Working in the US

Well in short everything you have heard about working the US is true. They work long hours, the pay is average but livable, days off and holidays are not so many and they like ordering tests. When talking to international medical graduates coming to the US about their reason for coming, the answer is universal answer  – training. There is a culture of teaching and learning. Every day there is one to four hours of teaching, rotations are one month long to give more exposure in a condense program length. Services are intern-led with senior residents providing supervision along with Attendings (consultants). The health system is a story of two tales.

On one hand you have the largest most specialized hospitals in the world offering the latest procedures and opportunities for cutting edge research. Then on other end there are vast amount of Americans with no insurance and the plight of the homeless and destitute is one of the most depressing things to watch in this land of excess. There is no doubt that more tests and imaging is ordered here but what is different is that the patient expectation is very high and under the litigation system, doctors have little room to miss things. Training settings vary from University hospitals, community hospitals, large County (public) hospitals or medical practices. Medical students in the US go directly into the specialty they choose after graduation, so New Zealanders generalist skills are well appreciated by most US clinicians. Training is shorter here between 3-6 years, though it is more intense and there are standard board exams and regulated program requirements.

Reason for coming

Coming to the US for post graduate training has both pros and cons, these need to be addressed by each person and more importantly long term goals need to be looked at to see whether this option is worth pursuing. Looking into where you want to live long term and how qualifications are accepted back in NZ and other places is important to investigate.

When to come

Planning is crucial. Again reviewing what your long term aims are, will dictate when best to train in the US. Traditionally New Zealanders have used the UK and the US for post fellowship training. Without fellowship you have to enter the MATCH and do a residency after gaining EFCMG (Foreign medical graduate accredited) status by sitting the USMLEs. (US medical exams)

Options for training

A full list of residencies and fellowships are listed on FRIEDA which is a electronic database. There are other fellowships that are not listed here and would be have to be searched on individual hospital websites.

Frieda

http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.shtml

What to do

All medical graduates must do the USMLEs, although for residencies the grades need to be higher. For residency letters of references (especially from the US) and observerships are important. The full process is outlined in the below websites.

www.usmle.org

www.ecfmg.org

This link is by an Irish doctor who matched in 1999 and is at Harvard is one of the best I have read.

http://www.internationaldoc.com

Summary

The US is option for post graduate training. It’s one that has to be weighed up for each person. It’s not for everyone and NZ offers world class fellowship training, but for some it offers opportunities not available in NZ and to bring these skills back home.

Xaviour Walker

Internal Medicine Resident

Mount Auburn Hospital

Harvard Medical School