Internship and Residency in USA

Vivara

Hey Guys,

Just wondering what the story is with doctors who did their medical degree here and then left immediately after to do specialist training in the USA. Say if I was then to work in the US for several years, how easy is it to come back here and get a position? (I'm not looking for a discussion on the recession, more like if there is a position available, would I be accepted?)

I want to do residency training in Neurology which, in the US, isn't a subspecialty of General (Internal) Medicine like it is here in Ireland (as far as I know?)... I doubt very much this would be an issue. But I just want to double check...

I've looked at all the neurologists currently working in Ireland. Many of them have US residency training. Some just have this residency training, while others did their 'residency' in Ireland (if you could call it that...) before doing it in the US. The impression I got from one neurologist (by email) was that the training in Ireland isn't structured in any way like it is in the US. I also was led to believe that if I wanted to get things done faster, it would be much quicker to go straight to the US after graduation (or the one year internship) instead of mucking around with training here, and that when I come back, my experience would be more than adequate and that I don't really need the additional experience as a SHO, Registrar, etc., etc., beforehand in Ireland.

So to summarise:

1. How would I be fixed with going straight to the US for residency after graduation and then coming back after working there for 8+ years?
2. Will neurology residency in the US (in a good university, hopefully) be OK for me to work as a 'Neurologist' without the previous 'training' in Ireland?
3. In addition, will it be an issue if I don't have the General Medicine training like in Ireland?
4. Will the year of internship in Ireland be necessary if I go through the full training in the US? Would I have to do that when I come back or is it not so strict if I was already licensed in the US? (I know there is a process with the Irish Medical Council and the Specialist Registrar...)
   

I'm a long way off from anything above, but I'm the kind of person that likes to have an idea of how everything works and where I will be in x years.

Thanks!

Ed.

dissed doc

Vivara wrote: »

1. How would I be fixed with going straight to the US for residency after graduation and then coming back after working there for 8+ years?
2. Will neurology residency in the US (in a good university, hopefully) be OK for me to work as a 'Neurologist' without the previous 'training' in Ireland?
3. In addition, will it be an issue if I don't have the General Medicine training like in Ireland?
4. Will the year of internship in Ireland be necessary if I go through the full training in the US? Would I have to do that when I come back or is it not so strict if I was already licensed in the US? (I know there is a process with the Irish Medical Council and the Specialist Registrar...)
   

There are a few things that will be necessary but basically, working as a consultant in Ireland will be determined by your eligibility to get on the specialist register.

The US residency for neurology (unless it has changed) AFAIR is 1 year general medicine internship + 3 years neurology. As you will have never held registration with the medical council, or complete a 2005/36/EC recognisable specialist training programme, you will be a Category E applicant. This means that basically you send all the details of what you did in your US training which gets sent to the training body (Royal College of Physicians isn't it) to see'/approve it as equivalent to the CSCST you would be getting at the end of the SpR. It is up to the training body to review your US training (on an individual basis I think) and determine your suitability to be on the specialist register.

The internship in the US should be translatable to an internship in Ireland - the medical council have specific criteria but I can't imagine it's a problem. But, you won't need it anyway as you will be looking to zip past all that.

Vivara

dissed doc wrote: »

There are a few things that will be necessary but basically, working as a consultant in Ireland will be determined by your eligibility to get on the specialist register.

The US residency for neurology (unless it has changed) AFAIR is 1 year general medicine internship + 3 years neurology. As you will have never held registration with the medical council, or complete a 2005/36/EC recognisable specialist training programme, you will be a Category E applicant. This means that basically you send all the details of what you did in your US training which gets sent to the training body (Royal College of Physicians isn't it) to see'/approve it as equivalent to the CSCST you would be getting at the end of the SpR. It is up to the training body to review your US training (on an individual basis I think) and determine your suitability to be on the specialist register.

The internship in the US should be translatable to an internship in Ireland - the medical council have specific criteria but I can't imagine it's a problem. But, you won't need it anyway as you will be looking to zip past all that.

Thanks so much for your reply. Everything makes more sense in my head now.

I'm also looking at combined residencies — particularly a combined residency in neurology and psychiatry. This would be one year of internal medicine, and four years of both neurology and psychiatry.

Would you have any doubts that such a residency, say at an Ivy League university like Columbia (high hopes, I know!), would be seen as satisfactory by a review board for the specialist registry in both neurology and psychiatry? It's probably a silly question—since it's in the top five places to study neurology/psychiatry in the world, but I'm just double checking what your opinion would be.

