Anaesthesia residency as an IMG

[ugm12]

Hello!

I am newly qualified UK doctor, looking to enter an anesthesia residency in the US (about to sit step 1). Could someone kindly explain the stages of an anesthesia residency? What is the difference between PGY-1 and CA-1 for example? And what stage would an international medical graduate enter training?

---

Members don't see this ad.

 

[vector2]

Anesthesiology training is 4 yrs in the US (pgy (post graduate year)1-4). The nomenclature can also be CA (clinical anesthesia) 0-3. Pgy1 = CA0 = CBY (clinical base year) = intern year, which is typically a medicine, surgery, or transitional year which involves a variety of rotations through different specialties. Most programs are moving towards an integrated model where you match and all 4 years are at the same institution, other programs only offer CA-1 through 3 and you are responsible for finding your own pgy-1 program. CA 1-3 are the years specifically dedicated to anesthesiology training. As an IMG you would enter at pgy-1 just like a new med school graduate here.

 

[ugm12]

Fantastic! That is extremely helpful. Thank you for the overview. So is the integrated model known as a "categorical" training program?

 

[waterbottle10]

Fantastic! That is extremely helpful. Thank you for the overview. So is the integrated model known as a "categorical" training program?

Yes

 

[deleted171991]

What type of UK grad needs to come to the US to practice anesthesia? Except in case of marriage, I personally would be very suspicious if I were the PD.

 

[gasblaster]

What type of UK grad needs to come to the US to practice anesthesia? Except in case of marriage, I personally would be very suspicious if I were the PD.

I've seen a number grads from medical schools in Canada, UK, Australia, Germany, Japan, etc come through my program for the training and option of working in the United States or in their home country afterwards.

 

[bashwell]

What type of UK grad needs to come to the US to practice anesthesia? Except in case of marriage, I personally would be very suspicious if I were the PD.

From what I hear, the NHS is unfortunately worsening as a place for doctors to work (e.g., worsening in working conditions, lifestyle, pay) and a lot of UK physicians (especially junior physicians) are trying to escape overseas in hopes of a better future. There are heaps here in Australia, for example see this article and also reddit post. Australia, New Zealand and Canada are still loosely part of the British Commonwealth so maybe it's easier for UK physicians to move to these places, while the US is obviously more difficult but still attractive.

 

[deleted171991]

I've seen a number grads from medical schools in Canada, UK, Australia, Germany, Japan, etc come through my program for the training and option of working in the United States or in their home country afterwards.

Respectfully, I still have to meet a doctor from Western Europe who came to the US just for training and was impressive. Especially in the era when European diplomas are easily recognized across the continent. Yes, one can argue the attraction of higher salaries and somewhat shorter training, but I don't buy it. First of all, European countries don't readily recognize American training, so the option of going back to one's country is a myth. But maybe I am wrong.

 

[dhb]

Respectfully, I still have to meet a doctor from Western Europe who came to the US just for training and was impressive. Especially in the era when European diplomas are easily recognized across the continent. Yes, one can argue the attraction of higher salaries and somewhat shorter training, but I don't buy it. First of all, European countries don't readily recognize American training, so the option of going back to one's country is a myth. But maybe I am wrong.

Good thing you haven't seen some from Eastern Europe then.

 

[deleted697535]

Respectfully, I still have to meet a doctor from Western Europe who came to the US just for training and was impressive. Especially in the era when European diplomas are easily recognized across the continent. Yes, one can argue the attraction of higher salaries and somewhat shorter training, but I don't buy it. First of all, European countries don't readily recognize American training, so the option of going back to one's country is a myth. But maybe I am wrong.

Yes. You are wrong. Europe contains many countries. Each do their own thing. The us and Canada is about as recognised a postgraduate degree as it's possible to get

 

[deleted171991]

Yes. You are wrong. Europe contains many countries. Each do their own thing. The us and Canada is about as recognised a postgraduate degree as it's possible to get

Really? Please show me a Western European country that recognizes American medical degrees (the easy way they do for EU degrees). Especially since we were talking about the UK, please show me where it says that the American anesthesia board certifications are recognized in the UK, especially to the same degree as EU diplomas.

