work hours: Europe vs US

[tr]

Does anyone know where I can find comparative information on a) policies towards foreign med grads, and b) resident work hours in various European countries?

I am curious because I may want to do my residency in Europe. I am currently in med school in the US, and my boyfriend is here getting a Ph.D. He is from Ireland originally and would like to move back to Europe (not necessarily to Ireland, just doesn't like the US). I have EU citizenship as well and have previously lived and worked there, so I think from a legal standpoint we are in a reasonably good position.

The problem is that I don't know where to begin to get information that will allow me to compare the requirements of programs in various countries. I need to know which medical systems have their doors reasonably open to US grads.

I am also curious about resident work hours. I know that some European countries (like Ireland and I think England as well) have tight caps on work hours, which is nice. Frankly I am not at all interested in money as I have a full scholarship from my program and will graduate with no debt; but I am very interested in 'lifestyle issues' and would love it if I could find a residency that did not require me to be there 80+ hours a week. (My best preference is neuro but right now I am considering psych solely because the hours are so much more reasonable, at least in the US.)

I would love to hear from anyone with any experience or information on these issues. Thanks!

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[tlew12778]

From my own experience, I don't feel that residents in Italy work as much as I perceive they do in the US. BF is interning right now in surgery and the guy that is doing his residency in the same specialty (vascular surgery) is there on a somewhat 9-5 basis (moderated to surgery hours when he's in the OR).

What I do notice, however, is that many residents will take other PT jobs to supplement their income. So, in addition to being in the hospital, they might work night shifts at some private care facility (we know one guy that is the night dr for a nursing home; another girl we know works for an insurance company as a call center translator... for some reason you have to have an MD to do this). So in the end, these ppl end up working the same amount of grueling hours to get by (bc residents in Italy are paid so little... they NEED to supplement their income).

I know that there are specific articles out there. In particular, I have read one comparing residency hours across Europe (not compared to the US). Unfortunately I don't remember what it was called or where it came from.

I think an important aspect for you to consider (aside from quality of life issues) is the bureaucratic red tape you will encounter trying to get into a residency as an American with an American degree. It might be worth looking into first.

 

[IlianaSedai]

I'm a little vague on this, but hasn't there been some EU legislation that limits house officer work hours to 48 INCLUDING call? I heard that from the BBC news -- and thought, "Damn, if that's all I'd have to work, I wouldn't *mind* having to repeat training years until I'm 40!"

 

[tr]

"I think an important aspect for you to consider (aside from quality of life issues) is the bureaucratic red tape you will encounter trying to get into a residency as an American with an American degree. It might be worth looking into first."

Right; this is why I asked whether anyone had information on which countries had systems that were more or less open to FMGs.

But let me repeat that both my boyfriend and I are EU citizens who have previously worked in Europe (he was born there, I'm American but 2nd generation and have been back and forth). So I hope that the red tape I will encounter will be more relevant to the educational side of things (having to take tests like the PLAB, etc.) and less on the legal side of things (since citizenship and working papers will not be a problem).

 

[tlew12778]

But let me repeat that both my boyfriend and I are EU citizens who have previously worked in Europe (he was born there, I'm American but 2nd generation and have been back and forth). So I hope that the red tape I will encounter will be more relevant to the educational side of things (having to take tests like the PLAB, etc.) and less on the legal side of things (since citizenship and working papers will not be a problem).

This is not true. Since you have an American degree it makes no difference... you will be considered an FMG and be treated like one.

One example, we have a friend who got her degree in Rotterdam. She is Dutch. Her bf is Italian, so she decided to try to enter into residency in Italy. She got her degree recognised by the Italian govt (it took 4 months even though EU law states that each country must recognise the degrees of all other member countries) and took the test to get placed into a residency program. She got the results back of her test, did well on it, but did not place into a program. When she went to ask the head of peds at the hospital she was interested in, he told her he would not take a resident who had not interned at that hospital (or in Italy) bc it was not fair to the non-FMGs since the number of spots is already limited. So she is slaving away (for free) as an intern this year with the hopes of being granted a spot in a residency program next year. And mind you, she is not really considered an FMG bc her degree was issued in the EU.

