US Med Student getting Residency spot in Ireland or UK?

[G.O.A.T.]

hi,

i am currently a us med student. my parents are from ireland and i have spent a lot of time there. for many years now, i have wanted to move to ireland, but there always seems to be something i have to finish first.....first college, then med school, then residency. as i am now half way through med school and starting to think seriously about my future, i ask myself, "why should i do residency in the us if i eventually want to move to ireland permanently?". i know if i ever chose to come back to the us, i would need to do a us residency, which might not be so much fun the older i get....but i am pretty certain i won't be coming back.

so i now find myself with many, many questions about the irish system and the chances of me pursuing my training there and ultimately my career there. so i will just spit out as many questions as i can think of, and if anyone can answer one, two, or as many as they can, i would be very thankful. i have tried looking on two dif irish govt websites, however could not really find what i was looking for.

oh....i would also love to hear answers as they relate to the uk system....perhaps the uk is a better option? and i have also spent a lot of time there and would def live there if i could not get ireland.

1) i have read about the glass ceiling encountered by many foriegn docs in ireland an the uk....eu citizens being given preferential treatment in regards to promotion. i am a dual citizen...i hold both american and irish citizenship and passports from both countries. so "technically" i am an irish/eu citizen, however my love of dr pepper will easily give me away as an american. will the fact that i have irish citizenship/passport help in the process? when applying for an internship or training, would i be treated as an irish citizen or a foriegner? when being considered for promotion, would i be an eu citizen or a foriegner?

2) if someone could give me the cliff's notes version on post grad training over there, that would be great. my understanding is it goes something like this....intern --> jho --> sho --> specialty training......is that right? i also have the idea that, unlike the us system, there are no fixed time periods for progression....you could be a stuck at one level for an undetermined amount of time, until you are promoted to the next....is that right? this is where i am hoping my irish/eu citezenship will help.

3) as i will be a us grad, i will have a huge financial debt to repay. i really have no idea what doctors over there make....i don't think they make as much as in the us, however if someone could ballpark it for me, i would really appreciate it. around how much would one expect to make during training/residency? around how much after training is over? does it vary greatly between the specialties like it does in the us? money is not a big issue....i'm sure they live quite comfortably, however i'm not sure if their students have to pay back hundreds of thousands of dollars....i obviously need to make sure i can do this....so if anyone has some rough numbers, that would be awesome.

4) would it be better to do residency here then try to move? i have thought about this, but it does not seem like a good option for a few reasons. after residency, i will be much older, may have a wife/kids, so it may not be as easy to pick up an move. right now, it's only me...i don't have to worry about if anyone else. also, if i did my residency here and then moved to ireland and uk, would i have to train all over again there? i really don't want to do that. that's why i now figure that if my plan is to live there permanently, i may as well train there too.

5) is this something that is going to be extremely difficult to do? does anyone know any americans who did not go to school there but trained there?

well i guess those are the biggies for now. thanks in advance for any responses.

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[BabyPsychDoc]

Hi,

I know little or nothing about Ireland, so all my comments relate to the UK.

ibut i am pretty certain i won't be coming back.

Never say never. You may be disappointed with the local system and wish to go back later on in life. Or, you may miss the US too much. Having completed a residency in the US MAY enable you to practice medicine as an attending in the UK. You have to check with each of the Royal Colleges for their rules and regulations.

1) i have read about the glass ceiling encountered by many foriegn docs in ireland an the uk....eu citizens being given preferential treatment in regards to promotion. i am a dual citizen...i hold both american and irish citizenship and passports from both countries. so "technically" i am an irish/eu citizen, however my love of dr pepper will easily give me away as an american. will the fact that i have irish citizenship/passport help in the process? when applying for an internship or training, would i be treated as an irish citizen or a foriegner? when being considered for promotion, would i be an eu citizen or a foriegner?

