qasidb
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So I'm in my final year of medicine from Prague and I'm eligible for full registration with the GMC (i.e. eligible to go into FY2). However, compared to UK medical students, I've learned so little so far in my final year (which is supposed to be like my "FY1" year) and I'm just terrified that if I do what my dad says and go into FY2, it's just going to end up being a catastrophe.

My dad says that there's not much difference in responsibility between FY1 and FY2 but is this really true? He is a doctor (GP) himself but he qualified in the 70's so things were, I assume, massively different then.

My intention was to go into FY1 so that I properly learn the basics of how to be a doctor, and then use that as a stepping stone to go into FY2. But surely being in my situation where I know comparatively so little to a UK medical student in their final year where I go straight into FY2 is not a wise move, no? Or does it really not make a big difference at the end of the day?
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iniajayi
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You know what is best for you. If you feel that you do not know enough to enter in FY2 then enter FY1. It will put your mind at ease. There's a video on Youtube where a FY2 is imparting knowledge onto an FY1 and I think it's something you should watch.

Here's the link: https://www.youtube.com/watch?v=GMYlFu4GAsw
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Smile88egc
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Have you worked in the UK NHS before? Many doctors I have worked with that have qualified abroad have not been able to work at the grade they were used to being in their home country as there is such a different in culture and systems, most had to step down to a grade below for at least 3 months, often 6 months before they were able to take on a similar responsibility level.

Remember as an F2 doctor you would be responsible for supervising more junior doctors who are newly qualified also and will need a high level of support to begin with.
The approval of your dad would be little consolation if you were to start your first job and find yourself underprepared.
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qasidb
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(Original post by Smile88egc)
Have you worked in the UK NHS before? Many doctors I have worked with that have qualified abroad have not been able to work at the grade they were used to being in their home country as there is such a different in culture and systems, most had to step down to a grade below for at least 3 months, often 6 months before they were able to take on a similar responsibility level.

Remember as an F2 doctor you would be responsible for supervising more junior doctors who are newly qualified also and will need a high level of support to begin with.
The approval of your dad would be little consolation if you were to start your first job and find yourself underprepared.
Do you mean as in stepping down from FY2 to FY1?

And no, I've never worked in the NHS before.
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Smile88egc
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No most doctors trained abroad that I've worked with have been working at middle grade/registrar level in their home country and have had to step down to tier 1 rotas when they start work in the UK.
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purplefrog
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I would strongly recommend starting off in FY1 as it provides a valuable safety net. As an FY2, as mentioned above, you will be supervising new doctors and be their first port of call for advice. You additionally will have more responsibility such as being able to make decisions surrounding discharge, and sometimes may be the most senior person on for whichever specialty you're posted in. If you're unfamiliar with cultural practices, even if your medicine is on point, this will make it very difficult and can also be a safety issue.
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nexttime
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(Original post by qasidb)
However, compared to UK medical students, I've learned so little so far in my final year...
How can you possibly know this though?

My dad says that there's not much difference in responsibility between FY1 and FY2 but is this really true?
I mean, not really. There definitely is a jump in responsibility. However, I would argue there is no jump at all in terms of knowledge expected. The main difference is that you are superficially more confident, quicker at administrative tasks (how you spend most of FY1) and have more confidence to ask for help when you need it.

...where I go straight into FY2 is not a wise move, no? Or does it really not make a big difference at the end of the day?
I've come across a handful of EU grads who have gone straight to FY2 and they have coped just fine. Statistically though, the drop down/drop out rate for this group is a fair amount higher than UK grads.

There was a case I remember on the first season of 'Help me I'm a junior doctor' - an Italian graduate became an FY2 in A&E. Well it emerged he'd never seen or heard of a neurological exam (its very common to just do a head scan in Europe), so obviously he couldn't continue and became an FY1 instead plus some additional training (note this might not always be possible but it was here).

Personally I would be wanting to skip FY1 if I could - there will definitely be a difficult adjustment and I'd definitely be writing off a month or so to bad times and long hours. But personally I do think if you make it clear to your supervisor and your seniors that just initially you are getting used to things and will need to call more often than normal, but also show a willingness to learn, then you'll get similar support to what an FY1 would get and you'll learn quickly.

Again to emphasise: FY1 is not really about learning medical knowledge. Most of your time is spent scribing for seniors, taking bloods and doing administrative jobs. Some users will disagree but personally I definitely forgot far more than I learned. Plus there is an applicability issue - ok maybe you'll learn something on your paeds/psych/respiratory medicine jobs in FY1, but how much does that help you when you start trauma and orthopedics as an FY2? Those were my actual jobs, in order!

