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America is better for the middle class (and for doctors), but I’d rather be rich in London than be rich anywhere else in the world (and so, seemingly, would quite a lot of people). Your view of the states isn’t wrong, but it’s not really right either. Even on your theoretical $500k joint income, you might find you’d be less wealthy than you imagine, I’ll put it that way.
And Brits aren’t “too poor” to afford air conditioning, it just hasn’t been hot enough for more than 10-15 years in the summer to warrant it. A/C is cheap to install in the brick terraces in which most average Brits live; average citizens of many much poorer southern European countries have it. It’s just not a huge thing here yet. If you live in a very expensive $10m listed townhouse in central London it’s harder to install (although still completely possible, many people I know have it), but you wouldn’t live in one of those for a while.
America is a great place, and average people have more material wealth in the US than pretty much anywhere else in the world, but they don’t seem (in my experience) much happier or more satisfied than their British or European peers. You have bought into the dream that the reality might or might not live up to. I will stay in ‘declining’ Britain for as long as the next Labour government don’t go full retard (I have low expectations, don’t worry). We shall see how long that takes, if it happens.
What’s your specialty? You can make a few hundred thousand a year as a consultant in London, provided you’re in something in-demand for private work. I wouldn’t expect a life of poverty as a British doctor.
Window air conditioning units can be had used for $50 here in America, or new for $250. I wonder how much they cost Brits.
Similar prices, as I said cost isn’t a bottleneck, it’s more that the average person might not use them more than 5-10 times a year. It is usually cold at night, and most offices and other indoor workplaces (stores, warehouses), as well as movie theaters, malls, gyms etc have A/C. For now, most Brits accept a handful of unpleasant evenings in the summer, over time I imagine that may change.
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This is true, but I have found that 1G immigrants have a far superior mindset in terms of appreciating what an average american has when they have it.
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I'm perplexed as to why you'd consider that a small amount of time to be baking in >30° C temperatures. You'd hope they'd learn by now.
Even the poorest Indians have ceiling fans, if they have a house for it, and I haven't seen this amenity at all in the UK in the dozen or so odd houses I visited.
I've regularly heard horror stories from my UK peers about how hot and suffocating NHS hospitals get in the summer, with many of them still not having air-conditioning (at least operational units), and once again without the small comfort of a fan. Indian doctors would riot, and we already are inured to far worse.
I'd rather cry in a limo than weep in a bus. I don't expect the US to outright cure all that ails me, but I'd be exceptionally surprised if it didn't make a dent. I hope you have a rough idea of how hard it is to indulge in the hobbies I'm interested in or find the kind of people I want to meet here.
I'm what would be called a Junior Doctor in the UK, at CT1 level. I have yet to specialize, but I might apply for Core Psychiatry Training in the UK if I can make the cutoff this year. I India, that makes me a GP, not that that's what I normally do. I'm usually working as an RMO, a nominally transitional role before one specializes, though I know poor bastards who get stuck there for decades.
If I do go for the USMLE, I'd certainly at least try to go for Psychiatry there too, albeit the snooty buggers don't recognize the credentials of anyone who didn't do their residency there even if they're a fully qualified UK shrink, or just done with the CCT.
We’re almost halfway through July (and the hot months in Britain are June/July/August) and we’ve had one or two days where it’s been uncomfortably hot, by which I mean 30 or 31 Celsius. There’s usually maybe three or four really bad days in summer where it gets up to 35-38 for an hour or two, but even then it drops back to 20-25 at night at the most.
In parts of the US that have similar climates to the UK there are also many people who don’t have air conditioning, even wealthier ones in old houses. Only now after last year’s horrific heatwave and fires are many people in the Pacific Northwest who didn’t previously had it getting it, and the UK obviously never has stuff like that happen.
