Any future in Irish medicine?

goldencrisp62

I look at some of the training schemes here (basic medical training) for example and it just looks like a black hole - a service job carrying charts for a few years with no promise or guarantee of ever making six figures/becoming a consultant.

This spr bottleneck sounds like a complete scam and even if you get on it you're not guaranteed anything after it.

I have no interest in any other specialty, little interest in GP. Yet GP seems like the only option to escape the hell that often is working in the hospital if you stay in this country.

What advise can you offer to someone coming out of medical school? Is USMLE and America the only option realistically?? Head off over there for five or six years and get fully qualified and then come back and hope for a consultancy post (is that even realistic?), or just stay there and make a quarter of a mill. train in the UK and make ok money? Professional Locum Reg?

The further I go into the system, the muddier the waters are.

nerrad01

id love to hear everyones thoughts on this, may be worth moving to the main health sciences thread and not the education one?

Vorsprung

Good idea, moved.

nerrad01

any of the more experienced doctors want to share their views on what they think of career opportunities in the irish health system??

Im a grad med student and from talking to people it does seem fairly bleak, the advise from most that ive got is to abandon ship and head to Aus/Nz/Uk....considering the loan i have it prob wont be much of an option for me.

I heard its something like 10% of spr`s are getting consultant posts is this true??? it sounds like all they did with the consultant salary cut was secure the huge salaries and private practise work for all the old consultants while condemning the new ones to crap pay and conditions (considering training times and expenses) and essentially forcing a lot of fantastic irish doctors to leave!

but sure what do i know im only a student! :pac: so id love to hear everyones elses views

Ihaveanopinion

This is where the challenge of GME comes. You have to ask yourself - why did you go back to do medicine. If the reason was,and I hope it was, because medicine is of interest to you then go do post graduate medicine. The post graduate programmes are long and the path is uncertain. The only definite (ish) path is GP.

There is no guarantee of a consultant job at the end of your training, anymore than there is a guarantee of a CEO job if you go work at google. The goal should be to train yourself to the best level possible and compete for a job at the other end. There is a chance you won't get a job in Ireland, as well as a high chance of not getting your first preference job if you do land an Irish job.

As cheesy as it sounds, medicine is as much a vocation as a job. So pick the speciality you love and run with it. It's a pain if you want a stable family life but like I said, that's the challenge with graduate entry medicine

nerrad01

Ihaveanopinion wrote: »

This is where the challenge of GME comes. You have to ask yourself - why did you go back to do medicine. If the reason was,and I hope it was, because medicine is of interest to you then go do post graduate medicine. The post graduate programmes are long and the path is uncertain. The only definite (ish) path is GP.

There is no guarantee of a consultant job at the end of your training, anymore than there is a guarantee of a CEO job if you go work at google. The goal should be to train yourself to the best level possible and compete for a job at the other end. There is a chance you won't get a job in Ireland, as well as a high chance of not getting your first preference job if you do land an Irish job.

As cheesy as it sounds, medicine is as much a vocation as a job. So pick the speciality you love and run with it. It's a pain if you want a stable family life but like I said, that's the challenge with graduate entry medicine

I love medicine and everything that goes with it, but as much as you like to candy coat it...its still a job! and comparing a consultancy post to becoming a ceo at google is ludicrous! its the same as anything else senior solicitor/architect engineer

and why cant medical professionals have stable family life while working as a doctor?? they have it in australia, NZ and the UK...its an indictment on the HSE that doctors are forced to choose one or the other here!

no wonder doctors are leaving in droves

Russellynx

Ihaveanopinion wrote: »

This is where the challenge of GME comes. You have to ask yourself - why did you go back to do medicine. If the reason was,and I hope it was, because medicine is of interest to you then go do post graduate medicine. The post graduate programmes are long and the path is uncertain. The only definite (ish) path is GP.

There is no guarantee of a consultant job at the end of your training, anymore than there is a guarantee of a CEO job if you go work at google. The goal should be to train yourself to the best level possible and compete for a job at the other end. There is a chance you won't get a job in Ireland, as well as a high chance of not getting your first preference job if you do land an Irish job.

As cheesy as it sounds, medicine is as much a vocation as a job. So pick the speciality you love and run with it. It's a pain if you want a stable family life but like I said, that's the challenge with graduate entry medicine

I think this posts exemplifies some of the problems with Irish medicine, especially amongst direct school entry. These extremely vain, naive, overindulged people, who are gluttons for punishment and actually have this fetish for subjugation, firstly to be made a gimp by their own consultant, then inherit this attitude and try and do the same to their juniors.

This kind of veiled accusatory question "Why did you go back to do medicine", implies you question other peoples motivations. What are yours? help people? cure the sick? These are puerile boyhood fantasies in-congruent with reality. Anyone who doesn't understand the importance of the Quality of life, work-life balance etc. shouldn't be allowed pontificate on the internet. This kind of attitude, "I'll work for peanuts because I love my patients and I am an altruistic person" is Rose of Tralee nonsense. The studies, all of them show this. People with this poorly developed, infantile coping mechanisms end up on the scrap heap or hanging from a rope.

There is essentially no good jobs in Irish medicine. Perhaps with the exception of public health or microbiology.

Furthermore, this analogy of consultant to "anymore than there is a guarantee of a CEO job if you go work at google" is completely bogus, demonstrates a complete lack of insight about jobs and employment in general, shows me you no nothing about google or similar companies. Another sign of this kind of fantasy belief in what consultants are and what they do.

CEO job in Google, are you serious? Are you actually this deluded. Listen we won't dissect the nonsense that is this statement but let's pare in back to something less delusional if still unrealistic. Compare it to CEO at some local business. Doesn't matter what. Does the analogy still stand? No.

