What! You mean you've never been to America? At your age? And you an Irish doctor, no less. Oh, I know, I know, it's a terrible shameful admission to have to make but this is actually my first time in America. You know, that's probably why I never got a consultant job in Ireland—because I didn't have the BTA. It is regarded as an essential prerequisite. The other minor degrees, like FRCS and MRCP, are just mere icing on the cake compared with the BTA.

As a young doctor, I remember all my mates heading off to America for their BTA degree and they all ended up with consultant jobs in Ireland, though what illegally washing dishes in a New York diner had to do with the skills required for a consultant post in Ireland …