So while you are correct in saying that you will have less of a problem bc you will not have to deal with visa issues etc., you should not discount the very likely possibility that it will be difficult to be placed into a residency program in the EU in general. This is why I mentioned that you might want to ask around (and not limit yourself to what the official rules and regulations are) to find out what kind of bureaucracy exists in the countries you are both interested in. I think that a thread dedicated to each country for which you would like info would probably get more traffic (just my opinion though).

As for this:

EU legislation that limits house officer work hours to 48 INCLUDING call?

If that legislation exists I have not seen it put into practice. I don't know anyone that stays at the hospital that little. Not even interns who are not "required" to be there (not in relation to US standards at least). Then again, I guess it depends on what specialty you are referring to. Everyone I know is in surgery (bc that is where my bf is) so they tend to be in the OR (or doing pre-op or post-op) for at least 6 hrs a day, not including emergencies.

 

[IlianaSedai]

To the original poster,

May I suggest that you arbitrarily pick a country that you would be likely to choose within the EU/EEA (for instance, Ireland, since your bf is from there)? Every country is slightly different. You may be getting a lot of information about Italy, or France, or whatever, but that doesn't apply to all of the EU.

Once you've picked your country, look up the web sites of the governing bodies and professional associations IN THAT COUNTRY. You will probably get a lot more information that way than by looking at the entire EU or EEA all at once.

Although many aspects of health care and medicine are being standardised across the EU, all of those countries had their own systems before the EU, and it has certainly not been enough time for them to completely even out. There are a lot of individual differences depending on whether or not there is a physician shortage, rules and regulations, etc. So you'll probably find a lot more information by investigating one country at a time.

 

[FionaS]

I'm a little vague on this, but hasn't there been some EU legislation that limits house officer work hours to 48 INCLUDING call? I heard that from the BBC news -- and thought, "Damn, if that's all I'd have to work, I wouldn't *mind* having to repeat training years until I'm 40!"

It's called the European Working Time Directive... Of course, everyone says that it's impossible etc etc, but they're being bullied into it by the EU, so eventually, I think 2010 is the latest deadline in the UK, that will indeed be the case. I think the UK opt out is 52 hours at the moment. And you will be told to go away if you try and stay later than that, because if you do that puts the Hospital in "breach" and they get fined...

It ain't all jam, but it used to be a lot worse!

 

[PathOne]

Certainly not an expert, but generally speaking nobody beats the US in terms of working hours. For most European docs it's probably pretty shocking to hear US residents rave about a 80 hr/week cap.
In Europe, the UK is known for being the toughest. NHS tries to limit resident work to 56 hrs/week, but not very succesfull. Don't know about Ireland. My impression is, that rest of Europe is about 40 hrs/week (clinical. You still have to put in hours for research in a lot of countries to get an attractive specialist training position.)
However, note, that because of the difference in working hours, requirements for specialist certification is generally longer than in the US. In Denmark, certain surgical specialties can take upwards of 7 years certified training (+the non-certified training & research you'd need to get the certified residency blocks).
Also true that US docs can be somewhat at a disadvantage, as there's no standardized tests like USMLE in Europe, and like IMG's in the US there's the problem that someone with a degree from an "exotic" locale is, to some degree, an unknown entity for program directors. So getting to do what you want CAN be a challenge. That being said, US medicine is certainly generally very well regarded in Europe.
But you have to find out where you'd like to live, and then do your research from there. In Scandinavia, there's beginning to be severe shortages, while there's a huge surplus of docs in Germany, and to some degree in France, I've heard. And that obviously affects your job opportunities...

 

[BellKicker]

I'm getting curious, pathOne.....

Where are you from and where are you at?