Thanks again.

Ed.

dissed doc

Vivara wrote: »

Thanks so much for your reply. Everything makes more sense in my head now.

I'm also looking at combined residencies — particularly a combined residency in neurology and psychiatry. This would be one year of internal medicine, and four years of both neurology and psychiatry.

Would you have any doubts that such a residency, say at an Ivy League university like Columbia (high hopes, I know!), would be seen as satisfactory by a review board for the specialist registry in both neurology and psychiatry? It's probably a silly question—since it's in the top five places to study neurology/psychiatry in the world, but I'm just double checking what your opinion would be.

Thanks again.

Ed.

Well I am no expert. But, I would think that both training bodies (RCPI for Neurology, and CPsychI for Psychiatry) would need to individually approve the training.

You might run across some problems though and more likely in psychiatry. What I have seen in psychiatry is that US residencies are generally regarded as equivalent to the BST 3 year MRCPsych-level programmes. For an example, I have seen adverts for middle east jobs that will go for CSCST or UK CCST, or American Boards with an additional 2-3 years attending experience to get a consultant post.

The old way of recognising non-Irish training in Ireland was at least 7 years of training to be eligible for consultant posts - and of that at least 3 (or 5 - I can't remember) in the subspeciality. So, you will perhaps have no trouble but bear in mind the new training programme in psychiatry is 6 years minimum - you will need to convince them that the 2 years in the US is equivalent.

What I gather is the most directly translatable route, is a residency + fellowship. This is roughly equivalent to the BST + HST system here and in the UK. You won't have a subspeciality in psychiatry after a residency, but for example if you did the combined programme + any of the 1 year specialities (forensic, child, substance misuse, etc., ) it would be clear and more easily supported of your specialist status. The residency in the US is good enough to practice as a generalist but even in the US many pursue fellowships because regardless of duration of general training or specialist registration, when it comes to an interview you will have a hard time competing for a psychiatry job with 2 years training compared to e.g., 7-8+ which is the norm in UK and Ireland.

The other thing to bear in mind is that while there are jobs for dual trained people in the US, that is mostly not the case in Ireland (or Europe) due to the job market being so much smaller. So, you might have 2 years of training in a field like general psychiatry and while it's admirable, 2 years of a fellowship in neurology instead would be much more likely to get your specialist training recognised and also get a job. It's who you are competing with as well. If you are looking at neurology, many consultants in Ireland will have MDs as well - so to be on par in the US and be competitive it may be a fellowship/PhD track during the end stages of residency. I know some of the residencies do this type of "academic" track - most consultants in Ireland will have some extra academic qualification (MSc, MD, PHD).

Honestly, I think do not dilute your time. You will (absolutely IMO) not be regarded as being specialist enough. There are also triple combinations residencies but the same warning stands: it's a great way to learn but not necessarily going to get you a job. Also, consider if you want to practice elsewhere in europe ever as well. Your training will need to be individually assessed in any country because it is not from the EU (at least 90% must be in your home country and 10% in another EU country to be automatically transferrable between EU states).

Colombia is a great programme from what I have read but remember it is geared to the US. So, it is one of the best programmes in the US for working in the US - that doesn't necessarily translate to the rest of the world.

Vivara

dissed doc wrote: »

The old way of recognising non-Irish training in Ireland was at least 7 years of training to be eligible for consultant posts - and of that at least 3 (or 5 - I can't remember) in the subspeciality. So, you will perhaps have no trouble but bear in mind the new training programme in psychiatry is 6 years minimum - you will need to convince them that the 2 years in the US is equivalent.

What I gather is the most directly translatable route, is a residency + fellowship. This is roughly equivalent to the BST + HST system here and in the UK. You won't have a subspeciality in psychiatry after a residency, but for example if you did the combined programme + any of the 1 year specialities (forensic, child, substance misuse, etc., ) it would be clear and more easily supported of your specialist status. The residency in the US is good enough to practice as a generalist but even in the US many pursue fellowships because regardless of duration of general training or specialist registration, when it comes to an interview you will have a hard time competing for a psychiatry job with 2 years training compared to e.g., 7-8+ which is the norm in UK and Ireland.

