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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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