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PaperclipPerfector  3mo ago (text post)   3116 thread views

Friday Fun Thread for January 12, 2024

Be advised: this thread is not for serious in-depth discussion of weighty topics (we have a link for that), this thread is not for anything Culture War related. This thread is for Fun. You got jokes? Share 'em. You got silly questions? Ask 'em.

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This isn't fun, more wellness, but I am going to abuse the immense power invested in me by virtue of being an admin and post here anyway.

How do I become more independent?

I speak in a very general sense. For an Indian kid, your life is set out on rails by your parents till high school, at which point your intelligence and diligence will determine what career you land, your college further constraining your options, until you end up in a life that proceeds with getting promoted, married, kids, and then dead.

But I am a homebody. It reflects on how deeply I hate the circumstances of my life that I am willing to throw so much away to leave it all behind. My parents, who I couldn't ask more of (other than having gotten my ADHD treated when I had begged them to), my dogs, my comfortable house and ailing grandpa, with whom every year apart is a non-negligible chance I'll never see him again.

But I lack drive. Curiosity? Yes. Intelligence? A quite decent level of it, if not world shattering. But so far my life has been railroaded along, with my only real choices being to either study hard or not, at least till the end of med school. I did take charge once, brushed myself into shape, proved, both to the GMC and to myself that I am a competent doctor. Or at least I did that as the first of many more times to come.

And now I feel adrfit. I can't go the country I wish to dwell in more than my own, that forms the earliest childhood memories of mine (unless I join the other illegal immigrants headed to El Salvador), I am forced to confront a mediocre life in a country that is in visible decline, hoping it beats the comforts of home (and the horrors of postgraduate training here).

I see people doing things out of sheer tenacity and drive, whereas I've mostly done things because I had to, or because I find the default path unbearable.

I don't want to live alone. It seems overwhelming. I don't want a job that saps me of all my energy and interest in doing anything else, let alone doing that while giving yet more exams.

I feel, for the lack of a better word, broken. I was moderately depressed, a feeling kept at bay through overwork and stimulant consumption in the hopes I'd achieve a brighter future, but they're dimming the lights as I speak. Shutting doors ahead of me as soon as I stepped through the ones behind.

If you think the stimulants help with that? A little, I guess. I wouldn't have made it through med school or all the exams since without them. But it doesn't solve the problem I see of being entirely unmoored, and I am not quite ready to resign myself to this life. Ritalin does not make what I've spoken of seem any less daunting. And the anti-depressants didn't work in the first place, and I tried a bunch of them.

I want the energy to explore alternatives. I want a job that pays well and treats me like I'm a skilled professional. I want to run a house without feeling overwhelmed and letting it go to rot. I want to be a father, and a good one, an even better one than my dad was to me, because he sacrificed his life outside medicine to give me the option of choice later.

If anyone has any advice, please share. My tether, while not quite fraying, gets ever tauter. I want executive function god fucking dammit, and nothing has helped. I just want something to look forward to, a route to a world where I can be, if not happy, content.

  • I can't go the country I wish to dwell in more than my own

Are there any other countries you can go to that, even if they're not your first choice of the US, are still better than your current option?

See, the same reason that I can't go to the US also locks me out of Australia, New Zealand and Canada.

It boils down to a single US company/non-profit that accreditates international med schools. Mine happens to meet the legal requirements for India, namely being recognized by our national regulator, but they skimped out on this one, since barring me and a handful of others, few of the previous graduates had any aspirations for going abroad, and those that did chose the UK. This was something I wasn't aware of when I joined, or I'd have dropped a year and tried for someplace better.

So imagine my gut-wrenching horror, years down the line, when I discover I'm locked out of the States, with no recourse short of the med school getting certified, and retroactively too to cover my batch. Which might still be possible. I consoled myself by thinking surely the UK can't be that bad right? But the more I learn about it, including from interacting with the locals, the lower my opinion of it goes.

In terms of alternatives, well, there's Germany and Hong Kong, maybe a few other weird places. None I wish to live in, for one reason or another.

At any rate, the UK still holds some pointless and misplaced sense of pride about its place on the world stage, hence them ignoring that US organization for the large part, even if they're used to verify the credentials of applicants. So that does so far seem the best option.

There might be some places like the Middle East, but I would despise living there, and I need to get more credentials under my belt before it's worth the effort.

