Question for the Doctors of MN

[Regularmumnetter]

DC considering doing a medicine course and have done a fair bit of online research so far. But have a few questions left:

1. after doing FY1 and FY2 in the NHS is it possible to move abroad, say USA, to begin speciality training? (would honestly be happy to work for anyone but the NHS)
2. can you choose each rotation you do during FYs?
3. what was the hardest year of med journey, e.g med school, FY, core training.
4. As I have found online after FY there are 3 years core training and 3 years sub speciality - how does a surgeon speciality pathway differ from this? and is it possible to take maternity leave during these years?

I'm currently a medical student on a graduate entry program (accelerated four year course). I'm not yet a doctor but I worked in the NHS for many years before deciding to do this, so I have a reasonable idea of how things work.

1. It is notoriously difficult for international graduates to gain residency in the USA. The American system heavily favours American graduates, and moving there after med school would mean choosing an unpopular specialty in an unpopular location (think GP/family medicine in the middle of nowhere). There are destinations where the process is less arduous, but all the people I know who have emigrated were already consultants.
2. In your final year at medical school you will be given access a massive nationwide list of potential jobs that are subdivided into different rotations, and you you rank these jobs in order of preference. You don't get to choose each individual rotation. Which job you get depends on your ranking in exams and your score on the Situational Judgement Test (SJT). You have to be willing to move anywhere.
3. I can't comment on this as I'm not yet a doctor, but virtually everyone I've spoken to has said that the hardest year is FY1, because this is the year you go from 'not a doctor' to 'fully registered doctor' and it comes at you fast.
4. Not all specialty trainings are six years in length. That's actually on the short side. For general surgery the specialty training is eight years long, assuming you take no career breaks on the way. It's perfectly possible to take maternity leave - this is a job with the same employment conditions as any other.

With all that said:

1. Don't fix on a specialty before you start med school. There is so much variety and you need to have broad interests in order to do well. Aside from this, of the the huge number of 18-year-olds applying for medicine thinking they want to do surgery, most will decide against it in the end. It's important to go in with an open mind.
2. How old are your DC? Assuming they're at school still, how do they know they're "happy to work for anyone but the NHS"? You seem to have strong views on this topic, to the point where I'm wondering how much of the decision-making is coming from the prospective applicant and how much from you. If they're interested in science, like problem-solving, and are a caring patient listener, medicine could be a good choice. The rest is irrelevant at this stage.

Consultant here. Graduated 2010 and CCT 2020.

1. Yes, although for USA would need to do the boards. Generally best to do all specialty training in one place. I have friends who have recently completed training in NZ after moving after F2. They will find it more straightforward to return to UK as they're now consultants in NZ.

1. Not really. Rank areas (but they are massive geographically) and then rotation sets within areas, can try to get a set with a rotation in a preferred specialty but it isn't guaranteed even after being allocated. A friend of mine picked a rotation with 4 months in Pathology in F2 as he had always wanted to be a pathologist. Got switched 2 months beforehand to ED for service provision reasons.

1. Personally, hardest years for me were F1 and 2. I did a very practical course and was v well prepared but it was still tough - I was young for my year and just 22. Being the being a lone dr in the unit overnight was scary. Also I knew what specialty I wanted to do and found the automatically being written off by consultants in other specialties I was rotating through was depressing. As soon as I said my plans they often stopped bothering to actively teach me anything.

Also felt much more like a number than a human. Allocated annual leave so I never got time off with my DH. I had to swap a set of night shifts to go to my grandmother's funeral. A friend of mine was put on shift on her wedding day despite telling the rota maker a year in advance.

1. Core training is generally 2-3 years and then higher training 3-5 years depending on specialty. You might do e.g. core medical training or core surgical training, then apply competitively to get into higher training e.g in respiratory medicine or vascular surgery. Same for other specialties like psychiatry. Paediatrics is slightly different and some are "run through" e.g. radiology is 5 years straight through. GP is usually 4 years. There are about 63 recognised specialties. All have postgraduate exams. It is possible to work in a specialty at "staff grade" or specialty doctor level without exams, but not to become a consultant. Many excellent doctors are this type - not in training and not consultants but with lots of experience post-FY.

V much possible to take mat leave, most medic parents I know had their kids during training.

