Working on the flip side.

[C.P.]

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I just thought I'd throw this up there for casual reading.
I moved to Australia about 5 days ago, started my new job pretty much 20 hours after landing, and it's seriously opened my eyes.

Every time I move to a new hospital, I've had to take stock of things and re-assess my assumptions, beliefs, and guiding principles, because I'll find different standards that make me question which is right, which is wrong, and which is simply different.
Each time, I actually find it refreshing, as it forces me to question a lot of my practices, defend them internally (and sometimes with others), and ultimately gain a better understanding of the science behind the practice.

What I'm talking about here is Dogma.

Surprisingly, a lot of what we practice is Dogma.
There's simply not enough time for us to take each thing one of our attendings in residency tells us to do, and look up an innumerate number of studies to either confirm or deny the validity of said instruction.
We listen, their description makes sense, and we go with it.

So, I land in Oz and hit the ground running (no better way to get over jet-lag). From day one, I'm wide-eyed like a 5 year old crossing the street for the first time, trying to dodge cars.

I hit my first case and one of the administrators of the department is hanging with me to help me figure out the ropes.
They're big on doing a pre-surgical "time-out" (which I am too, but I don't want this to turn into a debate on it so I'll skip the discourse).
Anyway, I finish up with my checklist and end as I always do: "patient has no allergies, what antibiotic course would you like?"

Seriously, I think I heard crickets.

The two surgeons stopped, looked up at me like a deer in the headlights, and just stood there.
The other Anesthesiologist with me laughed, looked at me and said "don't ask them, they've got no idea," then pulled out the gent and clinda to make up an infusion.

There was a battle a long time ago in Australia that I think we're just starting to fight here, which is for respect and acknowledgement of what we do.

They solidified they're position here amongst the other medical specialities a while ago and are well respected as "peri-operative and critical care" physicians. That respect was palpable amongst the other medical professionals I've been working around here.

It's refreshing.

Other interesting differences:
perioperative normothermia: not really picked up on yet.

IV acetaminophen and IV Cox-2 inhibitors: awesome!

LMAs for laparoscopic surgery. . . I've gotta think about that one for a bit.

spinals less than 24 hours after stopping clopidogrel. . . no need to think twice about that one: no thank you.

being at an academic institution, but having a tech that does everything short of intubate my patient for me. Kinda creepy. It's like having a live in maid that refuses to let me lift a finger.

"tea-time": wasn't sure on day one, but by day five, I'm advocating we all make it a part of the daily routine.

Oh, and each day the surgeon buys me coffee and has it sent up to my office as a "thank you." Also kinda nice.

Regional, at least at this hospital, is pretty well established, even though I've seen semi-successful techniques from some, (and awesome techniques from others).
I did a bilateral knee replacement (anyone do these regularly? I've never seen them do both knees at the same time in the past) today and popped in two femoral nerve catheters and then finished off with a spinal for the case. Everybody seemed to love it.

I will not start a competitive list between these two countries, I don't think that's fair or constructive. I will say that I've been fairly impressed at the calibre of the the attendings here, and am really looking forward to learning some new things and, hopefully, teaching some new things too (and ideally not looking like an idiot along the way).

I'll try and keep up some interesting, informative, and brief posts on some of he poignant things I come across while I integrate into their system.

 

[omniatlas]

Good to hear a different perspective from what we would usually hear on these boards 😎

Have you checked out the forum at http://www.anaesthesiamcq.com/ ; its more geared towards the Oz crowd.

I'd love to hear any more differences you've noticed practising over here vs in the US.

 

[Planktonmd]

Excellent post.
What you are describing is what everyone who practiced in other countries knows.
Anesthesiology in other advanced countries is a well established and respected medical specialty and they don't need to fight for that respect because they never lost it as we did here.
Unfortunately our fight to regain that respect is an uphill battle for many political and economic factors that we all know.
It is refreshing though to hear that the specialty is in good shape in other parts of the world.

 

[sevoflurane]

Way to grow some seroius hairy salty chocolate balls!

Proud of you and I don't even know you bro! You only live once right?

Your post reminds me of my time in Ireland... except it was scones and tea with milk at 10:00am

Have you experienced induction rooms? What time does theater open (8:30am?)

I'll echo what you and plank said... much respect for anesthesia outside of our country (not entirely true... but partly).

How hard was it to get out there and how long are you planing on staying?

C.P......Show 'em how we do it over here on this side of the pond.

Like team america says....

Good luck dude and please keep us posted!

**** YA....!

 

[RussianJoo]

Hi, thanks for posting. I was wondering if you could talk a little but about the process you had to go through to be able to practice in Australia? Did you have to retake any sort of board exam? Do you have to repeat any years of training?

thanks.