What FY1 definitely will teach you though, is about NHS bureaucracy, working efficiently, time management, and communicating well with seniors. All important skills.

I'd personally go into FY2 but its entirely up to you.

Edit: also bear in mind the cost to you of doing FY1 - it depends on circumstance exactly how much you'd lose but because you get paid less every year from then on its certainly >£20k over the subsequent 10 years. Having to drop out though will of course cost even more.
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Chief Wiggum
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In your situation, I'd prefer to go into F1 first.
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qasidb
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(Original post by nexttime)
I've come across a handful of EU grads who have gone straight to FY2 and they have coped just fine. Statistically though, the drop down/drop out rate for this group is a fair amount higher than UK grads.

There was a case I remember on the first season of 'Help me I'm a junior doctor' - an Italian graduate became an FY2 in A&E. Well it emerged he'd never seen or heard of a neurological exam (its very common to just do a head scan in Europe), so obviously he couldn't continue and became an FY1 instead plus some additional training (note this might not always be possible but it was here).

Personally I would be wanting to skip FY1 if I could - there will definitely be a difficult adjustment and I'd definitely be writing off a month or so to bad times and long hours. But personally I do think if you make it clear to your supervisor and your seniors that just initially you are getting used to things and will need to call more often than normal, but also show a willingness to learn, then you'll get similar support to what an FY1 would get and you'll learn quickly.

Again to emphasise: FY1 is not really about learning medical knowledge. Most of your time is spent scribing for seniors, taking bloods and doing administrative jobs. Some users will disagree but personally I definitely forgot far more than I learned. Plus there is an applicability issue - ok maybe you'll learn something on your paeds/psych/respiratory medicine jobs in FY1, but how much does that help you when you start trauma and orthopedics as an FY2? Those were my actual jobs, in order!

What FY1 definitely will teach you though, is about NHS bureaucracy, working efficiently, time management, and communicating well with seniors. All important skills.

I'd personally go into FY2 but its entirely up to you.

Edit: also bear in mind the cost to you of doing FY1 - it depends on circumstance exactly how much you'd lose but because you get paid less every year from then on its certainly >£20k over the subsequent 10 years. Having to drop out though will of course cost even more.
What do you mean when you say "you get paid less every year from then on"?
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nexttime
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(Original post by qasidb)
What do you mean when you say "you get paid less every year from then on"?
Well you get paid less in FY1 than FY2. Then in your second year when you're earning FY2 wages you could have been earning ST1 wages, which are higher still. Etc etc.

So you don't lose £20k straight away - the FY1 vs FY2 difference is only about £5k so you'll only have to 'pay' £5k to do FY1 (versus FY2). But over time the cumulative pay gap widens and at a guess you'd lose £20k in the first 10 years.
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MonteCristo
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FY1s don't actually have anywhere near as much responsibility as they often feel that they do. The nurses and other doctors do not expect a huge amount from FY1s and keep a very close eye on what they are doing. As a FY2 you would be a "Senior House Officer" and there will be a much greater expectation that you are able to do things by yourself without help. Help will be available if you need it but there will be a lot of grumbling if it turns out that you can't do basic procedures (e.g. cannulation, ABGs, NG tubes), administrative tasks (e.g. warfarin prescribing, authorising discharges) or competently assess a sick patient without help. As a SHO you will also likely be "on call" for your specialty and so the first person telephoned about new patients by GPs and the Emergency Department. I personally think that FY2 is (or should be) a big step-up from FY1.
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Lionheartat20
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(Original post by nexttime)
Well you get paid less in FY1 than FY2. Then in your second year when you're earning FY2 wages you could have been earning ST1 wages, which are higher still. Etc etc.

So you don't lose £20k straight away - the FY1 vs FY2 difference is only about £5k so you'll only have to 'pay' £5k to do FY1 (versus FY2). But over time the cumulative pay gap widens and at a guess you'd lose £20k in the first 10 years.
The pay progression points only happen at FY1/FY2/ST1/ST3/Consultant. And so an ST7 will earn the same as an ST3 - hence it doesn't affect you for every single consecutive year. However you do still lose £20,000 overall as you say - £4,300 F1->F2, £5,700 F2-->ST1 and £10,000 for ST2->ST3. So you are right with the maths

Somebody thought it would be a good idea* to pay an ST7 the same as an ST3.
*Correction - a good money saving exercise.
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nexttime
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(Original post by Lionheartat20)
The pay progression points only happen at FY1/FY2/ST1/ST3/Consultant. And so an ST7 will earn the same as an ST3 - hence it doesn't affect you for every single consecutive year. However you do still lose £20,000 overall as you say - £4,300 F1->F2, £5,700 F2-->ST1 and £10,000 for ST2->ST3. So you are right with the maths