CEO is the apex employee in a large organisation. There is by definition one CEO. Consultants are apex of particular teams and depending on the size of the hospital, apex of speciality or merely one of many. Large businesses which have CEOs (like all the hospital groups) have multiple managers at a high level. This is more akin to what consultants are.

Secondly, in any business, including google, you go in at entry level (intern) and can progress via ranks (akin to sho/reg/spr) but unlike Medicine, these jobs are permanent and not merely designed as training for manager. You cannot be a SHO for the rest of your life. There is no permanent SHO position in any hospital. You cannot get a permanent SHO contract, if you did it would probably not be realistic. Could you be a SHO with their demands for 30 years? Same goes for registrar. You can't sit in a hospital for 10 years as a reg learning your trade, you have to move around frequently. The analogy isn't appropriate. You can't just coast at SPR, it's a training position for a higher job. Everyone has to become a consultant or a GP, there is no middle ground in clinical medicine.

Becoming a consultant in Ireland is borderline impossible. The time frame and scope of the training plus the pure arbitrary nature of post availability never mind the necessity of the right contacts, the right look and the right name.

I don't know if there are any purely clinical jobs that are actually compatible with life in any internal med scheme anywhere. You go get a big job in USA or canada and you're doing first on call when you're 60 looking after loads of sick patients with out a junior doctor support but rather very good specialist nurses.

Ihaveanopinion

Oh dear I seem to have opened up a hornets nest there. The comparison to CEO of Google was being facetious - an over the top comparison. Take a step back and don't take it so literally.

Irish medicine isn't very different to other medical systems. In the UK, you have to rotate to a number of different sites in your programme. In the US, you don't but the criteria to get into medical school and then the post graduate programme of your choice are very high.

I think you may have chosen to take my comments out of context. The point I was trying to make is, if you want to peruse hospital medicine, then go do it. You have to make sacrifices but so does everyone else in any other profession. If you decide you want to do paediatric nephrology, sorry but you have to go abroad, that's the nature of a small market place. ( that's an extreme example also - before you get outraged) there are people who have managed to do their entire training in one location without uprooting family and then Net a job in ireland. They are in the minority.

I am not trying to upset anyone by stating any of this. I am just tryi to be informative. Pick the speciality you want and go for it.

Russellynx

Ihaveanopinion wrote: »

Oh dear I seem to have opened up a hornets nest there. The comparison to CEO of Google was being facetious - an over the top comparison. Take a step back and don't take it so literally.

Irish medicine isn't very different to other medical systems. In the UK, you have to rotate to a number of different sites in your programme. In the US, you don't but the criteria to get into medical school and then the post graduate programme of your choice are very high.

I think you may have chosen to take my comments out of context. The point I was trying to make is, if you want to peruse hospital medicine, then go do it. You have to make sacrifices but so does everyone else in any other profession. If you decide you want to do paediatric nephrology, sorry but you have to go abroad, that's the nature of a small market place. ( that's an extreme example also - before you get outraged) there are people who have managed to do their entire training in one location without uprooting family and then Net a job in ireland. They are in the minority.

I am not trying to upset anyone by stating any of this. I am just tryi to be informative. Pick the speciality you want and go for it.

Again I think you need to take a step back and take off your institutionalised glasses. You comments are trite and superficial and again, demonstrate a real lack of understanding about the subtext of this discussion. Are you actually a doctor or just a medical student?

This is the kind of stuff you're saying. "so you want to be a hospital specialist, that's a tough job to get, but if you persevere you'll get there eventually". Would you say the same to a kid who wants to play football for madrid? Just keep trying, practice your shooting, go to training, take your vitamin and sleep well, you'll get there in the end. Let's be less facetious, would you say that to someone who wants to be an astronaut? Just keep trying, go for it, maybe you won't be the sub-specialist-lead-astronaut but if you keep your eyes on the prize you'll get there eventually. REach for the stars, you may land on the moon.

Anyone who managed to live in one spot for 10 years as NCHD was obviously living in dublin and just kept going for posts in dublin area and doing locums until they got the schemes they want. So for anyone reading this, move to dublin (or maybe cork) if you want any change of becoming a consultant. And if they give you a post in kilkenny or waterford, sure suck it up, it's a small commute and it will be worth it in the end.

you haven't got a clue. nobody seems to. a massive collective Folie à deux, folie a ****ing wagon load.

Ihaveanopinion

A lot of anger there and not a lot of helpful advice for the OP. By your reckoning, he/she should just give up.

With regard to your comment about having to move to Dublin, it's not 100% the case but of course if half the population of the country and about half of the major teaching hospitals are there, it makes sense. You can train in Cork but fewer hospitals mean fewer quality training jobs. Expecting to train to specialist level in Tullamore is asking a bit much.

The OP was asking if there is any possibility of reaching specialist level in Irelamd and getting a job. The answer is yes, but it will require moving during your training and probably working abroad for a period of time. That stands for almost every speciality with the exception of GP.

But then my responses are trite and I don't have a clue so who would pay any attention to me

pc11

Russellynx wrote: »

I don't know if there are any purely clinical jobs that are actually compatible with life in any internal med scheme anywhere. You go get a big job in USA or canada and you're doing first on call when you're 60 looking after loads of sick patients with out a junior doctor support but rather very good specialist nurses.

Serious question: what do you suggest young doctors/students do instead? GP Research?

nerrad01

Ihaveanopinion wrote: »

A lot of anger there and not a lot of helpful advice for the OP. By your reckoning, he/she should just give up.

With regard to your comment about having to move to Dublin, it's not 100% the case but of course if half the population of the country and about half of the major teaching hospitals are there, it makes sense. You can train in Cork but fewer hospitals mean fewer quality training jobs. Expecting to train to specialist level in Tullamore is asking a bit much.