Nobody gives a damn about your soda preferences. You have the magic passport and you are white (I assume). You may be disadvantaged by not going to the same school as many of your colleagues and attendings, and not having your daddy play golf with your attendings. But, even so, you CAN make it. You do have to prepare for very tough competition, though.

2) if someone could give me the cliff's notes version on post grad training over there, that would be great. my understanding is it goes something like this....intern --> jho --> sho --> specialty training......is that right? i also have the idea that, unlike the us system, there are no fixed time periods for progression....you could be a stuck at one level for an undetermined amount of time, until you are promoted to the next....is that right? this is where i am hoping my irish/eu citezenship will help.

Actually, it is Foundation Programme (two years) --> SHO (basic specialty training) --> Higher Specialist training.
Your citizenship may help, however you have to realize that to progress from SHO to SpR posts you have to pass relevant college exams (MRCP, MRCPCH, MRCPsych, etc). This was attempted to be changed last year, and a run-trhough training was introduced, but it looks like it may be reverted back to the old system. Google MTAS, MMC, run-through training.

3) as i will be a us grad, i will have a huge financial debt to repay. i really have no idea what doctors over there make....i don't think they make as much as in the us, however if someone could ballpark it for me, i would really appreciate it. around how much would one expect to make during training/residency? around how much after training is over? does it vary greatly between the specialties like it does in the us? money is not a big issue....i'm sure they live quite comfortably, however i'm not sure if their students have to pay back hundreds of thousands of dollars....i obviously need to make sure i can do this....so if anyone has some rough numbers, that would be awesome.

As a trainee doc you start with GBP 25K per year PLUS whatever banding your post has. Banding is essentially extra pay for unsocial hours, as doc are subject to the European WOrking Time Directive which stipulates that EU workers can only work so many hours a week. Most often, the band is 50%. Then your salary increases by about 2K a year. So, you do make MORE than a resident in the US whilst in training. However, as you become an attending (consultant in the UK), you suddenly find yourself earning maybe only 15-20K more than your senior resident. Unless you do private practice. The catch is that you have to do a minimum number of hours for the government before you are allowed to do private practice - and the minimum requirement is something like 40 hrs a week. Ouch.

4) would it be better to do residency here then try to move? i have thought about this, but it does not seem like a good option for a few reasons. after residency, i will be much older, may have a wife/kids, so it may not be as easy to pick up an move. right now, it's only me...i don't have to worry about if anyone else. also, if i did my residency here and then moved to ireland and uk, would i have to train all over again there? i really don't want to do that. that's why i now figure that if my plan is to live there permanently, i may as well train there too.

See above. You have to check with each college. For example, you cannot practice family medicine in the UK after completing residency in the US, but you may the other way round. And for psychiatry, the reverse is true (or has been true until recently, when they changed it and now are thinking about changing it back....) I understand your hesitation re family issues, etc, however nothing is impossible. After all, your future wife may have dreamt all her life about moving to the UK....

5) is this something that is going to be extremely difficult to do? does anyone know any americans who did not go to school there but trained there?

Difficult? I dunno. Life is difficult. I moved from the USSR to the UK 7 yrs ago, have made a pretty decent career here and now am considering trying a US fellowship (my husband is American, so he wants us to give it a go). I know an american girl who went to medschool in the US, then married a british boy and moved to England. She did a brief stint in Oxford psych residency and now is training as a psychiatrist in Cambridge (where her hubby is going to medschool). Again, being white and having the magic passport helps a lot - though competency rules.

Hope this helps. PM me if further qs.

 

[G.O.A.T.]

Nobody gives a damn about your soda preferences.

babypsychdoc,

THANK YOU SO MUCH FOR RESPONDING! sorry for my rudeness in not thanking you earlier.....i was checking for replies constantly at first and wasn't getting any, so i just forgot about it until just now. seriously, thank you for your reply....it was very helpful.

 

[leorl]

The above is for the UK system. The Irish one is slightly different, mainly in that we don't have Foundation years (yet) and so internship is 1 year, not two. ---- > SHO years ---> MRCP exams for Registrar ---> Specialist Registrar ---> Consultant .