I understand. After the residency, I would plan to do a clinical fellowship, such as in Child and Adolescent Psychiatry (which is two years), and then possibly a research fellowship, possibly along the lines of schizophrenia research, which would then be another two to three years (depending on where I go).

dissed doc wrote: »

The other thing to bear in mind is that while there are jobs for dual trained people in the US, that is mostly not the case in Ireland (or Europe) due to the job market being so much smaller.

dissed doc wrote: »

Honestly, I think do not dilute your time. You will (absolutely IMO) not be regarded as being specialist enough. There are also triple combinations residencies but the same warning stands: it's a great way to learn but not necessarily going to get you a job. Also, consider if you want to practice elsewhere in europe ever as well. Your training will need to be individually assessed in any country because it is not from the EU (at least 90% must be in your home country and 10% in another EU country to be automatically transferrable between EU states).

I don't think there are necessarily dual-trained jobs in the US either. But, I think one decent reason to do a combined neuro/psych residency is recognition that whether you get a 'neuro' job or a 'psych' job, many of one's patients will be neuropsych patients. This is the same the world over. The division between the two fields is increasingly artificial, whatever one's opinions are. It's also a way of allowing a doctor to practice in either neurology at one point and then psychiatry at another point. I think the way the two fields developed completely separately in Ireland is odd, actually!

It does also sometimes strike me as someone who can't make up their mind, and after I finish med school I may be more inclined to one or the other, and that will probably make more sense then. This is just a way of seeing how it could work out if I wanted to pursue both.

dissed doc wrote: »

So, you might have 2 years of training in a field like general psychiatry and while it's admirable, 2 years of a fellowship in neurology instead would be much more likely to get your specialist training recognised and also get a job. It's who you are competing with as well. If you are looking at neurology, many consultants in Ireland will have MDs as well - so to be on par in the US and be competitive it may be a fellowship/PhD track during the end stages of residency. I know some of the residencies do this type of "academic" track - most consultants in Ireland will have some extra academic qualification (MSc, MD, PHD).

That seems like a fair point. Do you know of any neurologists in Ireland that have MDs or PhDs? I have tried to find biographies for consultants working in Ireland, but insofar, only one has an MD degree. I know you're not a neurologist (btw, what are you? ), but it seems like the only PhD topic would be a PhD in Neuroscience — and a four year PhD seems quite excessive, even though I would love to do that.

I'm not entirely sure a research degree would be necessary. Would you not agree that the aforementioned residency and say either a fellowship in neurocritical care/child and adolescent psychiatry and a number of years working in each field in good hospitals would be enough to gain a consultant post in Ireland (nor-mind specialist division acceptance)?

dissed doc wrote: »

Colombia is a great programme from what I have read but remember it is geared to the US. So, it is one of the best programmes in the US for working in the US - that doesn't necessarily translate to the rest of the world.

I get your point. However, you didn't seem to express this concern in relation to the individual neurology residency (without the psychiatry). Since consultants currently working in Ireland (I'll have to get their names, again) have the sole US Residency training + fellowship training, I don't see that being an issue; merely the combined one. Do you agree?

Again, it's great to be able to pick someone's brains — expert or not, you seem to have a good idea of what you're talking about! Thanks so much.

If anyone else has any opinions, it would be great to hear those, too.

Ed.

lonestargirl

Vivara wrote: »

I understand. After the residency, I would plan to do a clinical fellowship, such as in Child and Adolescent Psychiatry (which is two years), and then possibly a research fellowship, possibly along the lines of schizophrenia research, which would then be another two to

Just be aware that most residents go on J1 alien physician visas which are for a maximum of 7 years. You might run out of time with your plan.

Although I'm sure Columbia and NYC would be fab you must remember that residents earn about $45-50k a year and even with subsidised accomadation that's not going too far in the city.

Vivara

lonestargirl wrote: »

Just be aware that most residents go on J1 alien physician visas which are for a maximum of 7 years. You might run out of time with your plan.

Although I'm sure Columbia and NYC would be fab you must remember that residents earn about $45-50k a year and even with subsidised accomadation that's not going too far in the city.

Thanks lonestargirl. I would be hoping to get a H1-B Visa. Universities seem more inclined to support these in recent years. With a H1-B, its not necessary to return to Ireland after the allotted time and you can apply for permanent residency status.

Ed.

lonestargirl

Vivara wrote: »

Thanks lonestargirl. I would be hoping to get a H1-B Visa. Universities seem more inclined to support these in recent years. With a H1-B, its not necessary to return to Ireland after the allotted time and you can apply for permanent residency status.

I know a few that have stopped offering H1Bs for residency as it is work for them and ECFMG do the J1s. H1B is limited to 6 six years, you cannot apply for a permanent residency off your own bat your employer must sponsor you. I do know a few people doing residency on H1Bs but not any that have been sponsored for a green card.

dissed doc

lonestargirl wrote: »

I know a few that have stopped offering H1Bs for residency as it is work for them and ECFMG do the J1s. H1B is limited to 6 six years, you cannot apply for a permanent residency off your own bat your employer must sponsor you. I do know a few people doing residency on H1Bs but not any that have been sponsored for a green card.

