UK Medical Students -> the US

[qichenliu1]

Hello people. I'll be studying medicine at Imperial College London for the MBBS (Bach. of medicine & surgery) + Bsc (a 6 year course). I was wondering if anyone can tell me what I have to do to be able to practice in America (to start residency? Is this what it's called). Forgive me, I'm quite ignorant of the system in the United States. Is the MBBS recognised to any degree in the US? Are there any additional tests or courses I have to take?? Your help is very much appreciated. Regards.

Also, what are the major hospitals in the US? In the UK there's St Georges Hospital etc.

In the UK, medical students who come out of medical school (in a nut shell) first work as a Pre-registrial House Officer, then Senior House Officer, then Registrar, then Consultant (which is at the top of the ladder). Are there similar promotional ladders in the US? If so how long does it usually take to climb to the top of the ladder? In the UK it usually takes around 10 years.

Sorry to drag on, what's the salary like for doctors in the US?

Thank you in advance for your replies.

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[Miklos]

Hello people. I'll be studying medicine at Imperial College London for the MBBS (Bach. of medicine & surgery) + Bsc (a 6 year course). I was wondering if anyone can tell me what I have to do to be able to practice in America (to start residency? Is this what it's called). Forgive me, I'm quite ignorant of the system in the United States. Is the MBBS recognised to any degree in the US? Are there any additional tests or courses I have to take?? Your help is very much appreciated. Regards.

Also, what are the major hospitals in the US? In the UK there's St Georges Hospital etc.

In the UK, medical students who come out of medical school (in a nut shell) first work as a Pre-registrial House Officer, then Senior House Officer, then Registrar, then Consultant (which is at the top of the ladder). Are there similar promotional ladders in the US? If so how long does it usually take to climb to the top of the ladder? In the UK it usually takes around 10 years.

Sorry to drag on, what's the salary like for doctors in the US?

Thank you in advance for your replies.

You've got a lot of questions and I'm not sure that a single person can answer all of them.

Here is a very short response.

1) The MBBS is recognized as an equivalent to the MD provided that one completes the degree at a WHO listed school and completes the requirements set forth by the ECFMG. See www.ecfmg.org for details.

2) It is unlikely that you'll need to take additional courses, though elective rotations once you are in your clinical years in the US will help you a great deal. You will have to complete the USMLEs. See www.usmle.org

3) The postgraduate training hierarchy is much simpler in the US. You are an intern first year, thereafter resident and once you have finished your residency and board examinations, you are a specialist (equivalent to a consultant). Also, residency is much shorter in the US than in Britain. For training details for a particular specialty see FREIDA at http://www.ama-assn.org/ama/pub/category/2997.html

4) Getting into a residency is a competitive process, especially for foreign medical graduates. For statistics on how competitive each specialty is see
http://www.nrmp.org/2004advdata.pdf on the "Match" website www.nrmp.org

5) Salaries for US specialists are higher than UK consultants at direct exchange rates.

If you are serious about exploring the possibility of postgraduate training in the US, I recommend that you invest in Iserson's Getting into a Residency by Kenneth V. Iserson.

Miklos

 

[IlianaSedai]

Your MBBS (yes, Imperial counts as a legitimate medical school, duh )will be recognised as equivalent to graduating from a US medical school. So do you not need to take any coursework.

"Residency" is equivalent to the training period in the UK between graduating from university with the MBBS, and being qualified either as SpR or consultant depending on the medical specialty. If you truly wish to move (if your family live here, for example), earlier is better -- your postgraduate training in the UK does not in most cases allow you to skip years of US residency. As it takes years to become a consultant in the UK and also years to achieve a similar level of qualification in the US, most people are not willing to invest the many years (a decade? a decade and a half?) it would require to become fully quaified in both countries.

