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I am losing my mind from studying. The only positive is that I'm also losing weight, quite a bit of it. Turns out a diet of pizza, prescription stimulants and stress is effective for weight loss, not that I'd recommend it.
The exam I have to give in order to get into psychiatry training in the UK was originally designed to be administered to GPs, but COVID made quite a few other specialities adopt it because they couldn't conduct the standard interviews and couldn't be arsed to make their own exams.
I am absolutely sick of memorizing facts and figured that will be of zero relevance to my (hypothetical) career in psychiatry, something has gone very wrong if I'm confronted with a child with haematuria and a purpuric rash while working in that profession. ECG? Never heard of her. The worst part about those fucking things is that I manage to learn how to interpret them passably, usually before an exam, and then forget entirely a few months later. Of course, it is tradition that in some specialities, like orthopedics, the first thing that a Consultant does on being shown an ECG for their patient is to hand it over to the Reg with some excuse, who then sheepishly shows it to the most junior doctor at hand because they're the ones most likely to remember what the fucking squiggles mean. Or bleep Cardio directly.
Oh well, at least if I do make it this time, I will gladly accept it as a license to forget everything I've ever had to learn, in lieu of memorizing the myriad interactions of antipsychotics and anti-epileptic meds.
Don't get me started on the Situational Judgement Test, a cursed ethics component of the exam that involves guessing the correct way to order 5 options for handling an ethical dilemma, with no guarantee any of them will be remotely sane or relevant options. Especially when the GMC guidelines so utterly castrate and infantilize doctors that I am sometimes blown away by the fact that they take those dictats without coming to blows. Indian doctors don't give a shit what our regulators have to say, and even American ones aren't so utterly castrated.
Ah, my aunt comes to me begging for morphine because she's in acute pain. I recognize that's a bad idea to prescribe to her, even just on the grounds she's family, but no, even taking a look at her medical history and suggesting over the counter pain meds she can take while she's desperately searching for an out-of-hours GP or contemplating the >8h wait at the ER is somehow a bad choice.
FML, I'm going to RETVRN to my ancestors and till some fields first chance I get.
During COVID a bunch of UK doctors refused to come back to work:
It sounds like the NHS is a complete shambles. I saw an article saying that more was spent on litigation and payouts over maternity than maternity itself: https://www.thetimes.co.uk/article/maternity-payouts-twice-cost-of-care-times-health-commission-svdhsjhqk
I don't really know much about the NHS, never having worked there or experienced it. Sounds like a terminally ill bureaucracy in action.
The NHS is dysfunctional and sclerotic. Doctors are so unhappy with the state of affairs that they're striking regularly for almost a year now, primarily for pay as well as the terrible conditions. Salary raises have been sub-inflation for about 15 years.
Training is unnecessarily long, in comparison to international standards, and largely because the rotational aspect lets them shunt doctors over to subpar hospitals to meet staffing quotas without paying market wages.
The quality of care is going down the toilet, ER wait times are ridiculous, elective surgeries can take years. A psychiatry consultation for an ADHD prescription would take me about 2 years to get if I went through the NHS.
It's no surprise you heard that from an elderly medical professional. They remembered when doctors were respected and also decently paid, returning to the NHS must have been a shock (though this person is a nurse, but they've suffered too).
Many of the locals flee to fairer pastures, such as the US, or other Commonwealth countries, hence the NHS is propped up by international doctors for whom the terrible conditions are a step up still (like yours truly, not that I'm now sure it's an improvement). They're too scared to complain, accept subpar wages to get a foot in the door, and in general accept more abuse. At any rate, if I ever fix my USMLE issues, you can bet my pitstop there will be temporary. If not, well, it is what it is.
Christ. What does it take for the US healthcare industry to be considered greener pastures?
I guess
close air supportbags of money really do cover a multitude of sins.You're approaching the US healthcare system from the perspective of someone who is consuming it, not as someone working within it.
Sure, Residents are paid less on an hourly basis than they would make it they worked at McDonald's, given that 70 hour work weeks are hardly unheard of (though my understanding is that in Psychiatry it's far more reasonable), but if they have any reasonable level of temporal discounting, they have a median income of $250k to look forward to at the end.
A more litigious environment, the headache of dealing with insurance companies, annoying EMRs, these all pale in comparison to quite reasonably expecting to be a millionaire in a decade or less.
