Medical Training in UK or Ireland - future prospects?

bluewall

Like many people I'm about to take the GAMSAT next week. Ideally I would like to study grad med here in Ireland, but like many people I have also applied to the UK (for a mix of 4 year and 5 year medical courses) to try to maximize my opportunities.

In the highly theoretical scenario where I was lucky enough to gain places in both a medical school here in Ireland AND one in the UK, I am trying to figure out which would be better to choose in the long term.

Ideally I would prefer to train in Ireland and eventually work here. I gather that if I studied in the UK I would be obliged to do all of my post-grad medical training and specialisation over there (because it is too difficult to gain a place on the post-grad medical training programmes in Ireland coming straight from medical school in the UK) which means I could be committing around 10 years of my future to living in the UK including the initial 4 years at med school.

Basically what I am getting at here is that I would like to hear anyone's opinion on what they would prefer between studying in Ireland vs UK - bear in mind, it's not the actual study bit I'm worried about, but more so the career opportunities that occur thereafter..

If I eventually want to work as a doctor in Ireland, am I just better off getting into the system straight from medical school here? I would really like to avoid spending another 10 years in the UK if at all possible as I have already spent 6 years there studying and working.

On the other side, I have noticed a few doctors here on boards recently complaining that once they have done all of their SpR training in Ireland that they become unemployable because of lack of jobs. Is that really true generally speaking and if that is the case, am I stupid trying to plan my medical career that far in advance if there's a decent chance that I might not be able to practice here at the end of my training in any case!!??

I'm not asking anyone to look into a crystal ball here and make predictions, but I would like to hear from anyone with an informed opinion on the training opportunities and potential for reaching your desired career path in medicine via either an Irish medical school or one in the UK

Sorry for the long post here, and I hope it all makes sense! Cheers in advance for anyone who gives their opinion.

Susie-O-

Best of luck with the GAMSAT, i hope it goes well! I'm currently a 5th (of 6) year medical student here in Ireland, and I was recently at a 'So you want to be a Surgeon' talk in RCSI. Almost all of the SpRs from a wide variety of specialties said that doing your training here gives you a huge advantage when it comes to getting jobs/promotions - and also, which might be of help in you making your choice, there are a lot of consultants, both surgeons and physicians, who will be retiring in the next 10-15 years, thus opening up a lot of places for trainees...and several higher training schemes will be offering more places over the next few years to fill these gaps. There will also be more new consultancy posts! The short answer is, as far as I can gather, if you train here, you'll probably get work here, and can also go back to the UK, but if you train in the UK, you'll need to be damn impressive to get back here before SpR level! Hope that helps!

docbroc

If you got a place in the UK you would be better off taking it and staying put (assuming other commitments dont draw you back). Next year 600+ Irish medical students will graduate. This is >100% more than there are jobs available. The HSE is committed to increasing the number of consultancy posts indeed, however this is supposed to be at the expense of junior doctor positions. In other words - if they make room at the top, there is less room at the bottom. This means less training schemes and fiercer competition to get on the schemes. SPR's cost a lot of money for the HSE. They are limiting their numbers every year.

I have recently interviewed for a consultancy post. There were 35 fully qualified applicants for a single post in a single speciality. This is the only post that has come up in this speciality in the last 3 years. The next time a post comes up there will be 45 fully qualified applicants for it. This is one of the commonest specialities in the country. Plus it was was for a country hospital in the south west. The post went to someone who had done all their training in France.

The surgeons are lying to people like Susie because they are absolutely desperate for junior staff. They are in the process of changing basic surgical training to 3 years because of the staff shortage. 3 years of retractor-holding for 90 hours a week (imagine!) A few of my classmates have acheieved their exit exams in surgery. While its true there is less competiton for surgical places, not one of them is employed either. They get the odd locum job but thats about it.

My longwinded point is that you are better off staying put, even if you eventually want to work in Ireland. There are far more oppertunities and far far better training in the UK. Plus when you return you will be given more credit than people who have trained in Ireland. Also the lifestyle is much better (Ive worked in England) and your allowed to have a personal life. The NHS isnt perfect but its a damn sight better than the HSE mess.