However, all doctors in the US need more than a degree from a medical school -- they also need to take and pass three national, standardized exams called the United States Medical Licensing Exam (USMLE) Steps 1, 2 and 3. Here is an approximate timetable of when American students sit for these exams, which each require 1-2 months of full-time preparation during a holiday:

Step 1 - evaluates your knowledge of basic sciences. between the pre-clinical years and the clinical years of medical
school

Step 2 - during the clinical years of medical school

Step 3 - typically, during the first year or two of postgraduate training (residency)

As a non-US student, if you truly desperately wanted to move to the US (i.e. you were absolutely certain this is the right thing for you to do) I suppose you could afford the time to take Step I during a summer. It would make a lot of sense to take Step 1 immediately after your basic sciences and before your clinical years, as the basic sciences material will be freshest in your mind. However, most non-US medical graduates take all three of these exams after they have graduated, and frequently after they haved moved to the US.

Step 1 is the only exam you need to apply for residency in the US -- this makes it a bit stressful, as high scores are looked upon favorably. The other two exams can be taken after your applications have been sent in.

And I thoroughly recommend getting either the Isersons Getting a Residency book OR First Aid for the Match -- these are the US equivalents to So You Want to Be a Brain Surgeon? and they provide a great deal of career advice.

Edit: You will hear a lot of people saying that it is difficult for foreign medical graduates to gain a residency in the United States. However, from my observation UK medical graduates (the few that bother to move) rather uniquely tend to do very well, as long as their applications (Step 1 scores + other criteria) are reasonably competitive enough to make a programme decide to offer an interview. They are well prepared and I think the cultural politics favor them a bit -- especially because English is typically not a second language -- it is more than probable that interviews go especially well.

 

[IlianaSedai]

And if you are not serious about moving, and just want to spend some time abroad, contact US medical schools and teaching hospitals directly to arrange an elective during your final or clinical years of medical school. It is much easier and saves years of planning and work.

 

[FionaS]

Definitely do your elective in the States! Also a summer research programme between 1st and 2nd year would be good - only if you can afford it though.

Well, everyone else has covered most of it, so some advice on the USMLE.

It feels much harder than anything we do (purely because it focuses on slightly different things). If you decide to do it, then I'd get practice books from the start and get used to the exam format.

Best time to take Step 1 would be after the second year, or if you intercalate in your 3rd year (between 2nd and 3rd medical years) in a basic clinical/biological science then after that. You've long summer hols still then, so it would work.

Basically you want to do it when all those amino acids and other nasty niggly details like that are still fresh in your mind...

Are you starting 1st year this September? I'm a 3rd year who intercalated at Birmingham, with absolutely no intention of going to the states, but since I hang around here a lot I've picked up a lot, so could probably help you out a little

Good luck!

 

[Miklos]

Your MBBS (yes, Imperial counts as a legitimate medical school, duh )will be recognised as equivalent to graduating from a US medical school. So do you not need to take any coursework.

"Residency" is equivalent to the training period in the UK between graduating from university with the MBBS, and being qualified either as SpR or consultant depending on the medical specialty. If you truly wish to move (if your family live here, for example), earlier is better -- your postgraduate training in the UK does not in most cases allow you to skip years of US residency. As it takes years to become a consultant in the UK and also years to achieve a similar level of qualification in the US, most people are not willing to invest the many years (a decade? a decade and a half?) it would require to become fully quaified in both countries.

However, all doctors in the US need more than a degree from a medical school -- they also need to take and pass three national, standardized exams called the United States Medical Licensing Exam (USMLE) Steps 1, 2 and 3. Here is an approximate timetable of when American students sit for these exams, which each require 1-2 months of full-time preparation during a holiday:

Step 1 - evaluates your knowledge of basic sciences. between the pre-clinical years and the clinical years of medical
school

Step 2 - during the clinical years of medical school

Step 3 - typically, during the first year or two of postgraduate training (residency)

As a non-US student, if you truly desperately wanted to move to the US (i.e. you were absolutely certain this is the right thing for you to do) I suppose you could afford the time to take Step I during a summer. It would make a lot of sense to take Step 1 immediately after your basic sciences and before your clinical years, as the basic sciences material will be freshest in your mind. However, most non-US medical graduates take all three of these exams after they have graduated, and frequently after they haved moved to the US.

Step 1 is the only exam you need to apply for residency in the US -- this makes it a bit stressful, as high scores are looked upon favorably. The other two exams can be taken after your applications have been sent in.