It’s cultural, rather than financial, given how ubiquitous A/C is in second-world countries where disposable incomes are 1/5th or less of what they are in Britain. Conversely in even wealthier countries than the US that only occasionally have hot days, like Switzerland or Luxembourg for example, air conditioning is still not the norm. I have a ceiling fan (that I didn’t install) in London, although if I run it on the highest setting my upstairs neighbors complain, but I think it’s because there isn’t a dampener as in better ceiling fans.
I see. If it's only a few days, I can probably grit my teeth and bear with it. I've had to attend a non-ac school in the summer where the temperature hit 50°C, and not wet bulb either.
I've certainly never heard an Indian complain about their fan's vibrations disturbing anyone upstairs, but we like our houses sturdy. One downside of otherwise spacious American homes is how paper-thin the walls are, especially in apartments. My neighbors could be fucking and organizing BDSM parties next door and I wouldn't hear it.
What did you mean by this? If you’re interested in rationalist/TheMotte type hobbies you’ll find more people into them in London than in almost any US city other than San Francisco and New York (and even then it’ll be close). Outside of London the ratios will be similar to the US beyond those cities.
If you’re specifically into shooting Britain has an extensive shooting subculture, I walk past a few gun stores on my way to work every day where you can get your $20,000 shotgun customized with your family crest or whatever. I probably attend three shooting weekends a year and even if you run in other circles, clay pigeon shooting is pretty cheap,
there’s a huge hunting scene, many of my coworkers have outdoor hobbies like fishing or survivalist type stuff. The only thing you can’t get here are handguns.
When you were in London, where did you stay? There is something deeply depressing about a certain kind of middling urban British high street littered with kebab shops, fried chicken, betting stores and nail salons under a grey cloudy sky in the middle of the ‘dark’ season (November-March). But - yes, even with the NHS - on two doctors’ salaries, particularly those of two ambitious doctors, you really don’t have to worry about that being your life. There is great natural and cultural beauty here.
Fair point. I still crave the kind of close-knit community of rat adjacent people the Bay Area can claim.
I'm a gun nerd, and I primarily prefer the kind of tacticool shit you can get in the US. AR-15s, AR-10s, all the Picatinny rails, AN/PEQs and the like. Shotguns don't appeal to me in the least, the majority are too drab and boring, not to mention they're largely obsolete. I don't want guns for something as utilitarian as home defense, which is about all they're good for, but I still prefer the more modern stuff. Call it an artifact of playing more first person shooters than I care to name, and like 3.5k hours in Arma 3.
To help convey the point, since despite your general knowledge being excellent, you're unlikely to be familiar with this topic, it's akin to telling a guy crazy into pimping out his car with all the cool mods that he should be content to drive the tiny little toys the Japanese are fond of, since they suffice for getting you from A to B and have 4 wheels on them.
I'm not even that big on hunting, though I wouldn't say no to trying, and even there the kind of game you can bag in the US is far more interesting than the odd fox or pheasant. Shooting wild hogs with wildly overpowered guns from the side of a chopper? Hell fucking yeah.
My Airbnb was in Dagenham/Ilford, hardly the most bedazzling part of London. I still did tour the city, and while I liked it, I find myself merely fond of it rather than head over heels. I could just as easily live in Manchester, the only other city I visited, and I don't think there are any others that measure up to even the latter. Could well be wrong, but the UK is dotted with cities that have had the life blood drained from them to London.
I'd be far happier there if I made the kind of money you presumably do, but that's clearly not on the cards while living there, and if it is, it's because I'm overestimating how much you're worth.
Further, I don't know how closely you follow the affairs of the local doctors, but as someone who has kept a finger on their pulse for years, they're mad. Hopping, fuming mad. Years of pay erosion, no, decades, mid-level scope creep, rotational training, MDTs treating doctors like they're on the same rung of the ladder as nurses and pharmacists, terrible EMRs (most deaneries can't afford EPIC), London locum caps, the government responding to their demands in industrial action with an offered "pay raise" that's below inflation, it's all added up to make even the mild and timid locals, long content to sacrifice themselves on the altar of the ideals of the NHS, have enough.