Whereas a UK postgraduate trainee can look forward to 7 years of training to become a full Consultant (2 if they want to be a GP), and along the way, thanks to sub-inflation raises from a monopsony employer, likely make less money each year right until the point where they become a full Consultant and get a modest pay bump, with better options for working locum or private. Even then, a typical Consultant in the NHS makes $120k. So a relatively linear progression from $44k at the entry level to maybe 80k (swallowed up by inflation) after 6 years, followed by that bump.
So you take about double the time to make half the money in the end, with relatively limited scope for making a great deal more unless you're a specialist in great demand or willing to take on a lot of extra hours.
This is compounded by the sheer lack of respect UK doctors get, the vagaries of rotational training, and a lack of many of the creature comforts that doctors in most countries take for granted.
In contrast, Australia, New Zealand and Canada pay a great deal more, if not quite US levels, and recognize UK credentials without the need to repeat the USMLE and Residency.
If I had to make a subjective judgement, I'd say either the US or Australia offer the best tradeoffs in terms of money, WLB and consideration for doctors, 3rd World countries bottom out, and the UK is only modestly appealing to someone living in the former.
And all of this is assuming business as usual. I strongly suspect that I will not be employable as a doctor in 7 years, certainly not at those wages, because of the pace of progress in AI, as well as the profession being undercut in the UK by the NHS using NPs/PAs/ANPs to undercut doctors, and then gradually expanding their roles and authority.
A new PA makes more money than a fully qualified junior doctor post-MBBS, has better hours and fewer responsibilities since they can't prescribe at all, and only went through 2 years of a Masters course as opposed to the 4+2 a doctor takes to get there. Even my existence as an IMG, treated without any disadvantage compared to native UK grad, suppresses their conditions, though I can't complain about that for obvious reasons. In contrast, the US is far more protectionist, but thankfully psychiatry is a relatively friendly subject for foreign doctors looking to make the cut.
If I was currently eligible to give the USMLE (and I'm not, for no fault of my own, but it may or may not be fixable), then I wouldn't even consider the UK for a second longer, as opposed to grinding for the USMLE or at least Aus/NZ. Even if I manage to get into psych training, the moment I might become eligible I am going to go to Manchester and take a steaming shit in front of the GMC offices, and then fly off home to study anew.
@Throwaway05 is welcome to chime in if I'm misrepresenting the situation in the States, though of course he can't really compare conditions in the UK or India.
From what I can tell the U.K. is basically all downside - poor resources, poor autonomy, poor respect, poor pay. Great location if you don't already live there and want to get to the West. That's about it. The frog was boiled 30 years ago.
In the U.S. the frog is still being boiled - pay is down, respect is down, autonomy is down, documentation burden is up, malpractice is a joke, but pay is still fucking great (especially if you want to hustle), job security is absurdly rock solid (post-training....alarming during training), and we have the most resources and ability to do interesting shit, research, etc.
There's no doubt that almost all doctors in the world who aren't moored to a specific location would head over here in a heartbeat if given the chance.
But it's also worth considering the opportunity costs. Poor pay hurts less in Western Europe where nearly everyone's jobs are shit.
In the U.S. people in medicine feel like they are missing out on lucrative careers their peers are doing. You can argue they are overconfident in this, but it's not really arguable that doctors (at least during residency) are the hardest working professional class in the U.S., and you do frequently see them roll out into other fields like tech or consulting and kill it.
So yeah the U.S. miserable but it still has some benefits and I'm continuing to work here. If you snap your fingers and dump me in England? Shit I'm going to go farm or something instead.
Back when my dad telling me the UK was a nation in decline, my rejoinder was that it's better to move to a rotting edifice that is several decades ahead of us and only stagnating, than to sit back here.
In a similar vein, whatever problems American doctors have (I'm sure they do have problems, there's nothing perfect), they are experiencing a decline from a peak the rest of us have to crane up at in awe.
Being poor, or just mediocre, sucks, even if you don't have the same degree of unhappiness from comparison.
UK doctors make similar complaints, pointing to their friends who went into finance, consulting and so on and make double the money, in half the time. They feel the contract was broken, that the promise that as some of the most talented students who went through a rigorous training program of many years and made them highly skilled workers, they should be paid commensurately.
Some of them do jump into finance, but the sheer cramped smallness of the UK means there really aren't all that many places to go or ways to win big. The country itself constrains their options. I consider trying to apply for jobs in Pharma, as a medical lead or liaison, but my nature as a foreigner diminishes my worth to them, primarily as it stands in wrangling regulations and knowing the right people to push things through. Or I considered learning ML, but then that's become even more saturated.
And here I was talking about giving up and returning to till my ancestral farms, if the people who stole the land and genocided the village won't ask too many questions haha.
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