I am sticking to my initial opinion. Most people emigrate for economical or political (freedom) reasons. Most Western European doctors have no such reason to leave their home country or the European Union (and they don't), especially for a country where they have to pass their medical license exams from zero, and whose specialty board diplomas don't mean much on the other side of the pond. The same way most American doctors don't emigrate.

 

[deleted171991]

From what I hear, the NHS is unfortunately worsening as a place for doctors to work (e.g., worsening in working conditions, lifestyle, pay) and a lot of UK physicians (especially junior physicians) are trying to escape overseas in hopes of a better future. There are heaps here in Australia, for example see this article and also reddit post. Australia, New Zealand and Canada are still loosely part of the British Commonwealth so maybe it's easier for UK physicians to move to these places, while the US is obviously more difficult but still attractive.

Now that I could understand. A Commonwealth country is a completely different thing, part of the same system. Except the US is not one. An American residency graduate cannot easily practice even in Canada (otherwise there would be a ton of American anesthesiologists there).

Anyway, it's the OP's business. I was just saying that, if I were a PD, I would be circumspect and like to hear some explanations beyond "American medicine is the best in the world".

 

[Mad Jack]

Yes. You are wrong. Europe contains many countries. Each do their own thing. The us and Canada is about as recognised a postgraduate degree as it's possible to get

GME does not carry over with very few exceptions. The UK will take US anesthesia, pediatrics, and radiology qualifications. I don't know of any other country that accepts US credentials on the continent, however.

 

[anbuitachi]

They accept your training but you still have to pass their board exams dont you? Why would any UK doc want to come to US to practice anesth? haha

 

[deleted171991]

GME does not carry over with very few exceptions. The UK will take US anesthesia, pediatrics, and radiology qualifications. I don't know of any other country that accepts US credentials on the continent, however.

They will take it as a basis for entrance into residency training. American board certifications are not considered equivalent with UK specialist levels.

 

[bashwell]

Now that I could understand. A Commonwealth country is a completely different thing, part of the same system. Except the US is not one. An American residency graduate cannot easily practice even in Canada (otherwise there would be a ton of American anesthesiologists there).

Anyway, it's the OP's business. I was just saying that, if I were a PD, I would be circumspect and like to hear some explanations beyond "American medicine is the best in the world".

Good point FFP. Same with Australia as things are getting only more difficult here and tighter especially for foreign trained doctors, or so I've been told by a few different supervisors of training (which is like a PD) and others too. Apparently it used to be much more open even just a few years ago, but things are changing. I would think if the UK and Ireland health care systems start to worsen for junior doctors, then there will be more and more overflow to other countries like Australia, Canada, etc, but as a result these countries respond by making things tighter. That's my guess as to what I think is happening anyway.

 

[nimbus]

Respectfully, I still have to meet a doctor from Western Europe who came to the US just for training and was impressive. Especially in the era when European diplomas are easily recognized across the continent. Yes, one can argue the attraction of higher salaries and somewhat shorter training, but I don't buy it. First of all, European countries don't readily recognize American training, so the option of going back to one's country is a myth. But maybe I am wrong.

That's quite a blanket statement.

I've been very impressed with a couple of Europeans that came through our dept when I was a resident/junior faculty. One is a world reknown pediatric anesthesiologist and director of a children's hospital in New Zealand. Another became a pediatric cardiac anesthesiologist and very productive clinical researcher at UCSF for many years before he recently went into private practice. Both were outstanding clinicians, among the top 3% of anesthesiologists I've ever met. And both were very energetic boundary pushing human beings to boot with regard to athletic ventures and all around adventures. They were the epitome of work hard play harder.

It's never easy to uproot yourself, move and work in a different country. Some people just have that drive. I consider that a good trait.

 

[sevoflurane]

That's quite a blanket statement.

