Medical Training UK vs Ireland.

KildareKing

Hi everyone,

I'm a 4th year medical student, Im looking for advice regarding on where i should start my training. Applications for intern posts in Ireland start next year and applications for the foundation programme in the NHS start this summer. I look around me in the wards and where im doing my rotations and it seems like all the young consultants around me have trained abroad.

Everyone seems to be giving out about the HSE. Is training with NHS better, more organised etc? Is there any point in doing intern year Ireland, if in the future, if I want a consultant job, id have to leave the country. I also don't mind living in the UK, if it means that pay/working conditions are better.

Any insight regarding this matter will be greatly appreciated.

Dingle_berry

I don't know about the actual training in the HSE or NHS but the NHS is a different beast. It's a lot bigger, organised differently, more focused on cost reduction. The NHS also utilises allied healthcare professionals more and has professions that the HSE doesn't have yet (surgeons assistant, physician assistant, clinical scientists, etc). That COULD translate into consultants having more time to teach you and you having more time to learn (and more people to learn from).

Arbie

KildareKing wrote: »

I look around me in the wards and where im doing my rotations and it seems like all the young consultants around me have trained abroad.

Most consultants in Irish hospitals are probably still Irish-trained, but many will have mixed training, e.g. BST in Ireland, HST in UK. I have several friends who went after BST and a couple who went after intern year. I think only 2 went directly from college.

KildareKing wrote: »

Everyone seems to be giving out about the HSE. Is training with NHS better, more organised etc?

It depends on the specialty, but in general training in the UK is more organised and more formalised. The benefit of this is that you know where you stand, you know how much time you have to go, you are given clear targets for each year (e.g. perform X number of Y procedure), and the royal colleges have more rigorous mentoring and supervision standards. It can depend on the deanery and the specialty but I think they support struggling trainees better, tend to intervene earlier, and the hierarchy is flatter. I worked in the UK for a while and I did prefer their approach. I liked being able to call the consultant by their first name, sounds like a small thing but it makes it easier to gel as a team.

A downside of the UK is that they tend to be stricter when it comes to exams, annual leave, extenuating circumstances, targets have to be met, NICE guidelines are expected to be followed, etc. Not necessarily bad things, but it can seem a bit rigid. Consultants in Ireland still have quite a lot of influence on medical manpower and the training bodies, but in the UK it is more top-down, with more decisions made by policies/rules decided by the college/deanery and there is less local discretion. Overall, I think that it's fairer, but others have told me it feels stifling.

There have been some recent articles in the Guardian on staffing and training issues: https://www.theguardian.com/society/2017/apr/14/night-cover-is-almost-always-short-staffed-its-terrifying-doctors-on-rota-gaps

KildareKing wrote: »

Is there any point in doing intern year Ireland, if in the future, if I want a consultant job, id have to leave the country.

A major benefit of intern year in Ireland vs. UK is that it's just 1 year here versus a 2-year foundation programme in the UK.

If you do your intern year in Ireland you have the opportunity to work across different hospitals, meet different consultants/NCHDs, impress people, gather references, go to Irish conferences, network, etc. which can be of benefit if you intend to return to Ireland later in your career.

That said, if you do intern year here and then intend to apply to the UK for specialty training (ST) then you have had only 1 year of clinical time to prepare and you are competing against people who have had 2 years working in places that support their preparation and building portfolios which are targeted at the UK ST schemes.

Depending on the specialty, it may be better to do BST in Ireland and then go to UK. Any of my friends who did this ranked very highly and later got good consultant posts.

KildareKing wrote: »

I also don't mind living in the UK, if it means that pay/working conditions are better.

Pay is generally better in Ireland, both basic and overtime. Working conditions are generally better in the UK - obviously this can vary, but I have many friends working in the UK and every single one says their working conditions are better there - but bear in mind that they were coming from a crappy Irish system here which has improved in some ways since so it's quite subjective. We were working 100+ hours per week, 30+ hours on call with little sleep, regularly denied leave, etc. While we don't have full EWTD in Ireland yet, it's probably a better experience now, particularly for interns.

A big complaint my friends in the UK have is that many of the consultants in UK hospitals are relatively junior/inexperienced compared to Irish consultants. I worked in a unit in Ireland where every single consultant had at least 1 fellowship from a prestigious hospital abroad (Harvard/Oxford level), some consultants had 2 fellowships, and 1 consultant had done 3!! In Ireland we tend to have higher concentrations of very experienced, fellowship-trained consultants. In the UK they have run-through/streamlined schemes, and fewer consultants go on to fellowships. They also have a lot of staff grade/middle grade. So you may be in a unit with less experienced consultants. My friends have found it difficult to deal with sometimes - for example 1 reg I know has done almost double the number of surgical procedures as his consultant who is supposed to be training him, which he finds both awkward and frustrating.

Do you have a particular specialty in mind? People may be able to advise you better then as there are some things that vary greatly depending on specialty.

Anita Blow

Just to complement the above, I have some friends completing the Foundation Programme in the UK (NI specifically) now and anecdotally only from their experiences, Ireland comes out better in terms of working conditions.

They've had extremely excessive overtime (95 hours and more in a single week) with no overtime pay as such (there is no overtime pay, instead your rotation is 'banded' and you receive X% extra of your salary per month but essentially means you could be working any amount of overtime for that extra %)

Their rotas have been very difficult. One friend in Gen Med regularly worked 14-20 days in a row with no break and had one week where he worked 14 days in a row with 3 28 hour shifts in there and the remainder 9-5s with no day off in between.

Obviously their experience isn't indicative of the FP as a whole and absolutely there's a lot of positives, but it certainly swayed myself who had been thinking of doing it instead of intern year here.