MUDr. Štěpán Čapek, Ph.D., is a neurosurgeon specialising in cerebrovascular and endovascular procedures. In 2013, he graduated in General Medicine from the Second Faculty of Medicine at Charles University, and completed his doctorate between 2014 and 2021. From 2016 to 2023, he completed his residency at the University of Virginia in the United States and subsequently a fellowship in Seattle. He worked in New Zealand and now works in Charleston, West Virginia.
What brought you to the US?
I never planned to live abroad. I only went to Norway on Erasmus because of my girlfriend at the time – she more or less forced me to! (laughs) And that was the turning point. Then we spent a month on an internship in London. And I started thinking that I wanted to have some experience abroad. And to be honest, my dad also convinced me to go to the United States. He said that there is no better medicine anywhere else.
The United States offers a well-structured residency program (in the Czech context, this corresponds to pre-certification training or specialization, ed. note). It's hard to get in, but their system is fair to foreigners. While in Switzerland or Norway you always remain a foreigner – at least that was my impression as a student – once you get to America, no one cares where you come from. I also have relatives in the United States, so it seemed easier and more familiar to me than other countries.
At the end of my medical studies, I spent a month at Harvard, in neurosurgery. I also completed a few internships in Czechia. In Střešovice, in neurosurgery, I met Professor Hořínka, who helped me get a one-year internship at the Mayo Clinic. They offered me a research position there, and I stayed on as an employee for another year.
What makes the American medical education system attractive?
As a resident, you work hard and learn a lot. I enjoy neurosurgery immensely and wanted to learn it properly. But there is light at the end of the tunnel: once you become an attending, life gets better. Practice, financial rewards, support in research, all working conditions. Whereas in Czechia, you first start working and only then do you get certified, it is not structured so logically.
And if it hadn't worked out?
I didn't have to stay in the United States at all costs. I would have returned to the Czech Republic.
What project did you work on at Mayo?
I worked on peripheral nerves in neurosurgery.
What did you have to do to be accepted into the residency program?
I had to pass the exams required for diploma recognition – the USMLE (United States Medical Licensing Examination, ed.). They are the same for American and foreign students, not too difficult. The hardest part is making yourself interesting enough for them to take you over an American student. Neurosurgery is still attractive in America, although not as much as it used to be, but that's the same everywhere. There are two to three applicants for each residency position. Foreigners are a bit of a wild card that clinics consider compared to the sure bet of an American student, so they want to predict how you will behave. That's why, rather than exams, you need to publish, get letters of recommendation and contacts to get noticed.
Will experience from elsewhere help?
You always start from the beginning – many people who have been certified abroad then repeat the entire pre-certification preparation in the US.
What determines which specific clinic you get into?
It's quite unpredictable. You send your application to most workplaces, and if they like your application, they invite you for an interview. You rank these places, for example, geographically or according to the quality of the workplace. You might say, for example, that your top ten workplaces are located in the Mid-Atlantic region because you have family there. But the clinics also rank the applicants, and the "Match" system assigns you to the best possible workplace, so where you end up is ultimately completely random. Finding an attending position is like looking for any other job; there is no Match system involved.
I am reminded of the so-called placements, where under the previous regime you were assigned wherever they saw fit.
There is a certain similarity, except for the main thing, which is that the American system is fair and does not operate on the basis of connections, favoritism, and favors.
Where did you end up?
I completed my residency in Virginia, seven years. The head of the residency program sent residents abroad to gain experience, so I spent my sixth year of residency in New Zealand. It was wonderful. Then I returned to Virginia, and now, since I enjoy vascular neurosurgery, I am completing a year of vascular neurosurgery in Seattle.
What opportunities did you gain with your residency?
In return for the US government paying for my education, I will serve three years in areas with a shortage of doctors. I am moving to West Virginia. I have just signed a contract and will start working as a vascular neurosurgeon in Charleston in October. I am looking forward to working there, even though it is not as attractive a location as California, for example.
How does this affect your personal life?
It's difficult to balance, of course, especially when your partner is also a doctor. You have to make bigger compromises. In terms of personal life, the American residency program is much more demanding than the Czech system—but I never said that residents in America have a better life than in the Czech Republic. On the contrary: I wish I could live in Europe and work in America! (smile) The American system is suitable for people who don't mind traveling and are willing to make sacrifices. But traveling around America for work is normal.
What is life like for a resident in the United States?
Residency is a time devoted to learning. At first, you live at the hospital. We weren't supposed to work more than 80 hours a week, but that was our standard workload. Sometimes it hurts, and the first year you're a jack of all trades. Sometimes I worked up to 120 hours a week: you go home at 11 p.m., sleep for four hours, and go back to work. But I was in the operating room every day, I hardly ever did outpatient work. Two and a half thousand procedures. In my fourth and fifth years, I did a fellowship in interventional neuroradiology, which was a better life, but I was on call every other day. Even from home, but still. People work more in America than elsewhere. In New Zealand, the quality of life was much better, with more vacation time. As a resident, I only had two weeks a year and a few days over Christmas. It wasn't until now in Seattle that I had six weeks, and in the future I will have six to eight weeks, which is livable. You can get through residency because you can see the light at the end of the tunnel.
In America, I gained the important insight that if you are interested and hardworking, people want to help and support you, no one puts obstacles in your way. I think that for many older doctors, the greatest sense of satisfaction comes not from how much they have published, how many operations they have performed, or how much they earn, but from seeing the people around them grow. Although, of course, some are sometimes afraid that someone younger will surpass them.
How does the relationship between doctor and patient in the US differ from that in the Czech Republic?
From a doctor's point of view, I don't see any fundamental difference. A patient comes in with an illness, I explain the problem to them, discuss the options with them, and to the best of my knowledge and belief, I recommend or do not recommend surgery. I hope this is the same everywhere—although some doctors in the American healthcare system work in private practices and are evaluated based on how many surgeries they perform. So it may seem that they have an incentive to operate even when it is not necessary, and from time to time you do see doctors operating more than they should. On the other hand, I think that the fear of doing something wrong, which hangs over doctors in America, is greater than the incentive to perform an extra operation.
What are the patients like?
Unlike Czech patients, American patients have the option of choosing their doctor. Although they are motivated to remain in the healthcare system in which they pay insurance, they still have a choice. If a patient from Seattle wants a neurosurgeon from New York, nothing prevents them from doing so, except for sometimes higher co-payments. Traveling for healthcare is as normal here as traveling for work.
Patients here have greater autonomy and are also aware that they have greater autonomy. I think they are more educated, more interested in what will happen to them, and feel more strongly that it is their choice. Czech patients seem more passive to me.
