Monday, March 18, 2013

MiM Mail: Go back to the US?


This is an amazing blog. I have been following for many years, since before I was a mommy in medicine. I am not someone that makes friends easily, or even shares a great deal of myself with the friends I do have. This community has been an enormous support to me, especially since the birth of MK (now 1 year old). I have often wanted to write a post, share my story, but for some reason or another it never happened.

A little background about me; I was raised in the United States from the age of 2 and lived there until I came to England to go to medical school. At the time I thought it was a great way to come out of medical school without too much debt (I was born in England so qualified for greatly reduced tuition), and see another part of the world (US suburban living was boring me into a coma). The plan was as soon as I finished I would come back to where my parents and family was, back to the place I have always considered as home. Fast forward to now, I have finished medical school and married to a born and raised Brit with a baby who came as an utter surprise just before I was due to take Step 1. I have matched to an Obgyn program (like residency) in the UK. Obgyn is definitely my calling, and I would find it very very hard to do anything else. This is a seven year program (all the programs here are MUCH longer), and the hospitals I would be rotating through are less than an hour away from where I live. I have a great MIL who lives minutes away and is happy for me to split childcare between herself and daycare. Because I have a small child, I also have the option of working flexibly (3-4 days a week). This would mean taking longer to finish the program and less pay, but the option is there if I need it. Finally, even if I worked full time my schedule would not be as intense as what some of you have often described (typically 8-5 four days a week, 1 12 hour day a week, four nights in a row every 4-5 weeks, 1 weekend every 4-5 weeks).

I see the benefits of staying here and the positives that are offered by the system here. However I still can’t shake the feeling that I should go back to the US. I miss my parents and I feel like I don’t even know my siblings, I have been away for so long ( I do visit every year for at least 2-3 weeks, but somehow our schedules match up for a very small amount of that time) . I always envisioned our kids growing up together, and if I stay that it unlikely to happen. I miss friendly faces. I miss the sunshine in the summer and the snow in the winter (I miss SEASONS). Finally I miss the American attitude, which you don’t really appreciate until you actually leave and realise the rest of the world does not think the same way. In America, people have a can-do optimism that I would love my son to grow up in. I have seen well established people decide to follow their passion at 45 and drastically change careers, embarking on new challenges. There is a mentality that if you work hard, you will get wherever you want to be. I feel this does not really exist in England. Going back however would mean finding time with a young child and part time work to ace the steps, get into a US residency program and then survive it. And then not look back at what could have been?

I am not sure if my dilemma has any basis. I feel this way maybe because I am homesick and nostalgic at the thought of the next seven years and what that will eventually lead to. For all of you that know the American system better than me,and maybe even some of you who may have had experience in both systems, your thoughts and opinions would be very much appreciated!

-From EnMD


  1. I don't know if this is helpful or not...I work at an academic institution in the US that has a long history (20 years +) of using what we call "British rotators" in the dept. of anesthesiology. These are people who are not quite done with their British training (usually have about a year or so to go) who choose to come spend a year as basically ultra-junior faculty in my department. Usually, they have not taken the USMLE exams (not sure exactly how this gets approved, but anyway...) Most of them enjoy their time with us, but are generally surprised by how many more hours we work and the increased difficulty of some of the cases. The reasons they choose to do this year are many, but for most of them, it seems to be mostly a way to resume build. Apparently, and very different from the US, completing training in Britain does not guarantee one a consultant anesthetist job (essentially the equivalent of a U.S. attending anesthesiologist). It is my understanding that the job market in Britain is very tight and thus many fully trained, qualified physicians never actually get to practice as such. Thus, I have seen over the years, upwards of 1/3 to 1/2 of those who rotate with us try to turn their one-year rotator appointment into something more permanent, either at our institution or elsewhere in the US (with varied success). I don't know if this is the case with OB/GYN as well--something you may want to investigate further. While completing a US residency program makes things more straightforward to practice in the US, clearly it is possible for one to complete training in Britain and then come to the US to practice (you do have to take the USMLEs, but do not necessarily have to complete a US residency also--I have seen this route taken by a dozen or more people at my institution alone). Whether or not you want to come back to the US to do residency or not is an entirely personal decision--yes, it likely will be more intense than in Britain, but it is do-able--as is evidenced by the many contributors to this blog. Good luck with your decision!

  2. I can't begin to tell you how your dilemma closely mirrors mine 2 years ago!! I was raised in Michigan but have loads of family in England. I went over for undergrad, married an Englishman, and stayed on for medical school. My daughter was born 2 weeks after I graduated from medical school! I struggled with exactly the same things you describe: work-life balance seems so much better during residency years in the UK, but then so much better for attending years in the US! I completely agree with the comment above regarding attending positions in the US vs consultant positions in the UK. I hated the idea that I could spend 10 years training to be an anesthesiologist, working long hours (albeit not quite as long as in the US) and earning a resident's salary to not have a position at the end of it all. I did several away rotations in the US when I was in my clinical years of med school and found that many residents had families. And they were happy. Of course it was exhausting and required sacrifice, but it was such a comparatively short time that it seemed doable. I also liked how the US system (paradoxically) seems family friendly in that a lot of my co-residents have children and it's not uncommon. My attendings often ask about my daughter and family life and we exchange daycare info. I found that as a pregnant medical student in the UK, I was a complete and utter anomaly. Although there were services available for helping me get through residency, there was NO ONE ELSE doing it! At times I felt like a pregnant teenager in trouble, rather than someone who had been married for 6 years pursuing higher education. I'm now an intern in anesthesia in Chicago. It's definitely hard work and I'm often now nostalgic for the UK! But when I talk to my friends who are junior doctors back in the UK, I find we're actually working very similar hours.

    I also liked the flexibility inherent in the US system in terms of how you practice as an attending. There are so many opportunities to carve your own niche, you really can make medicine into exactly what you like! For me, that will hopefully be CV anesthesia a few days a week but with critical care weeks in the SICU in between, working mostly part time.

    I can appreciate your nostalgia for the US mindset, too. There definitely is a "can-do" attitude! While I loved working in the NHS and what it stood for, I so appreciate the perks of the system over here, too. For me, the final clincher was wanting to be nearer to family in the Midwest and my husband's decision that he preferred living in the US. Decision made!

    This is such a huge decision to make, especially because both systems are unnecessarily inflexible about changing countries during training. The only thing I can advise is that residency is shorter here, you work harder but it's not impossible to have a happy family life simultaneously. In the UK, you will work less hard in residency but for longer. American optimism will always be attractive, but so will British stoicism and the love of the NHS. Good luck with your decision and do let me know if you want to chat more via email. Uncanny how similar this situation is!!


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