Saw it mentioned in another thread that EPs have a difficult time working in some other countries because the training programs for EM/A&E are longer there. I did some brief reading and it appears the major issue is that the other countries still have immature EM training pipelines. That is, they take longer because they have a less focused training pipeline EM.
Is this correct? If so, do you think the more generalized background is a benefit or just a needless delay?
In many European countries residency training
in general is longer. Residency in Internal Medicine takes 5 years in many European countries (compared to 3 in the US). That is often after 1 or 2 years working as essentially a GP. Partly this has to do with work hours being significantly shorter in many European countries, so less bang-for-buck.
Is there some benefit to an extra year of training (all else being equal)? Probably. That's one more year to see something you haven't seen, mature in your decision making, etc. Is it worth it? Debatable. Look at the 3 v 4 year debates on this board. The same arguments could be extrapolated to 5 or 6 year residencies.
Extra time will always be beneficial, but you are going to face deminishing returns fairly quickly. In the end, we have to draw the line somewhere. At what point in training are MOST people comfortable enough to branch our independently? In the US the RRC has decided that it's 3 years. Judging subjectively from how well prepared new attendings coming from 3 year residencies seem to be, that seems reasonable. At least
for the US. Change a variable (work hours, medical culture, availability of technology, expectations from society, etc) and it may either become not enough or excessive.
To address the point on working over seas: In reality, it is often difficult for a person who has trained in one medical system to cross over to another independent of the duration of their training. Each country has a complicated bureaucracy around medical licensure and credentialling. If duration was the main issue, then docs from these 'other countries' with longer residencies should have no problems coming to the US to work. That's not the case. In the end, it seems best to train in the environment you wish to practice in.
