Introduction
The current divisive politics in the United States and the high cost of health care tempt many Americans to explore living in another country. I have met many Americans living in the U.K. who see the U.K. as a liberal ‘wet-dream.’ They view the U.K. as their utopia due to its multiculturalism, socialised medicine, relaxed immigration policies, and left-leaning politics compared to the United States. Regrettably, many individuals who initially perceive the UK as a liberal utopia eventually experience disillusionment. What they initially see, I believe, is a small part of a much larger puzzle. Once they arrive in the UK, many begin comparing the UK and US. Ultimately, after the glamour of living in a foreign country fades and reality begins setting in, many opt to return to the United States.
Why do so many Americans, after a few years, become disillusioned? This article will explore some of those reasons.
1. Because You Dream It Does Not Mean You Can Live It
Many Americans perceive Britain as having a lenient immigration policy. This leads many Americans to wrongly believe that they can pack up and move to the United Kingdom.
Like the United States, Britain has its own immigration rules. Over the last year, the government has found immigration is too high and is taking measures to reduce immigration. In particular, the government has raised the income threshold to obtain a work visa, barred those seeking graduate degrees from bringing their families, and is looking at ways to reduce student visas.
2. Free Healthcare is Not Always Better: Socialised Medicine Is Not Cure For All That Ails You
I have experience with both the US and UK health systems. While the UK system provides prescriptions for a fixed price and health care is free. However, free is not always better and free health care does not mean a health system with unlimited resources. Before COVID-19 and sith the exception of nursing in the UK, I held a very positive opinion of the UK healthcare system. Since COVID-19 my opinion has drastically changed.
Let me share an experience where the UK primary care system fails. In order to understand this experience, you need a frame of reference. I believe, UK GPs are very similar to US Physician Assistants (PAs). Recently, I waited over a year to be treated and endured endless phone calls to speak with various’specialists’ because my UK GP was not trained to prescribe a certain type of medication to treat a common condition. This meant, if I were in the USA, I would have been spared the long wait and I could have had it resolved by booking one (1) 15 minute appointment with my GP.
Another drawback of the UK primary care system there is no competition. Meaning, you have to register with a GP in your catchment area or go through process, with no guarantee of approval, to be accepted by a GP outside of your catchment area. This means quality of primary care is not forced to improve because there is no competition. Instead, the system assigns patients to GPs who practice in the area.
A third drawback, I feel medicine in the UK is not personalised but based on the what is the cheapest. I have fought with GP practices because non-medication qualified nurses were making recommendations for my asthma treatment based on cost rather than my history. Another example, it took me three years to get on the right medication because my GP started out with the cheapest rather than what would work for me. This meant I endured a lot of medication side-effects because my GP did not listen to me and prescribed the cheapest.
Regarding nurses in the UK, I generally observe that those who do not hold at least an MSN degree tend to operate at a LPN or LVN in the US. Even worse, I find that many UK nurses lack basic STEM understanding and exhibit an appalling lack of ‘bedisde manner.’ I have lost count of the number of complaints I have filed because my treating nurse lacked empathy, compassion, lack of medication knowledge to make a recommendation to the GP, and basic skills to address the issue. When it comes to booking appointments, I avoid booking any appointment with a nurse.
3. Lift, pudding, and other terms that will drive you batshit crazy
Many Americans that I know, when they come to the UK, look for their favourite American product or will bring them back with them when they leave the USA. To begin with, it’s important to remember that the UK is not ‘Little America’ located across the pond. Simply put, the United Kingdom is not a vassal state of America.
Many American products are available here, but the challenge lies in understanding their names and their UK equivalents. For example, in the USA, Dawn dishwashing soap is Fairy washing up liquid. I buy about 90% of my American products off of Amazon.co.uk, with the remainder being bought at my local Tesco, B & M, or, on occasion, Morrisons.
If learning different words for the same thing is bad enough, British English has its own set of words, and for my first few years in the United Kingdom, I felt I was learning a foreign language, and even today, I sometimes struggle with knowing the British equivalence for certain items and words.
4. Expect to be pigeonholed
Pigeonholed is a term I use to describe career development and progression in the UK. Unlike the US where a degree signifies you are easily trainable, you need less training, you have good communication skills and good problem solving skills. In the UK, you are seen with blinders. Instead of your skills being considered, many UK employers will look at the title of your role and your degree then make decisions based on them.
This can mean when applying for jobs, people often perceive you based on your job title rather than the skill set you possess. I found this to be very true when working in IT. My IT skillset and training allows me to become a business analyst or release manager; however, because my experience was more project management and change management, I worked in software and systems roles. Similarly, in the legal sector, my role as a contracts manager encompasses a wide range of responsibilities and I regularly get contacts for roles where my skills do not match the requirements.
Finally, when I lived in the US, employers focused on your potential because they could train and develop you. In the UK, it is like a puzzle. You need to match your skills to the role and then explain how your skills match it. This implies that you won’t have much flexibility in your field and you may find yourself limited to a specific job category because of the titles you held.
5. Be prepared to take a step down
Moving means change. It is very likely you will not make as much as you did in the USA and until you build some job experience in the UK, it is likely you will need to either work below your capabilities or work in another field because your role does not match a role in the UK. This can be true for LPNs, some teachers (e.g. substitute teachers), patient care technician, allied health professionals (e.g. medical assistants and x-ray technicians), possibly some social workers, lawyers (especially after recent UK changes), paralegals, and the list goes on. The point here, prepare yourself for a drop in pay, the possibility you may need to relicense in the UK, and you may need to do something different.
6. Expect lower pay
One area that Americans who live in the UK notice, is pay is much lower than in the US. A part of the lower pay, I believe, is the result of socialised medicine in the UK. Another part of the reason, I believe, lies in the socialist philosophy about equality, individuality, and anti-capilitalist ideology. In the UK, I feel, residents look more towards the State to solve their issues and don’t see themselves as being able to solve their problems.
For those who work in health or social care the lower pay stems from, I believe, there is no competition for jobs. The main employer is the government health system and pay, with the exception of London, does not account for location. So pay in the health and social care sector is dictated by the government instead of competition.
At one time, IT paid quite lucratively in the UK. However, from my experience, IT pay began flatlining when IT firms began outsourcing to countries that paid their employees less than the UK and recruited workers from countries where IT paid much less.
7. Stop comparing the UK to the US
If you are to acclimate to the UK it is very important to stop comparing the UK to the US. From my years in the UK, I have found it is very difficult to make a like-for-like comparison between the two countries. Even though both countries speak English and have democratically elected governments, the similarities end there. Each country has their laws, monitary policy, employment laws, and poltical systems. To be drawn into a comparison means, I feel, you are struggling with acclimating and I feel, you need to let go of comparing.