I've been very impressed with a couple of Europeans that came through our dept when I was a resident/junior faculty. One is a world reknown pediatric anesthesiologist and director of a children's hospital in New Zealand. Another became a pediatric cardiac anesthesiologist and very productive clinical researcher at UCSF for many years before he recently went into private practice. Both were outstanding clinicians, among the top 3% of anesthesiologists I've ever met. And both were very energetic boundary pushing human beings to boot with regard to athletic ventures and all around adventures. They were the epitome of work hard play harder.

It's never easy to uproot yourself, move and work in a different country. Some people just have that drive. I consider that a good trait.

Absolutely agree with you and have had the same experiences.

 

[deleted171991]

That's quite a blanket statement.

I've been very impressed with a couple of Europeans that came through our dept when I was a resident/junior faculty. One is a world reknown pediatric anesthesiologist and director of a children's hospital in New Zealand. Another became a pediatric cardiac anesthesiologist and very productive clinical researcher at UCSF for many years before he recently went into private practice. Both were outstanding clinicians, among the top 3% of anesthesiologists I've ever met. And both were very energetic boundary pushing human beings to boot with regard to athletic ventures and all around adventures. They were the epitome of work hard play harder.

It's never easy to uproot yourself, move and work in a different country. Some people just have that drive. I consider that a good trait.

Of course there are always exceptions. Just use your judgment.

Again, I was talking about Western Europeans coming from rich countries. And I was not talking about doctors who left their countries after graduating residency, or who moved to another country where their studies were easily recognized (e.g. Commonwealth, EU); I was talking about people who come specifically to the US for residency training now (the latter is pretty rare in Western Europe, usually family-related). Not about docs who immigrated to the US decades ago, when there was no EU-wide recognition of medical studies.

America is a big country. How many American medical grads do you know who went on to do their residency training in Europe?

 

[nimbus]

Of course there are always exceptions. Just use your judgment.

Again, I was talking about Western Europeans coming from rich countries. And I was not talking about doctors who left their countries after graduating residency; I was talking about people who come to the US for residency training (the latter is pretty rare in Western Europe, usually family-related).

Yes I'm talking about people who came for residency, from U.K. and Germany. That said, we had another German resident who claimed he was a fully trained general surgeon but who was so inattentive he was fired after his CA-1 year.

I also work with a superb pediatric ophthalmologist from Ireland who had to redo his residency when he moved to the US. He said his opportunity to become a consultant ophthalmologist in Ireland was basically nil until someone died.

 

[deleted171991]

Yes I'm talking about people who came for residency, from U.K. and Germany. That said, we had another German resident who claimed he was a fully trained general surgeon but who was so inattentive he was fired after his CA-1 year.

QED. All I was saying was that a doc who emigrates now from a rich European country to the US, for residency training, makes me way more suspicious than somebody coming from a poor(er) country. Unless they come for family reasons. Why? Because, in the last two decades, they have had a much easier time getting their studies recognized and working in another EU country.

Of course there are always exceptions. And of course no blanket statement can be correct, especially from a n=1 experience. Actually, one of the best docs I have ever met is an Englishman, and based on their books and blogs, I have a lot of respect for UK docs.

 

[deleted171991]

Yes I'm talking about people who came for residency, from U.K. and Germany. That said, we had another German resident who claimed he was a fully trained general surgeon but who was so inattentive he was fired after his CA-1 year.

I also work with a superb pediatric ophthalmologist from Ireland who had to redo his residency when he moved to the US. He said his opportunity to become a consultant ophthalmologist in Ireland was basically nil until someone died.

Ireland = poorer country, until 10-15 years ago (like Spain, Portugal, Greece). You wanna bet that he came here especially for the money, not the professional career?

Again, there are always exceptions. Even to one of the favorite rules on this forum, that US medical graduates are better than FMGs, who are better than US IMGs.

 

[ugm12]

Very interesting to hear opinions of US docs on this matter.

