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I'm Moving to America 🇺🇸 - Life Update

2020-07-03 · Long video (solo, talking head or whiteboard) · Ali · recording, 33:20 · watch on YouTube

Topic: Medicine and his doctor years (also: Goals, purpose and life design, Relationships and personal life, Work and career) · mode: Reflection and life update · tags: His own numbers, His own products discussed, Family

Ali, whose UK foundation years end on 4 August 2020 with no training application, sets out his tentative plan: take the USMLE and do an emergency medicine residency in America, to widen his surface area for serendipity after an Odyssey-plan exercise, for collaborations and his US audience, sparked by filming the Liberty Medics course with his friends Usama and Shireen.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Intro: a rambly life update on the USMLE and moving to America

00:01:02 — His plans change often; long-term plans are a myth

  • ★★★ Because the future is so uncertain, Ali calls a firm five- or ten-year plan a complete myth: at best a guess, at worst it holds you to a future you may not want. — 00:01:29

00:01:59 — End of his foundation years, UK versus US training, and the year out

  • ★★★ Ali's two UK foundation years end with his last day of work on 4 August 2020; he will then be unemployed, because he has not applied for any training programme. — 00:03:10 · Foundation Programme, United Kingdom
  • ★★ In the UK a future specialist such as a plastic surgeon spends four or five years, two foundation years and then core training, before specialising; in the US doctors specialise straight after medical school. — 00:03:10 · Foundation Programme, United Kingdom, United States
  • ★★ Ali says he joked in a podcast and a video that he forgot the training applications, due around November; he never really intended to apply, thought of applying only to see the interviews, and then did forget. — 00:03:10
  • ★★ Not applying straight to a training pathway after the foundation years is very common: more than half, by some figures 70 to 80%, of doctors in Ali's position do not. — 00:03:10
  • ★★ After the foundation years many UK doctors take a year or more out, mostly medicine-related: an extra emergency department year in London, research and travel, or locum shifts in Australia, which is very common. — 00:03:56 · London, United Kingdom
  • ★★ After school, six years of medical school and two foundation years, from 4 August 2020 Ali has his first break from full-time education or work. — 00:04:25

00:04:51 — What he will do in the break: travel plans and the USMLE

  • ★★ Asked what he will do in his break, Ali says he does not really know: he had thought of travelling the world, but with the coronavirus it is unclear whether he can. (unsure) — 00:04:51
  • ★★ Ali's travel plan for the break was a friend's wedding in Singapore in September, Southeast Asia, snowboarding in Japan from December to February, then Australia, New Zealand and South America. — 00:04:51 · Singapore, Japan
  • ★★★ While travelling Ali planned to prepare for the USMLE, the US medical licensing exam, partly because he likes exams and wants to relearn medicine, but mainly to keep open the option of moving to the US. — 00:05:20 · USMLE, United States

00:05:47 — Why leave the UK: optionality, surface area for serendipity and the Odyssey Plan

  • ★★★ Whatever field we are in, Ali says, we want to keep our options open and maximise randomness and optionality, a phrase he likes to come back to. — 00:06:13

    “We want to maximize randomness and optionality”

  • ★★ Many good things in life, such as meeting a partner, landing a big deal or getting a book published, come from serendipity: being in the right place at the right time. — 00:06:13

  • ★★★ Ali buys into the idea that we cannot control the luck events that hit us, but we can increase our surface area for them by exposing ourselves to more interesting things. — 00:06:54
  • ★★ Someone who never leaves a little country village has a small surface area for serendipity; someone who moves country every two years and has a widely read blog has infinitely more possibilities. — 00:07:34
  • ★★ To widen that surface area you keep your options open, meet many new people and face unfamiliar situations; after eight years in Cambridge Ali feels he is becoming the village person. — 00:08:14 · Cambridge
  • ★ Ali says putting himself out on the internet is its own serendipity vehicle, and promises more on that in a video at some point. — 00:08:14
  • ★★ The idea of moving to the US came partly from a video by Unjaded Jade, a study YouTuber, on how to decide what to do with your life. — 00:08:14 · United States
  • ★★★ The Odyssey Plan, an exercise said to be taught to Stanford business students: write in painstaking detail your life five years from now on your current path, on a completely different path, and if money and social expectations were no object, then see how you feel. — 00:08:55
  • ★★★ In his Odyssey Plan for staying in Cambridge, shared in his newsletter, Ali saw himself at 30 training part-time in anaesthetics, maybe some emergency medicine, supervising physiology for colleges and still making YouTube videos. — 00:09:37 · Cambridge
  • ★★ That five-year Cambridge future seemed too easy to Ali: a path neatly laid out in front of him, with no challenge, no discomfort and no growth. — 00:10:34 · Cambridge
  • ★★ Travelling the world and meeting new people broadens your horizons and increases your surface area for serendipity, which Ali wants for himself and everyone he knows. — 00:10:55
  • ★★ Moving to London would change little for Ali: his friendship group would stay the same, with a few new doctor friends and maybe more dates, and life would be much like Cambridge. — 00:11:19 · London, Cambridge
  • ★★★ If you have the option of moving to a new country, Ali says, it is almost a no-brainer to do it: nobody on their deathbed wishes they had stayed put. — 00:11:19
  • ★★ Ali feels he has stagnated a bit in Cambridge and craves a sense of adventure. — 00:12:02 · Cambridge

