USA & UK

[arteg]

I know I might be starting a controversial topic here..but I need your opinions & advice.
which is the best for residency training in surgery & subspecialities;the US or the UK ?? I am an IMG & interested in surgery;particularly pediatric surgery.. I'm very confused about the decision concerning the country to pursue my training in.
so I need your input & if there r any personal experiences.

my uncle runs a medical supplies company & he's trying to convince me that UK is better both in training & life style.

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[jms2002]

A big factor is where you want to live and practice the rest of your life. If US then you should do your residency in US - though not an expert - I am sure most would agree

 

[BellKicker]

Med school: Europe wins by a little.
Residency: US wins by more than a little.

I have nothing to base this on except it's somewhat of a consensus among people I have talked to who know both systems. I think residents in the US generally work harder than anywhere in the western world.

Obviously there are tons of personal reasons for choosing one over the other. I would always choose the US over the UK but that's just me. Why? Great people, beautiful country.

 

[SomeFakeName]

The UK system of surgical training is still very old school with limited spots to train surgeons. Furthermore, you have to jump through MANY more hopes to become an attending (called "consultant") surgeon in the UK. After med school, everybody has to do an internship year that doesn't even count toward your surgical training. After internship, you have to do 2 years of basic surgery training (BST), at the end of which you take the FRCS Part I exam. This exam has something like a 30% pass rate for first time takers, and it is common for trainees to take it up to 3 or more times until they pass. So you could be stuck at the same registrar (what we call resident) position until you pass this exam.

Once you pass FRCS I, you have to apply to hospitals for advanced surgical training (AST). If you want to do peds surgery, I think it is 4 more years of advanced general surgery training before you can do peds surgery. However passing FRCS I doesn't guarentee that you'll get an AST position, since one may not be available the year you want it, so you may have to wait out a year until one opens up. Once you get into AST and do 4 years of it, you take the FRCS Part II exam, which I've heard has even a lower first-time pass rate that FRCS I believe it or not. Once you pass the FRCS II, you can apply for a spot in peds surgery, which is EXTREMELY limited in the UK. If you're lucky enough to get one of them, then you will be a qualified ped surgery registrar by the end of your training...not yet a consultant (attending). The only way you can become a consultant is to wait for a ped surgery consultant to retire so his/her spot opens up so that you (and all the other ped surgery registrars) can apply for it...can you say fierce competition?! This is where heavy politics come into play, and I've seen guys who want to do surgical subspecialties wait around years as registrars until a consultant spot opens up and they get appointed to one. Ask yourself, do you want to wait around years (up to 10+) until you finally go from being a resident to a full-fledged attending?

 

[arteg]

especially SomeFakeName for the informative post.
will the picture be different if my aim is to get the FRCS in the surgical subspeciality (didn't decide which one yet; ped or CT) then come back to my home country? I'm not sure yet if I wanna settle in the UK,the doors are open for all possibilities. plz note also that I'm facing hard times getting the visa to enter the US (I was rejected once);that's why I'm asking about UK in the 1st place.. am I trying to convince myself that doing my residency training in the UK will make no big difference?? may be that's what I'm doing !!
so I wanna know if finding a place to so my BST & AST will be also such competitive even if I don't intend to settle in the country.which countries can accept me to practice medicine after doing the FRCS?
thanks for the help. thanks SomeFakeName for your assistance... looking forward to hearing from you about this topic.

 

[Purifyer]

Out of interest... why was your visa rejected? If you think you can train for a specialist position in the UK and then move to the US.......................... I am fairly sure you are dreaming. It's just politics, I think most countries do not recognise speciality training from other countries.

I think there _may_ be an slight exception amongst the commonwealth countries but I'm not sure.

 

[arteg]

My visa application was rejected because the consuler considered me the "potential immigrant" though i was representing my med school in a clinical conference in San Diego & I had all the necessery documents to proove that (invitation letter,recipiet of reg fees & letter from my med school) !!

