Is It Better to Be a Doctor in the US or the UK?
In this post, we discuss if it is better to be a doctor in the US or the UK. The answer may just surprise you!
There is no way to answer this question as it is entirely subjective. The best country to live in is based on multiple factors including salary, culture, healthcare system and general lifestyle differences between the countries.
Here is a brief comparison between the countries:
US: paid more, less free time, more opportunities.
UK: paid less, less paperwork, more free time, long training.
The similarities between the UK and the American system are greater than the differences.
The training received by both systems is world-class, resulting in doctors that put the patient first and cutting edge healthcare technology.
Both countries can also offer excellent quality of life, where if you are well off, a lavish lifestyle is entirely within reach.
In the US, you have to do a 4-year undergraduate degree before applying to medical school.
Medical school itself is a four-year degree which is broken up into two years of core science classes followed by two years of clerkships (aka clinical rotations).
- First two years: Core science classes in the first two years break the body down into systems (e.g. cardiac, respiratory) helping them prepare for their clerkships. The classes are taught via a mixture of lectures and lab work.
- Third-year: Then, students spend their third year of medical school in a series of clinical rotations. Some schools allow students flexibility in choosing which clinicals they will pursue, while some schools dictate most of the placements, only allowing students to choose one or two additional subjects.
- Fourth-year: After students have completed the required clerkships in their third year, they often choose an elective to go on in their fourth years. This is where they self-organise a placement in a speciality that they are interested in going into.
UK medical schools do not require a degree to be taken beforehand. However, for those that are unable to get into medical school the first time around, there is still the option of taking a degree first and then applying for medical school later.
The curriculum is similar to that of US medical schools except that it is stretched over 5 years.
- First two years: Mainly lectures and labs, covering the core sciences. Some schools have early patient exposure in the form of GP (family medicine) placements.
- Last three years: Three years of clinical placements, initially covering all the core specialities like cardiology and respiratory and then branching out into more sub-specialities like ophthalmology in later years.
The freedom that US medical schools give students in clinical rotations is not available in UK schools. US schools have to account for the fact that students will be deciding on a speciality as soon as they graduate, while UK medical schools understand that as FY1s (first-year doctors in the UK), they will have to go into a wide range of specialities.
This is because UK doctors don’t specialise until they have completed at least two years of being a junior doctor.
Because UK medicine is an undergraduate degree, students have the option of taking an iBSc (intercalated bachelor of science) at some point in their schooling.
An iBSc is a one-year degree that students can take to broaden their view of medicine. Some schools make it compulsory, while others make it optional. Subjects that can be chosen include pharmacology, biomedical engineering and business.
In their final year, students can also decide to go on an elective, which is typically in a developing country where the healthcare system is less structured, helping students experience how medicine is different across the world.
In the US, at the end of your undergraduate degree, you have to take the MCAT.
The MCAT is a gruelling 7 and a half hour exam that tests students abilities in chemistry, biology and physics as well as testing critical analysis and reasoning skills. It includes 230 questions and for most students is the longest exam they have ever taken.
Then, throughout medical school, students have to sit the infamous USMLE exams.
USMLE Step 1 (the first USMLE exam) is taken at the end of second year. It covers all the topic covered in the first two years of medical school.
Step 1 has recently been changed to a pass/fail model to reduce the emphasis that has been placed on the exam in recent years. Whether this will work to will just shift the focus onto Step 2 remains to be seen.
In your fourth and final year of medical school, you take the Step 2 CK and CS exams which cover the clinical material covered in the last two years.
Finally, after completing one year of residency (the internship) USMLE Step 3 is taken.
The exams are slightly easier in the UK (but undoubtedly still difficult).
At the end of each year, most medical schools have end of year exams. These exams cover the years content either in the form of essays or multiple-choice questions. There are only a few medical schools that still use essays as a primary way of examining students (e.g. Cambridge).
The exams are usually pass/fail and are based on lectures, which means as long as you know everything on the exam you should be fine.
In the final year of school, there tend to be three exams students need to take:
- SJT (situational judgement test) – ethical based questions
- PSA (prescribing safety assessment) – tests the prescription-making ability of students
- Final year exams – covers all clinical content that is needed to graduate as a doctor in the UK
There is no national exam board as of yet like the US’s USMLE (although the UKMLA sees to change that) which means all the exams are set internally by each University. They are regulated by the GMC to ensure some standardisation.
Time to Become a Doctor
The time taken to become a doctor is important to consider.
In the US, it can take between 10 and 13 years to become a fully qualified doctor (the time taken to just become a doctor is only eight years). This is similar to the UK.
In the UK, it can take between 10 and 14 years to become a fully qualified consultant. After graduation, you have to do foundation year training and then registrar training which can take more than nine years in total. Therefore the postgraduate training is much longer in the UK.
In the UK, it is also typical to take time out to boost your CV (resume). This is because consultant posts are very competitive, especially in big cities like London. Therefore, the time to be a doctor maybe even longer than 14 years.
If you are thinking of moving to the US from the UK though, these times will be different. This is because the US only requires 4 years of training after graduating to qualify while the UK requires over 9 years of training after graduating to become a fully qualified doctor.
Therefore, if moving from the UK to the US, you should consider how much quicker it would be to move to the US.
If you are considering this move, consider checking out this excellent course by liberty medics which takes you step-by-step through the process of getting into a US residency program as an international student/doctor.
