SO, but also failed USMLE because he/she didn't study properly (good student but wasn't motivated for the USMLE b/c he/she was planning on staying in Ireland anyway). This one is currently in the psych scheme. I know of plenty others who stayed, only recent enough to still be in junior positions and I don't think they're planning on staying long term.
 
I'm probably going to go through all the hoops to get back to the states just in case I don't want to stay at the end of the road. I'd love to at the moment, but like both of you said, that seems to be a transient thing.
 
What if you get nationalised? If I really want to move there, I'm going to try and become a citizen. Would that make things easier?

As for becoming a citizen .... it will take a number of years after graduation (your years as a student don't count). The fastest way of getting citizenship is to marry an Irish person - the catch is that you will need to live with your Irish wife/husband IN IRELAND for a minimum of 3 years to be even considered for citizenship - that rule was in part brought into Ireland in Nov 2002 to stem the rush of foreing nationals into Ireland and to have them claim citizenship after landing in Ireland at 8 months pregnant and giving birth then claiming citizenship based on their child's claim of birth-rite.

Source: one of my old roommates that works high up in the department of foreign affairs.
 
Yeah, I realized that. I was talking more about when consultant time comes around. I figured maybe they prefered citizens, but that apparently is not the case. At any rate, it is FAR too early for me to be worrying about any of this as much as I am. Once I get in, I'll start thinking about it more seriously.
 
People who want training go to England.

People who want training, and then to make lots of $$$ go to America.

It's that simple.

<--- Father worked in UK healthcare system, and now practices in U.S.
 
People who want training go to England.

People who want training, and then to make lots of $$$ go to America.

It's that simple.

<--- Father worked in UK healthcare system, and now practices in U.S.

bollocks, there's loads of opportunities to make serious cash in the U.K... and without a large chunk of it being taken away by medical indemnity insurance, which is nowhere near as high as it is in the states.

http://bmj.bmjjournals.com/cgi/content/full/328/7431/70-g
 
I can answer the U.K part of the question as I am studying in England rather than Ireland. I’ve met a few Canadians in schools here in Europe and the main reason they want to go back home is because Canada is where they always saw themselves practicing as a doctor. For them, Canada is home and that’s where they want to be. The new immigration/visa work laws are having a massive influence but this issue is still fairly new.

All the other stuff about money and career progression don’t make much sense. British docs make good money here and thanks to the whole MMC scheme, it’s much quicker to become a consultant. There are so many different angles to look at this from.

Hi johnny blaze,

are you a US citizen working/studying medicine in the UK? Are you planning on staying there after school? Any advice to someone thinking about doing their postgrad training/staying over there after US MD degree?
 
I know 4 - 1 Canadian and 3 Americans who've stayed long term. At least 2 because of significant others (1 of them went to the UK to do internship/residency and is now in Belfast). The other stayed because of SO, but also failed USMLE because he/she didn't study properly (good student but wasn't motivated for the USMLE b/c he/she was planning on staying in Ireland anyway). This one is currently in the psych scheme. I know of plenty others who stayed, only recent enough to still be in junior positions and I don't think they're planning on staying long term.

leorl, do you know if it was difficult for the 4 North Americans to go over? For the Americans, was it very difficult to go from US Med School over to internship/residency in the UK esp. since they aren't citizens (but maybe in the process of being one?)
 
Hi johnny blaze,

are you a US citizen working/studying medicine in the UK? Are you planning on staying there after school? Any advice to someone thinking about doing their postgrad training/staying over there after US MD degree?

what kind of advice? be more specific please
 
just any information:

a) the process
b) the difficulty
c) disadvantages
d) advantages

basically anything on going from US MD to practicing in the UK?
 
1) I’m not too knowledgeable about the process as I’m a U.K grad. From what I understand, you’ll have to take exams called the PLAB in order to be able to practice. It’s best to contact the GMC (general medical council) as they can give you a more offical breakdown of the conversion process for someone in your particular situation.

This website is really good and can answer most of your questions regarding the conversion process. http://www.bmjcareersadvicezone.synergynewmedia.co.uk/info_links.asp

2) If you are not a citizen of the U.K it will be very difficult getting a higher level training spot here. New changes to FMG working status means that you will only be considered for training spot if the institution is unable to fill it with a U.K/EU grad (who also holds citizenship).

3/4) Listing the advantages and disadvantages of training in the U.K is difficult to do as this is very subjective.
Pros
-More relaxed training – takes a bit longer to get to consultant level but you'll get there comfortably.
-The GMC controls how doctors practice and there is a strong custom to follow evidence-based medicine. Some people would think of this as a con but I think it’s an advantage depending on how you look at it. For example, CT surgery is a dead stick in the U.S mainly because of interventional cardiology. However, there are certain situations where CABG is proven to be more beneficial but cardiologists in the U.S are not regulated by an higher authority and cannot come under scrutiny for not referring out as they can in the U.K. Hence why a training spot in CT surgery is relatively easy to get in the states but still very competitive in the U.K, as it still has a good future here.
-Medical indemnity insurance is far less in the U.K.
-You are paid for time, not for procedures. Nobody really steps on anybody else’s toes here. The mentality of “if I don’t do the procedure, I don’t get paid” isn’t really an issue here.
-You are financially rewarded for academics (via clinical excellence awards); thus, an academic doctor can earn lots of money without having to do private work.

Cons
-Standard of living is very high in the U.K
-Postgraduate training process is changing, so it’s harder to predict where you’ll be in 10 years.
-A lot of profs here are mean and the British stiff upper lip takes some time getting used to (just my opinion)
-Fellowship exams are too broad scoped. This is an issue if you want to be super sub specialized. For example, having your FRCS means you are competent in general surgery, however, if you wanted to practice high risk colorectal surgery it would be up to your employers discretion as to how qualified you are (unlike the U.S where you’ll be board certified in colorectal surgery and have your FACS). Specialty specific standardized exams may be introduced in the future with the whole modernizing medical careers thing though.

I kept this an open message on the thread rather than a PM so other people could add their input, as some may agree/disagree with what i have to say (or point out any mistakes)
 
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