Applying for US residency
 

Hey,

Am a final year medical student in London applying for US residency in preferably Internal Medicine. So far have got 18 interviews and will start interviewing soon. Its going to be most virtual interviews this year due to obvious reasons. I need an H1 visa but I only applied to places that sponsor. Most of my interviews are for places on the East Coast mostly around Philly and New York city like Long Island and Westchester etc

Looking for general advice as I wont be able to see most of these places in the flesh. The starting salary is $65k which dont sound much but its more than what a new medical grad pays in the UK surprisingly.

Grateful for any general pointers or tips as to what to look for generally.

Thanks

Re: Applying for US residency
 

It very much depends where on the east coast you go. $65k won't last a day in New York, Philly, D.C. or similar big cities. Have you ever been to the US before? These cities are going to be a reality shock if not!

Re: Applying for US residency
 

Assuming he sleeps at the hospital when on shift and stays in hostels when he is off he could probably do it, but $65k gross before tax would probably mean living in a shared house further out in NYC metro. At least he is likely to have much lower student loans if he has qualified in the UK... a 5 year MBCHB, vs a 4 year UG premed and then MD in the US. The resident years are not really for earning money, it’s more like paid training.

Re: Applying for US residency
 

Yes of course I have been to Philly and NYC etc!! I did my electives on the East Coast! One of the main reasons I wanted to move to the US was the training is only 3 years and you are a Consultant. In the NHS it takes anything from 8-9 years minimum if not longer.

I only have 2 interviews at Manhattan hospitals and they both have subsidized housing at around $1200 for a 1 Br which to me is dirt cheap for Manhattan. I have no student loans either thanks to relatively low tuition fees in the UK.

My Philly interviews are all in the suburbs of Philly pretty much and some are in the suburbs of Pittsburgh too.

Re: Applying for US residency
 

I thought J's were more common for Hospitals?

Re: Applying for US residency
 

That's easy - you'll have subsidized housing, it's only for a year or two as your salary will increase rapidly and by a lot, and you'll be working all hours God sends anyway, so your decision should be based only on the career enhancing potential of the role and the reputation of the hospital.

Re: Applying for US residency
 

Did you already do your USMLE?

I worked at medical school down in NZ which has a program more similar to the UK than US and we got US students coming because it was shorter/cheaper even with international fees, but recall they had to go through an additional step back home.

Is the H1 your future employer will apply for cap exempt or do you have to do the H1b lottery next spring?

As part of my job I had to look at different models of medical education and the differences were pretty big. You could start at 18 in the UK/NZ and be in a hospital doing TI at 22 in year 4. In the US at 22 you would have done done a 4Y UG and then still have a 4 year MD ahead of you and not seen a patient yet. Some of the things I read were crazy, students doing a MD and MBA at the same time, so they would be prepared to manage their practice later on in their career. The most interesting part of my job down in NZ was setting up rural medical schools / electives. We put about 12 students in each and rather than doing “rounds” at a hospital with 15 other medical students they were seeing patients who came in to ER etc and they were the first diagnosis of the patient (check after by a Doctor). The idea was to encourage people to consider careers in places with shortages of Doctots (most aim to be a high paid specialist).

Having moved to NYC as single professional I highly recommend it, I had a great time although did not get to experience single life all that long. Aside from rental that can be a significant expense if you are actively “dating”.

Re: Applying for US residency
 

I know it’s not the question you asked but I just wanted to say never compare salaries between the UK and the US without also comparing cost of living. Most, if not all, jobs here pay more than the UK equivalent would pay. But that’s meaningless without considering that the cost of living here, even in subsidized housing, is much higher. Groceries, mobile phones, nights out, clothes, utilities...it’s all more expensive. I think the biggest shock for me, even though I’ve been here for several years, is still the difference in cost in food between the UK and here. And food is the only thing you cannot go without.

Re: Applying for US residency
 

I'd agree. This is a fairly unique scenario.

Re: Applying for US residency
 

Yeah course I did buddy am ECFMG certified I wouldnt have got any interviews without USMLE!! All H1s for docs are cap exempt and also exempt from any proclamations as clearly we are needed for Covid so that helps a lot!

Re: Applying for US residency
 

Most of the places that sponsor do both J and H depending on what the candidate prefers. Wont get into details but some prefer J for career reasons.

I only applied to places that sponsor the H, its cap exempt so no wait or any issues with that.

Re: Applying for US residency
 

I see your point but its all checks and balances. A doc starting out in the UK gets $35k and wont get past perhaps $90k even after decades of training. Sure some things are more expensive in the US but other things are way cheaper like electronics (e.g iPhone 12 pro max is 300 quid cheaper there which is nuts!), petrol, cars etc etc. Clothes? I found stuff like Ralph Lauren and other brands much cheaper in the US. So its pros and cons. For sure the opportunities are way more diverse particularly for medical professionals.