Bashwell is correct. Moral in the NHS is very low at the moment. Interest and enjoyment in clinical medicine is over shadowed by political discussions and moaning about workload. However this is certainly not enough to make us want abandon the NHS and leave the UK!

Purely as a contribution to this interesting thread, my main reason for pursuing a US residency is as follows:
As a medical student I had 2 month overseas elective (placement) at a university anesthesia department in the US. I found their particular area of anesthetic research fascinating, and wish to pursue it further, eventually aiming for a career as an academic anesthesiologist (in the UK or the US). This department's research is years ahead of anything I have seen in the UK. I understand the chance of matching to a specific institution is slim, but there seem to be far greater opportunities (and funding) for translational and basic science anaesthesia research in the US compared to here.

It's interesting to note that after speaking to UK docs in Australia and New Zealand, training abroad comes down to a choice between preferred lifestyle or preferred working environment. Working conditions, moral and pay are all better in the above countries, but time with family and friends, travel opportunities and home culture may be more important. I find the enthusiasm of US docs also appealing, and more fitting with my attitude towards medicine.

 

[738177]

Good point FFP. Same with Australia as things are getting only more difficult here and tighter especially for foreign trained doctors, or so I've been told by a few different supervisors of training (which is like a PD) and others too. Apparently it used to be much more open even just a few years ago, but things are changing. I would think if the UK and Ireland health care systems start to worsen for junior doctors, then there will be more and more overflow to other countries like Australia, Canada, etc, but as a result these countries respond by making things tighter. That's my guess as to what I think is happening anyway.

I'm curious, are there residencies in Australia that forbids non-Australians from applying?
In Canada, you can't apply to ANY residencies unless you're a Canadian PR/Citizen. For this reason alone, i don't think Canada will ever have a flock of foreign doctors coming in.

 

[bashwell]

I'm curious, are there residencies in Australia that forbids non-Australians from applying?
In Canada, you can't apply to ANY residencies unless you're a Canadian PR/Citizen. For this reason alone, i don't think Canada will ever have a flock of foreign doctors coming in.

I don't know Canada, but I think it might be similar-ish in Australia. In general, and assuming all other things are in order and equal between candidates, registrar jobs will go to PR/Citizens first in Australia. Actually I think it might even be a legal requirement for a reg job to go to PR/Citizens first before others. I don't know if others are completely kept from applying, it's just very unlikely others will receive a job if there are PR/Citizens applying for the same job.

 

[deleted171991]

Purely as a contribution to this interesting thread, my main reason for pursuing a US residency is as follows:
As a medical student I had 2 month overseas elective (placement) at a university anesthesia department in the US. I found their particular area of anesthetic research fascinating, and wish to pursue it further, eventually aiming for a career as an academic anesthesiologist (in the UK or the US). This department's research is years ahead of anything I have seen in the UK. I understand the chance.

Respectfully, unless you have a Ph.D. (or at least a meaningful research track), I call BS. But it may work on some naive American PDs. They just love to fall for this kind of soap opera.

But I am the kind of guy who finds most (but not all) academic research a waste of everything. If I want a good hypnotic, I just pick up the last issue of Anesthesiology or similar. I especially loved that recently-mentioned NEJM paper, which "proved" that angiotensin II is a better second pressor than... saline.

 

[ugm12]

Respectfully, unless you have a Ph.D. (or at least a meaningful research track), I call BS. But it may work on some naive American PDs. They just love to fall for this kind of soap opera.

But I am the kind of guy who finds most (but not all) academic research a waste of everything. If I want a good hypnotic, I just pick up the last issue of Anesthesiology or similar. I especially loved that recently-mentioned NEJM paper, which "proved" that angiotensin II is a better second pressor than... saline.

Do please explain what you mean by "I call BS"

 

[deleted171991]

Do please explain what you mean by "I call BS"

As in I believe it when I see it. If you already have a meaningful research track, or a research-focused degree (Ph.D.), then I could believe that you are so excited about a particular line of research that you would relocate to a different country just for that. Otherwise, I personally wouldn't believe that story. Just my 2 cents.