I know others who couldn't get a visa to attend the CSA exam..THIS IS MADNESS.

anyhow, plz guys post your input regarding the chances of an overseas doc to have an FRCS in a surgical subspeciality like ped or CT surgery,and if his chances would be better if he won't intend to stay in the UK after obtaining the FRCS.

thank you.

 

[SomeFakeName]

Arteg, as far as I am aware the FRCS credentials are recognized in the UK, Australia, India, South Africa, Malaysia, Singapore, Indonesia and most other Commonwealth territories. Many other European countries also accept FRCS credentials, especially those in dire need of surgeons. But please check to make sure the rules haven't changed for some of these countries in the past few years regarding FRCS training.

The actual problem is not becoming a FRCS, as most people can eventually pass the FRCS I exam, even if it takes several tries. The main problem is finding a spot to progress through your training so that you'll be eligibel for FRCS II. Many people can get through BST, but the problems usually begin when they want to get into AST and subspecialty training. The simple fact is that there are just too many applicants for AST than there are spots, and that is why a lot of surgeons remain at the same registrar position for a few years until they can finally get into AST. The same thing happens when they pass the FRCS II exam after AST and apply for subspecialty training, again they may have to wait a few years until a subspecialty position is available and they are chosen among all the other surgeons who apply. And again when they finish subspecialty training and want to become a consultant they must wait until a consultant position opens and they become appointed.

So as you can see, not only do you have to pass the FRCS exams, but passing the exams does not ensure that you'll progress straight through your training, as you may have to wait for some years between each step before you can progress.

My humble advice if you want to progress straight through your training with minimal delay is to try your hardest to get a categorical general surgery spot (5 years long) in the States. General surgery has been relatively unpopular in the States for a while now, with many categorical spots going unfilled in the Match. After these five years, you will be eligible to pursue subspecialty training. CT surgery has also been quite unpopular in the States, with many positions going unfilled every year for the past 5 years or so. Although Peds surgery has always been one of the toughest fellowships to get, the last couple of years have shown a decreased interest in this specialty as well.

 

[arteg]

thanks for your post.
actually,my initial plan was to try for a spot in the states.I've already prepared for USMLE step1 & will give it in a month or so;but all the plans are changed after the visa rejection.I'll try again after a couple of days & hope to be interviewed by another consuler this time. I still have the documents of the conference i'm attending in the states..I don't know what will happen if they reject me again. my friends say I won't be rejected if i apply after that to the CSA & try to get a visa to attend the exam.I think i might give it a shot if i got rejected for the 2nd time.

anyway,thanks for the useful posts my friend..plz try to keep in touch.
yours.

 

[Purifyer]

I'm just curious arteg, if you're not from the UK or US, where are you from? One of the 'central' european countries?

 

[Stephen Ewen]

I like to cut through all the clutter of this issue by recounting a story from an East African friend who had a severe accident that required many surgeries during a four month-long hospital stay. The hospital he was at was a mission hospital that was staffed about equally with short-term docs from the US and UK; so, he saw many of these docs come and go.

He stated, "Many of the docs from the two countries liked to say that their education was better than the others. But that is garbage. They are the same."

His perspective as the patient reminds us that different processes can sometimes produce essentially comparable ends. I would therefore suggest that this decision be made based upon the particular process you prefer, and upon entering the one that appears more sure for you to reach the desired end.

 

[arteg]

I wanna post my personal point of view here about the subject.
I think that getting your training in either USA or UK isn't all what you need to make a good doc (surgeon)... I beleive that personal attitude & the way you deal with your patients make a big difference.. as I said before,my uncle runs a medical supplies co. so there is a lot of interaction with the medical field. he's telling me the same;u can find a Board-certified surgeon who is less welcomed & respected professionaly than another FRCS guy.this isn't due to difference in academic or practical skills,it's just because he doesn't give a damn to that "human touch" .. this means less interest of patients to be treated by this guy.
does it make any sense or I'm talking like if I were reading the script of a movie??!!

concerning my nationality,I'm from Egypt.

 

[arteg]

Hi Purifyer & Stephen,
any comment about this guys?? I need to hear your opinions plz.

