VISTA Staffing Solutions | Locum Tenens

Note: This is Part 2 of Dr. Herring’s observations during a recent international assignment. Part 1 explained medical training and a doctor’s progression through the medical ranks.

About the practice of medicine

In general – No malpractice, sort of. If a complaint comes up, a government-appointed board decides whether to pay the patient/family some money for damages based on the merits of the case, and may take disciplinary action against the MD if indicated. This is ‘socialized’ medicine, so all residents and citizens get their care covered, but they have to pay for some things. For example, $20 to see your GP, or maybe $5-15 for some drugs (drugs are cheaper everywhere outside the US).

Emergency Department – Similar to working in American EDs about 20 years ago, as far as I can tell. On the minus side, you might have to wait up to four hours for a CXR because the radiographer is tied up in theatre. Also, you might have to convince a radiologist that a CT scan is really is necessary. On the plus side, you can make a clinical diagnosis without having to ‘rule-out’ everything under the sun with expensive tests to avoid litigation. Also, patients referred to the hospital for surgical or medical consultations are seen by those services in the ED and will only ask for your help if they need you.

Medical Training – Based on the UK system for obvious reasons.

1. Medical Student – Medical school is an undergrad program – you are accepted either from high school or after one year of undergraduate scientific studies. It takes six years to finish medical school.
2. House Officer – Equivalent to Intern, but at least two years. Also known as House Surgeon regardless of affiliation with any actual surgical practice. Their work is supervised by Registrars. A House Officer may work in any major field – meaning he/she may work in Surgery/Medicine/Peds or a combination, depending on the needs of the hospital. So an MD working as a House Officer in Surgery may actually have no intention of completing training in that field.
3. Registrar – Equivalent to Resident, except training lasts longer. Registrars have completed their House Officer years and have applied for their Registrar position. They practice fairly independently at times and are sometimes allowed to perform surgery without their Consultants present, etc. Training as a Registrar typically takes five years or longer, even in primary care fields like internal medicine. They also generally must re-apply for a new position every year, often moving to a new hospital every year. They typically do not finish training at the same hospital where they started. Also, not all Registrar positions are actual training programs, so working these jobs does not necessarily mean you advance up the totem pole the next year. This means you can be a Registrar for the rest of your career, which some MDs apparently don’t mind.
4. Medical Officer – A Medical Officer has completed some type of training program but has not reached the level of Consultant and must still be supervised in some aspect.
5. Consultant – Equivalent to Attending in that you are allowed to practice independently without ‘supervision,’ except it takes about 10 years of training after Medical School to attain this status. If you train in surgery, it is considered an honor when, at some point, you graduate from ‘Dr.’ to ‘Mr.’