Work in the UK/Ireland after US residency

[DrBacchi]

Hey

I'm a EU-citizen going through med school here in Finland. I would like to go through a 3-year residency in IM/FM in the US and then come to the UK and practice medicine. Is my training considered complete in the UK just after 3 years of US residency? Isn't the specialist training much longer in the UK? What positions would be possible to apply with such training? Thank you.

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[bonran]

Why would you train in the US only to go back to work in Europe? I am an Indian physician who has worked in the UK & then trained in the US. The only pro I see in training in the US to go back is that there is no place to train like the US if you are able to keep your clinical examination skills from your home country (the Americans are no good at the physical exam).

Otherwise, you will be worked to death in a US residency, you will be paid 1/3rd what you will in Europe & your health will suffer during the period of training.

After training, when you should be "reaping the benefits" of such hellish training, you want to go back to Europe where you will be paid less, wont be able to order investigations with the impunity that you could in the US and thus be very unsatisfied both professionally & monetarily.

Think about it........

Choose one side of the Atlantic & stick to it

 

[leorl]

I don't know if it's that clear cut. Junior doctors earn a good bit of money (well they did, with overtime) and consultants aren't really that far off our attendings in terms of the pay scale. No, you don't get to order everything that you want, but then again...why should you need to? Medicine in this day and age in the US is in my opinion completely overdone, with exorbitant costs fueled by unnecessary patient visits and therefore completely unnecessary investigations or management. I'd welcome a more european simplicity and definitely would welcome the european patient population any day over my American population which unfortunately can sicken me on a daily basis.

This doesn't really answer the OPs question though. Your training is not complete after 3 years of US residency, and you would not be able to become a consultant after 3 years of training. Most likely you'd have to complete a higher specialist training scheme. But I think each case like yours is individual and you'd have to review your training with the specific royal College you're interested in.

 

[DrBacchi]

Thank you for replying guys. In my understanding the UK GP salaries are quite the same as FM salaries in the US, so money shouldn't be a problem.

Back to my original question, at least a specialist training in my home country is approved by the UK. If it's not possible to move there directly from the US, then it would be possible to get licensed in my home country first and then move to the UK. Would probably be smart to go directly to do post-grad training in the UK, I must really look into that too. I just wouldn't want to limit myself to Europe, if I one day feel like I want to practice in the US.

 

[bonran]

Having trained both in the UK & then the US (in 2 specialties), I do not agree witht the above comments about US residency training & the ability to be a "consultant" in UK/IRE after residency training in the US. The big difference that I noticed between training in the 2 countries is that my learning curve shot up in my R-1 year in the US tremendously. Training in the UK in the same specialty for 6 months at a time was overkill & a waste of my time. Besides the lack of exposure to ICU training in the UK (which is under control of anaesthesia in UK) was a serious flaw in my training. Being exposed to the ICU, CCU, Respiratory CU & the Neuro ICU in my R-1 internal medicine training gave me a lot of confidence to deal with acutely ill & unstable patients. Besides exposure to evidence based guidelines & excellent ambulatory (outpatient clinic) training here taught me what to target in patients on follow up. I had done many clinics in the UK (anticoagulation, geriatrics, stroke, Parkinsons & renal besides medicine) but never knew what to do in them as there no clear cut guidelines despite there being a NICE protocols (not very evidence based & incomplete) to follow in the UK.

I also got a lot more exposure to clinical research in US training as opposed to silly & unpublishable "clinical audits" in the UK. At the end of my 4 yrs of training I had 3 abstracts in International meetings & a clinical research publication (retrospective study, not a case report or case series) in an international peer reviewed journal.

This is more than what some of my "consultants" had done in their entire career back in the UK. My training in the UK was good, certainly better than my home country, but it would not in all of its "higher specialty training" years have given me the exposure that I got in the US.

I speak having seen both sides of the coin. I am not making arm chair assessments on the need for further training in UK & Ireland after US residency/fellowship.

What would one learn in these countries when suppose as a cardiology fellow in the US one does 400 echos, 200 TEEs, 800-1000 diagnostic angiographies, 50-100 interventional angiographies & 100 pacemaker placements in 3 yrs? I remember the cardiology registrar in my UK hospital in Brighton barely got to do 50 diagnostic angiographies an year. In her 5 yrs of registrarship, she would have done barely 200 angios, less than the total number of interventions a cardiology fellow does in some of the bigger centers in the US (higher specialty training!! haha). I, as a neurology stroke fellow do 10-15 thrombolyses per month in my center, some of them end up going for clot retrieval or IA thrombolysis done by neurologists. That is more than what an entire NHS region would thrombolyse in the UK in a month. There are just 4-5 IA/mechanical centers in the UK compared to 200-300 in the US, mostly run by radiologists who have not idea of clinical medicine or interest in unstable patients. Where is the comparison???

Training is what you get out of it, not the "number of years" one spends being a registrar before being a "consultant". That is a poor choice of a word for attendings coming out of UK/Irish training.

As far as work & salaries go, it is certainly easier in the UK/IRE with the European Work Directives (48hr weeks & overtime pay, weekends off except 1 day every 6 weekends on call). One can lull himself into a feeling that they are working their butt off. Starting pay may be the same for FM in US & UK. But an enterprising FM doc with his own practice in US can earn upto $500,000, nowhere near what you can do in the UK/IRE. Again I have friends who have their own practices who earn this figure as FM docs. This is not something pulled out of thin air.

Also, I have passed my MRCP UK 1&2 (70% & 65% respectively), MRCPI 1&2 (81% & marks awaited-took the 19th Nov 2009 test, passed provisionally) based on my training in the US all in 1st attempts. So I am not someone who is speaking off his head.........

 

[johnny9]

Basic residency training is usually equivocal to pre-specialist training in the UK or Ireland. The story is different if you have also done fellowships in the US which would generally then be accepted.

Usually to practice as a consultant, you need to be on the Specialist Register. For that, the requirements are basically that your training is equivalent to e.g., someone who has CCT in the UK. Everyone who has CCT will have some specialist training, after general IM, e.g., cardiology, renal, etc., .

It's not a major issue, but you would need Residency + Fellowship to look for Specialty Registration with the GMC.

(On the issue of salaries, money is everywhere and in no way is guaranteed for any speciality. There are GPs in the UK apparently earning UK£380,000/year - the equivalent of US$620,000 http://www.dailymail.co.uk/news/art...ing-380-000-year--hours-doctors-200-hour.html. At the same time, another GP might earn UK£30k/year and work parttime.) - it entirely depends on how much you work and much time you are willing to focus on increasing income.