This is an important consideration and will create problems.

If you are considering remaining to practice in the US, you pretty much MUST have a H1B. Now, the complicating factor is that not all (by any stretch) of the residency programmes sponsor a H1B. Some fantastic programmes might simply have a Green Card/US citizen or J1 - no in between. From friends of mine, it is easier to convince them to sponsor you if you are a really strong candidate. You also need Step 3 for the USMLE to get a H1B, and if you are still in university, that is an impossibility.

In fact, from my recollection it's systematically impossible to go straight from college in Ireland to a residency on a H1B visa because you cannot meet the requirements to do the Step 3 exam.
- Step 3 is taken for the *state* you wish to be licensed in.
- Each state has different minimum *post graduate* clinical requirements for non US medical graduates. (http://www.fsmb.org/usmle_eliinitial.html
- some states will not allow you to sit Step 3 at all. States that do, will require at least 1 year of postgraduate experience, but usually 2 or even 3. This is because (again, going by my own recollection when I was lookign at all this over 10 years ago!) Step 3 is taken by US graduates to get a full state license, but it assumes you are already in a residency with 1 year done.
- For example, to get a H1B in New York, you need to have Step 3 passed. To even attempt Step 3, you need to have 3 years postgrad experience in your home country to be allowed sit the exam.

I know some others who have done the J1 and ended up doing the period in a federally designated underserved area. It's fine from what I have heard, but you might be in New York for 4 years on a J1 and then move to quite rural areas in Arizona or New MExico for example. Good experience but not everyone's cup of tea.

A fantastic thing to do is to enter the green card lottery. You never know. I won it, but never used the opportunity.

Vivara

Lonestargirl and dissed doc, you have certainly got me worried — but in a good way, I suppose! Thank you.

Reading this link on the Columbia Neurology program:
http://www.cumc.columbia.edu/dept/neurology/education/apply.html#i

They don't accept H1-B applicants like you said. I also became aware of a whole load of other requirements that they haven't made clear at all at all in the FAQ!

They mention what seems to be a combined program of preliminary internal medicine and neurology, but if you don't get that you have to apply to the medicine department for the preliminary program separately?

It then says that if you don't have the clinical experience, one should apply to a preliminary medicine program before matching, but the above implies that they are both done at the same time.

I'm confused.

And I have to say, a little bit disheartened. I have my mind set on the US for residency... I do not want to go anywhere else.

If I can manage a Green Card (there may be a way) — how difficult does everything on that page look for a Trinity Graduate? What would I need to do?

Thanks!

Ed.

lonestargirl

dissed doc wrote: »

I know some others who have done the J1 and ended up doing the period in a federally designated underserved area. It's fine from what I have heard, but you might be in New York for 4 years on a J1 and then move to quite rural areas in Arizona or New MExico for example. Good experience but not everyone's cup of tea.

The VA in Hosuton is populated with people working out their time in underserved areas. It's part of the Texas Medical Center and is a pretty decent hospital so it's not too bad working there. *Random fact - it's the 2nd largest federal building in the US after the Pentagon*

dissed doc wrote: »

A fantastic thing to do is to enter the green card lottery. You never know. I won it, but never used the opportunity.

+1, great advice

Vivara wrote: »

Lonestargirl and dissed doc, you have certainly got me worried — but in a good way, I suppose! Thank you.

Never too early to start investigating and planning

Vivara wrote: »

They mention what seems to be a combined program of preliminary internal medicine and neurology, but if you don't get that you have to apply to the medicine department for the preliminary program separately?

Lots of programs (neurology, radiology, anaesthetics, ENT) only start specialist training in 2nd year. You do a preliminary general medical/surgical intern year 1st. The will try to align their 2nd year spots with their preliminary positions but some people like to do their prelims elsewhere.

Vivara wrote: »

And I have to say, a little bit disheartened. I have my mind set on the US for residency... I do not want to go anywhere else.

Why? Have you been to the US? IMO there are aspects of it's medical care that are fantastic but the healthcare inequality is appaling. Poor people with a lack of access to basic primary care have a shockingly bad standard of health.