Susie-O-

I'm fairly sure that SpRs and registrars would gain nothing from 'lying' to us - it was a full and frank discussion in RCSI about the future for medical students, they weren't trying to plug their own specialties or saying anything that they didnt back up with proper facts/evidence....

docbroc

Did they mention the changes to the BST?
The enormous drop out rates ?
The blatant discrimination against female trainees in job allocation ?
That you will have to re-interview each year for a different job ?
The horrors of working in peripheral hospitals ?
What its like to work sat/sun/monday straight ?
Not getting paid overtime ?

Maybe lying is too strong a word. Highly selective truth management under the watchful eye of your consultant would be a more accurate (and verbose!) term

Susie-O-

They actually did mention all of that stuff - they did not paint a pretty picture at all! that's why i'd tend to believe the one or two positive points they did make!

dissed doc

Susie-O- wrote: »

Best of luck with the GAMSAT, i hope it goes well! I'm currently a 5th (of 6) year medical student here in Ireland, and I was recently at a 'So you want to be a Surgeon' talk in RCSI. Almost all of the SpRs from a wide variety of specialties said that doing your training here gives you a huge advantage when it comes to getting jobs/promotions - and also, which might be of help in you making your choice, there are a lot of consultants, both surgeons and physicians, who will be retiring in the next 10-15 years, thus opening up a lot of places for trainees...and several higher training schemes will be offering more places over the next few years to fill these gaps. There will also be more new consultancy posts! The short answer is, as far as I can gather, if you train here, you'll probably get work here, and can also go back to the UK, but if you train in the UK, you'll need to be damn impressive to get back here before SpR level! Hope that helps!

Nonsense. This has been aswered before. Almost all the SpRs may *believe* that it gives a huge advantage, but the fact of the matter is that someone who left and trained in the US to speciality level would be far more likely to get those jobs whenever x, y, z retires, and sooner, than someone who spent 15 years completing SpR in surgery in Ireland.

Person A: residency, fellowship at Mayo Clinic, with a few years working as an Attending consultant

Person B: basic and specialist training in Ballybogland Hospital Of No Particular Importance = ultrafail at interview.

It comes down to publications and research, more than some misled belief in systemic HSE goodwill towards homegrown trainees, who are regularly cast aside for better qualified applicants from abroad.

You will get much better experience, and be a much better candidate if you have UK or US (or EU/Aus/NZ experience). Chances are as well you will be on the specialist register after completing the 6 year ST program in the UK, which is much shorter than the BST+Research+SpR system in Ireland.

It is unlikely there will be any new consultant posts, even if you wanted them, in the HSE. Any new jobs will be in the private sector, or else retirement-replacement posts in the few remaining university hospitals.

EDIT: they may be technically correct, in that you will be better placed to get a year 3 registrar post after finishing year 2. However, when it comes to consultant interviews, all that crap falls by the wayside as there are a tonne of better applicants on the open market incl. UK/EU.

dissed doc

Susie-O- wrote: »

I'm fairly sure that SpRs and registrars would gain nothing from 'lying' to us - it was a full and frank discussion in RCSI about the future for medical students, they weren't trying to plug their own specialties or saying anything that they didnt back up with proper facts/evidence....

RCSI want your money. They want you to commit to surgery training for 3 years so you will give them 3k per year = 9k for training, for e.g., 200? 300? people a year? They can bank on a net income of around 3 million per entry group over a 3 year BST cycle. At the end of it all, most will become GPs anyway.

Susie-O-

Dissed doc, you seem to get very worked up about these things. Just my opinion, I'm only sharing what I've been told.

bluewall

Many thanks for all the replies so far..

So, would it be fair to say the consensus is that if I had the option of med schools, the UK might be the better route to take at this point in time (docbroc and dissed_doc)??

Do you know what type of med you'd like to go into Susie-O? Are you worried at all about your prospects of progressing in the areas you'd like, going on what you know and what some others are saying about their experiences in the current system?

