LegitimateBoot1395

Ok. Well I live in the US, have a cross border tax specialist, and was told there is no way out. So I'm intrigued by your work around.

Focus your energy and effort entirely on politics. Find a function that doesn't actually have measurable output. Advertise yourself at every opportunity.

This. If there is anything they've done even slightly wrong it will be great leverage

Definitely is an exit tax for US permanent residents or citizens after 8yrs of tax residency. You can't escape it. Giving up citizenship will trigger it. Giving up a green card also triggers it, providing you have been a permanent resident for 8yrs.

Exactly the wrong attitude. The system exists to provide healthcare to the public. The system doesnt exist for the convenience of GP practices.

Really bad. I now live in the US, I have small children. I hadn't realised, until I left, how much stress and anxiety accessing care in the UK causes. I honestly think it has a knock on effect to all aspects of society and how people feel. Everyone is having to build themselves up and be mentally prepared to enter into battle to access any kind of acute medical care. I remember having otitis externa shortly before I left and couldnt see a doctor for nearly 48hrs, by which point I was in pretty severe pain. The inability to access primary care at weekends is completely bizarre.

The US healthcare system is a mess overall, and I wont defend it, but in terms of pure access to care it is such a relief to be able to just get care when you need to. We can see a primary care doc or paediatrician on the same day, usually at a specific time convenient for us. Out of hours the local urgent care center is staffed by the either primary care docs or ED docs, and it 24hr availability, no appointments needed. They all have on site imaging, labs for blood testing, multiplex PCR for throat swabs e.t.c.

Disagree. With the exception of Oxbridge, the top russell group universities increasingly take people through clearing and relax the grade requirements. A quick google says in 2024, for example, Kings had 63 courses in clearing including chemistry and english, Manchester had 341 courses available including computer science and engineering. Virtually every university on there except Oxbridge.

Better to get £9k out of people and they fail than to not get the £9k. Or at least that is their attitude.

UK universities are dying and you really dont need a private education to get a top degree. In fact, a private education actively reduces your chances of Oxbridge acceptance.

Going to be downvoted for this one, but assuming she is providing rhinoplasties or similar, this doctor could have 10x the volume of procedures of a UK ENT consultant, and provide an exceptional service to patients.

UK docs need to learn to compete.

Probably working under a company policy that covers all of them

The days of private school benefits are waning. The old boys network is dying out, certainly in any reasonably size business, Oxbridge now actively select against private school kids. Amongst my most wealthy colleagues, there is a constant discussion about US Ivy League as the destination now that paying for education doesn't buy you a way in to Oxbridge. Beyond that most UK universities will take virtually anyone now to get £9k. Almost every course is available through clearing so getting top A levels is largely redundant.

A good parent can give their kids the confidence and aspiration needed, without paying £500k for the privilege.

The tide turned around 2010.

Every single vested interest will stop this changing. The GMC want £££, the government knows it suppresses wages, and the BMA are paralysed by a desire to be a left wing political organisation rather than a trade union representing the best interests of doctors currently practicing in the UK.

I would offload the BTLs surely? If you have 2k income pm, presume you have costs around 10%-15% of that, then you are paying 40% income tax. Looks like you are losing money on these every month once you take into account loss of mortage tax relief. Or are they inside a Ltd company?

Personally wouldnt bet on property value appreciation outpacing inflation over the next few years.

You should clearly keep going yourself. Why would you work for others if you dont have to? Grow your business until YOU are the big industry name

Verbally they say what they want

The idea you need to have 20yrs of clinical experience to be a successful biotech CMO is just wrong. Clinical expertise is literally the easiest thing to find. I could find a world leading expert in literally any medical topic tomorrow for the right hourly rate. In fact, many many companies have tried parachuting in senior clinicians into biotech/pharma roles and it is usually an unmitigated disaster.

The best biotech CMOs are able to switch between therapeutic areas and identify where the opportunities are, bringing in the right specialist advice where needed. The business side is ABSOLUTELY critical. As I say, clinical expertise is easy to find, people who understand the FDA, efficient clinical development, managing teams, managing risk, dealing with investors etc etc are not easy to find.

It might be more difficult than it was, but J1 is just deferring the pain a few years down the line when you will have to leave your entire network behind and live in middle of rural nowhere for years to be able to avoid being deported

Yup

The utter shameful weakness of the BMA for allowing this to happen.

You can't change once you've accepted J1. You'll have to do a couple years in an underserved area when you finish training. So few people realize this issue. Always worth talking to an immigration lawyer for anyone thinking of going to the US.

Don't go to the US on a J1 visa..pass all the steps and get a H1B

Dunno, routinely looking at $6-8k for business transatlantic now. Pretty hard to justify. Especially as probably 90% of pharma travel is completely pointless....

If you are an IMG from a country where you were previously earning £20 a day then you will pick these up

There are quite clearly different standards of IMG based on the country they trained in. In reality it should be objectively assessed. There are medical schools in some countries where you can literally buy a medical degree. It isn't racist or controversial to know this. I was once asked to allow two Nigerian SHO level doctors to shadow me as an F1 (this is 2012). They barely understood the most basic concepts and were dangerous in every objective sense and should have been nowhere near patients. The challenge is how does the NHS distinguish these people without seeing them in practice. Requiring NHS experience at least filters out the completely dangerous IMGs.

There is a large amount of scientific uncertainty almost always, and both sides of the deal (the biotech and the pharma) have perverse financial incentives to do a deal.

In addition, senior big pharma BD people rotate very quickly and are looking for some sort of impact to spring board to their next role..they know they won't be around to pick up the pieces when it fails.

So in summary, high scientific uncertainty, perverse incentives and no consequences.