Radiology residents in India are currently in a lucky phase. There is a boom in online education, which ensures that they will learn well irrespective of the quality of their local radiology faculty. There are multiple quality fellowships available for them to hone their subspecialty skills if interested. And the world is their oyster if they wish to settle abroad.
The UK NHS is quite understaffed and getting a position there is not very difficult once one completes FRCR. Similarly, the US is facing record imaging volumes, and many programs are offering combined fellowship plus faculty tracks to ECFMG certified radiologists (two years fellowship and two years faculty or other variations), rather than ask them to do the traditional four-year pathway (four different fellowships across four years). Australia has also relatively opened up, although the process there remains more cumbersome and slower.
Many radiology trainees wish to go abroad after completing their residency but are confused about where to go. If you compare US vs UK, here are the various factors to consider.
A. Eligibility: UK requires FRCR, while USA requires USMLE. FRCR seems to be an easier or at least a more rewarding exam to give as it is radiology based, unlike USMLE which is based on MBBS subjects.
B. Chances of getting a position: While getting into UK was much easier a few years ago, given the current shortage of radiologists in the US, landing a US fellowship and job is now fairly easy as well, even if you have a limited CV in terms of publications.
C. Work-life balance: Both countries offer great work-life balance compared to India. Weekends are off except the occasional call (emergency duty). Work hours are limited to 8-10 hours a day and there is ample vacation time. Work from home or telereporting is accepted in most US institutes, as is work flexibility in terms of signing up to work for only three or four days a week instead of five days; I am not sure of the UK status on this. Having said that, work pressure is less in UK compared to the US. You will be reporting many more scans per hour in the US compared to NHS. The work though will also probably be more specialized towards the subspecialty you have done your fellowship in, rather than the more general radiology work offered in most NHS hospitals.
D. Pay scales: As a fellow, you get paid 50-70,000 USD annually in the US. Once you become faculty, US will pay way more than UK. Salaries ranging from 300-600,000 USD are the norm once you become faculty, way higher than the NHS pay scale of around 100,000 pounds per year.
E. Long-term options: Board certification from the US or UK is helpful in getting a job in other countries like Australia and the middle-East as well. A US board certification will also enable you to come back to India (if desired) and do telereporting for an American company, earning in dollars while spending in INR!
The choice between US and UK is indeed complicated. While the appropriate choice will obviously vary from person to person, I have noticed that many trainees are opting for the UK simply because of the mental barrier of giving the USMLE Steps. What I would highly recommend is to remove the eligibility exam from the equation. Both exams take a decent amount of money and time to give. USMLE may take about a year to clear, and FRCR will in fact take even longer based on the availability of dates.
The chances of getting a position are also quite high as of now, be it US or UK. Hence, even this variable should be removed from the equation.
The decision should thus be based on work-life balance and pay scales. If you intend to keep the option of coming back open, then add the long-term options to the equation.
The current trend of going to the UK is substantially based on short-term convenience. FRCR is a more radiology-based exam, and clearing it gets you a cushy job in the NHS pretty fast. Subsequent paperwork takes is own sweet time before you get board certified in the UK, but it happens while you are working in the NHS. USMLE encounters more inertia as you need to read anatomy and biochemistry again (frankly though, I find them more interesting than x-ray physics). The initial 2-4 years in the US are as a fellow, before you become faculty.
However, if you look at it from a long-term Return on Investment (ROI) point of view, US massively trumps (apologies for using this word) over UK in the present circumstance. You spend a year extra giving the steps and currently one-two (or a maximum of four) years in fellowship training, and you would earn much more for the remaining decades of your life.
Both are ultimately great options. There are often personal reasons like family to prefer one over the other as well. But if that’s not the case, I would strongly recommend sitting down and dispassionately analyzing everything over the medium to long-term in terms of ROI before taking the plunge!
Wish you all the best!
– Akshay Baheti
PS: For perspective, I have written this just after attending RSNA 2024, based on my conversations and observations at the conference.
Cafe Roentgen 
Fantastic timing. Thank you! 🎉
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USA fellowship appears lucrative especially if u plan to settle in USA. But is there any benefit of doing Fellowship in USA and returning back to India especially if u want to work in the private sector. Are fellowships in USA better than other places in India and abroad? Is IR integrated in the diagnostic fellowships like in MSK and neuroradiology as is seen in few fellowships in India? Can anyone please shed a light on the above questions
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Perhaps the best Indian and US fellowships may be equivalent, but on an average, the fellowships in the US are worth experiencing. They are better structured, and teach a different approach compared to what we experience in India, making us much more balanced radiologists. The volumes reported there are also much more than the volumes in India, so we end up reporting many more scans in the fellowship.
Akshay
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Perhaps the best Indian and US fellowships may be equivalent, but on an average, the fellowships in the US are worth experiencing. They are better structured, and teach a different approach compared to what we experience in India, making us much more balanced radiologists. The volumes reported there are also much more than the volumes in India, so we end up reporting many more scans in the fellowship.
Akshha
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Thank you dr
One caveat, as to my knowledge, you can’t report scans from outside the US soil due to hipaa regulations
Can you correct me if you have different info?
