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Old Aug 8th, 2012, 05:11 AM
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It will probably cost you a lot more to study in the US.
nytraveler mentioned that Miami School of Nursing costs $18000 per annum. That's 11,500 pounds for the tuition plus you'd have living costs so the total could easily be double that or more depending on how cheaply you can live.

Don't forget airfares on top of that even if you think you won't want to go home there might come a time when you do or have to.

Why is your heart set on the US? Have you considered Australia?
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Old Aug 8th, 2012, 08:56 AM
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Another option you might consider - since you mentioned there seem to be differences between what nurse-midwives do in the UK and the US. Perhaps what would be closer is a labor/delivery nurse - who is an employee of the hospital and, under the supervision of an MD, actually cares for the women in labor (MDs only come in at the end for the actual delivery - or if there are problems and a C-section is needed.) Somthing like that might be closer and not require as much additional schooling.

Or, perhaps if the OP could explain further the role if the nurse-midwife in the UK it would be possible to give better advice.
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Old Aug 8th, 2012, 09:00 AM
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In the UK a midwife is the sole person helping a woman labour, as well as providing antenatal and postnatal care. A uk midwife delivers the baby and gives the drugs as needed. The only time a midwife in the uk doesn't deliver the baby is if forceps are used, or if there are problems when she's pushing etc. Is this different to america then?
And I did consider Australia, however preferably wanted to live in a place where I could have snow as well as warm weather
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Old Aug 8th, 2012, 09:54 AM
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It snows in Australia! They have ski resorts y'know.

Google snow in Australia and you'll find plenty of images of the white stuff..

Honestly if snow is the only reason to pick the US over Australia then think again and apply for your Australian working visa today!
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Old Aug 8th, 2012, 09:57 AM
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Kangaroo in snow
http://protectourwinters.org/wp-cont...the-summer.jpg
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Old Aug 8th, 2012, 10:50 AM
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>>In the UK a midwife is the sole person helping a woman labour, as well as providing antenatal and postnatal care. A uk midwife delivers the baby and gives the drugs as needed. The only time a midwife in the uk doesn't deliver the baby is if forceps are used, or if there are problems when she's pushing etc. Is this different to america then?
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Old Aug 8th, 2012, 11:54 AM
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In Pennsylvania, certified nurse-midwives function the way Lee Ann describes. Here is an e-how article on the requirements is PA. Perhaps you can find others like this:
http://www.ehow.com/how_5569823_beco...nsylvania.html
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Old Aug 8th, 2012, 11:56 AM
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Okay so a uk midwife is the same as a nurse midwife is the us? Do nurse midwives not work in hospitals?

I did look into Canada slightly. I looked at the climate but couldn't really work it out, I know it snows a lot there, does it also get warm weather too?

And wow US fee's are a lot, no wonder people save all there childrens live for it! Are the fee's paid upfront? In the UK we have a system where you only pay tutition fee's when you earn over £21000 a year, and its in small amounts. So while we're at uni we only really pay our living costs.
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Old Aug 8th, 2012, 12:05 PM
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Thank you suki- just seen that article and it was helpful thanks
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Old Aug 8th, 2012, 12:18 PM
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And in reply to Janisj- I know that places can't be generalised because obviously just because you live in one place doesn't mean you have the same opinion as other, however I've heard that more southern and 'redneck' place can be less tolerant and 'backwards'. I don't mean this in an offensive way, but I wouldn't want to live in a state where the majority of people or groups of people weren't open minded about gays etc. Whilst I'm a straight white person, I still feel that its important to live in a place where people are accepting. No offense meant in this comment by saying 'backwards'
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Old Aug 8th, 2012, 12:49 PM
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"I've heard that more southern and 'redneck' place can be less tolerant and 'backwards'. I don't mean this in an offensive way,"

How can that not be offensive? But never mind, read what I wrote again. The Dakotas (and some other states) are generally more homogeneous/less 'cosmopolitan' than others. Take that as you wish.

But really -- just about EVERY state has more tolerant and less tolerant regions/counties/neighborhoods.
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Old Aug 8th, 2012, 12:53 PM
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ooo katie, be careful of generalizations!

US fees for college are paid in advance. You can't graduate unless all fees have been paid (including parking fines LOL!.)
Some parents save for college... some have huge debt or the graduates bear the debt.


Summer in most of Canada is often better weather than the UK. Vancouver has great weather year round IMO.
Montreal has bad winters with heavy snow but it's equipped to deal with it (underground malls!). Summers are warmer/hotter than the UK.