 

[Doctor4Life1769]

Hi, thanks for posting. I was wondering if you could talk a little but about the process you had to go through to be able to practice in Australia? Did you have to retake any sort of board exam? Do you have to repeat any years of training?

thanks.

+1

I've always been interested in the Oz.

 

[jetproppilot]

Thanks for that man.👍

 

[RT2MD]

Proud of you and I don't even know you bro! You only live once right?

Agreed, that is awesome! Hope that I can do something like this in the future, maybe after I empty-nest-it! 😀

How hard was it to get out there and how long are you planing on staying?

Also interested in hearing these answers.

I was wondering if you could talk a little but about the process you had to go through to be able to practice in Australia? Did you have to retake any sort of board exam? Do you have to repeat any years of training?

Also interested in the answers to these questions.

Thanks for posting this, and sharing your experiences. I would LOVE to eventually go abroad to practice for a few months here and there (especially Oz, New Zealand, and Ireland)... to experience different culture, as well as how other physicians do things. I obviously have a long time until that will become a reality for me, but never too early to think about it.

Thanks again!

 

[Substance]

News surveys have conveyed that the happiest people on earth are Australians.

Us Canadians come a damn close second.

 

[Apollyon]

Are you on the east side of the continent, or out in the boonies on the west side?

(Perth is the big city on the west side of the continent - just like an outpost or oasis, but not a lot outside of it.)

 

[oldguy55]

For many years I have read the GasNet email list. A number of Aussies are active participants and it's always been interesting to learn the ways their practices differ from what we do here in the US. Opens one's eyes, for sure.

I've always thought that was one of the things that differentiates us from the typical CRNA: we can have an open mind to techniques that are unfamiliar, assess the applicability to our practice and adopt what we find useful. You know, think for ourselves...

 

[doctor712]

CP,

Interesting post, how did you procure a job in Australia? What sort of logistical (nightmare?) hoops did you have to hop through? What's the taxman situation like in both Aussie and US? Very curious about these things, and also, what prompted you to move there, precisely.

Sounds very cool

D712

 

[C.P.]

Wow,
Glad to see so much interest in the southern hemisphere.

On getting to Oz (it's more than clicking the heels of your ruby slippers together and muttering "there's no place like home.")

You'll need a few things:
1) motivation.
2) a lot of documentation.
There's a pretty well established process of getting into Australia, but to be honest, they're not that accustomed to getting applicant (at least in Anesthesia) to Australia, so it took a lot of emails and meetings back and forth to help everyone agree on how I'd ultimately fit in.
To do it, very briefly, you've got to have your medical credentials verified (this means med school, internship, and residency).
Once the Australian medical college does this, they then forward it on to the respective speciality (in my case Anesthesia), and then they assess it and decide what they want to do with you.
Ultimately, they'll ask you to come in for an interview (which was fairly brief), during which they'll try and clarify some details and ultimately try and wedge you into one of their final groupings.
On their end, they simply want to make sure you're safe, and tick off their boxes to complete their requirements.
Australia needs doctors.
In fact about 30% of their medical force (not just anesthesia) is international medical graduates.

Anyway.
After going through all that, they slotted me into a classification that kind of places me similarly to when we're "Board Eligible." The difference being that I'm still under a training classification, so i'm doing another year of residency.
The upside?
The work's not that hard (this is balanced by the extra effort needed to figure out how to safely work in a totally different environment), with work week's hitting 40 hours.
The pay for a senior resident? about 120k.

So, yeah i'm a trainee, but I really wouldn't want it any other way while I'm learning the ropes here.


So, what was my motivation?
I married an Australian. We settled in Los Angeles for a bit over 2 years, and I had a blast, she had a lot of fun, but ultimately, she wasn't finding her career fulfilling.
Happy wife, happy life. . . and we're off to Australia.

I always try and keep my options open, so since medical school (when we met) I'd been slowly working on getting forms together, keeping abreast of things, and ultimately applying for an Australian license and permanent residency along the way.

I've also got state license in Texas and Minnesota (where my parents and my brother live), just in case I ever need to spend any extended time there and want to work.

So, I'm here.
In fact, as part of completing the rest of my requirements, I figured I might as well get some additional training, and am in the process of applying for a pediatric fellowship (I like working with kids, but with the increased liability of the little ones, I figured that having more local training under my belt would be safer).

So, one week down, the rest of my life to go.
I'll keep you guys posted on some of the interesting things I come across along the way (and keep reading your posts to keep up on the cutting edge side of things).

 

[C.P.]

By the way,
I've always had a dream of setting up an academic exchange between the US and Australia. Bringing over attendings to spend a few weeks on each side to see how things are done in a different environment.

Start working on your canned talks for some future "guest lectures".

 

[WholeLottaGame7]

That does sound pretty awesome.