I love my job but I am one of the lucky ones..picked a reasonably good work life balance specialty and was treated well in training in particular re pregnancy, mat leave etc. However I'm conscious that my pay 12 years ago as an FY in a cheap city with v little student debt (I worked all the way through uni) was great at 22, but actually isn't that much lower than a current foundation doctor is looking at despite inflation, tuition fees and cost of living rises.

I'm never sure where these numbers about how much it costs to train doctors come from. Especially at the postgraduate level. I think a lot is extrapolated from consultant salaries assuming our job plans contain training. I get paid no more for supervising a core trainee when I happen to have one than when I don't, and either way I don't actually have teaching time in my job plan so end up doing all the assessments etc in my own time. So I'm a bit "hmmm" about the actual costs to the NHS. Trainees are brilliant value. To replace them all with non training doctors would cost the NHS far more than trainee salaries so again I'm not sure how those maths work out.

OP if your daughter is interested i think it's important to go in with her eyes open - no one does medicine for the money. But being a doctor will bring her lots of opportunities even if the career doesn't turn out to suit her long term

I'd also make the point that it's possible, but extremely rare, to work in the UK as a doctor entirely privately.

It is not possible to do postgraduate training outside the NHS. Most private consultants also have NHS practice. Private health care providers do employ non -consultants but there is little scope for training or progression in these roles. It's stuff like being on call overnight in the private hospital for everyone who's not been sent home. Clerking patients in etc.

So basically if your DD wanted to become a doctor outside the NHS she would need to go abroad to train, and if she wanted to return and e.g work for bupa, she might find opportunities are v limited. Our local Nuffield hospital won't employ any surgical consultants full time as they recognise the skill set is eroded by only doing private procedures (private providers cherry pick and often won't do more complex or urgent stuff, or in some locations anything that might result in the patient needing an ICU bed)

I think some people are being unnecessarily harsh. Take a look at the junior doctors UK Reddit and see just how many junior doctors plan to ‘CCT and flee’ most to Aus and NZ. The NHS treats junior doctors terribly and pays them less than a shelf stacker in Aldi in exchange. It relies far too much on people’s good will and guilting them with ‘the good of the patient’.

Its not unreasonable to want to be a doctor but also want decent working conditions, even if that means moving abroad for them.

A couple of pupils from my son's year went to Hungary for their medical school training, however this was about the time of Brexit, so you might be in for overseas fees. One girl turned down a place in a UK medical school to go there.
At the time, her dad who is a doctor was sure she would be able to practice in the UK after graduation.

In my department the fancy stuff is done by the consultants in the NHS, the more straightforward stuff (but which will earn you money) is done in private hospitals.

DH has many friends who have worked (and trained) in the UK and USA. All preferred USA.

Oh, and some say working as a GP or consultant is more stressful, no one above you to ask advice and ultimately you are responsible.

Budapest is in Hungary, not Romania.

Stickyfingered, I am puzzled by your post. Why should training in Budapest imply any obligation to work in Romania?!
Did you mean Bucharest? Budapest is in Hungary.

Will have to do US exams (multiple parts) which is like final yr med school all over again. If passes this, will start at FY1 level.

1. after training in the Uk and doing foundation training it is easy to do locums and stand alone non training jobs in countries like Australia / New Zealand. Other countries such as USA have other examinations/licensing issues. It is difficult to get into specialty training posts in other countries.
2. In the Uk you select foundation programme rotations by ranking your preferences. You don’t choose individual jobs The top students get the best rotations. You can apply for rotations outside your training region.
3. The hardest bit depends on your life circumstances. It’s mostly tough to be honest. Perhaps the first year of core training the easiest bit . It really dependents on what else is going on in your life. The best time to be pregnant is just after you have a rotation.
4. I’m a surgeon. Most UK surgical training pathways are minimum 10 years after medical school ( 2 years foundation, 2 years central/core, 6 years specialty) . Add in academic time, fellowships, maternity leave, less than full time training after kids. 15 years is common in women , I took 19.

I think you have to roll with the punches, training pathways change all the time. You can’t have a fixed plan at the outset.

I've heard about people going to Eastern Europe. Bulgaria? Cheaper than UK degree & then no sense of obligation to work in NHS afterwards.

