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Personal Views

Reflections from the other side of the pond

BMJ 1995; 310 doi: (Published 18 March 1995) Cite this as: BMJ 1995;310:745

I decided to move to the United States after completing my houseman's year because of the low morale of junior doctors, the severity of postgraduate examinations, and by the overall poor career prospects. The fact that I had dual nationality made the decision simple. It has now been 18 months since I started my internal medicine residency and I wonder whether the decision was the right one for me.

Firstly, postgraduate training in the US is much more structured than in Britain. For example, in internal medicine residents or junior doctors are enrolled in a three year programme, during which they rotate through various departments, such as the coronary care unit, intensive care unit, general medical wards, and outpatient clinics. There are elective months when residents can choose a particular rotation. At the end of the three years they are able to go out and practise as a primary care internist or to enter a fellowship and train as a specialist. It certainly gives me a sense of security knowing that I have employment for three years. I did not get this impression in Britain where junior doctors have to apply for jobs each year and move all over Britain. Here junior doctors know that they will reach the equivalent of consultant at the end of their …

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