The OP was asking if there is any possibility of reaching specialist level in Irelamd and getting a job. The answer is yes, but it will require moving during your training and probably working abroad for a period of time. That stands for almost every speciality with the exception of GP.

But then my responses are trite and I don't have a clue so who would pay any attention to me

tbh i do think you are very naive in your attitude and seem to accept the status quo that thousands of doctors went on strike to try to start the process to break it down. Accepting thats the way it should be is seriously doing yourself and every other doctor in the country an injustice

I came from a highly competitive profession before making the switch to medicine, now although it was long hours and high pressure we were actually protected by employment law and employers actually vauled performing staff.....something that is seriously lacking in the HSE.

anyone that thinks medicine is a magical selfless calling is in for a rude awakening when they enter the real world....its simply a job at the end of the day, but one that allows you to contribute to society in a meaningful way BUT it absolutely should not be at the detriment of your own life/health.

so getting back to the main topic id love to hear what people who have been through the system recommend...because i certainly dont want to be 8 years on a training programme only to realise its a dead end

Russellynx

pc11 wrote: »

Serious question: what do you suggest young doctors/students do instead? GP Research?

I recommend you don't do internal med. Other specialities have varying degrees of hazardousness. stick to stuff with consults and opd only? Surrender yourself to being a GP assistant and work 9-6 with 20 mins for lunch. Leave medicine and go work for the dastardly pharm companies. do dentistry.

Icemancometh

Russellynx wrote: »

I think this posts exemplifies some of the problems with Irish medicine, especially amongst direct school entry. These extremely vain, naive, overindulged people, who are gluttons for punishment and actually have this fetish for subjugation, firstly to be made a gimp by their own consultant, then inherit this attitude and try and do the same to their juniors.

This kind of veiled accusatory question "Why did you go back to do medicine", implies you question other peoples motivations. What are yours? help people? cure the sick? These are puerile boyhood fantasies in-congruent with reality. Anyone who doesn't understand the importance of the Quality of life, work-life balance etc. shouldn't be allowed pontificate on the internet. This kind of attitude, "I'll work for peanuts because I love my patients and I am an altruistic person" is Rose of Tralee nonsense. The studies, all of them show this. People with this poorly developed, infantile coping mechanisms end up on the scrap heap or hanging from a rope.

There is essentially no good jobs in Irish medicine. Perhaps with the exception of public health or microbiology.

Furthermore, this analogy of consultant to "anymore than there is a guarantee of a CEO job if you go work at google" is completely bogus, demonstrates a complete lack of insight about jobs and employment in general, shows me you no nothing about google or similar companies. Another sign of this kind of fantasy belief in what consultants are and what they do.

CEO job in Google, are you serious? Are you actually this deluded. Listen we won't dissect the nonsense that is this statement but let's pare in back to something less delusional if still unrealistic. Compare it to CEO at some local business. Doesn't matter what. Does the analogy still stand? No.

CEO is the apex employee in a large organisation. There is by definition one CEO. Consultants are apex of particular teams and depending on the size of the hospital, apex of speciality or merely one of many. Large businesses which have CEOs (like all the hospital groups) have multiple managers at a high level. This is more akin to what consultants are.

Secondly, in any business, including google, you go in at entry level (intern) and can progress via ranks (akin to sho/reg/spr) but unlike Medicine, these jobs are permanent and not merely designed as training for manager. You cannot be a SHO for the rest of your life. There is no permanent SHO position in any hospital. You cannot get a permanent SHO contract, if you did it would probably not be realistic. Could you be a SHO with their demands for 30 years? Same goes for registrar. You can't sit in a hospital for 10 years as a reg learning your trade, you have to move around frequently. The analogy isn't appropriate. You can't just coast at SPR, it's a training position for a higher job. Everyone has to become a consultant or a GP, there is no middle ground in clinical medicine.

Becoming a consultant in Ireland is borderline impossible. The time frame and scope of the training plus the pure arbitrary nature of post availability never mind the necessity of the right contacts, the right look and the right name.

I don't know if there are any purely clinical jobs that are actually compatible with life in any internal med scheme anywhere. You go get a big job in USA or canada and you're doing first on call when you're 60 looking after loads of sick patients with out a junior doctor support but rather very good specialist nurses.

You know nothing of my fetishes, but nailed it otherwise. Thanks for that.

take everything

nerrad01 wrote: »

tbh i do think you are very naive in your attitude and seem to accept the status quo that thousands of doctors went on strike to try to start the process to break it down. Accepting thats the way it should be is seriously doing yourself and every other doctor in the country an injustice

I came from a highly competitive profession before making the switch to medicine, now although it was long hours and high pressure we were actually protected by employment law and employers actually vauled performing staff.....something that is seriously lacking in the HSE.

anyone that thinks medicine is a magical selfless calling is in for a rude awakening when they enter the real world....its simply a job at the end of the day, but one that allows you to contribute to society in a meaningful way BUT it absolutely should not be at the detriment of your own life/health.

so getting back to the main topic id love to hear what people who have been through the system recommend...because i certainly dont want to be 8 years on a training programme only to realise its a dead end

Could not agree more. A job, a bloody good one if you're allowed do it in a way that doesn't compromise your health/life.
Mandatory long hours-shifts in medicine have always struck me as bordering on imbecilic, something exploited by managers while pandering to the martyr complex that a lot of doctors have. Fine if you want to do them, but nobody should be made do them IMO. And i don't really buy the "necessary for training" chestnut.

Naturally i feel that even more as i get older, but i've always felt that way. Sometimes i do feel i've wasted a lot of my life doing these shifts.