The funding of medical courses is subsidised heavily, and the NHS provides a great deal of the training. So here's hoping your daughter does not get in. Yes the NHS is in a poor state, but your attitude seems to be extra smash and grab.

Yes maybe it is unfair to take the governments funding and not give up your whole life to the NHS

Your dd is actively considering taking the training (that would be far more in many other countries) and leaving for one of those countries where she can work for more without anything like the student debt being paid by her colleagues in those countries. This is to her advantage and the detriment of a service that is strapped for cash already. Your dd doesn't have to help out but she needn't actively contribute to the problem by taking what's on offer and running, effectively playing the system. Social conscience.

I know someone who went to Australia and finished their training with their Husband who's a teacher. However I don't know much about how many years they had already done. They have had a baby in the past year and been in Australia for 3 years now. They don't intend to return.

I also have a relative in the first year of medicine and it's clear she's not really cut out for it, despite being highly intelligent. She's had a very sheltered life and despite doing some hospital work experience she's really struggling. She said she knew it would be hard but it's 1000 times harder.

Has she thought about being a doctor in the military?
The package looks quite good, my daughter was thinking of it.
apply.army.mod.uk/roles/army-medical-service/doctor

I’m a dr. I work somewhere with a lucrative private system. I could earn three times the salary with a lot less work. I’m afraid I’m one of those ‘ignorant’ people who considers ethics as well as intellectual satisfaction when making career choices.

Your daughter is misinformed if she thinks it’s going to be an easy road becoming a doctor anywhere. Specialty training in the US certainly isn’t easy.

If she’s interested in an easy path, there are many other non-medical career options. If she’s primarily money-focused, I’d suggest something outside of medicine also.

What a disgusting attitude to the NHS. I'm embarrassed for your DP.

I’m a nurse and worked for an nhs hospital that take US and Canadian medical students, I really don’t mean to be rude but they were clueless compared to the medical students at the same level in the NHS. Their clinical skills were shocking but I dont feel bad saying that as they said so themselves. Totally different ball game over there, they just could not keep up over here.

I mean this kindly, but you do seem a little over-invested in the details your dd's long-term career. Surely it's up to her to do the research, make the choices? She can't live her life through you anymore...

Yes, it does bear repeating that there are a lot of options within the overall healthcare field for an academically strong, scientific minded, driven and ambitious young person that will be both (a) more lucrative (b) less physically, emotionally, life-consuming-ly intensive than medicine that as a bonus don't also involve moving to the other side of the world (unless they want to of course!). I don't just mean nursing, allied health professions, healthcare scientists and so on (although it's a pity these are so often viewed as '2nd choices' for those without quite the exam results to be medics) but also research and clinical trials roles, pharmacology/medicines development, bioscience, medical engineering, digital medical technology, there loads of ways in which you have a really interesting and very rewarding (both financially but also in terms of making a difference) career choices if the whole lifestyle choice (and medicine really is that, wherever in the world you do it IMO), dedicating every waking moment to it, 24/7 working kind of thing isn't for you/your DC - and to emphasise I don't blame you/them for thinking this, at all, but it would be better all round to explore other options rather than training in medicine and ultimately not practicing where you trained.

I don't want to be critical of schools careers officers who do a difficult job (technology and the jobs that go with it are rapidly changing) and medicine is of course a brilliant career for those suited to it, but I really feel a lot of bright young people aren't well advised about this kind of thing and a lot of kids with A grade science A-levels are pushed towards medicine almost as if the's 'number 1 prize' ultimate ambition, without them being aware of the whole wide world of other choices they can make that would achieve a lot of the same things as medicine (money, prestige, helping people, hands-on non desk job work) without a lot of the drawbacks!

undecisive 😳 … and I’ve been there.

The salary is low because they are still training. A graduate doing a PGCE might only get £400 for the year.

You don't get a salary from private healthcare, it more like being self employed and the only role open before you are a consultant is to basically do cover, this is often part of your job at an NHS hospital so you will do 1 shift a week at a private hospital.

You DO NOT get respect from private work, I have only ever met one Dr who only had private patients, he was not that well respected. For most consultants they get their respect / reputation in the NHS and do private work for the money.

A friend's daughter went to Bulgaria to study medicine and has just finished her degree and come in the the NHS. I think she went there for cheaper fees. Not sure if the entry requirements were different?