What are the reasons you don't want to live in other european countries? While I'm not terribly happy with the direction of the EU or my home country, they do seem clearly preferable compared to the UK. Especially most of north europe has some in my opinion critical perks:

  • Parental money is pretty good, so having a family is quite easy
  • (medical) doctor income is pretty good in several of them AFAIK
  • objectively much better building standards
  • a bit more subjective, but just visibly not in as much decay; London - and even moreso the few smaller cities I visited - just outright disgusted me at times at how it looks and feels like a third world country. Run-down buildings with smashed windows, barbed wires around the nicer places, cars that are scratched all over, non-capital crimes go de-facto mostly unenforced, streets with mounts of trash and the occasional literal human shit, erratic junkies on most trains and busses. Fairly blatant antisocial behaviour is also quite normalised.
  • Food quality is imo also better, but admittedly a non-european may see it differently

I visited London a few years ago and didn't see any of those things you mentioned. Streets were pretty clean, I didn't see any smashed windows or barbed wire, and in like a week of wandering and taking busses and the chewb I only saw one belligerent junkie (on the street). Probably some neighborhoods are worse than others but I didn't avoid anywhere on purpose.

Hmm, it is not that I categorically rule out out other European countries, it depends.

Many of them are even more fucked than the UK is, at least when it comes to wages, even adjusted for purchasing power parity. France is slightly worse, Italy is pretty bad.

Germany is arguably better than the UK, even if only modestly so. It is actually a breeze to get into, but I would need to learn German and then practise in it, and while that is hardly the end of the world, the very modest bump up in wages makes it a borderline case.

(Switzerland is amazing to work in as a doctor, but very hard to get into, in addition to language requirements)

What other places do you envision, in Northern Europe, if not Europe as a whole? I can tell you that France is probably a no-go. Germany? I don't see any obvious advantage over the UK, like it's slightly better. Belgium? No idea, but I can check.

I should look into the Nordics, though I suspect language will be a problem again.

But I don't consider than in unsurmountable one, I can hold my nose and try not to gag while consuming surstromming if it's worth it haha.

a bit more subjective, but just visibly not in as much decay; London - and even moreso the few smaller cities I visited - just outright disgusted me at times at how it looks and feels like a third world country. Run-down buildings with smashed windows, barbed wires around the nicer places, cars that are scratched all over, non-capital crimes go de-facto mostly unenforced, streets with mounts of trash and the occasional literal human shit, erratic junkies on most trains and busses. Fairly blatant antisocial behaviour is also quite normalised.

I'll be honest with you chief, I'm Indian, and whatever grime and dysfunction I noted in London, it is well within what I'm able to tolerate, if only because I have low standards. But in all honesty, I toured quite a bit of the city and it was perfectly acceptable to me.

My Airbnb was supposedly in a bad neighborhood, but there were BMWs parked outside, the odd door left open, no grills or barking dogs. Entirely unremarkable.

It might be worse in the smaller cities, I only got to visit London and Manchester, which were both fine. The Metro was totally acceptable, full of working poor to UMC finance types alike. Nobody but one cranky old cunt made a fuss, it was all fine, and I was there for several months.

I appreciate the suggestion, and I'll take a look at what me feasible for me!

Can the UK act as a stepping stone to the US? Invest a decade there, get credentials that are valid in the US, then hop on over?

Your success in the rest of the world has very little relevance to your career in the US, as in (barring vaguely remembered exceptions for pioneering doctors and the like), they don't give two hoots what degrees you accumulated outside, at most they care enough to check if you have a basic medical degree, which if accredited, entitles you to give the USMLE and do a residency program. So even a relatively experienced doctor, native to the UK or not, is largely shit out of luck even if they've reached the highest level of certification outside.

This seems to be true after I looked it up, but either way, the reason I am screwed is because my base medical qualification (MBBS) is the issue (since my med school didn't bother to do the ECFMG thing, which is a proactive step and not something they'll just hand out without asking). This won't change unless the former does, even if I rack up an entire alphabet of additional degrees outside. My dad, nationally famous in his line of work, or the even more famous Director of my Oncology Department (widely recognized as the best in the country, or tied for it) would be in the same boat, as would almost any other doctor who didn't study in the US. You might have 30 years of experience and be at the peak of your niche, but in their eyes, you're required to jump through the same hoops as a wet behind the years grad from a US med school. And do another 3-7 years of training, even if your supervising doctor isn't qualified to teach you to suck eggs, you invented them.