And I thoroughly recommend getting either the Isersons Getting a Residency book OR First Aid for the Match -- these are the US equivalents to So You Want to Be a Brain Surgeon? and they provide a great deal of career advice.

Edit: You will hear a lot of people saying that it is difficult for foreign medical graduates to gain a residency in the United States. However, from my observation UK medical graduates (the few that bother to move) rather uniquely tend to do very well, as long as their applications (Step 1 scores + other criteria) are reasonably competitive enough to make a programme decide to offer an interview. They are well prepared and I think the cultural politics favor them a bit -- especially because English is typically not a second language -- it is more than probable that interviews go especially well.

Iliana,

I did not mean to insinuate that Imperial is not a legit school, I wrote the response to the broadest possible terms.

Regarding additional classes, this is a little more complicated, as each state sets up its own requirements. Again, in broad terms, as I do not know the UK curriculum in detail, therefore check with the individual state licensing board regarding their requirements. For instance, California requires 4 weeks of Family Medicine.

Also, considering the timing of the match, it is most favorable for all FMGs to get an ECFMG certificate before August 15 of the year preceeding the match so that their application can be reviewed by the most PDs. Therefore, I recommend that you have both Step 1, Step 2 CK and Step 2 CS in hand before that date, if at all possible.

Also, I don't believe that a SpR is equivalent to a US specialist. In which medical specialities do you believe this to be the case?

Miklos

 

[IlianaSedai]

SpR and fully qualified US specialist are not equivalent since SpR posts are still training posts, sometimes similar to US fellowships but sometimes closer to US residencies depending on the specialty. But there are some oddities that are just very difficult to classify by direct comparison. For instance, trauma surgery is done through orthopaedic surgery (WITHOUT additional training required? not sure on this one) in the UK, and typically as a fellowship required after general surgery in US. Emergency Medicine in the US is a straight shot out of med school, but is done through multiple routes in the UK(entering either directly as SHO or after medicine/surgery as SpR).

 

[kaito]

Hello everyone

I really appreciate all of the helpful posts on this thread as it's all very relevant to my current situation as well.

I'm in a similar position to qichenliu1 in that I've received an offer from a UK University (Liverpool Uni - ranked 4 for medicine) to study medicine this coming September.

At the same time however, I've been waitlisted for the PLME program in Brown University - a program where I undergo the standard 4+4 years to achieve a Sc.B and M.D. The only difference is that my entry into the Brown Medical school will be guaranteed so long as I maintain a certain GPA (yep, no second round of applications to worry about!).

Now if I get accepted into Brown, I'll be faced with the dilemma of having to pick between a UK/US medical education. Can anyone explain to me the pros/cons of each medical education system, and tell me which of the two qualifications (MD / MBBS) is more widely recognised around the world? I have no particular ties to the US or the UK, so I want to keep my options open to work abroad.

 

[IlianaSedai]

kaito,

I am at Brown, send me a private message if you have any questions.

The main piece of advice I would give is, it is always easiest to go to medical school in the country where you intend to practice. If your family is in the US exclusively and you see yourself staying in the States long term, then the easiest route is to go to medical school here. If you do not get into the combined programme, it is probably LESS trouble to go regular pre-med route and apply to US med schools, than it would be to get your MBBS and have to go through the work of taking the US national medical board exams all within a short period of time before applying for postgraduate training in the US. In a US medical school, you would spread these major exams throughout med school and your first year+ of postgraduate training and have lots of peer support -- much more calming on your nerves than taking them and going through the residency application process alone after graduating from Liverpool.

(That said, you already know in a small way what it's like to go through an application process alone without a great deal of guidance from local resources, since you've already successfully applied to university in two different countries. Think of moving countries after graduating from med school to be a much longer version of that.)

There is not a lot of guidance out there for people who graduate from medical school in one country, then want to practice in another. Forums like this are invaluable but advice is never consistent, and career books devote maybe a chapter to this subject at most. So when you get your degree in one country and then move to another to do your postgraduate medical training (it's called "residency" in the US), you are pretty much left on your own and you have to do a lot of extra legwork to learn the ropes, so to speak.