Ihaveanopinion

nerrad01 wrote: »

its simply a job at the end of the day,

We will agree to disagree on this one. Simply a job is clock-in/clock-out - 9-5 - walk away when your shift/hours are done. I don't think this is the case with medicine.

If you look at it from the patient side of things, which is really what its all about - would you like to hear from your doctor that its 'simply a job' from which they walk away at the end of their shift. Or would you prefer that they actually care about the job. Its a profession/career/vocation - if you prefer.

I agree that the training schedules should reflect a more sympathetic view to trainees social or family lives. Doctors are, and always have been/ protected by employment law. The problem is that the HR depts in the various hospitals havent always recognised that until reminded - frequently.

In terms of which speciality to train in - pick the one(s) you are interested in. Otherwise, it will just be a job

nerrad01

Ihaveanopinion wrote: »

We will agree to disagree on this one. Simply a job is clock-in/clock-out - 9-5 - walk away when your shift/hours are done. I don't think this is the case with medicine.

If you look at it from the patient side of things, which is really what its all about - would you like to hear from your doctor that its 'simply a job' from which they walk away at the end of their shift. Or would you prefer that they actually care about the job. Its a profession/career/vocation - if you prefer.

I agree that the training schedules should reflect a more sympathetic view to trainees social or family lives. Doctors are, and always have been/ protected by employment law. The problem is that the HR depts in the various hospitals havent always recognised that until reminded - frequently.

In terms of which speciality to train in - pick the one(s) you are interested in. Otherwise, it will just be a job

Why have they solved the problem in Oz and NZ?? you are still looking at it from this self punishing irish point of view!

It is simply a job.....that dosent mean you cant carry out your job with compassion, enthusiasm and aim to be the best possible doctor you can be! I cant understand how some doctors dont realise this...you seem to think sacrificing sleep/family life and health somehow makes you a better doctor! It dosent...it turns you into a depressed, demotivated, drained individual and unfortunately the ones that seem to realise this are the ones on a plane away from here!

i do think it will all change eventually as long and i think its great what some of the NCHDs have done so far

HeadPig

Ihaveanopinion wrote: »

We will agree to disagree on this one. Simply a job is clock-in/clock-out - 9-5 - walk away when your shift/hours are done. I don't think this is the case with medicine.

If you look at it from the patient side of things, which is really what its all about - would you like to hear from your doctor that its 'simply a job' from which they walk away at the end of their shift. Or would you prefer that they actually care about the job. Its a profession/career/vocation - if you prefer.

I agree that the training schedules should reflect a more sympathetic view to trainees social or family lives. Doctors are, and always have been/ protected by employment law. The problem is that the HR depts in the various hospitals havent always recognised that until reminded - frequently.

In terms of which speciality to train in - pick the one(s) you are interested in. Otherwise, it will just be a job

You shouldn't be allowed to post in this topic as you are disseminating foolhardy, uninformed and potentially deleterious information. You are reinforcing an injurious, martyrish mindset which was the cause of this whole disaster in the first place. Please stop.

Ihaveanopinion

HeadPig wrote: »

You shouldn't be allowed to post in this topic as you are disseminating foolhardy, uninformed and potentially deleterious information. You are reinforcing an injurious, martyrish mindset which was the cause of this whole disaster in the first place. Please stop.

I agree completely. Disagreeing with your worldview shouldn't be allowed. I apologise completely and will stop posting immediately.

busymum1

The current system encourages total commitment to the 'job' and is filled with lots of other very bright junior doctors who are willing to play this game.
If you can't or won't do this then get out now and find another area of medicine to work in.
Don't waste years of your life training in obs if you don't like being up at four in the morning as that will always be a requirement in that job and if you don't like it there are plenty of others willing to do it. If there are people as smart or smarter than you willing to work harder than you then you're wasting your time in that area. I'm not saying that's right but it's the way it is!

Junior doctors gradually trickle out of the hospital system as they realise that they are not willing or able to accept the awful cost to their personal lives and health that specialist training currently entails in this country. However many of them will have spent many years working in very difficult conditions at significant cost to themselves before they come to this decision and move onto something else. The current SPR scheme seems like a way to get good regs to work in peripheral hospitals with potentially no consultancy afterwards. How many consultants in your hospital stayed only in Ireland for training, very few I imagine.

Have a look at the consultants in your area of interest and think do you want those working conditions/lifestyle at fifty and are you willing to work/sacrifice personal life family etc the same as the current regs/senior regs to get there? Ask the regs/sho what their career plans are most people are very happy to talk about this and it will give you a really good sense of what the training will really entail.

There are areas within hospital medicine that don't have onerous on call hours at a senior level, ( dermatology, renal, rheumatology, oncology to name a few) but as a result the competition for those jobs is fierce.

Try to go overseas for some training if possible as Ireland is just too small to get a decent grounding in less common conditions, but working outside the system and trying to come back as a consultant can be a long road.
Also if you're used to working in a decent health care set-up the Irish system can be soul destroying to come back too. Now some consultants are heading back overseas as the system is just too difficult.

Decide what kind of lifestyle/working hours/earnings you want at fifty and find a job in medicine that will give you that.

I was pretty smart but I saw doctors who were smarter than me who were wiling to sacrifice everything and work much harder than me so I got out. I didn't want to be like the consultants I worked for. Getting a consultant post can be more about tenacity than ability.It's worked out well for me and I have no regrets.

I work to live but plenty doctors live to work. Don't try to do one if you want the other.

Good Luck.

ProfessorPlum

HeadPig wrote: »

You shouldn't be allowed to post in this topic as you are disseminating foolhardy, uninformed and potentially deleterious information. You are reinforcing an injurious, martyrish mindset which was the cause of this whole disaster in the first place. Please stop.