A few random thoughts:

• To match you will need to do a US elective and get a LOR
• Interviewing is going to be very expensive
• As a general rule H1Bs are going to be more common in rural, lower tier programs. They use it as a means to attract quality candidates to their programs.
• I've never heard of a residency program sponsoring a green card - why would they bother?
• The plan of action you outlined doesn't seem possible on a J1 or a H1B - you are going to run out of time

While it is important to keep the long-term plan in mind you also have to be cognisent of the fact that plans can change. You may hate neurology. You may love academia rather than clinical practice. You may meet the love of your life during residency.

dissed doc

lonestargirl wrote: »

Why? Have you been to the US? IMO there are aspects of it's medical care that are fantastic but the healthcare inequality is appaling. Poor people with a lack of access to basic primary care have a shockingly bad standard of health.

THat is good advice IMHO. For technologically advanced specialities e.g., interventional cardiology and so on, the US is definitely the place to be. But, for example in psychiatry, and other specialities which require good social services to function with it. This is why you have fantastically advanced services based on the work done in King's College (Maudsley originating) for example - publicly accessible low cost primary care, social services, etc., really go hand in hand with mental health services.

A few random thoughts:

• To match you will need to do a US elective and get a LOR
• Interviewing is going to be very expensive
• As a general rule H1Bs are going to be more common in rural, lower tier programs. They use it as a means to attract quality candidates to their programs.
• I've never heard of a residency program sponsoring a green card - why would they bother?
• The plan of action you outlined doesn't seem possible on a J1 or a H1B - you are going to run out of time

.

Yes that was always an issue. It was pretty much compulsory to do your summer electives in the US, or you would not have a chance at bigger cities and programmes. The overall cost used to be around US$5-6k between exams and flights to enter the match AFAIR. Also, I think the H1B is actually for 3 years and is then renewed. But, in case someone is considering big high paid US jobs, remember that the H1B is tied to your employer. You are definitely not free to apply for attending posts in private practices, for the most part.

My advice is still: if you want to practice (as a specialist) in the US, then train there. Even if it means a J1 to go immediately after graduating, and then work in a VA hospital. It works and many do it - I have friends who have since completed the ? 3 years in areas, have now got green cards. If you want to practice in Ireland (or indeed Europe) then save yourself a lot of effort and money by training for services here, and learn a second (or third) language! Train where you see yourself living in for the longer term.

I wouldn't worry too much about the money. Many/all of the people even in New York get by just fine on the salaries of $50k starting (in Colombia) - this is the average salary of New York state actually, and it goes to US$70k+ by 3rd year. IN Ireland you will start almost the same or maybe less - around €2000-2500/month after tax in your first years. In the US, it's usually around US$2500-3000. Also, because you will be on a H1B, there will be restrictions on moonlighting. US or green card holders can therefore hop around and pick up shifts in different places - you work for your visa sponsor only.

sam34

just to add a point re psych consultant jobs in Ireland- you really will need an md or phd... at the moment most candidates who are shortlisted for consultant jobs have them, and things are going to get more competitive overvthe next few years, with the same number finishing the higher training scheme competing for a small number of jobs.

Vivara

dissed doc wrote: »

Yes that was always an issue. It was pretty much compulsory to do your summer electives in the US, or you would not have a chance at bigger cities and programmes. The overall cost used to be around US$5-6k between exams and flights to enter the match AFAIR.

I know several doctors and other people in the National Institute of Health in Washington, D.C., so that shouldn't be a problem. Cost, by then, shouldn't be a problem

sam34 wrote: »

just to add a point re psych consultant jobs in Ireland- you really will need an md or phd... at the moment most candidates who are shortlisted for consultant jobs have them, and things are going to get more competitive overvthe next few years, with the same number finishing the higher training scheme competing for a small number of jobs.

Thanks. But as far as I can see, an MD in Ireland is just another name for a research fellowship (and has been described as such on a few websites I checked). I would, without a doubt, be doing a research fellowship before I come back — and I would be aiming for a top university. A Consultant Cardiologist I know, who actually trained in the US, told me that a research fellowship at Hopkins, Harvard, Cornell or Columbia would be considered far better than an MD at any Irish university. Would this be your assessment?

Can you give me a few names of psychiatrists with PhDs? Or at least tell me what area they did their PhD in? I actually have no idea — the only area that seems particularly relevant is neuroscience, and some Googling didn't turn up anyone with any PhD.

lonestargirl wrote: »

• To match you will need to do a US elective and get a LOR
• Interviewing is going to be very expensive
• As a general rule H1Bs are going to be more common in rural, lower tier programs. They use it as a means to attract quality candidates to their programs.
• I've never heard of a residency program sponsoring a green card - why would they bother?
• The plan of action you outlined doesn't seem possible on a J1 or a H1B - you are going to run out of time

While it is important to keep the long-term plan in mind you also have to be cognisent of the fact that plans can change. You may hate neurology. You may love academia rather than clinical practice. You may meet the love of your life during residency.