I have no idea at this moment which area I'd like to go into, but I'm just trying to make sure that I make an informed decision which goes beyond medical school - if I am lucky enough to have the choice between graduating into the HSE/NHS system!

Susie-O-

I'm currently interested in gastroenterology, or Intensive care medicine, and since they're both medicine options rather than surgery, I'm probably looking at about ten years before consultancy after I graduate! Since I've no experience of the UK system, I'm only basing my advice on what registrars generally say - if you wanna work here, your best option is to train here! That's all I know! good luck!

tallaght01

Susie-O- wrote: »

I'm probably looking at about ten years before consultancy after I graduate!

Yea, good luck with that!

bluewall

Susie-O- wrote: »

I'm currently interested in gastroenterology, or Intensive care medicine, and since they're both medicine options rather than surgery, I'm probably looking at about ten years before consultancy after I graduate! Since I've no experience of the UK system, I'm only basing my advice on what registrars generally say - if you wanna work here, your best option is to train here! That's all I know! good luck!

Thanks for your help anyway and best of luck with it yourself!

While we're on the topic.. an uncle of mine is a consultant gastroenterologist in one of the Dublin hospitals. In order for him to become a consultant in Dublin he had to move to the UK for 10 years to work/specialise and ultimately wait for a post to become available. I suppose that's par for the course these days!

dissed doc

Susie-O- wrote: »

Dissed doc, you seem to get very worked up about these things. Just my opinion, I'm only sharing what I've been told.

Not worked up, but you need a reality check.

In the past 30 years there have been around 13-15 thousand medical graduates from all universities in Ireland.30 years is usally the professional workign life of a consultant.

There are 1300 consultants in Ireland today.

Look around your medical school class. 9 out of every 10 medical students will NEVER be a consultant in Ireland.

Susie-O-

I just feel like there are a lot of people being quite cynical and bitter about the situation for medical graduates, and I think it's bad to give off this impression to prospective students! I'd much rather be optimistic!

RobFowl

Susie-O- wrote: »

I just feel like there are a lot of people being quite cynical and bitter about the situation for medical graduates, and I think it's bad to give off this impression to prospective students! I'd much rather be optimistic!

It's fairly grim at the moment Susie.
GP's are finishing their training and there are almost no vacancies so short term work or non at all is the norm.
NCHD posts are being cut and even still the conditions are so bad they cannot fill all the vacancies.
The new consultants contract is being implemented in piecemeal fashion and the HSE in particular seems to be at war with medics in general.
Maybe things will be different in 5-10 years but TBH if I wasn't in masses of debt from setting up a practice I'd almost certainly be off to the UK (and might yet anyway if the HSE CEO's plan to scrap all GP's contracts remains policy).

Jane5

Susie-O- wrote: »

I just feel like there are a lot of people being quite cynical and bitter about the situation for medical graduates, and I think it's bad to give off this impression to prospective students! I'd much rather be optimistic!

Susie, why would someone be "optimistic" for the sake of it? That's silly.

The one duty I feel I owe to prospective students is this: to warn them not to do medicine. At all.

Do something else. Anything else. Especially if you are as set on staying in Ireland as the OP seems to be. The conditions are horrendous, and set to worsen. The pay is not all that. The prospects for advancement are minimal at best. You are expected to give up your sleep, self care, family, hobbies, everything. If you are a woman, give up the idea of having children. Now. No job security. Whatsoever. Treated like dirt. People I know have collapsed from exhaustion, died in car crashes after illegal shift lengths.

If you are that hung up on working in healthcare, and can get the points-do Speech and Language therapy, Occupational therapy, Pharmacy even-yes there has been some upheaval recently but still worthwhile. The working conditions are not even comparable to medicine, they are so vastly superior. Job security-much much better. Pay much better-most doctors will not make consultant level and hence will not achieve six figure pay levels.

If you want a good job, not too hung on healthcare, be a teacher, still very satisfying and good quality of life.

If you love science and biology, medical scientist/laboratory technician very good, guaranteed work, excellent pay and decent conditions.