Re: Applying for US residency
 

Take it from those of us who live here, there are certainly things that are obvious to the visitor to the US that are cheaper - restaurant meals, electronics, and gasoline, but those are are small part of your ongoing living expenses and they are considerably outweighed by the higher cost of many other things including food and household consumables, half-decent appliances, such as fridges and laundry appliances, which are commonly priced at over $2,000 (per set in the case of the laundry appliances), and any savings on gasoline will be largely if not entirely taken up by the very high cost of car insurance. IME the most significant "hidden cost" (hidden from visitors, that is), is the tax on homes, which in the New York area, whether NY, NJ, or CT, starts at around $1,000/ mth for an unremarkable 3-bed family home, and for a new, larger home of the sort befitting a doctor, you could easily be paying $5k/ month in property taxes! :blink:

Then there are other costs of running a home in the US that have likely never even occurred to you, like the fact that the roof on a home in America only typically lasts 15-20 years, and sometimes less if damaged by storms or winter weather, and forced-air heating and airconditioning systems that last about as long. In both cases you are looking at $10k for low-end replacement, but a fancy roof/ heating system on a larger home in New York or the North East, could easily run $20k-$30k.

There are plenty of good reasons to love living in America, but low cost living is not one of them, and especially in the North East anywhere between the greater DC area and Boston.
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Re: Applying for US residency
 

I agree but low cost living never factored into my decisions and neither does it for the thousands of physicians that migrate to the US every year. I was just saying to the lady above that there are checks and balances with every country comparison. I know for myself the career opportunities for my profession in the US and the diversity of them far outweigh what I could get in the UK and that is the main reason for moving not a cheap iPhone or laptop!

Re: Applying for US residency
 

all true, but with the right specialty, once you have the experience you can also move to a much lower cost/tax state and earn a lot of money... I had a co-worker who’s wife was being offered close to $1m a year package to move somewhere in the sticks. I think she was a anesthesiologist... hard to do in finance, but they need doctors everywhere...

Re: Applying for US residency
 

true am no expert regarding income but for a $1m package would be more than likely very rural and you would be on call pretty much 24/7. Interesting you say hard in finance, one thing the pandemic has shown that with remote working office space is being made redundant so for finance do you really still need to be near NYC etc?

Its hard to say as I said before physicians dont move to the US because of cost of living its because of the opportunities available in the profession far outweigh those back home and for my field Internal Medicine the training is only 3 years and you are at Consultant level. In the UK you would be waiting 10+ years to reach the same level so its a no brainer really.

Re: Applying for US residency
 

Yes there are are longitudinal tracking surveys on it. It’s an issue for places like NZ and AU, they lose graduates they have invested significant public money into, to the UK mostly, as they can get a visa more easily, much bigger population so more chance to get experience, rate things happen less in places with a small population. They now offer student loan forgiveness and other things to get them to come back.

A lot of business was already in the “pipe” which helped with the move to remote for the short term at least. Also the compliance waivers for traders etc to work remote won’t be extended forever. There is also culture, friends, the arts etc in NYC and other similar cities... and for tech jobs they are already talking about adjust Comp for remote workers who move to lower cost locations. I was already mostly WFH before covid, but still had to be proximate to the NYC metro area...

Re: Applying for US residency
 

I read your header and thought you were initially referring to obtaining permanent residency in the US instead of medical residency in an US hospital.

I can't see that $65K will be much of a hardship for the first year or two of the residency. You will have subsidized housing and eating at the hospital cafeteria which will also cut down on expenses. You will most likely not be required to obtain private hospitalization which is a big chunk out of most people's monthly budget. You won't have all that much time off to party and will gravitate to your bed for much needed sleep.

Which hospital offers the best in terms of residency, i.e. affiliated doctors, specialties, etc.

Re: Applying for US residency
 

Ha yeah the hospitals give a meal card to eat in the cafetaria not canteen as I been corrected! They all give health insurance and its around $40 a month for a single person. The hours suck but only for the 1st year surprisingly, after that becomes easier as you are senior.

I know am going to miss Indian food from the UK. Indian ready meals are non existent in places like Wegmans, Whole Foods etc Even what I had in Edison, NJ at the restaurants were trash. The ones on Lexington Ave in NYC were even worse!

Hmm the best hospital well thats a hard question. They all seem good in different ways. Am not looking at fellowship some places give better prospects than others if you want to get into hard fields like Cardio or GI. I dont have loans so dont feel the need to go for those super high income fields.

Re: Applying for US residency
 

Did you try the ones down on the street with this place (named after London brick lane). Most similar I found to UK/Manchester curry, which by the way is nothing like the Indian I ate in Bangalore for a few years.