Thanks. I had an idea of everything on your list. And, yeah, I know... I may pick a different speciality altogether!

Thanks guys.

Ed.

dissed doc

Vivara wrote: »

Thanks. But as far as I can see, an MD in Ireland is just another name for a research fellowship (and has been described as such on a few websites I checked). I would, without a doubt, be doing a research fellowship before I come back — and I would be aiming for a top university. A Consultant Cardiologist I know, who actually trained in the US, told me that a research fellowship at Hopkins, Harvard, Cornell or Columbia would be considered far better than an MD at any Irish university. Would this be your assessment?

like i said, for things in specialities needing hitech expensive machines such as cardiology, sure. however, for psychiatry, an MD is quite normal for jobs in the dublin teaching hospitals, even to sit down at an interview. i know several, and also several psych consultants with PhDs. if yoy do not fancy an academic career, then no, but it will be harder.

When it comes to clinical experience and practice its my opinion that places in UK, Netherlands and particularly Australia have far more cutting edge mental health services than anything I have seen from the US. Australia is a fantastic place to train, from what I have heard from colleagues who have been in both.

Can you give me a few names of psychiatrists with PhDs? Or at least tell me what area they did their PhD in? I actually have no idea — the only area that seems particularly relevant is neuroscience, and some Googling didn't turn up anyone with any PhD.



Thanks. I had an idea of everything on your list. And, yeah, I know... I may pick a different speciality altogether!

Thanks guys.

Ed.[/QUOTE]

lonestargirl

Vivara wrote: »

I know several doctors and other people in the National Institute of Health in Washington, D.C., so that shouldn't be a problem. Cost, by then, shouldn't be a problem

Your elective needs to be clinical, with an attending who is in the field you are applying to.

sam34

Vivara wrote: »

Thanks. But as far as I can see, an MD in Ireland is just another name for a research fellowship (and has been described as such on a few websites I checked). I would, without a doubt, be doing a research fellowship before I come back — and I would be aiming for a top university. A Consultant Cardiologist I know, who actually trained in the US, told me that a research fellowship at Hopkins, Harvard, Cornell or Columbia would be considered far better than an MD at any Irish university. Would this be your assessment?

Can you give me a few names of psychiatrists with PhDs? Or at least tell me what area they did their PhD in? I actually have no idea — the only area that seems particularly relevant is neuroscience, and some Googling didn't turn up anyone with any PhDs

when you say "an MD in ireland is just another name for a research fellowship" i'm not too sure what you mean... i know more than a few people who have done research fellowhips here and gotten some publications but not gotten an MD or PhD. and, tbh, i dont think an MD/PhD from a "top university" in ths states would be looked on "far better" than an Irish one... at the consultant interview you get marks for qualifications and will get the same marks for an MD irrespective of where its from.


PhDs/MDs could be done in loads of areas such as neuroimaging, immunology of mental illness, metabolic abnormalities in mental illness, genetics......

Vivara

lonestargirl wrote: »

Your elective needs to be clinical, with an attending who is in the field you are applying to.

I'm aware of this — there are some clinical internships and electives (as well as many, many research based ones) at the NIH and it's subsidiaries.

sam34 wrote: »

when you say "an MD in ireland is just another name for a research fellowship" i'm not too sure what you mean... i know more than a few people who have done research fellowhips here and gotten some publications but not gotten an MD or PhD.

That's not what I said. What I mean is; since there are no such things as MDs (as research degrees) in the U.S., doing a research fellowship at somewhere like Hopkins or Columbia would be akin to doing an MD in Ireland. ASFAIK, an MD is essentially a research fellowship — just that you get a degree at the end.

sam34 wrote: »

PhDs/MDs could be done in loads of areas such as neuroimaging, immunology of mental illness, metabolic abnormalities in mental illness, genetics......

Thanks. I still can't find a single neurologist or psychiatrist with a PhD. I have found only one with an MD. But LOADS have residency training in the US and research fellowships — just like I'm planning to do.

sam34 wrote: »

tbh, i dont think an MD/PhD from a "top university" in ths states would be looked on "far better" than an Irish one... at the consultant interview you get marks for qualifications and will get the same marks for an MD irrespective of where its from.

dissed doc wrote: »

like i said, for things in specialities needing hitech expensive machines such as cardiology, sure. however, for psychiatry, an MD is quite normal for jobs in the dublin teaching hospitals, even to sit down at an interview. i know several, and also several psych consultants with PhDs. if yoy do not fancy an academic career, then no, but it will be harder.

