We're always hearing how advanced medical care is in other countries, especially the USA. Rishi Kotecha wondered if it was true and tells us how he found working in health care in America and Australia compared to the UK

Before my elective I was captivated by stories about medical practice in Australia and the United States. I had heard that medicine in Britain is 10 years behind these countries. I had a vision of limitless resources, pioneering procedures and research, high wages, and short working hours. My elective gave me an opportunity to assess the reality of this dream.

Nepean Hospital, University of Western Sydney, Penrith

Penrith is a small town near the Blue Mountains, one hour's drive west of central Sydney. Nepean is a small hospital with 400 beds serving west Sydney. All specialties are represented except specialised surgery. Facilities and technology are similar to those in Britain; the hospital can perform a wide range of procedures.

I spent four weeks working closely with the intern on the coronary care unit and consulting new patients with the resident. Although there was no set timetable, I attended tutorials and the extra teaching offered.

I was exposed to similar cardiac conditions as in Britain. Ischaemic heart disease is the leading cause of mortality, and congestive cardiac failure and hypertension are also common. Rare cases such as atrial myxoma, hypertrophic cardiomyopathy, and a cardiology consultation for advanced tetanus were clinical highlights.

The Australian health system has both private and public components. The state government funds hospitals and the federal government runs Medicare. Patients pay Medicare for health insurance, and hospitals bill Medicare for patient treatment in bulk. Doctors receive similar wages to those in Britain but pay is determined by the number of patients in your care rather than by the number of hours you work. The lower cost of living, however, makes for a comfortable lifestyle. Doctors work between 56 and 80 hours a week, which again is comparable to Britain.

In Sydney, cardiology waiting lists are short, especially for coronary bypass surgery. This is because the Australian government spends two and a half times more on health care per capita than the British government. Another difference is that there are enough doctors in Australia: it is difficult for doctors wanting to emigrate there to find a suitable post.

The elective was by no means all work. I was encouraged by the faculty to travel, and the hours were flexible. As the Australian dollar is weak compared with the pound I found everything relatively inexpensive, including travel and food. The cost of tuition and housing was reasonable, about £300 a month.

Massachusetts General Hospital, Harvard Medical School, Boston

I spent my second four weeks at Harvard Medical School on the advanced neurology rotation. Tuition fees were costly at $2700 (£1900). The faculty has a "fend for yourself" policy for international students. In contrast to Australia, there was no one to greet me upon arrival, and I had to arrange my own accommodation. This was perplexing as Boston is overpopulated and expensive. I found a room near the hospital for the equivalent of £900 per month.

Massachusetts General Hospital is situated in downtown Boston. It is run by Partners, a private company. The only government aided hospitals are the less luxurious veterans' administrations, which entitle war veterans to free health care.

Resources and facilities were limitless. Doctors subjected patients to the latest and costliest technology to achieve a diagnosis and cure, often at the expense of bedside clinical skills. Although they were extremely academic, many doctors showed little empathy. Ideas, concerns, and expectations of the patient were rarely contemplated, and not much emphasis was placed on psychosocial factors.

On the first day I was given a rigid schedule. My role was to admit, present, manage, and discharge patients under the supervision of the neurology service. The first week was overwhelming due to the large responsibility I held and the long hours. I gradually became an integral part of the team, however, and was regarded with respect rather than as "just a medical student." I also attended tutorials and outpatient clinics and sat a clinical exam during the final week. I encountered various neurological conditions, including tickborne diseases such as Lyme disease, which are common in New England during summer.

The wage range for US doctors is $85 000 to $2 000 000 (£60 000 to £1 400 000) a year, depending on specialty and private practice. High wages compensate for long working hours.

The high workload I had at Harvard meant that the opportunity to travel further afield was scarce. I took in the sights of Boston on weekends, although the high cost of living limited activities. Furthermore, the workload was so intense that I had
little opportunity to socialise with the other
students.

Is the grass always greener on the other side?

The NHS is widely criticised, and many people working for it hold the opinion that counterparts in other Western countries are better off under their respective health systems. My elective has led me to believe the contrary. In Boston there is undoubtedly more advanced technology and resources: this is reflected in health service privatisation and long working hours. However, many doctors do not show the same range of communication skills, psychosocial insight, and empathy as those in Britain.

Sydney has a laid back approach to practice; doctors have fewer patients, allowing them to spend more time with each individual. This is due to the higher expenditure per capita for health care and the high number of doctors. Despite this, doctors receive similar wages to doctors in Britain and work similar hours. The saturation of doctors in Australia makes promotion difficult.

My findings are not necessarily representative of medicine across these countries and may only be confined to large cities or these cities alone. Rural medicine is probably very different in practice, teaching, and funding.

Many health professionals are simply dissatisfied with their own personal situation, holding onto the belief that the grass is always greener on the other side as a means of escapism. This is human nature. The NHS is by no means a perfect model, but it seems that every country's system has pros and cons.