Did you notice that Australia has snow? Ski resorts?

Where have you been in the US that you liked?
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Old Aug 8th, 2012, 01:03 PM
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IF Canada were to be an easier place for you to move, Vancouver would be a great area.
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Old Aug 8th, 2012, 04:48 PM
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In the US most women are delivered by OBs. Some hospitals allow midwives access and some don't. The midwife would care for the mother before birth and mother and baby immediately after birth in the hospital. Midwives are allowed to deal only with uncomplicated births. If the mom is high risk for some reason she must be cared for by the MD. If there are any complications (more than 1/3 of births in the US are c-sections) MDs must deliver the baby (obviously a nurse-midwife couldn;t perform surgery). After the infant is born it is traditionally cared for by the pediatrician.

In the US we don't; have nursing care after birth. The mom is out of the hospital and on her own in 36 hours at most - except if it's a c-section. If a woman wants help with the infant at home she needs to hire a doula (experienced baby nurse) to help the mom learn the ropes. We do not supply this service as part of the birthing process and neither the government nor insurance plan will pay for this - it's directly out of the pockets of the parents. Naturally the insurance will pay for well-baby visits to the Ped - or perhaps Nurse Midwife if that is how the mom gave birth. But those visits are limited to the routine well baby care/vaccinations or a specific illness (and I don;t know if the nurse-midwife is allowed to do that. It's more likely to be a pediatric nurse practitioner.)

In the 36 hours in the hospital the mom gets instruction from the lactation consult and - in some places, more recently - has a psych evaluation to make sure she isn;t suffering from post-partum depression (after that woman in Texas killed her 5 kids). But I don't see how a nurse-midwife could continue to care for the child - unless she has a pediatrics practice too,

No - in the US tuition is cash on the barrelhead. You have to pay for the tuition in full at the beginning of each semester. There are student loans, but I'm not sure how that would work for an ex-US citizen, since many are supported in part by the government. As for student loans you typically have a grace period of 12 months after graduation to get on your feet and then have to start repayment. (When I did it you had to pay them back in 8 years or less - and my loans totaled more than the annual salary of my first job - though by 4 years later it wasn;t so bad.)

And $30,000 is nothing like the salary of a nurse midwife. If you are hired by a hospital you will earn about twice that (in the areas I know). If it's a state which allows private practice - then you need to build it up yourself. (My cousin the Assoc director of nursing earns more than $100K per year - and that's in a moderately priced part of the country.) So - the education costs a lot more - but in many places the income is much higher. (If you think about this it makes sense - even if a NM does only half of what an MD does - $60L per year is a whole lot less than $200K plus an MD would get.)
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Old Aug 8th, 2012, 06:07 PM
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That's definitely a lot tougher then it is in the UK. We have no time limit to pay back the loans and tutition, and if we never earn over £21000 by the time you're 55 (I think) the your debt is wiped. When you do earn over 21000 you start to pay it back and its tiny amount like a few pounds a week! Its only this year that our university tutition fee's have gone up, as before per year they couldn't exceed £3000.
How do parents/students afford to go to university if they are from a low income family? Do they just not go or are there other options available for them. In the UK if you parents earn under a certain amount your entitled to bursarys that you don't have to pay back.

In the UK for the first few days after the birth, the midwife is in contact with/visits the woman and child, and after this time she's passed over to a health vistor who she's with until the child reaches 5. I guess this is kind of equivelent to the ped. But different because we have the NHS. Then obviously if the child becomes ill the parents would either contact the health vistor, go the their gp, or go to A+E. Do you guys have to pay everytime you need to go to the doctors? And do you pay when you have a baby too? Out of curiousity, would you like the US to have something like the NHS.

And I meant it non offensively because its not my view point or opinion, but something that I've heard which is why I asked.
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Old Aug 8th, 2012, 10:55 PM
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In my childhood I always think that the best place to live is Florida. But know I recognize that hot climate and near-by sea can cause natural disasters and I don't won't to live here.
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Old Aug 9th, 2012, 05:55 AM
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katie,
Scholarships exist for low income students. Some are merit based (academic or for sports, music, etc) and a few highly qualified students can get a free ride (no fees) regardless of their income level (or their parents).
Others are related to parental income and are loans to be paid back before or after graduation at low interest.
Colleges also offer financial aid packages to students.
It's complicated obviously and nothing like the UK system. No cheap (formally free education) for all!