Even an IMG like me is an assault on their value, since we're far more likely to accept shit pay and working conditions, though they don't really hate us as much as they should if they were looking out for their own self interest. No wonder the exodus to the other parts of the Commonwealth, once a trickle, is now a tsunami.
Even the paltry pay raise that comes with seniority is eaten up by inflation.
Maintaining my current standard of living, as accustomed as I am to a father making a 99.99th percentile income, is hard. You have to run just to stay in place.
Is it still better than India? Of course! I merely see it as a transitional time till fairer pastures unless I literally can't do better.
Not a doctor, but as somebody who did a lot of dating in the last year or so in UMC circles in Australia,, I was pretty flabbergasted by both the sheer amount of UK medicos that'd relocated down here + the conditions they reported financially & work-wise. These were caring, type-A, intelligent women and largely just decided post COVID years that they no longer had any interest in continuing to engage with the system in the UK.
I'd like to call myself one of them soon enough, if I can (barring the type A personality or being a woman, both seem rather intractable haha)
The majority who remain in the UK are simply grumbling through the CCT program, or have personal ties and family that makes it hard to move. While I have those myself, after I'm already committed to leaving the matter, that's moot.
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I think most of that is legal in the UK, at least some variants of the AR-15 are I believe. Bolt action and semi-automatic rifles are legal. There might actually be some guns that are illegal in the US (or perhaps in certain states) but legal in the UK, at least so I was told by my friend who shoots regularly. It really is mainly just handguns that are prohibited.
My condolences, yeah that’s exactly what I’m talking about. These are some of the worst places in London, especially Dagenham. Two doctors on £70,000 a year have a household income of £140,000 (this is indeed 99th percentile for the UK), you can definitely live in a much, much nicer part of London (depending on how many kids you have, obviously). As I understand it, junior doctors whose “official” pay is only £35-40k actually make much more than that because of extra shifts and bonuses and locum stuff etc etc. I know many junior doctors aged 27-30 and they live in fairly nice places, travel a lot, that kind of thing. They all complain wildly, as you note, and yet they don’t actually seem as poor as they constantly declare themselves to be.
Also, you’re an ambitious guy and want to go into psych. My Harley Street psychiatrist charges £790 for a 45 minute consultation. He can’t be much older than forty. I very much doubt he’s a poor man.
I meet more people into that stuff out here than I ever did or do in NYC. London is home to Deepmind, home to StabilityAI, Meta has a pretty big team here, there are a lot of AI policy/lobby/think tank people around. The “kind of people” who are into this stuff a relatively common, at least. There are a ton of collaborations with doctors, I know a young ophthalmologist (maybe 35) working with Deepmind on using AI to find evidence of diseases in people’s retinas or something. The NHS is actually very open to AI research (as you joke), which actually could be an opportunity for you.
I looked it up, and the only legal AR-15s in the UK are chambered in .22lr, a glorified airgun. To reuse the previous framing, it's like offering the same car nut something that looks like a Lambo and has the engine of a 1993 Camry in it.
I mean, better than nothing, sure, but doesn't scratch the same itch.
(Bolt-actions fall into the same category as shotguns IMO, largely obsolete, I like the kind of guns you see after the 2000s, with all the drip, but that's just me, I'm sure there are people who treat them with more reverence)
Honestly I didn't dislike the place. I have a distant aunt and uncle who live in London, and by God they made it sound like you couldn't leave the house after nightfall. It seemed like a sleepy neighborhood to me, with plenty of expensive cars and no obvious security measures. The closest thing to being unsafe was when I was the tall dark dude in a hoodie walking home and mildly scared a young white couple entering their home.
I wouldn't be opposed to living there, but UK houses (that I can afford) are still tiny for my taste.
