Dec 30, 2020
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Hello everyone,

My daughter is a US Citizen and is interested in pursuing a career in medicine ( her current interests are in neurology / mental health / psychiatry ). We have been living in UK for the last few years and she is a resident here ( equivalent to green card in US ). She is currently doing A levels in four subjects ( Chemistry/Biology/Maths/Spanish ). Eventually she would like to practice in US as that is where the extended family is. She has good academic results in her GCSE exams and if she continues her academic performance, she stands a decent chance of securing a medical school admission into one of the good universities in UK.

We are not sure what would be the best pathway for her. Doing medicine in UK and pursuing residency in US by completing USMLE steps as a US-IMG or get into an undergrad program in US and pursue a pre-med curriculum and go through MCAT/med school in US to avoid any future issues with residency matching?

We really do not have many connections into the physician network to leverage/seek advice and I thought I would ask this network for any advice/experience sharing. Thanks in advance.
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Angus Avagadro

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Applying as an IMG has several downsides. I believe she would have better chances at scoring a good residency as a US grad as opposed to a UK grad. Many US residencies are quite competetive, and usually give preference to US grads since there is a relative shortage of residency slots in many residencies. Obviously some are more competetive, surgery, ortho, derm, ortho, etc. Others, like Fam Med, or lower tier Int Med are not competitive. Depending on what your daughter ends up applying for will make a big difference as an IMG. Most students interests change in med school. Mine did, as did my wife's. Most IMGs at good residencies are usually rock star candidates from their own countries, PhDs and or multiple research publications ,making it even harder for your daughter. IMO, I definitely go to a US med school. This is no knock on UK docs. The ones I have worked with are very well trained. Good luck and best wishes to your daughter!
 
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Banco

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If the plan is to practice in the USA, then going to a US Medical School makes things much much easier. The easiest way to do this is to go to a US undergraduate --> US Medical school --> US Residency; worst case scenario is she goes to a good US undergrad and decides medicine isn't for her, and then she can go work anywhere.

Alternatively she could get a bachelor's at a UK university --> US Medical school - but this is also going to be harder, as admission for international students into US medical schools is on average more competitive.

Trying to match as an IMG in residency is possible, but much more difficult, and will limit her for specialty choices significantly.
 
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LaughingGas10

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Agree with the other two posts above. Better to do US medical school if possible.

However, UK IMGs are at the top of the pole and do get preferential treatment over other country IMGs, due to excellent quality, good training and adds diversity to the residency. If she is guaranteed to go into psychiatry or neurology, these are two of the easier residencies to match into.
 
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Please keep in mind that foreign transcripts are not acceptable for admission to US medical schools. When I've seen applicants who were educated abroad, they typically take graduate level coursework (sometimes the entire PhD) in the US before applying for the MD.
Also, keep in mind that only 43% of applicants to US medical schools are successfully admitted to US medical school. Many more "pre-med" students never even make it to the point of making an application having been crushed by the pre-requisite coursework and/or the MCAT.

Your daughter needs to determine which is more important to her: to practice medicine but perhaps be cut off from practice in the US or to live in the US and maybe be lucky enough to practice medicine but maybe not.
 
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Dec 30, 2020
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Please keep in mind that foreign transcripts are not acceptable for admission to US medical schools. When I've seen applicants who were educated abroad, they typically take graduate level coursework (sometimes the entire PhD) in the US before applying for the MD.
Also, keep in mind that only 43% of applicants to US medical schools are successfully admitted to US medical school. Many more "pre-med" students never even make it to the point of making an application having been crushed by the pre-requisite coursework and/or the MCAT.

Your daughter needs to determine which is more important to her: to practice medicine but perhaps be cut off from practice in the US or to live in the US and maybe be lucky enough to practice medicine but maybe not.

Thank you to everyone who has responded. My admiration to everyone who volunteers their time to aspiring students. 🙏

We do not plan to apply as International student, ie UK undergrad--> US med school as the chances seem to be very slim. The choice is between UK med school --> residency in US OR pre-med undergrad in US --> possible med school in US.

As you point out, the question will come down to what is important to her. For a 17 year old, it is a daunting question. We are trying to collect as much advice and data as possible for her to make a choice. Thanks again.
 
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Lucca

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Thank you to everyone who has responded. My admiration to everyone who volunteers their time to aspiring students. 🙏

We do not plan to apply as International student, ie UK undergrad--> US med school as the chances seem to be very slim. The choice is between UK med school --> residency in US OR pre-med undergrad in US --> possible med school in US.