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I think there is a way out if you are telereporting for a US telereporting agency vs directly working for a Hospital or Imaging Centre. I know at least a few who are able to do the latter while staying hmin India.
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Sir if possible could you please explain this in a more detailed manner. I searched everything related to this but all I got online was that only prelim reads are authorised which is paid at 60% of actual value (still a handsome pay). I am just trying to compare this vs working for groups like everlight teleradiology in the long run by going the franczr route
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Afraid I do not have any idea about this.
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Thank you so much,
As far as I know HIPPA regulations prevent reporting scans from outside US soil
Do you have different info or know about board certified radiologistst reporting from outside the US ?
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I think there is a way out if you are telereporting for a US telereporting agency vs directly working for a Hospital or Imaging Centre. I know at least a few board certified radiologists who are able to do the latter while staying in India.
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Great post sir. Thank you.
I am a post MD radiologist working in southern India.
Sir I understand that I can apply for US fellowships only after completing at least step 2 of USMLE. But since most fellowship position applications start at least 1-2 years before the program start date, will I have to wait 1-2 years post USMLE to start my fellowship training.
The time lines are very confusing sir. Please guide.
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That is True. It is important to complete your steps quickly and start applying. If for example, you complete the steps by Sept 2025, you can apply and hopefully get something for 2026-27 fellowship (fellowships start in July). If however you can complete only by Jan 2026, it may be a bit late for getting the July 2026 position. Vacancies though are still always there and you need to keep approaching all programs to see if there is a vacant spot that can be filled.
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thank you sir
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Thank you so much Dr. for all this info
Can you please in your free time write your recommendations for best approaches to finding fellowships accepting international radiologists without prior US experience ?
I have looked at acr jobs & rsna but there did not seem many vacancies
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Check this out.
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Thank you Dr.Akshay! If I wanna pursue a fellowship from US, would MD radiodiagnosis be a better choice or DNB? Or doesn’t it matter?
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I don’t think it would matter too much as most programs accept both in the US. Usually though, MD would be more recognized globally. Quality of the program may be more important than degree.
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Hi Dr ,is there any route on joining US apart of the one with new fellowships towards four years?
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You can repeat residency. And in some exceptional cases, they may take you directly as faculty. USMLE remains a must though.
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good write up. everyone talks about pros, hot market, work life balance but no one is talking about cons like visa issues after finishing pathways, absurd taxation, home sickness, missing out on all the festivals, house and day to day chores that you have to mostly do by yourself (compared to India where you have enormous help from helpers/servents).
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These are related to life in the US vs India in general – they are agnostic of your profession. This blog is more on the difference in life as a radiologist.
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Hi sir,
Wanted to know about teleradiology options in UK after FRCR completion.
Is it mandatory to have CESR completed for telereporting, or GMC registration is sufficient.
And on the basis of GMC registration, can telereporting be done from India?
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Thank you very much sir for these insights.
Sir I am interested in Interventional radiology and wanted to know if doing a 2 year fellowship in US/UK is possible? Will it have enough hands on training for us? Long term i want to return to India after the fellowship, but however also keep the option of going abroad open. I assume a fellowship from UK/US will have more acceptance worldwide for a consultant position.
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US IR is traditionally difficult to get in but currently doable due to shortage of trainees. However, the practical application of what you learn in the US in India may not always be easy. For example, most HCCs get treated with TARE in the US which is not the scenario in the cost-sensitive Indian market. So do your research about the need to go there if you wish to settle in India for IR.
I cannot comment about UK as I have no knowledge about the situation there.
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Sir what about hands on learning, even if I do manage to get a position; would it be worthwhile compared to a DM from india
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You get a lot of hands-on learning in the US.. Don’t worry about that.. I cannot comment on UK as I haven’t worked there..
Akshay
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Thank you sir!!
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Thanks a Ton for writing such a beautiful piece bringing out the differences in the life of a radiologist being in US/UK. I am currently doing my fellowship in USA Northeast in a prestigious university and just after a few months in to training they asked me for the next fellowship which I happily accepted. After 6 months of hardwork they offered me a job at the same institution as a faculty after comletion of my two fellowships. I moved to US after working 6 years in India as a general radiologist in different roles, in both academic and private setting but I can say without any Bias that so far this fellowship has been the most enriching time post MD. In India, the expectations from a radiologist can be unrealistic at times creating unimaginable pressure on the reporting young radiologist who then becomes more of a reporting machine rather than a problem solver. Work life balance is great and so is the learning part of the fellowship. I am a part of big real time research projects which are being done not just for the sake of enhancing the publications number but for actual furthering the frontiers of our beautiful specialty.
As for the cons part, its similar across any immigrant group, a feeling of loneliness and away from home becomes overwhelming at times, the new customs, work atmosphere can be challenging for a new comer, wife if on the dependent visa may feel depressed etc etc. Yet I’d say in the end that if one is aiming for a robust personal/professional growth for a next few years; the pros like prospect of subspecializing, learning advanced skills and technology, having some international exposure, doing research in cutting edge environment and boosting your CV with American board of radiology certification far outweighs the cons.
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