Barking was a little more exciting, I kept an eye out for the apparent plague of phone snatchers, but no luck. Other than a lot of places selling jerk chicken, it was largely inoffensive to me.
All of those represent additional work on top of the ~48h work week. I just applied for an ER job in India for a few months, because I know that ER locums are quite lucrative and I want to go prepared, even if I hate it. Even then, locums are drying up as more people bow out of training and perma-locum. Add in London rate caps that are a blatantly cartel-like action by a monopsony employer. Not all doctors locum, and if I have a reasonable assessment of the circles you run in, you're likely meeting the more driven/successful lot.
I intend to use my ADHD as a convenient excuse to work LTFT and then locum on top, but that has a mild risk of pissing off the ARCP examiners. I don't think simply locum-maxxing is an option, because my Skilled Workers visa needs a sponsor.
By all means I'm not saying that it's the worst possible life, it clearly beats India, but I need to make money, fast. That, or citizenship in a First World country, and while the UK is straight forward in that you just need to stick around for 6 years (5+1 for the whole rigmarole), that's about past my median timeline for AGI. In an ideal world I would qualify for an investor visa somewhere that can take care of its citizens after they're economically obsolete.
I am deeply lazy, and if you want me to work more than I absolutely have to, you'd best offer me a motivating salary. Can't complain if the free market doesn't share the same high assessment of my worth, but the NHS is the very opposite.
GPT-4 is a better doctor than I am. The UK government knows that's true for most doctors, and is already using it as a cudgel to scare them. The fact that they're not terrified and rioting is a sign of their ignorance, not the government's. Shame this had to be the one place where the government was remotely farsighted. It'll happen everywhere of course, but later in the US where doctors have more leverage to raise hell.
You then have the potential for robotics to improve (and it has), or simply the trained monkeys like ACPs who can do procedures at the behest of Dr. House LLM.
Even if not literally all doctors are useless, a mere 90% of them being superannuated and then fighting for the remaining positions will make life hard if nothing else.
To end up in that position would take 7 years minimum, same issue. I can still be hopeful, but betting my future on it? Not the same IMO. In fact I expect opportunities like that to be entirely gone before I get a good thing going.
At least in ML I get in on the thing that's going to eat the world, assuming I can cut it.
So, in order of preference:
I fix the ECFMG issue and go to the US, or at least Australia, New Zealand or Canada. Subjectively 80% chance of me being happy.
Upskill myself into a related but different line of work. 60%?
Stay in the UK and make the most of it. Like 40 at best.
Return to India, where at least my dad owns a hospital. It's a small hospital, but it's still something. Just highly at risk from the rest of the country catching fire. Man the odds are bad.
Can you disagree on timelines and implications? Certainly, I'm no expert, just a very scared person trying to sell beachfront properly as the tides get higher. I consider myself lucky to at least know it's coming, and make the trivial preparations I can.
Hmm, that's a cause for hope!
TL,DR: UK not great not terrible.
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Why? Not doubting, just curious. You didn't really explain your claim.
Incredible climate (almost never too hot or too cold, very few days are below 40 or above 80 degrees) if mediocre weather (although if you're wealthy you can use the vastly more generous UK vacation time head south a few times over the most depressing November-February period).
Incredible greenery in Central London with huge urban 'royal' parks that are immensely well-kept like Regents and Hyde Park, and unlike most cities so many streets are tree-lined with tall trees that have been there for a hundred years, often with beautifully kept garden squares kept for residents.
Local government in wealthy neighborhoods are flush with cash because of the UK's system of local government funding (largely property taxes from businesses, which aren't redistributed, so single streets in Westminster or Kensington generate more tax revenue than entire poor counties in the North of the UK) and generally not overrun with wokeness like city councils in big US cities, so the streets are usually very clean, swept every day, very little garbage piles up, no awful smells like NYC or Paris.
Very few homeless people and those there are are the quaint kind of Kurdish migrant family or military veteran wino/addict rather than fentanyl monsters like in San Francisco, so you can walk around even at night with very little risk.