RUN away from medicine. I wish someone had been honest with us when we started out. You can incur a lot of debt on the way that traps you in your NCHD role. Don't do that. This is my honest advice to you. I would never try and blow sunshine up anyone's ass for the sake of it. Med is not a good choice in Ireland.

Svalbard

UK, ftw.

Better medical education and post graduate training. Chances are you may end up going there for specialist training at some point so you might as well just start off in the system and plum for run-through training. It will be faster, the training will be better and you will be more likely to get a job - here, in the UK or elsewhere.

The one possible exception is GP training - you may be marginally better off to do that here, but that is by no means certain and there are plenty of UK trained GPs working in Ireland (as we are not training nearly enough currently).

Susie-O is wrong. She is not being optimistic, she's delusional.

bluewall

Jesus... I never thought when I started this thread I would be met with such depressing replies.

I'm already a healthcare professional, so a move to medicine is something I'm 100% about. I'm certainly not against going back to the UK, I'd just rather avoid it if possible. I have a place on hold in a med school there.

So I gather that the only plausible route at the moment (in the Irish system) would be perhaps to train as a GP? I have no doubt some one will jump out of the wood work now and say that training to be a GP/future prospects as a GP in Ireland are no use either!!

If there's anything else that any of you want to get off your chests with regard to a future career in medicine please don't hold back now.. forewarned is forearmed!!

docbroc

I think DocDanekas post sums up most of it.

Breezer

bluewall wrote: »

So I gather that the only plausible route at the moment (in the Irish system) would be perhaps to train as a GP? I have no doubt some one will jump out of the wood work now and say that training to be a GP/future prospects as a GP in Ireland are no use either!!

RobFowl wrote: »

GP's are finishing their training and there are almost no vacancies so short term work or non at all is the norm.

Actually this is something I'd be very curious about. I'll be finishing up my undergraduate training soon and my aim is to be a GP. From what I've heard and read, the current shortage of GPs in Ireland is only going to get far worse over the next decade or so, and steps (small ones, admittedly) are being taken to address this, the increased number of training places next year being a start.

So what exactly do you mean when you say there are no vacancies, RobFowl? It just seems counterintuitive. Go on, depress me, I'm able for it

Susie-O-

This has gotten ridiculous! Bluewall, I'm sorry you're getting such negative responses! I could tell you at least twenty registrars to talk to who are really positive about their current jobs, and their future careers, and I'm not exaggerating at all - send me a PM if you'd like me to tell you all about the RCSI meeting I was at and exactly what was said.

as far as I can see here, all your getting is doom and gloom from people who don't seem to be in medicine for the right reasons anyway....

It's really wrong and unfair to make the profession seem so terrible to someone who is clearly very interested in this as a career. The bottom line is, nobody knows how things would be by the time bluewall is finished internship. So stop being such miserable gits!

RobFowl

Breezer wrote: »

So what exactly do you mean when you say there are no vacancies, RobFowl? It just seems counterintuitive. Go on, depress me, I'm able for it

Most GP practices are a combination of GMS and private work. All state payments have been cut by 10-15% gross. This has resulted in most practices not being in a position to take new GP's on.

Setting up practice is difficult and costly and access to GMS contracts is quite restrictive for new entrants.

Also non GP trained doctors are allowed work as defacto GP's (although they are not allowed hold GMC contracts). This contrasts with the UK where all doctors working in General Practice are trained GP's.

The plan for the future is based on a cut of about 10% in state funding for Primary care but an increased number of doctors. So more doctors will be around but the total amount of money available for practices will be less. This is a challange to say the least and younger GP's especially are struggling to pay their mortgages etc at the moment.

Breezer

RobFowl wrote: »

Most GP practices are a combination of GMS and private work. All state payments have been cut by 10-15% gross. This has resulted in most practices not being in a position to take new GP's on.

Setting up practice is difficult and costly and access to GMS contracts is quite restrictive for new entrants.

Also non GP trained doctors are allowed work as defacto GP's (although they are not allowed hold GMC contracts). This contrasts with the UK where all doctors working in General Practice are trained GP's.

