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  1. #1
    drnick07's Avatar
    drnick07 is offline Senior Member 514 points
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    UK training before US training?

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    I'm just curious if anyone knows if a US citizen has ever done junior doctor training (house officer, senior house officer, i.e. residency) in the UK and then did residency in the US?

    So why would anyone do such a thing? Because you can make more money as junior doctor in the UK than as a resident in the states (just as long as the stays stronger than the $). Thus you pay off your debt faster. (see below). Also they work around 50 hours/week, not 80! Plus there is much more holiday (vacation time) (15days study leave + 27days vacation/annual leave + bank holidays).

    Here's some numbers to crunch if you have the time:
    http://www.nhscareers.nhs.uk/nhs-knowledge_base/data/5340.html
    http://www.bmjcareers.com/pdf/doctorspay.pdf

    Real life example. A 1st year peds SHO (from india, btw) i was talking to last night takes home 2,600/month after taxes. Thats 31,200/year = $55,848 (today's exchange rate 1=$1.79). Realize 1st year peds residency in the US starts at around $40,000 (before taxes). I generally go with the idea that Uncle Sam takes back 25%, so that leaves $30K take home for a US residency. Net extra $26K by working in the UK.

    And so you say "...but the cost of living is higher in the UK." Actually i pay less here in the hospital provided housing (250=$440/month) than i did during clinicals in michigan ($650/month). Sure eating out is more expensive and so are the pints, but that doesn't make up a large portion of my expenditures (i.e. i'm not an alcoholic who likes to eat at expensive resturants.)

    Some things left for me to consider as i await replys:
    1. Since more time will elapse before i begin work as a US attending (with obviously a higher salary than a resident), that is more time before i can really start paying off my debt (at a higher rate). That delay may offset any short-term gains while working in the UK. (I'll work the numbers and get back to you.)

    2. I may have to start off as a house officer (i.e. internship) the 1st year, who make less than a SHO and about equal to that of a 1st year resident.

    3. Personally i'm only looking at working in the UK for 2-3 years. Any more and the time since taking step 1 will be > than the 5 years quoted by many residency programs.

    4. The NHS allows SHO's to pick up overtime at a higher pay scale and that can tremendously add to one's net income. However those opportunties sometimes are few due to the large number of unemployed/locum doctors in the UK who pick up those opportunties first.

    5. The UK recently implemented a system by which EU residents are given priority to hospital positions before non-EUers. The sentiment among the non-EU doctors is that very few EUers apply for jobs anyway as it is and that is not likely to change, owing to the requirement to be able to speak and understand english fluently (especially difficult in the slang-filled british english).

    any thoughts? Dr. B? Steph? Hanson? Doc?
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  2. #2
    tRmedic21 is offline Elite Member 510 points
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    Yes but you have to repeat residency training when you come back to the US. Therefore you lose years at the higher attending physician salary. Not worth it, IMO.

    But even regardless of the money differences, there's no WAY I'd want to work as an SHO for a few years and then start back over as an intern. Skeee-rue that, man.
    bleh

  3. #3
    stephew is offline Moderator Guru 512 points
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    well aside from the many years, you move around a lot in the UK and you have repeat as TR notes. Youd be making the big bucks sooner by going through residency in the US and getting to be an attending. Plud dont underestimate the pain of taking someone else's orders for a good part of your adult life.
    Steph
    If you get a warning, put on yer manpants and stop whining about it.

  4. #4
    Kirst is offline Senior Member
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    Um...

    If you're looking for a well paying job while preparing for your US route, I can see the advantages in working in UK as a junior/senior doctor.

    The trouble is, the system is now "Foundation 1 and 2" years, no longer "Pre Registration House Officer" known before as "Junior House Officer". Now all medical graduates enter a 2 year scheme, for which they go through application process in October for a job that starts August year after.

    The whole PRHO, JHO, SHO system is now completely gone. After finishing F1 and F2 years, the doctors move onto Specialist Training scheme which upon entering, lasts 6 effective years. Or one can opt to enter the GP training scheme which is 3 years. the ST scheme will train you to become pediatrician, orthopedic surgeon, psychiatrist, radiologist, etc. GP scheme will train you to become general practitioner (family doctor).

    The only doctors exempt from this F1/2 and ST schemes are the ones that are already in PRHO/JHO/SHO/SpR scheme of previous system.

    You would be expected to enter the new F1/2 and ST scheme. That means clearing PLAB 1, 2 and IELTS (unless you're EU grad). And that also means applying a year before in October for a job that starts in August. And the competition you'll face is far stiffer in UK than it is in US. F1/2 posts are EXTREMELY limited in UK and is one of the biggest problems that GMC is facing. They actively discourage foreign doctors from applying for F1/2 jobs as there are just a little over enough to meet the demands of their own UK graduates. UK however, still has opportunities for foreign doctors who have few years of post graduate training already under their belt from overseas that can join on senior SHO or SpR level. This clearly does not apply to you.

    Job opportunities in PRHO/JHO/junior SHO/F1/F2 levels are scanty and it's a known fact to many. When I was in Edinburgh, two of the PRHOs I worked with ended up going to Australia and New Zealand to pick up their second year training as they had no luck finding a placement in UK. If even UK graduates have trouble finding jobs, it'll be an uphill battle for you as a foreign graduate- unless of course you have some serious inside connections.

    Anyway, to become a consultant (attending) in UK, it'll now take 8 years- whether it be in plastic surgery or internal medicine. post graduate training is far shorter in US, not to mention pay is better once you start working properly. living is cheaper and tax is smaller in US also. What's more, you stand a better shot in finding your first year job in US going through NRMP for a prelim or transitional spot than you would in UK going through their match system for F1/F2.

    Hope that sheds some light on the other side of the pond, it seems like your source was a little biased.

  5. #5
    PathOne is offline Member
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    Assuming the ultimate goal is to work in the US, I find the math terrible, due to the simple fact that none of your UK training will be accepted in the US. So every year you'd elect to stay in the UK, you'll effectively loose AT LEAST an amount equivalent to 100% of what you'd make as a UK resident.

    Just like you'd want to complete your medical degree as fast as possible, you'd want to complete your Graduate Medical Training (residency) as fast as possible. If you want to stay in the UK (or Europe), please do so. But if you want to work in the US, then the sane thing would be to complete your US residency as fast as possible, and start earning real money.
    Last edited by PathOne; 04-20-2006 at 09:09 AM.

  6. #6
    Miklos is offline Elite Member 511 points
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    Good responses above.

    I'd like to add one small recent detail:

    Non-EU citizens will require a work permit as of July of this year. This effectively means that they will only be able to compete for spots after British grads and EU citizens.

    Considering the shortage of training spots...

    If I were you, I'd reconsider your plan and focus on getting a spot in the U.S.
    Last edited by Miklos; 04-20-2006 at 12:59 AM.

  7. #7
    drnick07's Avatar
    drnick07 is offline Senior Member 514 points
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    UK training before US

    Thank you all for your responses. Kirst, I find that very few (if anyone) around here in Poole understand what the new F1/F2 will involve, let alone the implication for non-EU/UKers, so your post was especially insightful.

    After i crunched the numbers, regardless of the likelihood of gaining a post, economically it might only make sense to do what i suggested if you have a very high interest rate on your loans, have lots of them (~200K$), and you won't be paying any of it off during your training. Otherwise, the extra /$ you make in the UK won't compare to the 2 years sooner you'll be making an attending's salary (as has already been said) when most of your debt is paid off.

    Maybe in 10 years i'll be looking at what is involved in coming over as a staff grade or locum. Still, i envy the UK-system for its proper internship (PRHO/F1).
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