You seem well aware of a lot of things. FYI, everything is getting revamped in Denmark so the old "specialist at 45"-problem will hopefully disappear. There used to be such a ridiculous point scale in residency apps that if you wanted to do an OB/GYN residency, you'd need a PhD, multiple publications, teaching experience etc etc.

Things are a lot better in Sweden and Norway, though, and many Danes have been known to do their residencies there.

 

[PathOne]

Danish pathologist, trained in Copenhagen, when publication req. was ridiculously high, as you point out. Planning to do advanced research & training at Memorial Sloan-Kettering in New York because 1) it's considered best in the world, at least in my spec. 2) No doc from Denmark has ever been there 3) most people says it can't be done. So somebody gotta prove them wrong!

 

[BellKicker]

PathOne, I dropped you a personal message.

 

[GABA]

while there's a huge surplus of docs in Germany QUOTE]
That`s not correct! Especially in Eastern Germany there are lots of open positions and hospitals are seeking for foreign applicants, mainly from East Europe. In some rural areas doctor`s practices have to shut down, because there are no successors in family medicine.
In Western Germany the situation is a bit different. In some big cities there is still a high density of doctors whereas smaller hospitals have problems to fill the jobs.
As the number of young doctors entering the residency does not keep up with the number of retired doctors the shortage will increase. Also many docs go abroad (esp. Switzerland, GB, and Sweden) or into the pharma industry because of bad working conditions and poor payment.
I?m not sure about the work hours, but as far as I know they range from 50 up to 70 h/week at big university hospitals.

 

[PathOne]

I stand corrected re. Germany (and quite possibly other countries.) My comments re. Germany wasn't based on pertinent statistics, but rather on the fact that in the past there's been organized quite a few Danish-courses for German physicians, because there was so many coming to Denmark. That could have changed, or been due to salary/employment factors. However, I certainly think it's safe to say that the problem of an aging physician population (and an aging population overall) cuts across European borders... Situation with lack of physicians are if not most severe, then most effectively dealt with, in Norway, where a recently graduated friend of mine w/o specialization is making $100000+/yr as a per diem FP.
So a fair amount of possibilities exists!...

 

[Petra]

while there's a huge surplus of docs in Germany QUOTE]
That`s not correct! Especially in Eastern Germany there are lots of open positions and hospitals are seeking for foreign applicants, mainly from East Europe. In some rural areas doctor`s practices have to shut down, because there are no successors in family medicine.
In Western Germany the situation is a bit different. In some big cities there is still a high density of doctors whereas smaller hospitals have problems to fill the jobs.
As the number of young doctors entering the residency does not keep up with the number of retired doctors the shortage will increase. Also many docs go abroad (esp. Switzerland, GB, and Sweden) or into the pharma industry because of bad working conditions and poor payment.
I?m not sure about the work hours, but as far as I know they range from 50 up to 70 h/week at big university hospitals.

Your absolutely right Gaba, there are plenty of open position both in western and eastern Germany. Especially in family medicine they are running out of physicians. The only places without shortage are the university hospitals.

Why is that? Because residency training in Germany sucks. Disorganized, without any plan, you spend over 60% of your working time with useless paperwork. Don?t expect to get much training. So, no surprise plenty of German residents leave the country and go to Sweden, Denmark, UK or the US.

Working ours are officially about 40 h per week, unofficially and from my personal experience there are depending on your specialty and hospital somewhere between 60 to 80 h, but of course you are not paid for that.

So guys, stay away from residency in Germany, I personally left after three years too.

 

[roo]

Advice Re: Ireland

The working hours directive started last year.

Internship year sort of sucks the same way that it sucks in a lot of US residency programs.

If you are doing psychiatry, then Ireland is for you. You can bypass some of the glacial advancing Irish ranks of Intern>Senior House Officer>Registrar>Senior Registrar>Consultant in the field of psyche.

There isn't enough psyches there, and thus a lot of recruitment from abroad.
This is converse to every other discipline where there is more than adequate supply since so many expats want to go home to work in addition to the regular crop of new docs from Irish schools.

Best wishes,
roo