To be fair, Ihaveanopinion is just pointing out the reality of the system. He/she is not agreeing with it, or saying that it should stay that way! If you are in the field, that is what you have to expect. Things will change, but in my experience, very slowly, so I wouldn't count on things in Ireland being dramatically different any time soon. So, like it or lump it, if a decent work/life balance is on your 'must have' list, you might like to reconsider your choices. Unfortunately it's a fact.

Ryder

nerrad01 wrote: »

tbh i do think you are very naive in your attitude and seem to accept the status quo that thousands of doctors went on strike to try to start the process to break it down. Accepting thats the way it should be is seriously doing yourself and every other doctor in the country an injustice

I came from a highly competitive profession before making the switch to medicine, now although it was long hours and high pressure we were actually protected by employment law and employers actually vauled performing staff.....something that is seriously lacking in the HSE.

anyone that thinks medicine is a magical selfless calling is in for a rude awakening when they enter the real world....its simply a job at the end of the day, but one that allows you to contribute to society in a meaningful way BUT it absolutely should not be at the detriment of your own life/health.

so getting back to the main topic id love to hear what people who have been through the system recommend...because i certainly dont want to be 8 years on a training programme only to realise its a dead end

the last post you attacked was actually pretty sound. My perspective, 14 years post medical school, is similar. True, you can treat it as a job and then should pick a specialty with short training and with little on call commitments. Anaesthesia would be a decent ver, GP similarly.

The other option is to do what you like - then it does become a vocation if you want to be a specialist physician or surgeon. I'm almost finished, almost, and my training wasn't excessively long by peer standards. To commit that much time does take its toll, but you need to like what you're doing and presumably judge the sacrifice as worth it. At that le el, trying to pretend its simply a job is ridiculous, and if it is, then you/I are a bigger fool for putting those hours in

Situation is similar in the states, but the duration of training is shorter. End career result is the same. Should a trqinee go post medical school - yes good to go then and do a residency who h entitles you to be board certified and build a career ther....but I would worry if your intention was to come back to Ireland. dwpwnding on your local competition I think it would be a disadvantage to do all your training abroad.

Consultancies are obviously difficult to get. With a pyramidal structure, lots leave, lots get to the end, go abroad, and then find out they're happier abroad. In short I don't know of any unemployed specialists, and very few working abroad who can't get home.

Hope that helps, feel free to ask more if I can answer anything more directly

Ryder

HeadPig wrote: »

You shouldn't be allowed to post in this topic as you are disseminating foolhardy, uninformed and potentially deleterious information. You are reinforcing an injurious, martyrish mindset which was the cause of this whole disaster in the first place. Please stop.

uncalled for. You have a differing opinion, fine. I disagree with this martyr label as it implies an effective alternative, but I welcome and appreciate your alternative opinion

goldencrisp62

Thanks for all the replies guys.

More specifically what would be the issue with going to america after intern, doing residency and fellowship and then hoping to come back to Ireland?

What issues would you face?

Surely when you've been trained to that level, the HSE would need you more than you need them??

Ryder

goldencrisp62 wrote: »

Thanks for all the replies guys.

More specifically what would be the issue with going to america after intern, doing residency and fellowship and then hoping to come back to Ireland?

What issues would you face?
jw
Surely when you've been trained to that level, the HSE would need you more than you need them??

if your ultimate plan was to come back then I wouldn't advise it. Sure there are unfilled jobs, bit they tend to be peripheral nob specialist jobs....it's still reasonably competitive in most specialities. Hard to see 6 years into the future, but unlikely that things will change much. If anything get more competitive as I suspect graduate entrants will most likely want to stay

US training may be hard to convert to Irish depending on the area.....its typically shorter and not as broad, although mostly equivalent. If you get that sorted then I would worry that you would come off worse against a local candidate.....who everyone knows, trained here, and most likely went on fellowship to a centre of excellence. That's not to say you shouldn't go.....the us have a great system and training. Hours are longer than here, and training is a little shorter depending on specialty. If you train there you can stay easily.....not so easy if you didn't train yher, but the big problem is that I THINK, it would be difficult to return to Ireland as a consultant

Nonoperational

Russellynx wrote: »

Again I think you need to take a step back and take off your institutionalised glasses. You comments are trite and superficial and again, demonstrate a real lack of understanding about the subtext of this discussion. Are you actually a doctor or just a medical student?

This is the kind of stuff you're saying. "so you want to be a hospital specialist, that's a tough job to get, but if you persevere you'll get there eventually". Would you say the same to a kid who wants to play football for madrid? Just keep trying, practice your shooting, go to training, take your vitamin and sleep well, you'll get there in the end. Let's be less facetious, would you say that to someone who wants to be an astronaut? Just keep trying, go for it, maybe you won't be the sub-specialist-lead-astronaut but if you keep your eyes on the prize you'll get there eventually. REach for the stars, you may land on the moon.

Anyone who managed to live in one spot for 10 years as NCHD was obviously living in dublin and just kept going for posts in dublin area and doing locums until they got the schemes they want. So for anyone reading this, move to dublin (or maybe cork) if you want any change of becoming a consultant. And if they give you a post in kilkenny or waterford, sure suck it up, it's a small commute and it will be worth it in the end.

you haven't got a clue. nobody seems to. a massive collective Folie à deux, folie a ****ing wagon load.

That's as ridiculous as the CEO of Google comment to be honest.

Ihaveanopinion

goldencrisp62 wrote: »

Thanks for all the replies guys.

More specifically what would be the issue with going to america after intern, doing residency and fellowship and then hoping to come back to Ireland?

What issues would you face?

