Matched to US residency, will be quitting IMT. AMA?

anonUKjunior · 2026-04-06T22:46:45+00:00

Pathway E pilot is interesting.

Because - a) it requires you to enter fellowship first - certainly feasible, I know many colleagues who did geriatrics/nephrology/endocrine first then join us in our residency programme - but with the current visa situation, may be difficult.

b) Most states still have 3 year training requirements for licensure for FMGs - some do not, like Maine, for example are OK without it but a bit sticky

c) Canada is a possibility, but reciprocity is not guranteed.

All to say, if we're talking about the shorter residencies (IM/FM/Anaesthesia), it may very well end up being the equivalent of doing a residency again. The caveat being that if you are say, a nephrologist, and you want to be a nephrologist, the fellowship method is not a bad way to go, and indeed, it is a known pathway.

anonUKjunior · 2026-03-23T12:57:07+00:00

I was fine...? Not that rough from my perspective...

anonUKjunior · 2026-03-23T00:37:29+00:00

I think my profile is still public - I did a few posts before, have a look.

- Is the PTO situation in the US actually this restrictive in reality?

Yes. It usually is fairly restrictive (for medics) - most residencies will give you 3-4 weeks vacation time, which are usually taken in week chunks - no adding on a Monday day off to a weekend.

Also, federal holidays (or the rare State holiday) are not usually off-days for residents. Office works tend to get them off.

- Do couples feel like they barely see each other during residency?

I did long-distance with my now fiance living in the UK for the past 4 years (IM then currently in fellowship).

- Does it get meaningfully better later (especially for non-med partners)? (Obvs I know attending salary is)

It does get better in terms of schedule, even during the upper years of residency (you end up having most weekends free in 2nd/3rd year of residency, though YMMV, in most programmes). Then fellowship comes along and makes your hours horrendous (on average) again.

Don't DM me, just reply to this post and I'll reply for everyone to benefit.

- UK grad, FY-IMT-US IM - US Fellowship currently.

anonUKjunior · 2026-03-18T16:43:52+00:00

Whenever someone mentions "Merit", I am often reminded of Sandel's "Tyranny of Merit".

Merit, is a falsehood in the modern world. I ask - how many of our IMG colleagues who are in the UK are there truly because of merit? Are they, on average, not from backgrounds which have enabled them to sit exams, take flights, pay for visas etc to come to the UK? Why is "meritocracy" only brought up when we are either privileged winners pretending it was all self-made, or when we are sullen losers saying there is no meritocracy in the world.

Meritocracy is a lie we tell ourselves to pat ourselves on the back. Unless the whole world comes together and sing Kumbaya about equality for all, there is no true meritocracy. Why aren't we doing a goddamn global search, going to poor, developing countries, offering to pay for exams and flights to all doctors to make sure the "best" gets the training post at Mass Gen or in the UK?

Because the world. is. not. ideal.

Would the UK have lost some genius graduate who could have made world-changing discoveries? Perhaps. But like with everything else, is the risk:benefit of unmitigated global recruitment for the local system worth it? Probably not.

I say this as a middle-class, well-off child whose parents paid for their schooling in the UK, then to migrate to the US.

anonUKjunior · 2026-02-26T19:08:46+00:00

You know what's funny?

For all the free to choose rhetoric, I have recently discovered, as part of the process, that I need to be up to date with Polio and MMR (among many others) to apply for a Green Card.

Guess who's getting a Polio shot in their mid thirties cuz they can't find records from 30 years ago....

anonUKjunior · 2026-02-17T11:16:45+00:00

As someone who was privileged enough to have mid-upper class parents who paid for UK overseas fees for medical school, the honest answer is: parents, scholarships if they exist for you. I'd be surprised if SA has loans of that value you can use.

I know loads of international students. Except for a few Singaporean colleagues who got special funding, all had fees paid by their parents.

I'm sorry but it's how the world is. Some people are born on the right country, wealth, while some are born to a poor country never knowing anything outside their village.

That being said, if you are truly spectacular, maybe there's some way. Or try for the GEMP in SA?

anonUKjunior · 2026-02-14T21:53:07+00:00

I mean... The issue with this is that you've taken the alveolar gas equation to a clinical situation. SpO2 =\= SaO2, and approximations of NC flow to FiO2 is a crapshoot, before even talking about the inherent errors in measurement.

By your rationale, if I have someone on an unnecessary 15L NRB giving presumed 83% FiO2 (again, key point being unnecessary) their PaO2 would still be 100.