As you point out, the question will come down to what is important to her. For a 17 year old, it is a daunting question. We are trying to collect as much advice and data as possible for her to make a choice. Thanks again.
If I was your daughter, I would choose to go to a UK medical school and re-evaluate whether I want to practice in the US or UK once I'm near the end of it.

The average med student in the US is taking on 200k+ med school debt (at my school, without any financial aid 4 years of MD runs you about close to 400,000 $) and undergraduate debt isn't too much better at 50-300k depending on what kind of school you go to and how much aid you get. Admittedly, med school financial aid has become more generous in recent years but its an absolute crapshoot if you can get into the schools with the best aid even if you are a top student. I congratulate your daughter on a stellar HS performance that has afforded her these options, definitely something to be proud of but it's hard to predict for anyone at that stage how they will fare in US MD admissions. The average med student in the US is starting med school at 24/25 after taking 1-2 years after college to get into med school. That means your daughter will likely be a first year med student in the US around the same time that she would be finishing the 5-6 year MBBS/MBChB course in the UK.

US docs make more than UK docs and residency training is shorter but the road up to and through med school is slightly longer and orders of magnitude more expensive. US job market for MDs is wide open for most specialties because of highly aggressive guild behavior, I know the UK market is a bit tighter across more specialties. Residency match is much tougher as an IMG but slightly better coming from the UK and even better if she's coming from Oxford, Cambridge, Imperial, or UCL, most likely.

Admittedly, I am biased in that I am not all that concerned with earning as much money as possible and having lived in both the US and the UK I vastly preferred living in the UK. Like it's not even close, frankly.

So, on balance, that is my calculation as to why I would choose to start in the UK right away and re-evaluate where I want to train at the end of it. If money is no object and your daughter is extremely confident in her abilities, the US premed --> med school option is the absolute safest and surest bet to practicing in the US in the long-run. Question is: Is that what she will want in 15 years from now when shes about to be out of training?
 
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Angus Avagadro

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If I was your daughter, I would choose to go to a UK medical school and re-evaluate whether I want to practice in the US or UK once I'm near the end of it.

The average med student in the US is taking on 200k+ med school debt (at my school, without any financial aid 4 years of MD runs you about close to 400,000 $) and undergraduate debt isn't too much better at 50-300k depending on what kind of school you go to and how much aid you get. Admittedly, med school financial aid has become more generous in recent years but its an absolute crapshoot if you can get into the schools with the best aid even if you are a top student. I congratulate your daughter on a stellar HS performance that has afforded her these options, definitely something to be proud of but it's hard to predict for anyone at that stage how they will fare in US MD admissions. The average med student in the US is starting med school at 24/25 after taking 1-2 years after college to get into med school. That means your daughter will likely be a first year med student in the US around the same time that she would be finishing the 6 year MBBS/MBChB course in the UK.

US docs make more than UK docs and residency training is shorter but the road up to and through med school is slightly longer and orders of magnitude more expensive. US job market for MDs is wide open for most specialties because of highly aggressive guild behavior, I know the UK market is a bit tighter across more specialties. Residency match is much tougher as an IMG but slightly better coming from the UK and even better if she's coming from Oxford, Cambridge, Imperial, or UCL, most likely.

Admittedly, I am biased in that I am not all that concerned with earning as much money as possible and having lived in both the US and the UK I vastly preferred living in the UK. Like it's not even close, frankly.

So, on balance, that is my calculation as to why I would choose to start in the UK right away and re-evaluate where I want to train at the end of it. If money is no object and your daughter is extremely confident in her abilities, the US premed --> med school option is the absolute safest and surest bet to practicing in the US in the long-run. Question is: Is that what she will want in 15 years from now when shes about to be out of training?
Thanks for presenting a fresh perspective. I have traveled to the UK several times, had a fellow who became a colleague from London in the past. She painted a slightly different picture. Its my understanding, and please correct me if I'm wrong, that Consultant positions, aka Attending Physician in the US, are set at a fixed number. You must continue as a Registrar, aka Resident physician in the US, with a Registrar's salary,until a Consultant position becomes available through retirement or death. In some specialties this could take a decade or more. This is another reason I suggested to attend a US school. Are you able to add any additional information to this? Thanks very much. Btw, she had to return to London due to her husband's job loss and found a Consultant position quickly, but she also had skills few if any in the UK had at the time.
 