With regards to you asking the surgeons which antibiotic choices to use; I've often wondered why we do that. The response seems to usually be in the form of a question: "I dunno, ancef?" If we're managing the medical portion of the case, it would seem appropriate it for us to be the ones selecting the antibiotics.

 

[yasawa]

When I did an anesthesia rotation in Europe, I definitely noticed the difference in respect that the surgeons and other specialists had for our specialty. I think part of the reason is that critical care and preoperative care is embedded in their anesthesia practice. Hospitalists did not exist and the anesthesiologists managed all inpatients postoperatively. Some european countries don't even have ER docs and so anesthesiologists staff all of the trauma centers. The surgeons really respected our role since we took care of their patients both in the OR and out of the OR. The other reason is that I think they have a more established role for CRNAs there. Their roles are more defined and the anesthesiologists do not let them do any procedures. Some didn't even let the CRNAs intubate. I do not want to turn this into a debate but I think that we need to have a set of standards within our speciality that everyone follows. Some attendings at my hospital (primarily the older ones) let them do everything while the younger attendings don't even let the CRNAs speak with the patients in the morning. There is definitely a spectrum and I think we should make it standardized like other countries.

 

[C.P.]

Way to grow some seroius hairy salty chocolate balls!

Proud of you and I don't even know you bro! You only live once right?

Your post reminds me of my time in Ireland... except it was scones and tea with milk at 10:00am

Have you experienced induction rooms? What time does theater open (8:30am?)

I'll echo what you and plank said... much respect for anesthesia outside of our country (not entirely true... but partly).

How hard was it to get out there and how long are you planing on staying?

**** YA....!

OR starts from 8 to 8:30, but it's not reeeeeaaaalllly starting at that time.
The patient shows up in this adjacent bay attached to the OR (maybe that's an induction room). We chat out there, throw in an IV (a "cannulae"), and then do any procedures/blocks that need to be done.
After that, we wheel the patient into the operating room and start.

Getting into Oz, if you really wanted to do it, here's what you need:
about a year and a half of paperwork, more paperwork, and then an interview.
This is also going to cost you about 10k with the application fees and the flight to Australia for the interview.
Once you've done this, you're looking at a year in a senior resident position, and then having to take a final exam.
Once you're done with that, you're fully licensed, but slightly limited.
To keep their desperately needed newly arrive docs from competing with the already established docs, you're not given a billing license anywhere but an "area of need." for 5-10 year (depending on how rural you go.
There's lots of ways around this that'll allow you to work where you want, but to ultimately get the "go where you want" card, you've got some restricted time.

Pay scale:

From the looks of things, if you take an academic job, 250-300k plus benefits.

Private practice: 600k+.

I may have mentioned before, you've really gotta have some motivation to jump ship to Australia. Mine was for the wife, but maybe you're looking for a different future, have a bit of a doomsday prediction about the US or its medical system, or are desperately trying to increase your likelihood of skin cancer, then it's not an off the cuff kinda thing to do.
There's a lot of benefits to being here. Collectively they wouldn't have made me choose to make the switch, but I think I'm going to be glad I'm here.
You've just gotta look for the upside and focus on that.
That's not unique to my situation though, that's kinda my universal mantra.

 

[racerx]

👍 Thanks for sharing your story!

 

[C.P.]

+1

I've always been interested in the Oz.

At this point in time, once you get through all the approval processes, you have to do a 12 month period, essentially as a fellow.
at the end of the 12 month period you undergo a "workplace base assessment," which is two people coming out and shadowing you for a day, then discussing a couple of your cases and how you managed them.
After that. . . you may have to take their final oral boards.
"May," because past applicants with similar training to mine (UK applicants) weren't required to take the exam, but they're in the process of rewriting the rules and I may be required to take it now.

The big kicker?
from the moment you receive your first license (this occurs when you first start working as a fellow), you have a ten year restriction on your billing license.

What this means is you can only bill if you're working in an "area of need."

If you're working in a severe area of need, they'll cut your time down to 5 years.

Three catches:
one: this ten year waiting period, it ticks away whether you're working or not. In other words, you could do your training time, take the exam, and then leave till your time expires and come back, unrestricted.

Two: after doing 12 months (even as a fellow) you can start doing locums, which pays better than locums in the US.

Three: you still have the opportunity of working in large, urban areas, but the hospital has to give you a "staff" position, which means you take a slightly lower income, but full benefits package. This is just hard to come by as the hospital won't collect private insurance money if a patient you treat has private insurance.

Sound a bit mind-numbing? welcome to my life right now and then add immigration, international taxes, malpractice insurance and tails in two continents, and a baby on the way in November.

Is it worth it? For me, I think so.
For anybody else? it depends on your predicament.

 

[dhb]

Thanks C.P. interesting stuff