If there are any exceptions, they're not worth noting, or at least not relevant in my case.

If it was just the US, I could moan and bear it, but quite a few of the countries that are better than the UK still rely on that US body I mentioned, in much the same manner most small countries are content to follow FDA regulations without really bothering to set up their own equivalents, or at least accept them uncritically. The UK just happens to be too proud to do that.

Please do not listen to English people talk about England. Particularly online.

I'm not english but lived in London for a while and concur with what he writes. London is allegedly one of the best places in the UK but still sucks for long-term living unless you're either a well-earning childless professional or among the super rich, also doctors afaik objectively earn very bad by western standards in the UK.

I suppose it depends on what you are looking for. London, as visualised by this rather excellent FT graphic is somewhere that is stereotypically inhabited by those in their twenties to early thirties. When it comes to having children, many professional couples chose to move to one of innumerable picturesque towns or villages that encircle the capital.

Sure, I have personal friends who have chosen exactly this path. And I'd maintain that unless you're elite enough to go to oxbridge or similar, you're better off going to another country altogether. The apartments/houses are lower quality while also being more expensive than comparable places on the mainland, parental money/day care subsidies suck in the UK while income isn't as high as the US to make up for it, and the areas are also generally more decayed.

Who else am I supposed to listen to? I've been following along for years, and I know they've got a point.

There's a difference between earnest bitching like on /r/Residency, and seething discontent and rage, including regular striking, and I have heard much the same from people I personally know.

Have you considered Singapore? Developed, English-speaking, short flight to India for visiting relatives, great food.

I have considered it, and it's for all practical purposes outright impossible. They take only the top 0.1% of doctors, imagine just taking the Harvard Med Graduates from the US.

Otherwise I would have happily taken it up, it's a pretty cool place.

How hard is it to get the credentials now?

So far, the ECFMG has been less than helpful, including when my med school reached out to them, but in my personal correspondence, they told me that it was possible, including retroactively certifying me and the other graduates if there was conclusive evidence we met the same standards.

I have been busy with work and studying for the UK, but the moment I get a time to breathe, I'll try and corral a bunch of my juniors and pressure the Admin, though I have tried before, it was only just a handful of us, and I've heard the kids are far more keen on getting the fuck out of here than my complacent peers.

All hope is not lost. I just don't know how much remains.

Is there any way to get a degree with another medical school within a reasonable amount of time?

Is it possible? With enormous difficulty, maybe.

Most people don't end up in the peculiar situation I find myself in, so there's no streamlined route for it. "I'm dissatisfied with the med school I went to, I want to do the whole thing again at a better one" is an extremely weird thing to do, so nobody does it, at most people might end up transferred while in their course. Or study extra hard to get into a good training program, which I am doing, but it doesn't solve the root problem.

I believe even having a medical degree makes you ineligible to apply again, at least in India. Because why would you do that?? And in the US, well, getting into med school is tough enough, I doubt my rationale would convince the committees.

The closest is say, someone who is a refugee. Maybe your med school in Ukraine/Syria/Gaza got blown up, so you plead your case directly and potentially have some requirements waived. My med school is sadly very much intact, it just hasn't done something that is simultaneously expected and also optional.

But even if I could, I don't think it's a good idea. First of all, repeating med school would suck. More importantly, at the bare minimum that's 4 years gone, maybe 5 or 6. I'm already worried about being made obsolete before I finish my full training! There's no way to just fast track med school, and even alternative/parallel careers like nursing/PAs take time, and while I bitched about PAs before, I don't think becoming one is a net positive.

In a very different universe, say if I was to jump back in time a decade, that might be something I could begrudgingly consider, but right now? I'm sure you see why it's a bad idea, at least if you agree with the issue of AI and unemployment.

You could go for a masters or something and do research?

I have considered that, but thank you for suggesting it. The main issue is that a Masters would take about 2 years, and research doesn't pay well, be it in the UK or US.

In a vaccum, I don't think it would have been a bad idea, but for example, I think a Masters in Data Science probably needs more in the way of previous experience, so does something like ML/CS.

They all cost money, they all take time, and while I can grudgingly handle the former, I can feel the clock ticking.

Something like stats or CS could help, maybe in me making a lateral move from medicine to pharmaceuticals, in some kind of advisory or managerial role, but even then the competition is getting stiff.

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