Few towering skyscraper canyons like Manhattan outside two specific neighborhoods, extensive beautiful old architecture, gorgeous white stucco Georgian houses with very high ceilings to live in.
Many of the best restaurants and bars in the world of every imaginable cuisine.
Many of the world's best private schools, the best symphony orchestras, one of the top-2 best arts and culture scenes in the world next to NYC (and depending on your tastes possibly the best), great gyms and spas, really every possible service someone wealthy could want because of the density of wealth.
Generally excellent and clean subway system not beset by the homeless or other criminal elements that connects wealthy residential neighborhoods with the London's business districts in the City and Canary Wharf quickly and with trains every one or two minutes during commuting times.
Very safe in wealthy residential neighborhoods at night, low property crime rate by standards of US urban core, extremely little violent crime (typically about 100 homicides a year in a city of 10 million, compared to 435 even in NYC, which is very safe by US standards and which has a slightly smaller population).
Excellent connections to continental europe by plane and train, a wide diversity of popular professions, and a generally functioning and ordered administration by the standards of major western cities.
Note, the above is at least partially restricted to the neighborhoods real estate agents would call 'prime central London' (Chelsea, Kensington, Mayfair, Marylebone, Notting Hill/Holland Park, Belgravia, a few other places close to the above, and then some inner suburbs like Hampstead Village and St John's Wood).
I largely agree, London seemed quite nice in my experience. I wouldn't have nearly the same qualms about living there if I could also keep the analogous US salary. Unfortunately that's not really feasible as far as I know.
My girlfriend really wants to settle there, whereas I look at our bedraggled finances and find Manchester is just rich enough for my blood.
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It's worth pointing out that this isn't just a non-American thing, either. I grew up in the South, where air conditioning is a precondition of living a tolerable life, and you would have to be desperately poor not to have central air. When I later moved to a college town in the Upper Midwest, it took me a while to figure out that window mounted air conditioning units wasn't a sign of dire poverty where I had moved to; rather, the summers were mild enough that people often would only want air conditioning for a few weeks every year, and if they lived in older, well-built houses, the pain and cost of upgrading to central air wasn't mostly worth the trouble for them, and a few window mounted units were fine. This was all counterbalanced by the much more drastic (and expensive in time and attention) measures they would have to take to mitigate absolutely brutal winters, of course.
Central air conditioning is a rarety in India, and I haven't seen any but the very upper class opt for it in their homes. We usually just air-condition the rooms we spend the most time with and grit through the rest.
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Of course, in actually cold areas, you don’t need to take punitive special measures to keep the houses warm, since all housing is constructed to keep the warmth in as a matter of course.
Here's Finland compared to Wisconsin (where I lived): https://www.crownscience.org/places/finland/wisconsin-us
And Finland compared to Minnesota: https://www.crownscience.org/places/finland/minnesota-us
And Finland compared to North Dakota: https://www.crownscience.org/places/finland/north-dakota-us
In general, the Upper Midwest is physically far from any large bodies of water (i.e. oceans) that would moderate its temperature, and the plains up north through Canada don't have any significant mountains to dampen artic winds. It's a legitimately cold part of the world, at least for how populated it is (Minneapolis metro area is something like 3.7 million people).
There's a reason that historically Wisconsin and Minnesota had a disproportionate amount of early immigration from Sweden and Norway.
OK, I stand corrected.
How did you not know that the midwest is next to... Canada.
Because it's still to the south of Canada. Finland is on the same latitude as Alaska, and even knowing the Gulf Stream warming effect etc., my automatic assumption for all of the 48 states (and Hawaii, of course) is that they're automatically warmer than Finland.
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I always used to think the Mid West had to be the geographical center of America. I mean, that's what the name most suggests to me, before I first checked a map.
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Large parts of the upper Midwest get actually brutally cold in the winter- the dakotas in particular.
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