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Lucca

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Thanks for presenting a fresh perspective. I have traveled to the UK several times, had a fellow who became a colleague from London in the past. She painted a slightly different picture. Its my understanding, and please correct me if I'm wrong, that Consultant positions, aka Attending Physician in the US, are set at a fixed number. You must continue as a Registrar, aka Resident physician in the US, with a Registrar's salary,until a Consultant position becomes available through retirement or death. In some specialties this could take a decade or more. This is another reason I suggested to attend a US school. Are you able to add any additional information to this? Thanks very much. Btw, she had to return to London due to her husband's job loss and found a Consultant position quickly, but she also had skills few if any in the UK had at the time.
this has changed in the last 10 years, but yes that is in fact how it used to work. The bottleneck wasn't at consultant, but at becoming a specialty registrar, and only for certain specialties. Say you did your 5 years of med school after HS and then 3 years of general medical training including 1 intern year and 2 "senior house officer" years. At that pt you applied to your medical specialty registrar. The number of registrar posts is fixed so if you wanted to do something very competitive like cardiology or plastics you might get "bottlenecked" at your senior house officer position for several years until you succeed at getting a registrar post. That's not really how it works anymore and the path is supposed to be more streamlined, but competitive specialties are still competitive. It's not unlike our system, except the competition bottlenecks for specialties happen like after 2nd year of what we would call residency instead of during your final year of med school (for what it's worth they think it's pretty silly that we decide who gets to do what specialty with an exam you take in your 2nd year of med school instead of how ppl perform as full-time practicing physicians). This is my superficial understanding from my friends from the UK still in training.

but your larger point is correct. The system is obviously very different, and its not like the UK or the NHS are perfect. NHS has a big junior doctor dissatisfaction problem (so do we, but for different reasons), and even though work hours are generally better in the UK (capped at 48 hours a week for junior doctors) a lot of docs still have to work longer than the cap and then do so for no extra pay simply because of how squeezed the NHS is for resources / manpower. It takes ~8-10 years post med school to become a consultant in most specialties (5 years post med school to become a General practitioner) so the total training time mostly ends up being a wash at the end of the day. BUT you get to the doctoring part of your training much faster, and have much less debt. Pros/cons.

My larger point is that a 17 year old with the right passport to have this option should probably consider not taking out a mortgage's (or two mortgage's) worth of debt to do medicine and re-evaluate what they want out of their career/life at when they are on the other side of med school, given they are completely sure this is the career for them, because the UK -- even with all of its own problems -- does offer many advantages to longterm living/lifestyle/security. The US offers lots and lots and lots of money****** with which you buy those things for yourself. dealer's choice.

*** in specific job scenarios, after debt payments for 10-15 years, depends on your specialty and geography
 
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Angus Avagadro

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this has changed in the last 10 years, but yes that is in fact how it used to work. The bottleneck wasn't at consultant, but at becoming a specialty registrar, and only for certain specialties. Say you did your 5 years of med school after HS and then 3 years of general medical training including 1 intern year and 2 "senior house officer" years. At that pt you applied to your medical specialty registrar. The number of registrar posts is fixed so if you wanted to do something very competitive like cardiology or plastics you might get "bottlenecked" at your senior house officer position for several years until you succeed at getting a registrar post. That's not really how it works anymore and the path is supposed to be more streamlined, but competitive specialties are still competitive. It's not unlike our system, except the competition bottlenecks for specialties happen like after 2nd year of what we would call residency instead of during your final year of med school (for what it's worth they think it's pretty silly that we decide who gets to do what specialty with an exam you take in your 2nd year of med school instead of how ppl perform as full-time practicing physicians). This is my superficial understanding from my friends from the UK still in training.

but your larger point is correct. The system is obviously very different, and its not like the UK or the NHS are perfect. NHS has a big junior doctor dissatisfaction problem (so do we, but for different reasons), and even though work hours are generally better in the UK (capped at 48 hours a week for junior doctors) a lot of docs still have to work longer than the cap and then do so for no extra pay simply because of how squeezed the NHS is for resources / manpower. It takes ~8-10 years post med school to become a consultant in most specialties (5 years post med school to become a General practitioner) so the total training time mostly ends up being a wash at the end of the day. BUT you get to the doctoring part of your training much faster, and have much less debt. Pros/cons.

My larger point is that a 17 year old with the right passport to have this option should probably consider not taking out a mortgage's (or two mortgage's) worth of debt to do medicine and re-evaluate what they want out of their career/life at when they are on the other side of med school, given they are completely sure this is the career for them, because the UK -- even with all of its own problems -- does offer many advantages to longterm living/lifestyle/security. The US offers lots and lots and lots of money****** with which you buy those things for yourself. dealer's choice.

*** in specific job scenarios, after debt payments for 10-15 years, depends on your specialty and geography
Thanks so much for your insight! I believe this is quite helpful for the OP.
 
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