This is the second post of our series discussing the option of working abroad as a doctor after graduating from medical school in the UK. In this blog, we will discuss a particularly popular destination for many professionals (not just doctors!): the United States of America. Hopefully, this blog will help you learn a bit more about the process of becoming a doctor in the USA and the pros and cons of doing so.
The simple answer is yes! UK doctors can work in the USA but the process can be arduous and the competition is high, especially for international medical graduates (IMGs), but it is not impossible! You will need to undertake several exams, apply for a competitive residency program, have several interviews and go through the matching process, which once successful means you will then need to apply for the appropriate visa. This entire process can also be quite expensive and can cost up to $15,000 (mainly because of exams and travelling back and forth), but if you think about the long term picture and consider the potential salaries you could earn as a doctor in the USA, it might just be a worthwhile investment.
There are different points in your medical career as to when you can move abroad to work, and in our previous blog, we discussed the differences in applying to Australasia as a graduate, upon completion of the foundation program, as a registrar or as a fully qualified consultant/GP. In the case of the USA, unlike other countries, it is possible to move immediately after graduating from medical school. In fact, if you are extra prepared and begin the application early, you can technically start residency training in the July after graduating so you are not losing any time at all. However, the whole application process is time-consuming and the likelihood is that it will take some time after graduating to sort out the exams/applications/admin before actually starting work. However, this extra time is insignificant in the grand scheme of things, considering the length of specialty training programs in the USA as we will discuss later. Unlike the UK, American residency/training programmes ask graduates to pick a medical specialty immediately after medical school. Therefore, there is no foundation programme where you can gain experience of working in different specialties to have more of a feel of what you like and dislike. This may not matter if you are dead set on what you want to do but if you are still slightly undecided then it may make more sense to work in that specialty first in the UK via the foundation programme before committing to it in the USA.
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Yes, the UK medical degree is part of the World Directory of Medical Schools so is recognised in the USA. However, having a recognised medical degree is just one of the requirements to work in the USA as a doctor. We will explain the other criteria, one by one, in a bit more detail below.
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As mentioned earlier, this is a complicated process, but we will try and take you through it step by step. The first thing to do is to get some clinical experience in the USA under your belt. This is really useful for an application as an international medical graduate and will give you a better idea as to what it is like working as a doctor in the USA before you make any big decisions. These experiences are generally split into clerkships or observerships. Unlike doctors, medical students have the indemnity to do a clerkship in the USA. A clerkship is where medical students can assist in patient care (almost like an equivalent to FY1 in the UK). However, international medical graduates do not have adequate medical insurance to be involved in care and so usually have to do an observership which is less hands-on. The practical nature of a clerkship can have more benefits and presents an opportunity to potentially receive a letter of recommendation which is helpful in the application process. A timely moment to do this would be during your clinical elective at medical school, this is usually towards the end of your final year and is where students can go abroad for several weeks to experience a different healthcare system.
Around the time of your final year of medical school, it might also be a good idea to start working through the USMLE exams which are necessary to apply for graduate medical jobs in the USA. The USMLE is split up into three ‘steps’: the Step 1 exam tests pre-clinical knowledge; Step 2 tests your clinical knowledge and is made up of a multiple-choice paper and an OSCE; and Step 3, which is similar to Step 2, is a two-day examination which prepares you for clinical practice by testing your diagnostic and management skills using computer-simulated patients. Remember, these are long, difficult examinations that are quite important in determining application success, so early preparation is necessary. Also, before graduating it is worth starting the ECFMG certificate process, this is effectively a verification of your medical degree which is required to apply for the residency program, although you will not receive the certificate until you graduate and pass the USLME. However, you can kick off the process before you graduate and it will save time in the long run.
Once all the exams and admin has been passed, you will need to apply for a residency program, be interviewed and go through the infamous matching process. The ‘match’ begins in March every year and sorts out where US and international graduates are placed in terms of location and specialty via a complex algorithm. You might have to score a bit more than American graduates in the USMLE to enter residency as an international graduate, but it is by no means impossible to get a place, and in 2018 60% of IMGs who applied were matched. There are ways you can increase your chances of being accepted, such as by achieving a good USMLE score, having done a clerkship, having some research under your belt (abstracts, presentations, publications) and by choosing a less competitive specialty such as pathology, internal medicine, neurology, paediatrics, or general practice/family medicine. If everything has gone to plan, and you have been matched to a residency programme, then the last jigsaw piece of the puzzle is to apply for a visa which is usually sponsored by the residency program. However, think about what is on offer as the nature of the visa that they sponsor can have permutations over whether you will need to return to the UK or not for a few years after training.
The big pull of the USA (and most international countries) is the salary. Although US training doctors tend to work an average of 55 hours a week (compared to 45 in the UK), they can earn significantly more. In the first year of residency (called internship), you will earn an average of $55,200 USD (this can vary based on area), which rises each year in residency with top residents earning around $65,000. Although, this may be similar to a registrar in the UK, remember that you work as a resident immediately after graduation (i.e. no foundation programme) and the training programme to become a specialist is shorter than in the UK. After training, the salary increases significantly with specialist doctors (consultant equivalent) earning an average of $346,000 annually or even more for those self-employed or in high earning specialties (cardiology and orthopaedics). To have more of an idea as to how these figures stack up to the salaries of doctors in the UK, check our blog ‘What happens after Medical School in the UK’.
Working in the USA has its benefits including its training pathway, better finances and arguably improved quality of life (but this is rather subjective). In the USA, postgraduate training quality is recognised as a similar standard as to the UK but is much shorter and so means you can become a senior or fully qualified doctor/consultant in as quick as four years compared to at least ten in the UK. Post-residency, some doctors may do a fellowship for a couple of years which can take it to six years, but this is still appreciably quicker than in the UK. As mentioned earlier, the income potential in the USA is much higher and combined with a shorter pathway, it means you are earning lots of money a lot quicker. But of course, all that glitters is not gold, and moving would potentially mean leaving family and friends behind; leaving the flawed but enviable NHS for largely private insurance-based healthcare; and leaving the life you had to an unknown future across the Atlantic.
Applying to work in the USA is a big step. It involves huge investments of time and money and therefore having a good understanding of the application process as well as a strong desire to work there is really important. This article just touches the surface of the information out there for international medical graduates (and there is a lot), and so it is definitely worth doing some more research as you begin your clinical years in medical school and ponder where you want to work post graduating. Thinking about it early will give you time to try and organise an elective in the USA in your final year and work towards taking the USMLE. Remember that although it may seem a daunting process, there are hundreds of thousands of IMGs working in the USA right now, and so it is by no means impossible, especially if you are methodical in your approach and you’ve done the preparation.
Author: Dhillon Hirani
Editor: Allegra Wisking