I went to their course in real life and it was truly one of the best I have ever been to and this online course proves to be just as good if not better.
Disclaimer: This is an affiliate link meaning I get a small commission for every sale. Therefore if you want to support revising rubies, check out the course. That’s all I ask.
In summary here is the time taken to be a doctor:
- US: 4 years undergrad + 4 years medical school + 4 years residency = 12 years
- UK: 5 years medical school + 2 years foundation years + 7 years registrar training = 14 years
Quality of Education
The quality of education is similar in both countries.
The medical school education is very similar. Most of the learning is self-directed and involves a large amount of google searching.
Therefore the training itself is comparable.
It could be argued that because the US exams are a big factor in future career decision, the emphasis on learning and studying for exams is much greater. This could result in students being more knowledgable doctors, however, whether this has any impact on patient care remains to be seen.
The other thing to consider is how postgraduate training in the UK results in doctors being much more well rounded. This is because you have to do a total of 6 rotations in your foundation years (3 per year) all in different specialities.
These rotations help doctors intimately understand different specialities, something which US doctors cannot say.
However, it also needs to be said that speciality training is possible better in the US. That is because you have to apply for a specific program. The program then accepts you.
This means each program has an incentive to ensure you get the best training possible because they have personally hired you.
In the UK, it is all done nationally, and there is no such feeling of responsibility that hospitals feel to ensure adequate training. This can result in some hospitals not giving training an adequate time that is needed.
US doctors earn more.
Attendings in the US earn roughly double compared to consultants in the UK.
To see a detailed breakdown of the difference between US and UK doctor salary, see this blog post.
However, here is a quick comparison of the two countries and the pay the doctors get:
|US ($)||UK (£)|
Quick Comparison of US and UK Doctors Salary
The working hours of doctors are known for being tough.
However, it depends on the country you work in.
In the UK, junior doctors average 45 hours of work time every week. This is only slightly more than a typical 9-5 job.
There are occasions where the shifts are particularly long (e.g. 13-hour shifts do happen), but when these happen they are always followed by a break allowing doctors to appropriately relax.
Doctors in the US on the other hand can work a lot more than 45 hours a week. Their average can be upwards of 55 hours a week.
Guidelines set out by the Accreditation Council for Graduate Medical Education state that residents are allowed to work a maximum of 80 hours a week.
Most of the time residents don’t reach that 80-hour maximum, however, there are occasions where it does happen. 40% of this work is not direct patient care but more administrative tasks like doing paperwork.
Because the number of hours worked a week is higher in America, the quality of sleep and therefore the quality of life can be slightly worse than the UK, especially for doctors who are still in training.
In one survey, 20% of residents reported they slept an average of 5 hours or less per night.
Junior doctors in the USA work twice as much per week as they do in the UK.
UK: 40 to 50 hours per week.
USA: 50 to 60 hours per week.
It is important to note though that once doctors become fully qualified, the hours can be very flexible. Both in the US and UK, doctors can work part-time if they like or work extra hours if they need to pay bills.
The longest working weeks are certainly when doctors are training, regardless of the country.
There are a lot of UK doctors who lament at the restrictions of working in the NHS.
This tends to be in terms of facilities, equipment and working conditions.
I remember when doing work experience I was shadowing an ENT consultant. He advised me against applying to medicine, saying how if he was to apply again now, he would choose a different career path.
The NHS is a wonderful service that provides free healthcare to anyone who needs it, however, it does have its shortcomings, especially when compared to the US system.
For example, it is common for doctors to complain of cuts in budgets resulting in patients not getting the care they need. Another complaint is that the technology that glues the NHS together in the form of computers and applications are old and slow.
There are even hospitals that are still using paper notes for their patients.
The US system on the other hand doesn’t have the same complaints.
Rather they tend to complain about the insane cost of health and malpractice insurance as well as the cost of their own and families education (they may have loans of there own they need to pay off or have kids that go expensive schools – not the biggest complaint in my opinion especially if you are earning $300K or more).
Lifestyle is one of those things which is one of the most important to consider if deciding between the two countries.
However, unfortunately, it is one of the most subjective and varied, even within a single country.
It is also closely linked to the amount of money you make, although not always.
For example, in London, a good doctors salary might be able to result in an average single bedroom apartment, while that same salary in Scotland would result in a house with great views of the country.
The same applies in the US if you compare cities like New York and Idaho.
One thing that you could also consider is the crime.
Crime rates in both countries are lower than undeveloped countries, however, the US tends to have higher crime rates than the UK overall.
This combined with the level of gun tolerance the US has, it might be slightly safer to live in the UK. But, you also have to consider that the US is a huge place that has good areas and bad areas just like every other country.
Therefore if you are smart and live a decent life, you will probably never encounter any serious crime.
In the UK you also get longer paid leave and maternity leave, an important consideration for those wanting to start a family.
As you can see, lifestyle is a difficult topic to discuss in the broad sense of the word and it is something you will need to decide for yourself which is better.
It is your choice where you want to go.
Both countries offer excellent training and lifestyle options, however, there are clearly advantages and disadvantages of both.
For example, US doctors get paid more but have to pay for healthcare and malpractice insurance, and UK doctors don’t get paid as much but have lower University fees and better services like healthcare and public transport.
If you are considering a move to the US, consider checking out this course by liberty medics which takes you step-by-step through the process of getting into a US residency program as an international student/doctor.
Disclaimer: This is an affiliate link meaning I get a small commission for every sale.