And so the dream dies...

[WalterDandy]

...with my 192 on Step 1. I knew I'd taken on too much trying to do Step 1 at the same time as my finals here in the UK. Bit gutted. Despite the fact that I've got a PhD and done lots of clinical electives, I know that realistically there isn't a US residency director who'll touch me with that score as an IMG .

Still, as a PhD holding candidate at a highly respected UK med school, I've got every chance of getting a training spot here so its not all bad. (Would have loved to have trained Stateside, tho...) The dream was good while it lasted. Ho hum

So bring on the MMC, e-portfolios of competencies and a dead rainforest's worth of pointless beaurocratic forms to complete on an hourly basis. Its great to be British!

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[WalterDandy]

(I'm kind of fishing for dis/agreements btw - all comments gratefuly received. Thanks)

 

[NPR]

Are you talking about a neurosurgery residency spot?

I'd agree it looks bleak. 192 for an American grad would probably serve as the final nail in the coffin. Probably worse for an IMG.

 

[WalterDandy]

Are you talking about a neurosurgery residency spot?

I'd agree it looks bleak. 192 for an American grad would probably serve as the final nail in the coffin. Probably worse for an IMG.

Afraid so. Its a bit of a shame that I've got 2 postgrad degrees from excellent institutions and that my chances are all determined by this 3 digit score. Still, I can't complain, I took the test at the only time I possibly could have and I did all the study that the time allowed. And at least I passed so maybe there's the chance of a fellowship later in my career.

Just out of interest, does anyone know why the UK and US don't recognise each other's medical school qualifications?

 

[Tired]

Just out of interest, does anyone know why the UK and US don't recognise each other's medical school qualifications?

We don't recognize anyone else's qualifications, except maybe some of the Canadians, and that's because they're basically Americans anyway.

 

[NPR]

Just out of interest, does anyone know why the UK and US don't recognise each other's medical school qualifications?

I've always wondered this myself. Compared to a graduate from Oxford or Cambridge, my medical school is probably a large steaming pile of cow manure.

And yet, when it comes time for residency applications, I'm still better off than a FMG from those universities.

Maybe it's because they spell recognize as recognize? Just kidding

 

[SexySurgeon]

Apply to AS MANY places as you can. Yeah neurosurgery is probably out, but try to find some other specialty you like, at least. I mean, there's SO many specialties that would accept someone with a 192.

Have you taken Step 2 or Step 3 yet? Did you do well on them?

And hey, at least you didn't fail Step 1. You PASSED. So at least you can go to internal medicine (sucks I know) but after that you can get a fellowship in something else right?

 

[SexySurgeon]

On another note - look around for hospitals and specialties that are in DIRE NEED of doctors. And see what connections you have. You might just get a spot somewhere in a specialty you like, the only thing is it won't be in a terribly desirable area, but so what. If they desperately need doctors they will take you. And remember, you didn't fail, so it's not the end of the world. Think about the thousands of people who failed Step 1 who would kill for your score.

And from what I've heard, there are people who did residencies in IM, and then later went on to do surgery. Not brain surgery, but they became surgeons none the less.

Best of luck

 

[WalterDandy]

Thanks for your wise and kind words, people. Much appreciated.

I had a really big think about things the past few days and as much as I hate what they've done to our training here in the UK, and as much as I would rather live and train as a surgeon in the United States, I couldn't give up the chance of neurosurgery here for internal medicine or general surgery aross the pond. I just couldn't.

As I'm sure you all understand, its all about the brain, right?

Still, no regrets, I knew it was a massive ask for anyone to do. I mean, I tried to do in 6 months part time what you people do in 2 years and I've real respect for all you guys getting 240s, 250s and beyond. I now see what an incredible achievement that is.

Anyway, what with correcting all your spelling, how would I find the time to do any surgery???

Now all I have to do is my clinical finals - starting next week with the OSCEs!

 

[sethnavajo]

I wouldn't say all is totally lost. If you absolutely decimate the step 2s, I think you would be able to redeem yourself enough for a few interviews, at which point your research/PhD might stand out.

 

[angry energy]

Afraid so. Its a bit of a shame that I've got 2 postgrad degrees from excellent institutions and that my chances are all determined by this 3 digit score. Still, I can't complain, I took the test at the only time I possibly could have and I did all the study that the time allowed. And at least I passed so maybe there's the chance of a fellowship later in my career.