The plan for the future is based on a cut of about 10% in state funding for Primary care but an increased number of doctors. So more doctors will be around but the total amount of money available for practices will be less. This is a challange to say the least and younger GP's especially are struggling to pay their mortgages etc at the moment.

Oh wonderful :rolleyes:

You seem to be quite knowledgeable on this, would you mind me asking if you're a GP yourself? And also, to bring the focus somewhat back to the Ireland vs UK debate, would you recommend GP training in the UK or in Ireland at the moment, based on those future plans? What about Northern Ireland? And is there anywhere I can go to find out more about this (I don't mean the GP training scheme websites, I mean the situation in general).

RobFowl

Breezer wrote: »

Oh wonderful :rolleyes:

You seem to be quite knowledgeable on this, would you mind me asking if you're a GP yourself? And also, to bring the focus somewhat back to the Ireland vs UK debate, would you recommend GP training in the UK or in Ireland at the moment, based on those future plans? What about Northern Ireland? And is there anywhere I can go to find out more about this (I don't mean the GP training scheme websites, I mean the situation in general).

I'm a GP all right and it is a great career choice (mostly) .

If you can get a training position in ROI it does give you some advantages in getting a substantive post mainly by giving you more contacts and knowlage of the way the Irish system works. That said it's a bit easiler to get a place in GB but quite difficult in NI. The quality of training is much the same just that it is more geared towards the NHS.

The issue with Ireland at present is that NCHD jobs have changed dramatically this year. The present CEO of the HSE has a stated policy of stopping all GP's state contracts and replacing them with a tender process. This is considered absolute nonsense by every GP I know BTW. It's also make it near impossible to run a practice with any semblance of long term planning.

@Susie Just because posters do not agree with your rose tinted vision of the Irish healthcare system does not mean they are in it for the wrong reasons

docbroc

Susie-O- wrote: »

This has gotten ridiculous! Bluewall, I'm sorry you're getting such negative responses! I could tell you at least twenty registrars to talk to who are really positive about their current jobs, and their future careers, and I'm not exaggerating at all - send me a PM if you'd like me to tell you all about the RCSI meeting I was at and exactly what was said.

as far as I can see here, all your getting is doom and gloom from people who don't seem to be in medicine for the right reasons anyway....

It's really wrong and unfair to make the profession seem so terrible to someone who is clearly very interested in this as a career. The bottom line is, nobody knows how things would be by the time bluewall is finished internship. So stop being such miserable gits!

All i can tell you is that I have been 10 years working in the Irish system (apart from a brief fling with the NHS). If you want a real picture of Irish Doctors I'd suggest you attend an IMO meeting instead. I think you would find it extremely informative. I don't think its anyone's intention to do anything other than warn about the all too harsh realities of life in medicine. If I was starting where you are starting today I would not do it over again. I lost a goodly part of my youth to medicine and what I have in return is bugger all. Dont get me wrong, i used to love what I did but the endless work, the total destruction of my personal life, the bullying and hypocrisy - they just kill you. At the end of the day I dont want to let other people down that path without at least the courtesy of a warning. Over the last two years things have seriously deteriorated in Irish hospitals and they are getting worse (Not that they were great to start with). Everyone I know is desperate to get out. I sincerely hope things are different for you Susie but I really doubt it.

PS If you could send me the names of these Registrars I'd be grateful . I have some magic beans to sell

Jane5

Susie
Use your head, love. If you got the points for medicine, I'm sure you can work this one out.

RCSI are privately run to the best of my knowledge. Hence, like all private organisations, they like money. If you want to do a course in RCSI, such as medicine, or pharmacy, it costs the big bucks. If you want to be a surgeon after you finish med school, you pay 3000 euros a year, for three years, just for the SHO part of the training. This is besides all the "mandatory" courses that they make you do and charge you for. The training is you, in a hospital somewhere else, for 100 hours a week, working hours you aren't always paid for, holding retractors and covering A&E for days on end.

So every bright eyed youngster they manage to convert into a surgical SHO makes them a minimum of 9000 euros.