00:12:27 — Why America over Canada and Australia: exams, collaborations, his audience, residency length

  • ★★ From what Ali has heard, Canada is notoriously difficult for international medical graduates to get into, because of its visa and medical systems, though it is still on the cards. — 00:12:27
  • ★★ Australia is generally much easier for a UK doctor to get into: the UK medical qualification is accepted there and only some visa steps are needed. — 00:12:57 · United Kingdom
  • ★★ Ali wants to do his medical training in a big developed country broadly similar to the UK, such as Australia, Canada or the US, rather than somewhere totally novel. — 00:13:27 · United States, Cambodia, United Kingdom
  • ★★ Getting into American medicine means taking the USMLE exams, Step 1 and Step 2 CK and CS, but Ali likes taking exams, so this does not count against America. — 00:13:27 · USMLE, United States
  • ★★ Studying explicitly for the USMLE would benefit Ali's channel, giving him study-with-me and revision content: a synergy few USMLE candidates have. — 00:14:10 · USMLE
  • ★★ Being in the US would unlock collaborations: most of his YouTuber friends, such as Thomas Frank, Matt D'Avella and Sarah Dietschy, his agency Standard and productivity people like Tiago Forte and Nat Eliason are there. — 00:14:33 · Thomas Frank, Matt D'Avella, Tiago Forte, United States
  • ★★ By Ali's YouTube analytics, about 27% of his audience is in the US, about 12% in the UK and about 12% in India. — 00:15:29 · United States, United Kingdom
  • ★★ Moving to the US would give Ali content: he could vlog the move and compare the UK and US medical systems from working in both. — 00:15:59 · United States, United Kingdom
  • ★★ An emergency medicine residency in America takes three or four years, against about seven years in the UK, two years of acute care training and then four or five as an emergency registrar. — 00:16:42 · United States, United Kingdom
  • ★★★ America's many peripheral draws, unrelated to medicine, which Canada, Australia and the UK lack, put it at the top of Ali's list for his residency. — 00:17:26 · United States, United Kingdom
  • ★★ Ali sees nothing wrong with the UK or the NHS, a fantastic service he loves; staying in one place for a long time is simply less interesting to him. — 00:17:26 · NHS, United Kingdom

00:18:09 — When he is going, money, where, his flat and his tech, specialty

  • ★★★ The process apparently takes about two years: Ali hopes to take the USMLE between December 2020 and February 2021 and maybe be in America around 2022. (hedged) — 00:18:09 · USMLE, United States
  • ★★★ Ali's end goal has never been to work as a doctor full-time but part-time, two or three days a week. — 00:18:34
  • ★★ A doctor in America working two or three days a week makes $200,000 to $300,000 a year, Ali says. — 00:18:34 · United States
  • ★★ Ali makes more than a part-time US doctor's pay from his YouTube videos. — 00:19:02 · United States
  • ★★★ High US pay is not a motivation for Ali: medicine is not how he wants to make money; he wants to earn on the side from other things and do medicine for fun, his goal since his first year of medical school. — 00:19:02 · United States
  • ★ Ali has no idea where in the US he would go, though New York seems cool; he might do residency there and then move back to the UK, to Canada or elsewhere as an attending. (speculative) — 00:19:25 · United States, United Kingdom
  • ★★ Ali's flatmate Molly is moving out in August 2020; if he leaves the country he will rent the flat out. — 00:19:25 · Molly Hunt
  • ★★ Ali plans big suitcases with a travelling pop-up studio, a light, a few stands and a proper camera, so he can film anywhere in the world. — 00:19:54

00:20:22 — Why sit the USMLE, and YouTube as a side hustle

  • ★★★ Ali is leaning towards emergency medicine as his specialty. — 00:20:22
  • ★★ Ali is partly sitting the USMLE because he misses studying; his brother's cynical view is that the exam fills the void of having no job from August. — 00:20:22 · USMLE, Taimur Abdaal
  • ★★ Travelling for six months might give him more value, Ali admits, but he is fairly risk-averse and likes the security blanket of preparing for an exam such as the USMLE. — 00:21:12 · USMLE
  • ★★★ Keeping YouTube a side hustle has psychological benefits for Ali: as a full-time job he would rely on it for money and have to do it, while as a side hustle it is something he wants to do. — 00:21:12