At the moment, interns are getting base pay at roughly 33500 euro per year, but then currently we can earn a crapload of overtime. EU Working Time Directive is still not in place yet (technically a violation of EU policy), but they are gradually looking towards implementing it. There are problems in getting it into effect at the moment. With EUWTD not in effect, most of us will be earning anywhere from 60-80 k... pretty good. You don't really save much in your first 6 months while you get set up as an independent person and pay back those minor bank loans and fly to the US for interviews or whatever, but starting from January the next 6 months you can earn enough to put a dent into those staffords. I would anticipate EUWTD to be in place by the time you'd graduate though, and althought pay may rise a bit to compensate for lost overtime pay, it probably still wouldn't be as much as we are earning now.

If you are serious about practicing in Ireland, then the easiest for you would be to train here. Intern posts go to graduates of the schools that the hospitals are affiliated with. It is very hard to break into if you're not already in the system. I do not know any Americans working here who did not do their medical training in Ireland. However, I wouldn't say that Ireland would be the most specialized place to train. it probably would be easier doing a higher residency post than trying to break into a more junior one.

 

[G.O.A.T.]

thanks leorl. it was helpful.

 

[pitman]

Hi leorl,

I just graduated from the U of Queensland, and apparently our grads can get full registration in Ireland:

http://www.medicalcouncil.ie/registration/firsttime2.asp#5

I'll stay in Queensland for internship this year and prob for a second PG year, but am thinking of moving to Ireland after that.

As follow-up to your last post, I'm wondering whether "full registration" means the same as here -- as equivalent to having finished internship in Ireland; and how difficult it would be with such full registration to get an SHO job there.

Tanks,
pitman

 

[leorl]

hey pitman, full registration does mean the same. So you get your internship accreditated by the medical council, and you'd be eligible for full registration with the irish medical council and thus eligible for jobs. The difficulty of getting an SHO job would be dependent on what you're trying to get into. You can get stand-alone SHO jobs, which apparently may not count towards training credits, or you can try to get into an SHO scheme (surgery, medicine, paeds, gp, etc.) which would obviously be more competitive. That is less clear-cut, with some program heads looking for a broad base and some being more strict. I'm not quite sure why you'd like to come to Ireland for a training scheme though, if you can do it in Canada?

 

[pitman]

well, I'm still being the romantic. I'm in no rush to be anywhere, and don't know where I'll end up. I'm more thinking Ireland for a year or two, but who knows! I'm really just checking my options now that I've jumped the med school hurdle.

Tanks.

 

[leorl]

I understand what you're saying. In that way, an Irish training scheme could mean more exposure for you. For instance, the surgical scheme (the BST or basic surgical training) is 2 years where you rotate in a several surgical specialities for 3-6 months, giving you longer exposure than a traditional 1 month rotation. Likewise in the medical scheme, you spend 3-6 month rotations in various medical specialties. However, while this may be good experience, should you choose to return home at some point, it may not count towards your residency and you may have to essentially repeat residency.

 

[pitman]

Yeah, some time in a programme may not count in the end, but Ireland recognizes up to a year of Australian specialty training, and I think Qld does at least that (assuming I'd be starting a programme in one country before moving to the other). And once a registrar, most colleges will allow you to take a year or two off to practice somewhere else.

Also, some programmes like to see an extra year or two of training before you apply, with some wanting diversity of experience.

Then again, some docs here enjoy being house officers and don't enter a college by choice for many years. I guess I'll just have to see how I feel when the time comes! ok, I'm not *quite* as flippant as I sound, but almost..

 

[leorl]

nah, it definitely takes awhile for people to choose what they want, and so I say take the time! there's no use being rushed into something you might eventually regret. Besides, whatever experience you get, it'll always be helpful. There's no real way it can hurt you, you know? People here...they end up in sho training for 2-3 years and even after that, many people don't know what they want.