england or america?

[sp1124]

hello i was born and raised in america until i finished high school at which point i started attending a medical school in poland, of which i am now in my 3rd year (out of 6). i'm not trying to sound unpatriotic but the possibility of practicing medicine in england or any other part of western europe is very appealing to me (esp since i will have an MD from an EU country). after searching online though i couldn't find any place to get any sort of advice on whether this is a good move. is it better to practice in america or england/europe? what process would i have to go to after i get my MD regarding licensing (since i am an american citizen, not an EU citizen)? what countries are the best to practice in? should i do my 3rd and 4th year clinical rotations in america or poland?

if you can answer any of these questions or provide me links or just give me any sort of advice regarding this matter i will greatly appreciate it. thank you.

[Back_To_School]

What languages do you speak as this would probably be one of the deciding factors? You will find it incredibly difficult to get a training post in the UK as you're not an EU citizen, even if your degree is from the EU as they're now producing more than enough homegrown graduates to fill most of the training positions.

Perhaps Ireland or Malta?

I don't think you'll find a clear cut answer to what country is better to practise in but, if you are intending to eventually go back to the states then your only real option is to train in the states as the US doesn't recognize any postgraduate training which was done in Europe and you'll only have to start your residency again anyway as ridiculous as that is.

Personally I would rather train in the UK but, I have no intention in going to the states. Maybe Canada one day though.

If you have the choice between Polish or US rotations then US rotations without a doubt!

[sp1124]

thank you for your input. the only european languages i speak are english (of course) and spanish, so maybe spain could be an option for me. i wouldn't plan on moving back to america until i retire if i were to practice in europe (although that is a long time away, as is everything that i am mentioning; i just want to be able to keep my options open). it seems the best thing for me to do is to get licensed and do my residency in america, as an american license is widely accepted internationally.

like i said, i have a long way to go until i have to make this decision, but thank you very much for your advice.

[shrey]

Hey there, I would definitely recommend home (US) because you still might have access to some of the competitive residencies (although your scores have to be excellent but nevertheless, you would get a much better preference than an FMG).

Regarding Spain, it would be awesome to do rotations in La Universidad de Salamanca but it wouldn't do you any good if you intend on going back to the States. And besides, doctors in Spain are not very well paid (which is why many are moving; although Spain does have a very good health care system like the other Western European countries).

England would be an amazing option but like Back_To_School said, it's quite hard as they're having adequately trained EU citizens.

America is definitely your best bet and regarding rotations in Poland or US, then go for US (because you will be able to get some letters of recommendation and build up some contacts in case you want to land a good residency spot)......

[Genossa maximillian]

Nothing wrong with wanting to practice outside the USA, why you say that it is an unpatriotic thing? Don't be silly ;) (no offense intended).

According to my information, holding a degree from a EU school gives you an advantage when it comes time to practice in ANY EU country, let's start from there. If you check any of the medical councils in Eurpoe almost all have adoted such language. Now in terms of being and expatriat, non-citizen that may be the issue, unless you really declare your intentions of permanent residence and evetual citizenship in Europe. Not impossible. But you have to check each country's requirements for post grad training too. In Spain for example, you have to take and survive the MIR, a tough exam in Spanish in order to be elegible to compete for a grad post and specialize, then compete for a job in the government, which everyone wants. Government there pays better than the private sector. I have friends in the private sector with 2 jobs and I know of unemployed doctors in Spain, yes, a sad reality. Of course, and contrary to the U.S.A. they will give priority to a Spaniard first and foremost before considering an expatriat. Same principle aplies almost universally all over Europe, they are very protectionsit about their own.

Good luck!






hello i was born and raised in america until i finished high school at which point i started attending a medical school in poland, of which i am now in my 3rd year (out of 6). i'm not trying to sound unpatriotic but the possibility of practicing medicine in england or any other part of western europe is very appealing to me (esp since i will have an MD from an EU country). after searching online though i couldn't find any place to get any sort of advice on whether this is a good move. is it better to practice in america or england/europe? what process would i have to go to after i get my MD regarding licensing (since i am an american citizen, not an EU citizen)? what countries are the best to practice in? should i do my 3rd and 4th year clinical rotations in america or poland?

if you can answer any of these questions or provide me links or just give me any sort of advice regarding this matter i will greatly appreciate it. thank you.

[sp1124]

thank you very much for that information. i'm not really planning on going to spain (my spanish is not nearly that good). i guess if i were to move to europe, it would be to the uk, as language would be a barrier anywhere else. what does the post grad training in the uk consist of? whenever i search for anything about immigrant doctors to uk, i get stuff for people coming from india and language proficiency tests and stuff, so i doubt i would have to do that.

[Back_To_School]

Don't take this as gospel but, I think this is how it works.

Grads from UK schools enter into a 2 year apprenticeship, the FY1 and FY2 years. After that you start your residency. The chances are, because your degree is from outside the UK, you will be exempt from the FY1 year and will go straight into FY2 as the last year of most EU degrees counts as an internship of sorts. This is not the case in UK medical schools as most of their degrees are only 5 years long and do not have the year of rotations at the end of it.

The good thing going for you is that you won't be competeting for FY1 posts. The bad thing from what I've heard is that a lot of the FMGs/IMGs that go straight into FY2 are horribly unprepared and seriously out of their depth because of the lack of patient contact amongst other things due to the language barrier whilst at medical school.