Top definition
I call bull****
The act of calling bull****: When one person says something that another person is not in agreement with, that second person may "call bull****" on whatever the first person said. By doing this, they are expressing their disagreement with what the person said in a humorous and yet serious way.
Person1: "Of course I don't drink! I'm not 21 yet so that's illegal."

Me:" Umm sorry, but I call bull**** on that. I was with you last night at that frat party and you were far from the perfect little sober college student you're pretending to be right now."

 

[deleted697535]

I don't know if you american/Canadian guys realise how bad things are in Ireland/uk for new staff now. We train 3 times longer than you and do multiple fellowships to beg for a job that pays just over 100k euro/us/GBP all equal.
Moral is not at an all.time low. There is no moral left

 

[deleted171991]

I don't know if you american/Canadian guys realise how bad things are in Ireland/uk for new staff now. We train 3 times longer than you and do multiple fellowships to beg for a job that pays just over 100k euro/us/GBP all equal.
Moral is not at an all.time low. There is no moral left

I certainly didn't. But don't look just at the annual salaries; look at the hourly pay, lifestyle etc. An American anesthesiology resident works 60-70 hours/week, and an attending 50-65. Far from the European numbers AFAIK.

Also, think about locking yourself into the American medical system, and whether that's really worth it to you, given all the midlevel encroachment. With what I know now, the US would probably be pretty low on the list of countries I would do my residency training in. For a UK grad, my uninformed guess is that a Commonwealth country is a much better solution long-term, especially if contemplating a possible return home.

EU regulation

Junior doctors in the European Union fall under the European Working Time Directive, which specifies:

• 48 working hours per week (down from 56 under the old UK regulations), calculated over a period of 26 weeks.
• 11 hours continuous rest per day
• one day off each week, or two days off each fortnight
• 20 minutes of continuous rest every 6 hours

However, junior doctors may choose to work more than 48 hours a week, or opt out of the EWTD entirely by signing a waiver with the employer. They may not be punished for not working more than the directed hours. Many trainees nonetheless feel obliged to work longer hours. The rest times are mandatory, but may be taken at another time if it cannot be taken as scheduled.[33]

I work more than 48 hours, even as an attending.

 

[gasblaster]

Of course there are always exceptions. Just use your judgment.

Again, I was talking about Western Europeans coming from rich countries. And I was not talking about doctors who left their countries after graduating residency, or who moved to another country where their studies were easily recognized (e.g. Commonwealth, EU); I was talking about people who come specifically to the US for residency training now (the latter is pretty rare in Western Europe, usually family-related). Not about docs who immigrated to the US decades ago, when there was no EU-wide recognition of medical studies.

America is a big country. How many American medical grads do you know who went on to do their residency training in Europe?

I can only speak from what I know from what I've seen, but I trained at a top academic program and during my time there we had residents that were from and completed their medical education in Japan, China, Singapore, Australia, UK, Russia, Canada, Pakistan, Iceland, Columbia, and Brazil. In terms of returning to their home country and practicing, from what I understand, most of these countries recognize the residency training in the US as long as they completed their medical education/boards/licensing from home. Their are some nuances though (i.e. Canada does require an additional year of training beyond ours because their anesthesia residency is 5 years). I'd say about 1/4 to 1/3 return back.

 

[nimbus]

I can only speak from what I know from what I've seen, but I trained at a top academic program and during my time there we had residents that were from and completed their medical education in Japan, China, Singapore, Australia, UK, Russia, Canada, Pakistan, Iceland, Columbia, and Brazil. In terms of returning to their home country and practicing, from what I understand, most of these countries recognize the residency training in the US as long as they completed their medical education/boards/licensing from home. Their are some nuances though (i.e. Canada does require an additional year of training beyond ours because their anesthesia residency is 5 years). I'd say about 1/4 to 1/3 return back.

I'm sure the "top" programs draw a different caliber of IMG than an average program. The quality of the IMGs you encounter depends on where you encounter them.