Brick Lane Curry House, NYC
79 2nd Ave, New York, NY 10003
(212) 979-8787
https://goo.gl/maps/X1C9zKhR7yVhJqSWA

Re: Applying for US residency
 

Probably because so much of what passes for "Indian" food in the UK is actually Pakistani.

Re: Applying for US residency
 

I can't help with Indian food in NYC since I totally detest anything with curry and the one time I ate in an Indian restaurant, although the meal wasn't prepared with curry, I didn't find it enjoyable.

Suppose it is like finding good Chinese food. You need to go to the area where Chinese reside to find good restaurants. Thankfully, there is China Town in lower Manhattan. I'm sure there is an area in NYC that attracts Indian immigrants, just as there are areas for the Poles and Germans.

As for pre-packed Indian foods, you need to go to Trader Joe. Frozen Indian meals are sold in Costco and Sam's Club. You will probably even find decent curry meals in Irish and English pubs in the city. Just have a look around and ask people.

Re: Applying for US residency
 

Jackson Heights has many Indian restaurants, as well as grocery, gold jewelry, and sari shops.

Re: Applying for US residency
 

Yeah jackson heights is kinda the NY equivalent of Edison I never been will check it out if I match to a NY program ;)

Re: Applying for US residency
 

I used to live there — haven’t stopped by in a while, but the New York Times had an article about the area recently and a variety of ethnic stores and restaurants appear to be thriving!

Re: Applying for US residency
 

I just have this vision of it looking very similar to the streets you see on the film 'Coming to America' I had a quick quizz on streetview and they looked kinda similar :lol:

Re: Applying for US residency
 

The shopping area is probably similar, but the adjacent residential area is definitely not as gritty, with somewhat stately apartment buildings! Here is the NYT's virtual tour (if the link is behind a firewall, I'm sure you can google it):

Jackson Heights, Global Town Square

Re: Applying for US residency
 

Bizarre I just checked but coming to america was filmed in Brooklyn! LOL not sure why but you learn something new everyday

Re: Applying for US residency
 

While I don't disagree with the essence of what you said, there are numerous regional cuisines in India, which is hardly surprising given the size of India, both geographically and the size of the population, but Pakistan didn't exist during the British rule over India and was only carved off India by virtue of being given independence the day before the rest of India, so there is a fairly good reason for "Indian food" to include food styled from the cuisine of what is now Pakistan.

As an aside, while checking my facts, I discovered that "Pakistan" is a synthetic name, derived from Punjab, Afghania, Kashmir, Sindh and the "tan" from Balochistan, to give "Pakstan", with the "i" reportedly added for each of pronunciation (someone should tell the Americans this re aluminum :nod:). Conveniently, in Urdu and Farsi "pak" means "pure" and "stan" means "land", making "Pakistan" "pure land", .... give or take an i.

Re: Applying for US residency
 

The curry houses did not really get going until the 1970's.

Re: Applying for US residency
 

Perhaps we should thank Idi Amin? Well at least if he wasn't dead.

Re: Applying for US residency
 

So seeing as Pakistan became an entity in 1947, when a restaurant serves the cuisine of that specific region it is reasonable to term it "Pakistani" all these years later.

Re: Applying for US residency
 

Quite possibly "reasonable", but that is rarely what happens, which was I presume what caused you to comment on it. :lol:

Re: Applying for US residency
 

Not sure how this thread has now ended up as an ethnic food debate haha

Anyways to get back onto the original subject have already had my first few virtual interviews and they seemed to have gone really well. On a couple of them they said it was pretty rare for a UK graduate to apply for residency in the US and if they could give me a pre match they would have given me one.

They actually asked me which visa I prefer I said H1b that question I kinda wasnt expecting. Anyway looks pretty hopeful for now :thumbup:

Re: Applying for US residency
 

Welcome to BE ;)

Good luck. Am I right in thinking that you are obliged to go wherever you are matched? If so, I would strictly limit the research you do into any particular location. I haven't been through the system myself, but have had close friends in it. Not investing too heavily into any one employer or location is strongly recommended.

Re: Applying for US residency
 

Yes you have to go where you matched. Yes I am not looking at too much in one particular location but most of my interviews are concentrated on the East Coast

Re: Applying for US residency
 

Hi, I know some medics who made the move from UK to USA, not very common though.
What medical school are you at?
I am surprised that you are applying as a 5th year med student, I seem to recall problems with that regarding your graduation dates and exams in the UK. Don't UK med schools finish and graduate in July which is too late for starting residency here in the US in June?
All the people I know came during foundation training years or took gap years.
It is a good idea though, the income potential is much higher for physicians. The people I know would have made £100k as consultants in the NHS, yet here in the US, as surgeons in the high earning fields such as orthopedics and cardiothoracic, they are clearing $500k and with much shorter training time.
How did you do in the USMLE exams?
This is my first post btw as a long-time lurker