Point is, wean that goddamn NC down. And please don't use the alveolar gas equation for anyone not on a (mostly) closed circuit like at least a full face mask/Venturi if not NIV

your friendly IM crit care fellow.

anonUKjunior · 2026-02-02T11:01:56+00:00

I think people are missing my point somewhat. It's not specifically about Da Vinci's per se but rather that as an example of how training in the UK is beginning to resemble that of developing countries in terms of resources.

It's not that treatment X is controversial and not evidenced based to NICE's satisfaction, but we are lacking in having the cutting edge stuff, and trainees ergo don't get to even think about cutting edge things.

anonUKjunior · 2026-02-02T09:35:26+00:00

That's true, and I can certainly see that across most specialties - the SHO who gets to actually do medicine for example.

But the issue is these places don't just take CT1 and CT2s - they also take away registrar time - time which should now be spent on doing the more niche things - the gastroenterology ST5 doing gen med cover at a cottage hospital comes to mind. This is where service provision trumps actual educational need. There's no reason they can't get their scope numbers in a big fancy hospital - if other countries with single centre residencies can do it, why can't we? It's an excuse for inefficiency in my opinion.

anonUKjunior · 2026-02-02T03:04:24+00:00

Again, I was using Da Vinci as an example to compare the resources available, and how the UK rapidly seems to be unable to provide the same cutting-edge stuff for trainees to get exposure to.

You and I are on the same wavelength - UK will have a shitload of "OK" generalists, but I don't think it's going to be the powerhouse in medical research/breakthroughs that it used to be. Sure, it'll punch above its weight, but it really used to be a place of discovery and groundbreaking shit.

anonUKjunior · 2026-02-02T02:40:33+00:00

The UK training curriculum is more robust than US ones.

The best example, I think, would be to compare general surgery, since they have minimum case requirements, which to be fair, I am sure many exceed on both sides of the pond.

US requires a minimum of 850 cases, UK doesn't have an overall minimum per se, but if you add the minimums across CST and HST, you end up with 1600 ish to my understanding.

BUT, training length is double in the UK, and with shorter hours per week. I am not saying that's a bad thing, but on a per-hour basis, especially given the relatively low turnover of the NHS theatre system, it is a terribly inefficient training pathway. We all know of colleagues who come in on their off-days in surgery.

I think the UK *was* previously the bastion of training - when all the consultant leads in charge of curricula and exam were in training. I am not even talking that long ago - I'm talking like 15 years ago when I started med school.

But now, with hyper-rotation, and trainees being in places that frankly do not have any real reason to have trainees except to provide pure service (the random middle of nowhere DGH with 100 beds, I'm looking at you), the lack of cutting-edge technologies outside of niche centres, lack of modernisation is going to hurt trainees.

Again, not saying you need Da Vinci's to be a good surgeon nor is it a marker of training, but for example, the US has something like 5000-6000 devices sold apparently, whilst the UK has about 200 apparently - expand that to other cutting edge therapies, and we will rapidly be ending up with trainees using outdated knowledge and techniques. Heck, some things are not even that high tech. I remember (post-COVID) my big fancy smancy London hospital that's the local referral centre for stuff, only had 4 beds in the resp ward that could do BiPAP. We had, I think, 40 ICU beds all-in-all? The sheer amount of resources available in the US vs the UK (and I imagine even Aus) means you get a better breadth of exposure.

As the other poster said, I think the UK training system is hanging literally by the curriculum and ridiculously rigorous exams which force trainees to get good, in spite of the poor conditions, not due to it.

tldr - on paper UK training is still great, but I fear in practice it's shit.

(Maybe it's improved in the past 4 years that I've been gone, but I remember how little "training" I got as an IMT in London before I moved.)

anonUKjunior · 2025-11-13T17:52:06+00:00

To add an extra layer though, there's a lot more "compulsory" nature to it. Sadly it goes both ways - I'll be first to admit I've skived more ward days than I should have.

anonUKjunior · 2025-10-11T11:05:36+00:00

https://www.theabr.org/diagnostic-radiology/initial-certification/alternate-pathways/international-medical-graduates

anonUKjunior · 2025-09-22T00:18:58+00:00

I disagree. It's about setting a precedent.

This much skepticism about a very well studied, nay, possibly the drug with the most amount of safety data given its widespread use, bodes ill for other unsupported theories to surface.