Surely when you've been trained to that level, the HSE would need you more than you need them??

the training in the US is focused and of a shorter duration than Ireland. If you do a medical residency, its typically 3 years. A medical fellowship can be multi-year also. Still shorter than Ireland. If you train in the US on a J1 visa, you would have to leave at the end of your training, except in certain circumstances.

In terms of returning to Ireland, you would have difficulty getting your training recognized. There is no reciprocity between Ireland and the US, therefore if you are board certified in X, you won't automatically get on the Specialist Register for X on your return. This means you may be ineligible for a HSE hospital post. You have to apply to the relevant training body in Ireland to get your training recognized, which can be difficult. The main issue that tends to come up is - your US training would be quite specific and would lack the generality of Irish training.

There are people who have done this route but it is not as straight forward as it should be. There is reciprocity between the UK and Ireland - so training in the UK is much easier.

nerrad01

Ihaveanopinion wrote: »

the training in the US is focused and of a shorter duration than Ireland. If you do a medical residency, its typically 3 years. A medical fellowship can be multi-year also. Still shorter than Ireland. If you train in the US on a J1 visa, you would have to leave at the end of your training, except in certain circumstances.

In terms of returning to Ireland, you would have difficulty getting your training recognized. There is no reciprocity between Ireland and the US, therefore if you are board certified in X, you won't automatically get on the Specialist Register for X on your return. This means you may be ineligible for a HSE hospital post. You have to apply to the relevant training body in Ireland to get your training recognized, which can be difficult. The main issue that tends to come up is - your US training would be quite specific and would lack the generality of Irish training.

There are people who have done this route but it is not as straight forward as it should be. There is reciprocity between the UK and Ireland - so training in the UK is much easier.

yea we were told by our consultant that there has been a general shift towards irish doctors doing their fellowship year in european centres of excellence as opposed to american ones which was the norm in the past. and that it is getting tougher to come back....but thats second hand info im posting tbf.

i can see her point but, you have an irish doctor with 8-12 years training, with prob a postgrad qualification and a fellowship year somewhere, who has been working in the system and prob knows a lot of the interviewing consultant vs. an irish doctor who did a straight 5 year residency applying for the same post with half the experience having prob never worked in the irish system with no contacts

seems like not much of a contest to me

Truman Burbank

goldencrisp62 wrote: »

I have no interest in any other specialty, little interest in GP. Yet GP seems like the only option to escape the hell that often is working in the hospital if you stay in this country.

Hi OP, I'm confused. What are you interested in? Do you mean that you are interested in General Med (Internal Medicine)?

On going to GP to escape the hell of hospital medicine (a very fair description of the latter), I think it would also be fair to say - given write-ups/commentary over the last couple of years (especially) by the media and GP's themselves - that GP is shaping up not to be The Holy Grail that many think it is. For the hundreds of you who do not want to be GPs and are only choosing it for shorter hours in the long run - forget it. Life in a job just going thru the motions? No way to live. I think.

goldencrisp62

I want to do internal medicine.

I want to make a decent wage, ie 6 figures upwards.

And want to have a solid career path/course to the top.

Can the latter two ever be achieved in Ireland ?

ThatDrGuy

goldencrisp62 wrote: »

I want to do internal medicine.

I want to make a decent wage, ie 6 figures upwards.

And want to have a solid career path/course to the top.

Can the latter two ever be achieved in Ireland ?

In short, they can be but it's highly unlikely. Even if you succeed, the personal cost for most people is horrific. I've seen suicide, drug abuse, alcoholism and complete breakdowns amongst my peers. In spite of all that - some push through. Of course with one stroke of a pen the health minister decimated all their future earnings and there wasn't a damn thing they could do about it. I lasted 5 years in Irish medicine before I made the best decision of my life and got a real job. If I was you, I would do my internship and head off to pastures new asap. That would be Oz/Nz. There is a lot of talk here about the US, I'm not sure why. They have plenty of medical students of their own - they don't want you. It's not like you can just waltz over there and land on a residency scheme. If do do get somewhere it will likely be bumblef*ck Texas or Alaska. If you think Tullamore is remote, believe me there is much worse out there (same can go for the Antipodes but working conditions are much better ).

Truman Burbank

ThatDrGuy wrote: »

In short, they can be but it's highly unlikely. Even if you succeed, the personal cost for most people is horrific. I've seen suicide, drug abuse, alcoholism and complete breakdowns amongst my peers. In spite of all that - some push through. Of course with one stroke of a pen the health minister decimated all their future earnings and there wasn't a damn thing they could do about it. I lasted 5 years in Irish medicine before I made the best decision of my life and got a real job. If I was you, I would do my internship and head off to pastures new asap. That would be Oz/Nz.

Entirely agree. There are substantially more doom and gloom lives living, and indeed lives ruined, than there are smiley happy faces. (Though for balance, there should be contributions from the 's). (The other smiley ended UP there by accident!)

OP - you probably already knew all this. Stay at your personal peril IMHO.

ThatDrGuy - 5 years? I'm impressed. And doubly so that you left.

Palinpropism

Russellynx wrote: »

I think this posts exemplifies some of the problems with Irish medicine, especially amongst direct school entry. These extremely vain, naive, overindulged people, who are gluttons for punishment and actually have this fetish for subjugation, firstly to be made a gimp by their own consultant, then inherit this attitude and try and do the same to their juniors.

This kind of veiled accusatory question "Why did you go back to do medicine", implies you question other peoples motivations. What are yours? help people? cure the sick? These are puerile boyhood fantasies in-congruent with reality.

This is the best description of that persistent attitude i have ever heard.... I find it hard to believe someone genuinely trying to assess where their balance lies between job choice and life choices has their motives for doing med in the first place questioned. The CEO of google line gave me a good laugh though. This person clearly has had no exposure to the health system and is making swarmy observations from the comforts of college.