 

[Skip Intro]

Originally posted by arteg
I beleive that personal attitude & the way you deal with your patients make a big difference...

this isn't due to difference in academic or practical skills,it's just because he doesn't give a damn to that "human touch" .. this means less interest of patients to be treated by this guy. does it make any sense or I'm talking like if I were reading the script of a movie??!!

Little anecdote for you... (I agree with you)

One of the guys in my class is just, quite simply, brilliant. He studies as much as anyone else in our class, if not more. He is a 4.0 student and will graduate with honors. One of the proctors during our recent "orals" for intro to clinical medicine told him, in front of a group of people, that attempting to grade him "was a waste of time for the faculty" because he knew the stuff so cold. For the life of me, I can't figure out why he did not get an admission to U.S. medical school, but was probably one of those guys on the cusp.

But - here's the catch...

I can already see the "blossoming" of the arrogant, I'm-smarter-than-you-therefore-I'm-better-than-you mentality in this guy. A lot of people change when they go to medical school, especially when they find that they are "naturals" and this stuff comes easier for them than it appears to for their colleagues. Some people just tend to work faster through the learning curve.

Humility is something that is hard to teach to certain people. Usually, the way this is done in medical school (and has been my experience so far) is that the faculty will ask questions of you until you can no longer answer them. Some people, for whatever reason, seem to already know as much as the faculty does on a particular subject. So, the humility training doesn't work. This breeds arrogance in the individual. And, before you know it, he's talking to everyone like they are beneath him. Yes... I've seen this happen, haven't we all?

I admonish anyone reading this to understand the take home message here, and what was echoed in arteg's post: it doesn't matter where you do your training - it's ultimately what kind of person you are. That's what people see. That's what matters. Learn and remember to be respectful, patient, and tolerant of others who may not be as intelligent as you are. Don't believe so much in yourself that you think you know everything. You are asking for trouble if you do so.

 

[arteg]

I'm so confused now about what shall I do next..
switch the whole thing to UK,or use it as a transiet step & reapply for USA from there (remember,my US visa application was rejected) or go to a country like New Zealand ??
p.s: I know the chances in Canada for IMGs are very rare.especially in a field like surgery.
what makes me feel terrible is that I was accepted to do electives for 6 months in surgery at some very nice & top-ranked American SOM (NW,Tuft's,UC...) .. but I couldn't make it because I didn't get the visa !! : (

any advice guys ?? US again , UK or NZ ??

 

[Purifyer]

I'm only a third year medical student, so I'll start with a disclaimer that I don't know everything, and I am likely wrong

You can't use the UK as a transient step. I don't really understand what you mean by this, becomming a house officer, and then applying for residency in the US? I don't really see the point.

It's far easier to get a visa into NZ than the US/UK/Australia. But I'm not sure that your qualifications would be accepted in NZ, you'd at least have to sit IELTS (english test), and probably have to convince the medical council that you're competent.

The NZ system is just as 'bad' (and good, depending on how you look at it) as the UK system... in fact... it virtually is the UK system. I know a 'brilliant' guy who was shafted out of getting into a speciality because of 'politics' (at least thats how the rumour goes... essentially no consultants liked him). He teaches physiology at my med school now to the preclincial students.

It really depends where you want to practice. If NZ, train in NZ. In my opinion you want to go the US, but with a visa rejection you don't have many other ideas.

Australia might be a nice option, it's like a mini-US in the pacific

Edit: I spilt coffee over the keyboard as I was writing this post, the keyboard died and as a result a mass flux of q's flooded the post.. sorry ;D

 

[arteg]

what's the difference between BST & AST ?? what r the responsibilities in both phases & the average operative experience ? I heared that during BST, the resident or so called SHO don't perform surgeries.. may be just an assistant but no more.. is that true ? I also heared that in AST which usually lasts for 5 years, u'll practice GS the 1st 3 years then choose your subspeciality the next 2 years & then take your FRCS II in that speciality at the end of your AST.
clear up this part to me plz.
thank you.

 

[arteg]

anybody here can help with this topic ??
I need your input guys.