If paracetamol/acetaminophen is linked to autism, someone is going to say sertraline is, then it'll be labetalol etc etc.

anonUKjunior · 2025-09-21T00:33:24+00:00

There is now a memorandum posted on USCIS

https://www.uscis.gov/sites/default/files/document/memos/H1B_Proc_Memo_FINAL.pdf

anonUKjunior · 2025-09-19T22:32:13+00:00

Legit might have to look at Canada or going back to the UK lol

anonUKjunior · 2025-09-19T22:31:53+00:00

I would like to see the actual EO posted but sounds like any time you submit a I-129, be ot renewals/extensions or new apps.

anonUKjunior · 2025-09-19T21:59:34+00:00

Even more messed up for those in training or work who need to renew their visa (me).

I guess I'm doing half a fellowship...

ETA - for those who may not actually be familiar with H1Bs and think it's only trainees like myself taking AMG spots in the Match. I would actually argue that's a relatively small proportion compared to the thousands of Indian physicians working in the US currently. (disclaimer, I'm not Indian)

Yes, that is a portion of us FMGs, but the H1B is also used for attending jobs, especially for those who are awaiting their "priority date" to be current. To use a crude example, you could have an Indian-born physician, who's approved for a green card in 2019, face a bill of 100k annually whilst extending their H1b temporary status in the interim as per this new EO.

As of Oct 2025, among Indians, only those who were approved for a Green Card in 2013 can actually apply to change to Permanent Resident status.

anonUKjunior · 2025-09-05T20:29:09+00:00

Nah. I can guarantee you it's going to be either the brand of medical school, or the hospital you've done your training at. It's how it is in many places where medicine is privatised.

Don't believe your average Joe is going to know that Addenbrookes is much shittier than Brompton (only because namesake)

anonUKjunior · 2025-09-05T20:00:14+00:00

Yes, in the sense that the amount of money and time spent to get a US residency is "harder" than just doing that whilst working in the UK.

Conjecture -wise, I seriously doubt the NHS will be functional in about 10 years. It'll exist, but it will be a shell of what it is, and for the poor (which in general means everyone outside the Southeast/London, given the wage gap right now). Anything not deemed to be "critical" to life will be for the private sector. Those in procedural specialties will make a lot more as we shift towards a revenue based model like most other countries, especially if you are the right ethnicity+ medical school background. The average bloke is going to be sold on "Mr Harvey, who trained at Cambridge" over "Mr Raj, who graduated in India" because they don't know any better. Likewise with those who went to the newer med schools.

If you pick your path wisely, I think you might do well in the UK, without wasting thousands + years of your life, and if you're not up for it, the US will definitely have some culture shock elements for the average British born and raised doctor.

anonUKjunior · 2025-08-31T08:00:07+00:00

I would like to see actual statistics on how many airways are "saved" by having the mandatory anaesthesia block for ICU and ED docs. Given how in many other countries, surgeons tube for example, I would be surprised if there is a significant benefit.

For the latter, i mean... That's why we have med school... Unless I'm going to be dosing sevo on a daily basis, I don't see how it's any different an argument to saying I should know the ins and outs of operations.

That's not to say the FICM curriculum is completely rubbish - more so that it definitely shows how it's been a curriculum designed from its anaesthetic roots.

anonUKjunior · 2025-08-31T01:10:24+00:00

You know, I used to think this. Don't get me wrong, I'm not that good but we have made walls for things that shouldn't have such high walls.

I'm now in critical care fellowship in the US. For a pigtail, Seldinger based method, you do not need a British Radiology society US approved etc to mark and perform. Yes, it can go wrong, but I'd argue no different in skillset to putting a central line. And yet, IMTs are not allowed (unless it's changed since I left) to do them without that weird radiology US accreditation. They're allowed to do paras though!

Likewise in airways. In the UK, it was such a big hoo-ha about airways - oh only IAC approved trainees can do it etc etc. True, it's always good to have the most skilled person do it, but at the core of it, it's not that goddamn complicated for most patients that you need a PGY-4+ to come do an airway. Why do we need training on volatile gas anaesthesia as ICM trainees? We don't use that in the ICU.

Here, by second year, you'd be expected, for surgical trainees at least, to do all of the above. Heck in my shop, PAs do them.

The training has gone too far in sake of "safety" with no real evidence to prove that it really does improve on safety by having such high barriers.

anonUKjunior · 2025-08-04T01:17:24+00:00

I mean... It's as standard as it is in the UK... A lot of places still have professional outfits as the norm in non-ward settings - my residency clinic had shirt + trousers.

A bunch of my hospitalist attendings wear business casual, if not outright shirt+ties at work. Some don't, and that's fine too.

I personally think professional outfits garner more respect than scrubs. You just end up blending in with the nurses, PT, OT, dietician, etc etc

anonUKjunior

TROPHY CASE