Just out of interest, does anyone know why the UK and US don't recognise each other's medical school qualifications?

history. foreign grads don't do as well on step 1 as we do. some say its language. i say medicine is medicine, and if i were a program director, even if you call ulcerative colitis "fjksdlhfuir", i dont want to teach you how to treat it AND how to say it in english. i'd be interested in comparing the step 1 scores from those of england vs. USA.

secondly, clinical experience. i am a fourth year, doing neurosurgery sub-i's now, and can tell you i'm post call right now after being awake for >40hrs. On average, i work over 110 hours a week. When i was on obgyn, surgery, and even medicine on some weeks, i easily hit 100 hours a week. an american program director knows that their american med students were worked HARD. and if theyre up for this residency, they know what hard work is.

abroad, clinical years aren't nearly as taxing; i remember reading the average french residency is barely 40hrs a week. even the average derm resident can't beat that (i believe average last quoted as a resident was 42 hrs).

that's why if i were a program director, i'd be very wary of foreign grads, and wont consider them unless theyre already neurosurgeons, or have AMAZING credentials.

in addition, best case, oxford can have the preclinical quality of Harvard and the clinical rotation quality of UCSF, and still i wouldnt even open the application of a 192 from harvard/ucsf.

sorry. i think your best bet, if you truly love surgery, is to go for a community surgery residency in USA and do a fellowship, or try to get in after finishing a residency.

best of luck to you.

 

[gonogo]

abroad, clinical years aren't nearly as taxing; i remember reading the average french residency is barely 40hrs a week. even the average derm resident can't beat that (i believe average last quoted as a resident was 42 hrs).

oh European lifestyle. 35 hours a week, 6 weeks of vacation / year, can't believe some still complain.

 

[BlondeDocteur]

Walter, having studied at both places, I can tell you that the US doesn't recognize any other country's medical qualifications because our systems are entirely different. We're taught an entirely different paradigm of medicine here, and I believe that's largely based on $$$$ (as in, we have much more of it here than elsewhere, due to private market forces).

The preclinical education is deemed to be roughly equivalent-- which is why we all take the same Boards, as an equalizer (equaliser).

As a poster mentioned above, in the US we work *hard*. So, so, so much harder than students in other countries. This is because we don't ration care. We don't have waiting lists-- everyone gets seen. So the pace on the wards, not to mention the sheer hours worked, strikes most people from the UK as completely alien, and terrifying. For example, in the UK when I'd go into the John Radcliffe, things wouldn't really get rolling till 9 AM. The consultants would stroll in for rounds an hour or so after that. There would be a 30 minute tea break in the morning to leisurely discuss the patients. Most people would be home by 4-5 PM. On the surgical services, the ORs would only run from 9-3 since the NHS simply couldn't fund that many patients' ops. I would go to the pub with surgical residents who would bitch and moan about their 50 hour work week (after all, it was so much more than their mates who went into IM or anesthesia or whatnot, who were working 35-40 hrs/wk). The British students who do electives at our hospital here (quite popular since they think they can hang out in New York) are appalled at how much we work, and spend most of their rotations looking like (tired) deer in headlights. Even the Germans think we're nuts, and that should tell you something.

Plus residency training is so random in England-- you spend half your time applying for random slots in whatever field you choose all over the country. It struck me, as an American, as very piecemeal.

And lastly, money affects more than just the volume of patients. We have to deal with insurance hassles that you would never encounter (BUPA aside). We order a billion more tests and imaging studies-- and these are considered irrevocably the standard of care; to not order them is malpractice. If someone trained in an environment where government rationing hangs over them like the sword of Damocles, they would never, ever think to order the workups that we do. We have by far the most advanced technology, all the newest toys, which people overseas do not get the opportunity to train on.

In short, even though the UK and the US are both highly advanced nations, private market v. socialised care makes a world of difference. The training is simply too different to permit someone trained entirely in the British system to practice here unfettered.

 

[Blondbondgirl]

This response is not meant to be malicious, I am just a bit appalled at the America vs. Europe attitude.
Although there are many things that I agree with in the above post, I find it unbelievable that one could claim we Europeans don't know how to play with the big toys. Guess what financial pressure means? Using our BRAINS to diagnose (not memorizing top 10 lists and performing an anti-malpractice battery) and only the technology necessary. If medicine in Europe was so much worse, studies would show it! We have the same protocolls for many diseases...
In fact, the WHO voted the French system the best in the world! whoops!

In my experience in rotations in the States and Germany, American students could play with the toys at a younger age (in training) and tell you right off the bat the top 3 most likely DD with treatment, but as soon as all that was r/o, they were lost! call the specialists, they cried!

European students are trained to think, primarily, and hone their tool skills later- so after residency, both are probably the same, (as Americans gain experience with the zebras with time in their field, and Europeans get faster in the daily routine in theirs).

I agree that it is a money issue, OP, to get back to the original question. I would say apply anyway! Maybe outside the match! If it doesn't work out now, finish up in the UK and find a way to come to the States- I have a feeling medicine is going to change dramatically, and we might need specialists FAST!

Anyway, good luck!

 

[PaddyofNine]

... and as much as I hate what they've done to our training here in the UK,

Out of curiosity, what changes in particular are you talking about?

 

[BlondeDocteur]

Blondbond-- I agree with you that American incompetence at the physical exam (I mean the real, honest, subtle physical exam) is a travesty. I wish I was half as good as most of the European students I see.

 

[DrDre311]

My physical exam is fantastic. I may or may not be American.