Same story with healthcare. We pay for healthcare.. most people have some form of insurance from their employer or Medicare (a subsidized form of insurance for those on low income).
Medical insurance covers part of our medical expenses and then on top there are 'co-pays' where the patient is charged each time they visit the doctor or ER or get x-rays, medications, etc

The home visits you describe by the midwife and the health visitor just do not exist here.
There aren't any home visits unless they are paid for privately.

So you can see there are big differences between the two countries.
I know that unless you're rich or you marry an American you will find it very difficult to get visa to live here. With money you can pay your way to study here and be in a better position to get a working visa with contacts but it would still be difficult.
It certainly would not guarantee that even if you trained and qualified in the US that you could apply for jobs here.

Look into Canada or Australia or Europe. You're lucky to have these options!
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Old Aug 9th, 2012, 07:22 AM
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In terms of education - there are merit scholarships and there are some available for low income students. Many parents start saving for kids education when they are born and it's typical for relatives to give monetary gifts for that fund for kids' birthdays and Christmas as well as a regular gift for the child.

If you are upper middle class or above your parent usually pay for you education - although it is often a strain even then if you have more than one kid. parents often do a remortgage of their house to pay for it.

For other kids they - and their parents - use a combo of scholarships (from the state, university, parent's employer and a host of other sources), student loans and working (many students work both during the summer and part-time during the school year - waitressing, department stores - any sort of job that can be done outside of school hours). (I did university on a merit scholarship that covered tuition, loans that covered room and board and worked 2 jobs in the summer and part-time during the school year to pay for fees, books, clothes and expenses. This is not at all unusual.)

And actually the US has a much higher percentage of kids in higher education than the UK (the last number I saw was about 75% of high school grads have some college/university). Esp for medical specialties, people often come out of school with huge debts that they have to repay - in a limited amount of time.

Also - our healthcare system is much different. We have no such thing as a nurse/health visitor. New parents are on their own except for a couple of basic post-birth visits for the mom (OB or NM if that's who delivered the baby) and well-baby/vaccination visits to the Ped or NM (if that's who mom used). The visits for the mom are usually covered by the cost of birth - typically a single fixed amount unless there are complications. Cost of baby visits come out of the parent's private insurance or pocket (unless they are below poverty line and get Medicaid - not easy to do). And yes, you have to pay for every MD visit - no matter the reason.

There are basically two types of insurance plans provided by employers (but to which the employee has to contribute a certain amount - based on the plan and how many people it covers). I have a generous employer and cover only myself - so I pay about $150 per month. If I were to get insurance as an individual - without an employer - major medical in New York (hospital and MD visits - no drugs, eye care or dental) costs about $1300 per month.

My employer offers an HMO plan (you pay $10 per MD visit but must use the MDs in the plan and have to get a referral to go to a specialist) or an open plan. With the latter - which I have - you can go to whatever MDs you want at any time with no referrals. If the MD is part of the network I pay $25 versus the $300 or so the visit would ordinarily be. If the MD is out of network (several of mine are and 2 don't take insurance at all - my derm and my Gyn) - I have to pay the bill myself and then submit to the plan - which pays 80% of the usual and customary. So for those visits I usually end up paying $60 to $100 of the cost and the insurance picks up the rest. The plan covers hospitalization completely as long as the hospital is in network (and almost all are). I had surgery about 6 years ago and was in the hospital for 5 days. The bill, of which I didn't pay a penny, was for $123,000. The cost of the surgeon (out of network, but recommended as the best) was extra - $22,000 - of which I had to pay 20%.

One of the major issues our government is facing at the moment is the number of people that have no health care coverage and how to resolve that. (If you are in an accident or have a heart attack you will be taken to an ER and treated - but you will be billed for every penny.) So many people don;t get proper care since they just can't afford it. The current administration is trying to change that - but many conservatives feel this is not something the government should be involved in - each man for himself.

And while I do think there should be a better solution for the poor - no I definitely do not want a system like the NHS. In the UK there are too many people denied access to drugs that could help them because of cost. And there are too many people who have to wait for procedures that are not emergent (hip and knee replacements for instance.) My SIL just had the former - and from the time she decided to have the surgery it took less than 3 weeks for her to interview the two potential surgeons, pick the one she wanted, have the surgery and be out of hospital and into the rehab center. I want healthcare for all - but better healthcare for all (I don;t think this is something we should have to compromise on).

