The View From Outside The U.S.

Looking Outward

This is a complicated moment for medicine and healthcare writ large in America. We don’t profess to have all of the answers or even pretend to know exactly where to start. But we do have an inkling that some of the most useful perspectives, and perhaps even the outright solutions, exist beyond on our own borders.

If you have been following our HC International series, you may have noticed something interesting - not just in the pieces themselves, but in the responses to them.

For us, these conversations have been genuinely illuminating. They’ve challenged assumptions we didn’t realize we were carrying and exposed approaches to training, work, and life that simply aren’t part of the American medical imagination.

At the same time, a number of these pieces have prompted unusually strong reactions. Much of the pushback has come from American physicians and surgeons, often dismissing the quality of medicine in the countries being discussed, typically without much explanation as to why (or with the usual stereotypes - “Try booking a surgery in X country and see how long it takes…” “There’s a reason why you don’t hear about surgical innovations coming from X country…”).

What’s become clear through this response is not a lack of rigor abroad, but a lack of exposure at home. Many American doctors have never been meaningfully introduced to other systems, other standards, or other ways of organizing a medical life, and so difference is easily mistaken for deficiency.

The series began quietly, with a conversation over coffee in Paris - a setting that made visible how deeply culture shapes surgical life. Not just how operations are performed, but how days are structured, how rest is protected, and how the work fits into a broader human rhythm.

From there, the perspective widened. In Portugal, a surgeon described a system where limits around time, family life, and responsibility are not aspirational but codified - imperfect, but explicitly protected. In New Zealand, we heard from a system built with guardrails: unionization, structured hours, and an intentional resistance to the slow normalization of excess.

We’ve also examined the contrasts between French and American surgical culture more directly - surfacing assumptions so ingrained they often go unnamed, and asking what it actually feels like to practice medicine inside different systems. Not just how one survives them, but how one lives within them.

Taken together, these pieces aren’t meant as a comparison exercise or a catalog of alternatives. We are not here to advertise to doctors thinking about moving abroad. They’re an attempt to widen the frame - to show that the way medicine is practiced in the United States, for all its strengths, is not the only way serious, rigorous, high-quality care is delivered.

Let’s face it - our institutions are not coming to save us. Just 2 weeks ago, the United States formally withdrew from the World Health Organization. As formal structures of global collaboration weaken, we’ve felt a responsibility to keep the lines of conversation open ourselves. This will be an ongoing project, and one that we take seriously.

The questions that emerge - about training, autonomy, rest, responsibility, and meaning - are shared across borders. What differs is how each system chooses to answer them, and what it decides is worth protecting.

So, the next time you hear someone say, “Surgery is life or death: 80 hours a week is the only way you’re going to be trained properly,” you can confidently tell them they’re full of shit.

A Few Of Our Favorite 'Progress Notes' From January

Life In Between

By Rotem Kimia, MD

It took years of training to indoctrinate the belief that my time belonged to the hospital, but only a few months of unlearning to realize that my time belongs to me. And if I’ve discovered anything, it’s that “when work is done” is not the end of the story. It’s where the story finally begins.

The Case For Knowing Things The Hard Way

By Frances Mei Hardin, MD

The future of healthcare will undoubtedly include AI, telehealth, automation, and digital tools, just as London now includes GPS alongside black cabs. The question is not whether technology belongs (it does) but whether we continue to value the human capacity to know deeply, judge wisely, and act independently. The Knowledge survives because it preserves something essential: the human desire to understand the world well enough to navigate it on our own terms.

New Med Students Apologize More Than They Breathe

By Iya Agha, DO

There’s a difference between humility and self-erasure. Humility is knowing you have things to learn. Self-erasure is acting like you don’t belong at all. And you do belong. That seat wasn’t a clerical error. Someone read your application and believed you could become the kind of person entrusted with human lives.

An Intensivist Walks Into A Bar

By Latha Panchap, MD

While she seemed upset at the suggestion, I hope Dr. Shah was able to take some time to reflect on my words and potentially Google some season highlights. She could consider reaching out to the junior resident for a round of pickleball and a drink to pick his brain. If she finds it difficult to appreciate the intricacies of the sport and sheer greatness of Patrick Mahomes, Dr. Shah could also choose one to develop an interest in Taylor Swift and Travis Kelce’s relationship, which would at least be somewhat adjacent and acceptable enough.

Rank List Webinar

If you missed our Making Your Rank List webinar, we had an incredible turnout and a truly candid discussion with our panel of surgeons and residents across ENT, plastics, urology, HemOnc, and dermatology.

👉 Watch the full replay on YouTube

We cover:

How to evaluate programs after interviews are over

What “culture” actually looks like from the inside

How medicine and surgery physicians approach ranking differently, and where they overlap

Common mistakes M4s make when building their list

How to balance ambition, safety, geography, and life

What not to over-weight when ranking

Featuring: Maheetha Bharadwaj, MD, Elizabeth Malphrus, MD, Andrea Rustad, MD, and Laura Vater, MD, moderated by Frances Mei Hardin, MD

Your Podcast Binge List

We linked some YouTube and Spotify pages for you, but click here to listen to any of our shows on the platform of your choice.

• Social Rounds - Tony Chin-Quee, MD, Frances Mei Hardin, MD - Why Residents Need a Transfer Portal

• Fem MD - Lauren Umstattd, MD & Stephanie Pearson, MD - What Happens When a Doctor Can’t Operate Anymore

• Surgeons with Purpose - Mel Thacker, MD & Dr. Kat Hudon - Courage to Climb the Second Mountain

• Surgeon, Interrupted - Frances Mei Hardin, MD & Dr. Claire Oduwo - A Normal Life Feels Soft When You’re A Doctor

• The Other Human in the Room - Joan Chan, MD & Dr. Hillary McBride - Healthcare Human Conversations

Explore Our Growing Podcast Network

Here’s what’s live and ready for your next commute, call-room break, or coffee run:

• Social Rounds - Tony Chin-Quee, MD + Frances Mei Hardin, MD

• Fem MD - Lauren Umstattd, MD

• Surgeons with Purpose - Mel Thacker, MD

• The Other Human in the Room - Joan Chan, MD

• Surgeon, Interrupted - Frances Mei Hardin, MD

Want to Get Involved?

Since launching, we’ve been blown away by how many physicians have reached out asking, “How can I get involved?”

Here’s how:

• Submit your writing for consideration on our blog

• Pitch us a creative idea or original column

• Apply to be a guest on a podcast

• Follow us and share our content on Instagram, TikTok, and YouTube 

The Collective only works because of voices like yours, and there’s always room for more.

Until next month,
The HC Team

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