Are you surprised then that they are all positive and upbeat about it all? And all "hey, gang, do it in Ireland!"?

HQvhs

Jane5 wrote: »

Susie
Use your head, love. If you got the points for medicine, I'm sure you can work this one out.

RCSI are privately run to the best of my knowledge. Hence, like all private organisations, they like money. If you want to do a course in RCSI, such as medicine, or pharmacy, it costs the big bucks. If you want to be a surgeon after you finish med school, you pay 3000 euros a year, for three years, just for the SHO part of the training. This is besides all the "mandatory" courses that they make you do and charge you for. The training is you, in a hospital somewhere else, for 100 hours a week, working hours you aren't always paid for, holding retractors and covering A&E for days on end.

So every bright eyed youngster they manage to convert into a surgical SHO makes them a minimum of 9000 euros.

Are you surprised then that they are all positive and upbeat about it all? And all "hey, gang, do it in Ireland!"?

RCSI operates under the free fees scheme, although it is a private college and does not receive state funding.

I was at a similar event to the poster above regarding careers. They didn't paint a very pretty picture of Ireland or the UK. In fact the US and Australia were the most highly recommended.

I don't claim to know many doctors, but the vast majority of those I know spent at least some time training abroad. So I can only imagine that training abroad is beneficial to your career. In my opinion I think that having to go abroad at some point is an inevitability if you want to progress in medicine. Although I could well be wrong!

Susie-O-

Let me clarify, the registrars I spoke to did not go to RCSI, were affiliated to UCD/Trinity, and their associated hospitals, and please, PLEASE don't be so patronising as to call me 'love'. Just because I'm still a student and not jaded and a pessimist doesn't mean you can all rain on my (and all other positive medics who enjoy what they do) parades. I've never seen such negativity! You have one of the greatest jobs ever and all you want to do is whine about it, and stop people who may actually have a vocation for it!

dissed doc

Susie-O- wrote: »

Let me clarify, the registrars I spoke to did not go to RCSI, were affiliated to UCD/Trinity, and their associated hospitals, and please, PLEASE don't be so patronising as to call me 'love'. Just because I'm still a student and not jaded and a pessimist doesn't mean you can all rain on my (and all other positive medics who enjoy what they do) parades. I've never seen such negativity! You have one of the greatest jobs ever and all you want to do is whine about it, and stop people who may actually have a vocation for it!

Vocations are for the samaritans and the priesthood, not for medicine. As a physician, you are meant to always advocate for your patients (ignored when the trolley crisis was described years ago, when suicides were increasing), to always be enhancing your knowledge (but training grant cancelled), to always be pushing for better and better care (as more and more funding is cut for services).

Any of the docs here who have been out in the Irish system for > 5 years know exactly that the system in place and that the opposite is happening. If you are an uncritical thinker, with a "vocation", perhaps you are the ideal punching bag for HSE management. They don't like people who step out of line and think for themselves or demand better for their patients. They want committee-driven tick-box doctors.

As regards specialities: as we are trailing the UK by 10-15 years, it's likely that GP is the best one to get into, and fully private at that. GMS is as good as buried. Per-service and numbers based systems in the UK are workign well. I know of several new GPs who have not bothered with "vocational training" (there is that word again) or GMS, and seem to be doing a lot better, happier patients, and better working life in fully private services.

Susie-O-

dissed doc wrote: »

Vocations are for the samaritans and the priesthood, not for medicine.

Haha, that just proves my point.

Vocation
–noun
1.
a particular occupation, business, or profession; calling.
2.
a strong impulse or inclination to follow a particular activity or career.
3.
a divine call to God's service or to the Christian life.
4.
a function or station in life to which one is called by God: the religious vocation; the vocation of marriage.


So you were half right. But medicine is definitely something that you need to have a calling for, no? And I wonder about all of you who are bitching about the length of time it takes to get to consultancy! so what? You're still a doctor, being paid pretty damn well (admittedly not as well as in times past), doing something you should enjoy and find rewarding. Please stop the attacking, I'm as entitled to my opinion as everyone else.