I'm not sure if you're aware of it - but when companies market new drugs in europe - even new types of drugs that resolve problems that can now only be treated with difficult surgery - they typically plan on marketing to the Big 4 (Germany, France, Spain and Italy) first and put the UK in the second tier, with former iron curtain countries - since potential sales are limited due to extreme restrictions on prescriptions. And for some oncology drugs (which are approved for use in more than 60 countries around the world - and paid for by govt's and insurance plans), use in the UK is still restricted by a very complicated approval process.

So the systems are very different - with different goals and expectations. Apparently the NHS works in the UK (although my colleagues in the UK all have private health insurance) but would never work in the US.
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Old Aug 9th, 2012, 05:45 PM
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wow that's extremely hard, I cant imagine having to pay all that money up front. The cost of university fee's puts a lot a people off going, and our fee's are easy compared to American.
Yeah I think less than 50% of uk college students go onto go to uni. That's insane that so many go on to go university, especially with such high fee's.
Because so many people are coming out with degree's, does this make it harder to find jobs? A lot of people who have degree's in the UK areb't getting jobs because of there being so much competition, so I imagine there must be even more competition in America.


If the mum went into labour expecting a normal delivery and only had the money/insurance to cover this-what would happen if she needed a c section or if complications arised and she had to have life saving surgery. Who would fund this?
If a person is unemployed how would they get an insurance plan? Or if they were a pensioner? So if you have children, would your employer put them onto your plan?
Wow $300, that's a lot! Is an MD a normal doctor then?

I didn't realise surgery and hospitalisation was so expensive. Does everyone in the US have insurance? If they don't and they were rushed in for the surgery you had, how would they ever pay that?

So if you are in an accident and end up in A+E (ER) you have to pay it even if you have insurance? (sorry didn't quite understand that point)

I think that conservative view (each man for himself) is quite a harsh view point. I know many hard working people who do not earn a lot, and would probably not be able to afford insurance if we had it this way. But that shouldn't mean that when they're sick or in need of medical they can't access any. My Grandparents have both worked from the age of 14-65 and never complained. Now theyre getting older they're needing a lot more care and help (my Granddad has had two ops in the past year) and i dread to think how they would get on if we didnt have the NHS in their circumstances.

As much as your points are true about waiting for non emergent surgery and being denied access to drugs, I have never known anyone who has had problems getting access to drugs they need. I can't imagine being sick and having to worry about having to pay (even if it is a small amount) because i'm guessing most people don't have such a good plan as yours? Good point on having to compromise though. Do poorer people in the US still have to compromise even if they do have a plan (like on good surgeons)?

I didn't know that about the big 4, which I suppose is a big downside to the NHS.

I guess you like what you grow up with really. People often complain about the NHS here, however I dont know how we'd function without it. And such a drastic change to healthcare in the US probably wouldn't be welcomed.

Although the US and Uk are a like in many ways, I cant believe all the differences. Having researched it more and looked into, if i ever did get the opportunity and chance to live or travel America, I don't know that I would ever be able to become used to it.

I watched an episode of 16 and pregnant the other day and the young girl and her boyfriend in it had no money and loads of debts, and didnt even live with her mum (living with her grandma instead). When watching this, having learnt about the insurance plans, I didnt understand how she paid her fee's for having her baby?

Thanks for all the information, and sorry about the 21 questions!
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Old Aug 10th, 2012, 06:52 AM
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>

Well done on doing some research!
Check out this forum for British expats. There's a forum for Brits moving to the US and it will be more helpful to you than Fodors at this point. Click on the link for the discussion forum and you will find information about obtaining visas and other practical info about moving abroad.

It's quite common for people to emigrate and after a period of time (the 'honeymoon period') decide it's not for them and return to their homeland. So, it's wise to think carefully about a move and consider if you can accept all the cultural differences.

The US is very different from the UK. Canada and Australia have more in common with the UK for obvious reasons

www.britishexpats.com

Regarding healthcare and insurance here... yes, everyone pays to visit the ER (usually a co-pay if you have insurance which can range from about $20-$100 ).
The patient will be billed for any treatment not covered by their insurance.

Children can be added to your plan through your employer.
We have good medical and dental insurance through my husband's company but we still pay over $600 a month for this (for a family of 4). We still have to pay co-pays for any visits and pay co-pays for any prescriptions and generally budget about $3000 per year for this.

My friend had breast cancer and her medical costs for surgery, chemo and radiation totaled over $1,000,000 but she has insurance so it cost her a few thousand dollars in co pays.
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