Thread by @usamasyedMD

💣 This one is going to be a mine-field... Here's why I decided to pursue a medical career in the US 🇺🇸 rather than the UK 🇬🇧. NOTE: this is not me saying what OTHER people should do, simply giving my own thinking. You are free to disagree, there's no 'right answer'. 🧵 1/

🤩 New Experience: I'd spent the majority of my life in the UK, dad was a doctor, I went to a 'good school', got into a 'good uni', and became a doctor. Felt like if I stayed in UK, best case scenario, my life would just be on repeat, now through dad's eyes. Felt too safe. 2/

💵 Money: bet you didn't think I'd go there this quickly, right? (That's the sound of 100 keyboard warriors pressing delete on their "OBVS JUST FOR THE MONEY!!!!" tweets.) Yep, I didn't think being a doctor in the UK was a well-compensated job for how stressful and long... 3/

a training journey it is. For those not aware, the starting salary for a (on average) 24 year old newly graduated doctor in UK is around $35,000 a year. It creeps up year on year by around $5k/yr, until you become a 'Consultant' in around 5-10 years after grad. Then $100,000. 4/

"That's more than the average salary, this is so tone deaf for you to say!!" True, it is more than average. You'll never go hungry as a doctor in the UK. But compared to 'equally qualified'/ competitive fields? Dentists>. Bankers >. Management consultants >. Lawyers >. 5/

"But medicine is a calling, not a job! It's not about the money!!!" - the trust patients place in doctors is sacred, worthy of reverence. But, at the end of the day, being a doctor is a job for me. Being fairly compensated matters, and I didn't think the NHS did this. 6/

💉 Training Pathway: I wanted to be a dermatologist. Let's compare the pathways in the UK and US after graduating medical school. 🇬🇧 F1, F2. CMT 1/2/(3?). Derm ST training 3-5 years. To get a Consultant (Attending) job in London, I needed a PhD (3 years). Total 12 years-ish... 7/

🇺🇸 PGY-1 (internal medicine one year), PGY-2 to PGY-4 dermatology training. Hundreds of Attending jobs available immediately upon graduation. Total 4 years (maybe add 1 year to apply, take USMLEs etc.). 8/

🏅 Quality of Training: you may be forgiven for thinking, "12 years in UK, 4 years in US, the UK doctors must be MUCH better trained!" Well, this links to my next point...training is a lottery in the NHS. If you happen to get lucky and are with a great Consultant, have good... 9/

rotations at functional hospitals, you will get excellent, well-rounded training. It can also be the complete opposite; over-stretched, burdened with menial tasks and focused on service provision rather than making you a better doctor. US has greater resources + staffing... 10/

so the junior doctors can focus on becoming better doctors. We rarely draw labs/place catheters. We have caps on how many patients we're assigned. Steps like this give us more time to LEARN, not run around like headless chickens making sure the hospital doesn't fall apart. 11/

📕 Research/ Innovation: The last factor was that I wanted to train at an academic center, be at the 'cutting edge' in my field, and be able to innovate in that space. The vast majority of this type of research/innovation happens in the US, as they have more generous grants. 12/

✋ Just to head off a predictable response. "So you're just selfish then? UK trained you and then you left." - Yep. I won't martyr my professional career as an abstract show of loyalty to a nation state. I choose what is best for me and my family long-term. No shame in that. 13/

Perhaps the blame for doctors wanting to leave the NHS (whether to other countries, or leaving salaried training jobs to 'locum' and start botox/filler clinics like 1/2 of them now do...) is to fix the system, not blame those who choose to leave it. 14/

It's also interesting how nobody throws these same comments towards businessmen that leave the UK, or lawyers, or footballers. "UK funded your training and now you leave!!!" But doctors are expected to be uniquely self-sacrificing... 15/

🩺So that's my summary of why I chose to train in the US! Eager to hear your thoughts, and as ever, if any of this gave you benefit, consider retweeting the first post in this thread to help reach others who may find it a useful insight! #usmle #NHS #doctor #medicalstudent