Graces7

have noticed in recent hospital admissions that the vast majority of young drs are both female and foreign. is there a reason for this?

Biologic

ThatDrGuy wrote: »

In short, they can be but it's highly unlikely. Even if you succeed, the personal cost for most people is horrific. I've seen suicide, drug abuse, alcoholism and complete breakdowns amongst my peers. In spite of all that - some push through. Of course with one stroke of a pen the health minister decimated all their future earnings and there wasn't a damn thing they could do about it. I lasted 5 years in Irish medicine before I made the best decision of my life and got a real job. If I was you, I would do my internship and head off to pastures new asap. That would be Oz/Nz. There is a lot of talk here about the US, I'm not sure why. They have plenty of medical students of their own - they don't want you. It's not like you can just waltz over there and land on a residency scheme. If do do get somewhere it will likely be bumblef*ck Texas or Alaska. If you think Tullamore is remote, believe me there is much worse out there (same can go for the Antipodes but working conditions are much better ).

I just matched to my first choice of residency programme in the US, straight out of medical school. I interviewed at some of the top programmes there, including Ivy League schools, and was well received. I'm not saying this to inflate my own ego, just to let people reading this know that what you have said about the US is largely false. I do agree that you can't just waltz over there. It's a LOT of hard work and expense to get a strong application, but is definitely possible and the situation isn't nearly as pessimistic as you're stating.
The rest of what you've said I completely agree with, hence my application for the US.

Edit: regarding getting back to Ireland, I've no idea how that will pan out. The J1 visa for training lasts 7 years once you stay in a training position. When you enter on a J1 training visa you agree to return home for 2 years on completion of training. If you want to stay, the possibility of that depends on your specialty. Generally, internal medicine doctors are in short supply and there's plenty of areas who will sponsor you to stay. If you subspecialised in high-altitude haemorrhoid surgery, not so much. There are plenty of other ways to get the home requirement waived, but working in an under served area is the easiest.

Russellynx

Biologic wrote: »

I just matched to my first choice of residency programme in the US, straight out of medical school. I interviewed at some of the top programmes there, including Ivy League schools, and was well received. I'm not saying this to inflate my own ego, just to let people reading this know that what you have said about the US is largely false. I do agree that you can't just waltz over there. It's a LOT of hard work and expense to get a strong application, but is definitely possible and the situation isn't nearly as pessimistic as you're stating.
The rest of what you've said I completely agree with, hence my application for the US.

Edit: regarding getting back to Ireland, I've no idea how that will pan out. The J1 visa for training lasts 7 years once you stay in a training position. When you enter on a J1 training visa you agree to return home for 2 years on completion of training. If you want to stay, the possibility of that depends on your specialty. Generally, internal medicine doctors are in short supply and there's plenty of areas who will sponsor you to stay. If you subspecialised in high-altitude haemorrhoid surgery, not so much. There are plenty of other ways to get the home requirement waived, but working in an under served area is the easiest.

not doing intern year? hope the arse doesn't fall out of your residency at any point or you certainly will have problems getting back

Biologic

Russellynx wrote: »

not doing intern year? hope the arse doesn't fall out of your residency at any point or you certainly will have problems getting back

Cheers.

goldencrisp62

Russellynx wrote: »

not doing intern year? hope the arse doesn't fall out of your residency at any point or you certainly will have problems getting back

you sound like a very very bitter man Russell, perhaps sour because you didn't do so well in your own USMLEs?

Biologic has given great advice and tips on this site for those of us hoping to head over the pond and there's no need to be a little green in the face. We are all here for the same reason at the end of the day.

Biologic

goldencrisp62 wrote: »

you sound like a very very bitter man Russell

+1. Very bitter and very wrong. I can apply for intern year next year if "the arse falls out" of my residency.

Russellynx

I actually got a good step one but didn't get any electives in the us so I don't feel confident ill match anywhere except somewhere worse than Ireland. However, residency is a four year contract and intern has to be completed within 2 years of graduation, so in year 3 of your so called dream job and things implode you can't come back very easily. Just saying, however your reaction formation is noted.

ProfessorPlum

Russell, a bit of advice. It's hard enough to survive in the job when you're optimistic. That bitterness is going to eat you up. And I don't mean just your reply to Biologic, it's evident in all your posts on this thread. You've got to get over yourself or it won't end well.

Russellynx

On the contrary.

I wonder which one of us has the more mature defence mechanism. I am merely being realistic, and trying to iron out the naive wishful thinking. We've all accepted our fate here, and are all trying to skirt around it. You can suppress the negativity or sublimate it into positive thinking but reality doesn't change.

From my observations, how this entire machine works (the health system) seems to be based on the resilience of the NCHDs. In my opinion, there is emerging evidence that will soon be well accepted that this resilience is disintegrating as the profiles of people in the job change in congruence to generation change.

Only a tiny minority of people in their 20s in this country within medicine are going to have what it takes to get to the top. The vast majority are just going to leave or settle for GP. We'll see better organised GPs with modern facilities and 4-5 GPs working together and people will be making 100k not 200k in that profession. Not bad money but not top top money.

Those Graduate entry people will fit this profile superbly. Essentially they'll realise that the gravy train is gone and it's all about getting a practice together and having the balance.

Bitterness is important, it's only the caustic soda that gets the drains clean.

Biologic

Russellynx wrote: »

I actually got a good step one but didn't get any electives in the us so I don't feel confident ill match anywhere except somewhere worse than Ireland. However, residency is a four year contract and intern has to be completed within 2 years of graduation, so in year 3 of your so called dream job and things implode you can't come back very easily. Just saying, however your reaction formation is noted.