The deal with the GMC is this. They will only give you a training post if it can't be filled by a UK grad and as the UK are now pumping out more doctors then they need for the first time in history it will make it very unlikely that you will be successful in gaining a place on a training program. It's probably true also that preference would be given to Commonwealth applicants as we love to steal Aussie and Bok vets, so the same is probably true for Doctors:D

[sp1124]

ok, so it sounds like residency in the us is my best option (also in case if i wanted to move back to america). how do my chances of successfully moving to england look from there and what would the process be? assuming i pass the usmle, would i need to take a licensing test in the uk? sorry, i know my questions seem like they never end, but this entire thread has been very helpful to me :)

[diogenes]

A few points about what's been said so far and then I'll try to answer your latest question.
As an American citizen who obtained his MD in the EU you would still have to do the UK licensing exam (PLAB) - just like those guys from India. You might get an exemption from the language part, but in any case it's not gruelling.
Citizenship is crucial. The driving force is EU employment law - which is designed to ensure a free labour market for EU citizens: that you came here and invested not a little time and money is not generally considered very important. Related to this are EU Directives which aim to homologate professional qualifications across the Union.
As an aside, EU citizens may be licensed without PLAB in the UK with degrees from the Caribbean, whereas non-EU'ers (and Brits:evil:) must take the licensing exam.
You must also bear in mind the distinction between requirements for licensure and job prospects (including any work permit needed, as in Britain).
What the others have said already about the increasing difficulties of IMG's getting jobs, especially in the UK, should not be taken lightly or ignored. Much may change by the time you are ready for all this, but I don't think it will have moved in your favour.
Another point to watch is that there may be concessions and advantages in some countries for the foreigner who qualified there and wants to practise in that country - but these are not necessarily transferable to other member states.
I can't comment in detail on other EU countries. However I would be surprised if a least some of the other 26 states didn't have similar restrictions to those of the UK. Given the endemic doctor unemployment and chronic underpayment that exists in a number of countries and the indifference of EU law to such matters it would be remarkable if there were not some protectionism outside the UK too.
So what happens if you do residency in the U.S.? Same thing really. You would normally have to take PLAB to be licensed here: PLAB and USMLE majestically ignore each other! There are exemptions for those who have medical specialist credentials, post-grad qualifications or sponsorship for training at one of the Royal Colleges of medicine. Once again though, you will need a work permit which shows that the job could not be filled by a British/EU citizen.
By the way, PLAB is a little easier than USMLE (its history and purpose being rather different); but it is not to be trifled with either - it's not an insignificant exam.
Here's a news item that's relevant to some of this discussion -BBC NEWS | Health | New rules to limit non-EU doctors (http://news.bbc.co.uk/1/hi/health/7230987.stm)

[sp1124]

i was reading up on the HSMP Tier 1 visa, and it seems that that can be applied to doctors. would that make the process any easier? are they hard to obtain? what level of training would i enter into if the visa application were to be successful?

also, is the plab as important in the uk as the usmle is in america? IMG's here in america are able to get spots on very competitive residency positions due to an excellent usmle score. what qualifications are seen as the most important when i am applying for training in england?

[diogenes]

Unfortunately the whole point of the announcement highlighted in that link above is to prevent non-EU doctors from accessing training here and appears to override the HSMP provision. You see there has been a lot of concern, anger even, about these recently increased numbers of UK graduates chasing too few training opportunities. There is already much muttering about having to accept EU grads. on equal terms: authorities here would love to be able to restrict them.
Of course there's a certain amount of crystal ball-gazing in all this. This is uncharted territory for the UK - after 50 years of being a substantial importer of medics we are suddenly closing the gates - but demographers and planners don't always get it right. We'll need to see how this pans out in practice over the next few years.
For the moment though your chances of obtaining employment in the UK as a doctor would seem to be best if -


You did residency in the US and...
completed some specialist training there
you were applying for less popular jobs here

[diogenes]

.................................................. .....also, is the plab as important in the uk as the usmle is in america? IMG's here in america are able to get spots on very competitive residency positions due to an excellent usmle score. what qualifications are seen as the most important when i am applying for training in england?
Indeed, I should have mentioned that PLAB score doesn't matter, it's pass/fail. But again, what you are up against are those new rules which look set to make it very difficult for you to train here.

[PathOne]

As a general rule, you'd have to assume that you'll want to spend your ENTIRE working life in EITHER the US or Europe. Thing is, that there's really no mechanism for getting recognition for specialist training across the Atlantic.
Options:

1) IF you are a EU-citizen AND graduate from an EU-country AND complete specialist training and get licensed, you're entitled to get your name on the specialist register in ANY EU-country.

2) IF you fullfill the criteria above, but DOESN'T hold citizenship of a EU-member state, your specialist status will generally be reviewed on a case-by-case basis. You might have to redo some training.

3) If you move to the US with a European specialist certification, you will need to redo ALL of your training (with a rare exception in IM, where you can get some of your non-US training approved).

4) If you get your specialist training in the US and then move to Europe, you must sit for the general medical examination of the country you're moving to and can apply for recognition on a case-by-case basis. However, it's certainly not uncommon that you'll be required to redo ALL of your specialist training.

So, in summation: In terms of geographic opportunities, you'll need to be a EU-citizen to gain full advantage of mutual recognition of specialist training, and you REALLY need to decide which side of the Atlantic you'll want to work.