The same marks? What are you on? I would like to think (I don't know, though) that they would take into consideration what the research was actually on. I hope to God it's not a checklist; which seems to be what you're suggesting. If I was someone who was involved in research at one of the top facilities in the world for a period of four years, it shouldn't matter whether I end up with a PhD or an MD or a XYZ. I just had a discussion about this on the Student Doctor Network. I think you are too focused on the title of things, and not on the experience and work involved. A four-year research fellowship at Columbia or Hopkins or wherever mightn't be 'far better' in your eyes; but it's certainly equal to an MD at an Irish university. It will definitely tick a box for a career in academic medicine, anyway!

And dissed doc, I'm not sure where you got the idea that I want to take a shortcut and hop back to Ireland — in my original post I made it clear that I want to work in the US for several years. I was merely looking at my options with regards to coming back to Ireland after that. This debate led me to check the careers of several neurologists and psychiatrists currently in top positions in Ireland. A good chunk of them did a residency in the United States (and half of those actually had no training in their speciality in Ireland). An even larger amount did a further fellowship and many also did research fellowships — far more than the amount who have done MDs, and way way more than anyone I've found with a PhD. (But as I've asked several times, please enlighten me with some names...)

So with a little research, I could have found out the answers myself. Nonetheless, it certainly was a lively discussion! Thanks guys.

Ed.

sam34

I am not going to name names on a public forum as I would be quite pissed off if someone did that with my name, but I know plenty consultant psychs with an MD and some with PhDs. it's up to you whether or not you believe that.

and as for asking me "what are you on"? . I'm giving you my advice and the benefit of my experience as someone who has relatively recently gone through the consultant interview , feedback and appointment process. you get marks based on ( among other thi gs) your professional qualifications. if you have an MSc/ MD/PhD you get x/ y/ z no of marks. if you don't have those then you don't get the marks in that section.

but, tbh, your attitude is quite smug and condescending and I have no interest in posting here anymore.

dissed doc

Vivara wrote: »

The same marks? What are you on? I would like to think (I don't know, though) that they would take into consideration what the research was actually on. I hope to God it's not a checklist; which seems to be what you're suggesting.

Like I said, to sit down at an interview, there are typically minimum requirements. Competency based interviewing standardises scores for clinical experience, publications, additional degrees, etc.,. It very much is a checklist, to keep it standardised. This is expected practice for consultant interviews (not just in Ireland).

If I was someone who was involved in research at one of the top facilities in the world for a period of four years, it shouldn't matter whether I end up with a PhD or an MD or a XYZ.

It's one of the top facilities for certain types of research in the US.

Every insitution has speciality areas for research. YOu will find there is far more cutting edge neuroscience coming from Netherlands, early psychosis from Australia, and service development in the UK insitutions. I think before you have even started training or developed an interest area, you have decided on what you will be pursuing without knowing what it is you get there. If you end up wanting to do schizophrenia and early psychosis research, then several Australian centres are definitely far far ahead of the US in that regard.

So, what exactly is it in Columbia that leads you there. "leading centres" is like saying "knowledge economy". It's really meaningless - because no centre is leading in all areas. Psychiatry is much like general medicine. You do some basic trainning, but the subspecialities are poles apart much like Cardiology vs Dermatology after doing basic medical training; forensic vs. psychopharmacology research, vs community and social psychiatry vs intellectual disability psychiatry. There are as many areas in psychiatry for specialisation as there are in medicine or surgery, which is why pursuing a centre without saying what specifically you are wanting to do your 4 years of research in, is a little ridiculous (IMHO).

This goes back to why I suggested not diluting training. Go to the EPA or APA congresses and see who is there. But, then you see the speicalist conferences and really, the experts will be from the most unsuspecting places with little or no branding impact. Follow the expertise, not the brand, but good luck anyway.

lonestargirl

Vivara wrote: »

I'm aware of this — there are some clinical internships and electives (as well as many, many research based ones) at the NIH and it's subsidiaries.

Although they look like great electives they may not be the most strategic option for matching. Ideally you would go to the place that you were thinking of ranking number one, the letter of recommendation is all about personal contacts not the reputation of the institution.