Wrong again, residency is 3 years. And I don't know where all this talk of defense mechanisms is coming from. You created an issue about residency going bad when it's not a big consideration. Given the situation in Ireland, and what has been said so far (including by you), it seems much more likely that I'll leave medicine if I stay here. It looks like you're bitterly looking for negatives. The chance of me completing the first 2 (hardest) years and then leaving in the third is minuscule. I'm more worried about getting hit by a car. I'm being very realistic about my future in medicine, and that realism is largely what led me to emigrate.

Now I'm incredibly excited about starting training in a few months and am much more optimistic about my future in hospital medicine than I was a year ago. Interviewing in good US programmes was a breath of fresh air. The programmes are largely run by dedicated educators with ample scheduled teaching time, loads of support staff, a prescribed curriculum, a definite end point, and genuinely happy trainees. This isn't "naivety and wishful thinking", it's reality.

Also, I don't buy the whole "I didn't get any electives" line. They're not randomly assigned, you apply for them. Everyone in my class got all the electives they needed. If you "didn't get" any, it's because you didn't make time for them. Since we're talking defense mechanisms, that's rationalisation on your part, a neurotic one.

Anyway, I'm out. This is leading to a pointless back and forth, and most of my responses will be along these lines. I understand your concern about not being registered in Ireland, but in my opinion it's a tiny price to pay for better conditions. If anyone has any questions about applying to the US I'd be genuinely happy to help.

Russellynx

Biologic wrote: »

Wrong again, residency is 3 years. And I don't know where all this talk of defense mechanisms is coming from. You created an issue about residency going bad when it's not a big consideration. Given the situation in Ireland, and what has been said so far (including by you), it seems much more likely that I'll leave medicine if I stay here. It looks like you're bitterly looking for negatives. The chance of me completing the first 2 (hardest) years and then leaving in the third is minuscule. I'm more worried about getting hit by a car. I'm being very realistic about my future in medicine, and that realism is largely what led me to emigrate.

Now I'm incredibly excited about starting training in a few months and am much more optimistic about my future in hospital medicine than I was a year ago. Interviewing in good US programmes was a breath of fresh air. The programmes are largely run by dedicated educators with ample scheduled teaching time, loads of support staff, a prescribed curriculum, a definite end point, and genuinely happy trainees. This isn't "naivety and wishful thinking", it's reality.

Also, I don't buy the whole "I didn't get any electives" line. They're not randomly assigned, you apply for them. Everyone in my class got all the electives they needed. If you "didn't get" any, it's because you didn't make time for them. Since we're talking defense mechanisms, that's rationalisation on your part, a neurotic one.

Anyway, I'm out. This is leading to a pointless back and forth, and most of my responses will be along these lines. I understand your concern about not being registered in Ireland, but in my opinion it's a tiny price to pay for better conditions. If anyone has any questions about applying to the US I'd be genuinely happy to help.

see ya in 10 years, see who is working for whom.

Nonoperational

I personally couldn't go through college and risk not being able to be registered back here, but good luck in your career. Very exciting times ahead of you!

Biologic

Nonoperational wrote: »

I personally couldn't go through college and risk not being able to be registered back here, but good luck in your career. Very exciting times ahead of you!

Yeah that's the only scary part, if people intend to come back. Thanks for the well wishes.

Ryder

Biologic wrote: »

Yeah that's the only scary part, if people intend to come back. Thanks for the well wishes.

where did you match?

Biologic

Ryder wrote: »

where did you match?

Sorry, saying that would make me instantly identifiable by name cos I'm the only non-American to match there. It's really not relevant though. If anyone wants help building a competitive application I really would love to help.

pc11

Russellynx wrote: »

On the contrary.

I wonder which one of us has the more mature defence mechanism. I am merely being realistic, and trying to iron out the naive wishful thinking. We've all accepted our fate here, and are all trying to skirt around it. You can suppress the negativity or sublimate it into positive thinking but reality doesn't change.

From my observations, how this entire machine works (the health system) seems to be based on the resilience of the NCHDs. In my opinion, there is emerging evidence that will soon be well accepted that this resilience is disintegrating as the profiles of people in the job change in congruence to generation change.

Only a tiny minority of people in their 20s in this country within medicine are going to have what it takes to get to the top. The vast majority are just going to leave or settle for GP. We'll see better organised GPs with modern facilities and 4-5 GPs working together and people will be making 100k not 200k in that profession. Not bad money but not top top money.

Those Graduate entry people will fit this profile superbly. Essentially they'll realise that the gravy train is gone and it's all about getting a practice together and having the balance.

Bitterness is important, it's only the caustic soda that gets the drains clean.

GEP here. I would actually be fine with ending up in GP in a well-organised practice with decent life balance and earning 100K so I'm not too clear why this would be bad?

I agree that the NCHDs are being stretched intolerably. It's simply wrong.

Being older I have much less time to build a career and repay debt.

etymon

Oh God.. don't feed the troll lads. PS Biologic isn't the only non-American in our class to match. Well done lads! Amazing job. I don't think they'll be crying into their cappuccinos in ten years' time somehow.
I'm thinking of doing Psych so I don't think the misery of SHO and reg years is going to be quite as applicable… I hope not anyhow. Still delighted I went back to do medicine. Love it.

Russellynx

trust the lawyer to go into a branch of pseudo medicine. sure why didn't you just do chiropractor instead? or become a coroner. actually it makes sense, coffee breaks, MDT nonsense, read the irish times, go to a tribunal, add 20mg of this or that, refuse to treat a patient because she is from the wrong side of the road all kinds of stuff attempted lawyers would find attractive.