I would be absolutely thrilled to have the chance that you have, but that's because I am seriously weighing the possibility of being in the UK long term. If I realised while studying in the UK that I really wanted to remain in the US long term, however, I would not be so thrilled at all -- it's an awful lot of work to (re)qualify in a different country.

That said, I think it seems somewhat easier to graduate from a US medical school and move to the UK, than it would be to graduate from a UK medical school and move to the US. I do NOT think it is impossible (to move from one to the other) and I'm fairly sure that given enough commitment to doing this, you CAN do it. But if you are serious about living in the US when you're 40, I think it would be advisable to go to medical school in the US -- if you read this forum, pre-med without a combined program can be competitive but is not impossible. And the same goes if you are serious about living in the UK at age 40.

 

[kaito]

Thanks IlianaSedai for all the advice - I definitely have a lot to think about before I pick which school to go to. I'm really thankful that I came across this website in time - it would've been awful finding all of this out in medschool. Thanks again

 

[FionaS]

SpR and fully qualified US specialist are not equivalent since SpR posts are still training posts, sometimes similar to US fellowships but sometimes closer to US residencies depending on the specialty. But there are some oddities that are just very difficult to classify by direct comparison. For instance, trauma surgery is done through orthopaedic surgery (WITHOUT additional training required? not sure on this one) in the UK, and typically as a fellowship required after general surgery in US. Emergency Medicine in the US is a straight shot out of med school, but is done through multiple routes in the UK(entering either directly as SHO or after medicine/surgery as SpR).

Yeah, I've had this problem in trying to work out equivalents!

All our Trauma surgeons are Orthopods - and no you don't do 'extra' training - it's considered part of the standard Ortho training. Don't forget that we don't have to worry about gun shot wounds, so I guess less general surgery is needed. Plastic surgeons may have a special interest in trauma, but it's a pretty minor part of their workload.

Emergency Medicine (or A&E as we call it ) is one of the few specialities you absolutely can't do straight out of med school, in complete contrast to the US.

Miklos - California only require 4 weeks of family medicine? I've already got 6 - and another 7 to go! That's pretty much standard in the UK... I really don't want to go into FP

 

[Miklos]

Miklos - California only require 4 weeks of family medicine? I've already got 6 - and another 7 to go! That's pretty much standard in the UK... I really don't want to go into FP

Fiona,

My point was only to illustrate the problems faced by FMGs going to the US. Every state medical board makes its own rules.

Miklos

 

[PTCA]

I think it is more appropriate to correspond UK spr status to US fellowship status (or even 2nd fellowship status, concerning some specialties)
Only a fraction of medical graduates gets to either of these.
However, the philosophy of the system is vastly different
A US doc having only completed a residency can end up making much more than a UK consultant, in certain fields.

 

[Apollyon]

Emergency Medicine (or A&E as we call it )

Casualty, did I hear you say??

Ever see the movie "Paper Mask"? Love it!

 

[Apollyon]

That said, I think it seems somewhat easier to graduate from a US medical school and move to the UK, than it would be to graduate from a UK medical school and move to the US.

See, I think it's the other way around - with the EU, and the thousands of Italian graduates getting automatic full registration now, I thought the UK clamped down on non-EU. Also, I've heard horror stories about the PLAB.

From the UK/A/NZ, I haven't seen people have problems. I knew also of an Indian guy that did all his GME in the UK, then came to the US on an "O" visa (for "special talents or abilities" - he'd published something like 30+ papers in heme/onc), who got 6 months off his 3 year IM residency.

Also, the vagaries of UK GME (and the outright racism against people from the Indian subcontinent) make it more scary - to be a Senior Registrar forever? Ouch! There's a guy here at Duke who went to school in Nigeria, then did an?sthesia in the UK, and it took him 11 years - insane! However, when he came to Duke, they have him on a special "foreign scholar" permit, so, as long as he stays at Duke, he doesn't have to repeat his residency, and he's a full consultant.

The difference is, I see, you can be "all that", and still be kept down in the UK, but, in the US, if you work hard enough, no matter who you are, you can move up. The current director of the NIH (National Institutes of Health) in the US is an Algerian radiologist! Here is a link to his (5-page) CV.