Vivara wrote: »

I still can't find a single neurologist or psychiatrist with a PhD. I have found only one with an MD. But LOADS have residency training in the US and research fellowships — just like I'm planning to do.

Just be aware that what was the best training option when they graduated might not be the best option now. The gulf between US and Irish medicine has closed greatly in the last 15 years. As Dissed Doc has said, the US is no longer the be all and end all for every speciality.

sam34 wrote: »

and as for asking me "what are you on"? . I'm giving you my advice and the benefit of my experience as someone who has relatively recently gone through the consultant interview , feedback and appointment process. you get marks based on ( among other thi gs) your professional qualifications. if you have an MSc/ MD/PhD you get x/ y/ z no of marks. if you don't have those then you don't get the marks in that section.

I'd listen to her.

dissed doc wrote: »

Like I said, to sit down at an interview, there are typically minimum requirements. Competency based interviewing standardises scores for clinical experience, publications, additional degrees, etc.,. It very much is a checklist, to keep it standardised. This is expected practice for consultant interviews (not just in Ireland).

+1, SPR interviews etc are similar.

I think you are placing a lot of emphasis on the 'name' of the institution. People are going to look at the people you worked under/with as much if not more than the institution (and I'm saying that as someone who worked in the no.1 cancer hospital in the US). Go on an elective 1st and see if you like it, don't rank somewhere if you can't see yourself happy there - it will be a very long residency otherwise. I know a friend of a friend who is in internal medicine residency at the Mayo clinic. She hates it. It's ultra-competitive, with your colleagues 'stealing' cases and stabbing you in the back when they can. There's nothing in Rochester except the hospital so it's very hard to make non-medical friends. She's matched to a fellowship and can't wait to get out of there.

Carsinian Thau

Hope it's ok for me to hijack this thread a little bit but I have a quick additional question about interning and residency in America.

As stated before, some of the medical specialities only begin their specialisation in their 2nd year of residency. Anaesthetics is in this category and is the one I'm interested in. I was wondering if I were to do one of the 3 year residencies in Internal Medicine and then apply to do Anaesthetics, would I be disadvantaging myself compared to someone who just does the prelim and then heads straight to Anaesthetics? Or if I'm setting myself up for additional difficulty?

And also, I'm interested in coming back to Ireland too (actually not looking to spend too much time over there, I'm already a patient in the Irish hospital system and have concerns over getting insurance in America so I don't think I should spend too much time there). Would such training allow me to come back as an SpR or would I have to come back as an SHO?

(Btw, and I do apologise for this, it may be very obvious but I a very dim understanding as to how the progression along the different levels of doctor works).

lonestargirl

Carsinian Thau wrote: »

As stated before, some of the medical specialities only begin their specialisation in their 2nd year of residency. Anaesthetics is in this category and is the one I'm interested in. I was wondering if I were to do one of the 3 year residencies in Internal Medicine and then apply to do Anaesthetics, would I be disadvantaging myself compared to someone who just does the prelim and then heads straight to Anaesthetics? Or if I'm setting myself up for additional difficulty?

The main issue here is funding and visa time. You will be limited to 7 years on a J1. Residency spots are funded by Medicare and once you start a residency program it starts a funding clock based on the length of that program (i.e. 5 years if you chose general surgery but only 3 years if internal medicine). Once you have used up your funding a hospital would have to find the money for your salary itself. This may or may not be a big deal for them, there are programs who are accredited for more places than they are funded for who regularly fund some spots themsleves.

Carsinian Thau wrote: »

And also, I'm interested in coming back to Ireland too (actually not looking to spend too much time over there, I'm already a patient in the Irish hospital system and have concerns over getting insurance in America so I don't think I should spend too much time there).

Oddly enough this is probably not a big deal. The inequalities in the US system start with access to insurance. As a single person buying it you will be screwed, no way they will cover your existing condition and it will cost and arm and a leg. However the best insurance is a group plan provided by your employer, generally for residents they pay for it in full too. These plans are the creme de la creme of insurance. My husband's covered 90% of everything upfront, mine covered 80% but both had a limit (about $10000) beyond which they covered 100%. All pre-exisiting conditions were covered. These plans cost our employers about $1000 each per month. I had my son in the US and from my 8 week appointment through to the 6 week post-partum one with a c-section birth cost me $2500.

Carsinian Thau wrote: »

Would such training allow me to come back as an SpR or would I have to come back as an SHO?

In theory you could come back as a consultant (*each specialty must be evalauted seperately and the college guidelines examined*). You may need a fellowship to make you competitive for consultant posts though.