Somebody thought it would be a good idea* to pay an ST7 the same as an ST3.
*Correction - a good money saving exercise.
Despite specifically mentioning the first 10 years, I think for some reason I had long term/consultant pay in my mind when I wrote that, which does still increase fairly gradually year on year. But yes you are right. In fact, your observation changes the dynamic a bit to mean that actually you can expect to lose £20k in the first 5 years before it flattens out/becomes too distant to think about, rather than 10. That's quite a substantial loss for a young person - that could be most of a houe deposit right there...
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MonteCristo
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(Original post by nexttime)
Despite specifically mentioning the first 10 years, I think for some reason I had long term/consultant pay in my mind when I wrote that, which does still increase fairly gradually year on year. But yes you are right. In fact, your observation changes the dynamic a bit to mean that actually you can expect to lose £20k in the first 5 years before it flattens out/becomes too distant to think about, rather than 10. That's quite a substantial loss for a young person - that could be most of a houe deposit right there...
£20,000 gross taken from the top end of your pay over a number of years can only be interpreted after deductions. £20,000 - 9.3% (NHS Pension Scheme contribution) - 12% (national insurance) - (40% marginal rate of income tax) = £9,577. Less than £10,000 spread over a number of years isn't worth struggling at work or risking your long-term reputation by starting out as a sub-standard SHO.
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nexttime
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(Original post by MonteCristo)
£20,000 gross taken from the top end of your pay over a number of years can only be interpreted after deductions. £20,000 - 9.3% (NHS Pension Scheme contribution) - 12% (national insurance) - (40% marginal rate of income tax) = £9,577. Less than £10,000 spread over a number of years isn't worth struggling at work or risking your long-term reputation by starting out as a sub-standard SHO.
Is £10k take-home worth struggling at work for a short period? Can I say... probably yes?

There is an increased risk but its also the job you are qualified to do. Show me a doctor who wasn't nervous about starting FY1. You can't advise everyone to drop down a grade.
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MonteCristo
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(Original post by nexttime)
Is £10k take-home worth struggling at work for a short period? Can I say... probably yes? There is an increased risk but its also the job you are qualified to do. Show me a doctor who wasn't nervous about starting FY1. You can't advise everyone to drop down a grade.
I wouldn't advise everyone to drop a grade but I'd seriously consider this if I were moving to work in a different country. It's not just struggling for a short period either. Reputations are important and no-one wants to be the "struggling" junior if that can be helped.

A lot depends on whether the OP has done a full year as a doctor or whether his/her sixth year was actually spent as a medical student. My understanding is that graduates of six-year medical degrees in European countries are considered eligible for full GMC registration even though they have not yet practiced medicine.
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qasidb
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(Original post by MonteCristo)
I wouldn't advise everyone to drop a grade but I'd seriously consider this if I were moving to work in a different country. It's not just struggling for a short period either. Reputations are important and no-one wants to be the "struggling" junior if that can be helped.

A lot depends on whether the OP has done a full year as a doctor or whether his/her sixth year was actually spent as a medical student. My understanding is that graduates of six-year medical degrees in European countries are considered eligible for full GMC registration even though they have not yet practiced medicine.
I'm currently spending my sixth year as a medical student, with not a lot of that time properly working in a hospital. And yes you're correct, those with six-year degrees studying in the EEA are generally eligible for full registration like myself.
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Ghotay
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I have seen European grads go into F1 and F2. Most do struggle at the start of F2 but by mid way through most people seem to have caught up. Then again I also saw a girl who went into F1 and had to drop out for 4 months before returning (after which she was fine). So it's pretty variable dependent on the individual
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Hi just saw this thread and I just wanted to share some concerns! I saw the starter of this thread said he was worried about the lack of knowledge. I am 5th year of a 6 year programme in EAA and I am also bricking it! I really feel like I don't have enough knowledge, particulary for those night shifts where you are pretty much alone!
I don't really know any Med Students at home who I can compare my knowledge with so of course I don't really know.
Since English is not the native language here, I haven't done an awful lot of meaningful systematic history taking (in my opinion) and I don't know, i'm just freaking out. Anybody graduated from abroad and came back home to work ?
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Okorange
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I'd consider going to FY2 if you can. Medical training is long, and every year you can save is huge. You may feel that you aren't ready, but you'll be surprised how much support you will get and how quickly you will learn. Worst case scenario, you start FY2 and you choose to go to FY1 if you can't handle it. No harm no foul.
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