Oh, Canada! Every presidential election cycle, my colleagues joke that if the election result is not to their liking, they will move to Canada. On election night 2016, “move to Canada” trended on Google, and the Canadian immigration website crashed. This election cycle America is having an existential crisis. What does America stand for? Who is American? What are American Values? This time around, my colleagues aren’t chuckling. Instead, they are frantically emailing Canadian colleagues, scouring the Royal College of Physician & Surgeons site for details, and hoping they don’t have to take additional exams. So, to ease the presidential election anxiety, here’s a guide on practicing medicine in Canada. Medical licensure/registration Medical licensure/registration criteria in Canada are unique to each province, specialty or subspecialty, and location. It also depends on whether you want a full registration or a provisional/restricted license. You can obtain a restricted license in Ontario without repeating examinations or training as long as you passed the USMLEs, completed an ACGME training program, hold ABMS board certification, and currently hold a full state medical license. The restricted license can be renewed indefinitely. British Columbia has similar criteria as Ontario for obtaining a provisional license, though they do expect you to take the Canadian boards, known as the Royal College exams, and advance to a full medical license within a specific period of time. Some provinces require the total length of postgraduate training to be equivalent to that in Canada. For example, in Canada, internal medicine training last four years compared to three years in the U.S, and emergency medicine training in Canada is 5 years, compared to 3 to 4 years in the U.S. For a U.S.-trained physician, ACGME accredited fellowship training contributes to this requirement. For example, three years of internal medicine residency and a one-year fellowship meets the 4-year requirement for postgraduate training in internal medicine. Notably, family medicine physicians boarded through the American Board of Family Medicine (ABFM) can benefit from Canada’s reciprocity agreements. This agreement allows an ABFM diplomate to directly seek certification in Canada without additional examinations. Most American physicians will initially obtain a provisional license allowing them to practice medicine in their specialty with supervision for 12-18 months. The clinical supervisor must hold a full license in your specialty and review a handful of your clinical cases monthly. They will serve as a mentor to educate you on local resources and practices. In general, supervision is more helpful than onerous. Finding a job There are several approaches to finding a job. One approach is to make a list of all the hospitals and or clinics in the province and to cold email/call them to find out if they have openings in your specialty and a local supervisor. You can search Canada-wide job boards like MDwork and drcareers, province-specific job boards like Health Force Ontario or Health Match BC, or utilize an international recruitment agency. If you work in an underserved field like psychiatry or family medicine, you will have an easier time finding a job. A highly specialized individual’s job prospects may be limited to the urban areas. That being said, if the province or hospital needs you, it may be possible to practice without completing medical licensing exams or boards. Work culture and salary Canadian Medicare is Canada’s universal, decentralized, publicly funded health system. Canadians are provided a basic level of coverage under Canadian Medicare, and two-thirds of Canadians purchase private insurance to cover other services. Most physicians are independent contractors – they buy their own health insurance, their own malpractice insurance, and contribute to their own retirement plan. Malpractice insurance premiums depend on the specialty but is significantly less expensive than in the U.S. Physician services are reimbursed through a fee-for-service model, though there has been a movement to alternative payment models. Salaries depend on the specialty, with family physicians making around 271,000 CAD, medical specialists making around 338,000 CAD, and surgical specialists earning 446,000 CAD. Planning your move? Follow these 3 steps. Step 1: Choose a province. Decide on the province you want to move to – the process is province-specific. Step 2: Apply for licensure and find a job. Apply for provincial medical registration/licensure and find a job with supervision simultaneously. You can submit credentials for provincial medical licensure at physiciansapply.ca. Step 3: Immigration. Immigration policies are province dependent. Physicians qualify for Express Entry as a federal skilled worker, and when approved, are invited to apply for permanent residency. You will need to take an English or French Language test. Transitioning to Canada can take 6 months or longer, so if you are committed to moving, start this process early. Bottom line Moving to Canada and practicing medicine is doable and does not require repeating training. Depending on the province, you may have to take the Canadian boards. Now that you have prepared your get-away car make sure you vote! Ashwini Bapat and Kayla Wolofsky are palliative care physicians. Emeric Bojarski is a psychiatrist. This article originally appeared in Hippocratic Adventures. Source
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