00:21:54 — The spark: filming the Liberty Medics course with Usama and Shireen

  • ★★★ The spark came from Ali's friends Usama and Shireen in New York: Usama, a dermatology resident in Manhattan, flies to the UK every year to run Liberty Medics' physical course on how to make it in America. — 00:21:54 · United States, United Kingdom
  • ★★ Ali urged them to make an online course: a physical course is a real pain, with venues, logistics and printing, while an online course is filmed once and earns forever. — 00:22:24
  • ★★★ Usama proposed that he and Ali go in together on the online course, Liberty Medics' How to Make It in America; on 2 January 2020 he and Shireen came to Ali's house in Cambridge and they spent two days filming it. — 00:22:54 · United States, Cambridge
  • ★★★ Filming the course from behind the camera, hearing Usama describe life in the US and how to get there, Ali began to think of doing it himself. — 00:22:54 · United States
  • ★★ They changed the course's structure, adding filmed sofa discussions in which Ali questioned Usama on US pay, work-life balance and a system that denies care to people who cannot pay. — 00:23:37 · United States
  • ★★★ In about two hours of discussion Usama answered most of Ali's objections to working in the US: poor work-life balance, resident burnout, 50 hard weeks a year, and checking insurance before treating. — 00:24:46 · United States
  • ★★ Usama (quoted): Usama told Ali that had he stayed in the UK he could see how his life would turn out: marriage, children aiming for Oxford and Cambridge medicine, the suburbs near London, the same life as his own. — 00:25:19 · United Kingdom, Cambridge, London
  • ★★ Usama's story matched exactly what Ali had thought in his Odyssey Plan a few weeks earlier: he could see how that movie plays out. — 00:25:47
  • ★★★ Adventure is the main thing that sells the move to Ali, and America for its other benefits. — 00:26:26 · United States

00:26:55 — Viewer questions: YouTube with 80-hour weeks, lifestyle, friends, guns, healthcare costs, guilt about leaving the NHS

  • ★★★ Doing YouTube while working 80 hours a week is possible: with a team, Christian or Angus handle editing and uploading, and Ali has filmed after 13-hour shifts. — 00:26:55 · Christian, Angus
  • ★★ Three people work in Ali's team helping with the videos. — 00:26:55
  • ★★ In the US the lives of residents and attendings differ: attendings have much more autonomy and can work part-time, while residency is not part-time. (hedged) — 00:27:35 · United States
  • ★★★ None of these decisions is permanent for Ali: thanks to multiple streams of passive income he does not need medicine to survive, so he can leave America if he dislikes it. — 00:28:01 · passive income, work optional, United States
  • ★★ The world is open to a doctor, and even more open with the financial freedom not to be tied to a place by money. — 00:28:28 · work optional
  • ★ Asked what he will miss most about the NHS, Ali says he does not really know, and that he likes the logo. (playful) — 00:28:28 · NHS
  • ★★ Ali is not much worried about leaving friends: once working you see friends rarely, he sees his medical school friends about twice a year and could fly back from America more often. — 00:28:57 · United States
  • ★ Ali is not really scared of guns in America: he thinks a doctor has little to worry about. (hedged) — 00:28:57 · United States
  • ★★ Before talking to Usama, Ali's uninformed view was that people in the US who cannot afford care are denied it, making the NHS morally superior. — 00:29:42 · NHS, United States
  • ★★ In their 25-minute video on care for people who cannot pay, Usama defended the US position reasonably well, Ali says; he does not know enough to defend it himself. — 00:30:24 · United States
  • ★★ Ali feels no guilt about leaving the NHS; senior doctors say the NHS runs on goodwill, which the shortage of protective equipment in the coronavirus pandemic brought out. — 00:30:24 · NHS
  • ★★ Young medical students may think they will give their lives to the NHS, a sacrificial idealism Ali says almost no one keeps a few years into being a doctor. — 00:31:13 · NHS

00:31:36 — The current plan and sign-off

  • ★★ The NHS, the country's biggest employer, will survive without Ali: in such a huge organisation an individual makes no difference, so he sees no reason to feel guilty. — 00:31:36 · NHS
  • ★★★ Ali's current plan: prepare for the USMLE, which he has started, ramp up once his job ends in August 2020, then aim for an emergency medicine residency in America, always subject to change. — 00:31:36 · USMLE, United States
  • ★★ Ali also likes the idea of working in Australia for a few months, or being a doctor on a cruise ship for a year or so. (hedged) — 00:32:18

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Emergency medicine · Liberty Medics · NHS · Odyssey plan · United States · Usama · USMLE

Also: People: Angus · Christian · Matt D'Avella · Molly Hunt · Nat Eliason · Sarah Dietschy · Shireen · Taimur Abdaal · Thomas Frank · Tiago Forte · Unjaded Jade

Organizations: Addenbrooke's Hospital · Standard · Stanford University · West Suffolk Hospital

Concepts: Core surgical training · Foundation Programme · Gap year · luck surface area · optionality · passive income · Plastic surgery · work optional

Places: Australia · Bury St Edmunds · Cambodia · Cambridge · Canada · India · Japan · London · New York · New Zealand · Singapore · South America · Southeast Asia · United Kingdom

Also centred on Odyssey plan: 20 Lessons that Improved My Life

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