In the pre­vi­ous arti­cle, we dis­cussed the steps you should fol­low before immi­gra­tion and once you had land­ed. We also gave some tips on how to increase your chances of secur­ing a posi­tion con­sid­er­ing the high com­pe­ti­tion in this field. In this arti­cle, we will dis­cuss the routes you might seek to start prac­tic­ing. Please remem­ber you might have high­er chances in one route than oth­ers based on your qualifications.

Routes

In Cana­da ( and in most Amer­i­can states ), there are sev­er­al routes to enter into prac­tice. Our focus is on the Cana­di­an routes, yet this can be a good guide for most Amer­i­can states. You need to under­stand the tips, then check out the cri­te­ria in each state.

1- Residency 

The most com­mon and direct route is apply­ing for a res­i­den­cy spot, yet not the easiest. In Cana­da, there is an annu­al res­i­den­cy match through CaRMS, which has two iterations. The first iter­a­tion ( in most provinces except one or two ) has two streams—one stream for Cana­di­an grad­u­ates and the oth­er for inter­na­tion­al med­ical graduates. The sec­ond iter­a­tion has one com­pet­i­tive stream for all appli­cants. Every­one is com­pet­ing for the spots that did not match in the first iteration. This route depends on your back­ground, i.e. the train­ing you had in your home coun­try before immi­grat­ing. Were you a spe­cial­ist? A fam­i­ly doctor/ Gen­er­al prac­tion­er? Or did you arrive direct­ly after med­ical school with­out any training? If you had train­ing, then you should focus on the spots match­ing your back­ground. For exam­ple, if you were a radi­ol­o­gist, then apply for radi­ol­o­gy etc. Some spe­cial­ties, as men­tioned, are very hard to get in because of the lim­it­ed num­ber of spots and the high com­pe­ti­tion. Then you might start think­ing about oth­er options to make it eas­i­er. Yet, you have to con­vince the com­mit­tee of your sin­cere inter­est. They always won­der why an orthopaedic sur­geon is apply­ing for inter­nal med­i­cine or psy­chi­a­try, etc. ( that’s just an example ). Here we go back to our advice regard­ing doing some work with the group to present your­self well. For exam­ple, approach this pro­gram by email request­ing observer­ship oppor­tu­ni­ties or research projects. You should ask for a meet­ing and explain why you are chang­ing your route from surgery to med­i­cine, etc. It is eas­i­er to con­vince them this way rather than just wait­ing to have your appli­ca­tion reviewed. Be hon­est, tell them it is hard to join plas­tic or orthopaedic res­i­den­cy, yet you were always inter­est­ed in inter­nal medicine/family med­i­cine etc. If you had not had any train­ing back home, this might be to your advan­tage. This allows you to apply to sev­er­al pro­grams ( again after doing work with each ). I mean, you should keep your­self busy by doing lots of observerships/ research with sev­er­al groups—for exam­ple, one with inter­nal med­i­cine, the oth­er with gen­er­al surgery, third with psychiatry. I am just giv­ing exam­ples of broad­en­ing your options since you do not have a cer­tain spe­cial­ty back­ground. You can eas­i­ly mould your per­son­al let­ter for sev­er­al spe­cial­ties since you did not have cer­tain spe­cial­ty training. Our advice is to apply for the first iter­a­tion; you should also apply for the sec­ond if you do not get matched. Why? Because the admin­is­tra­tion and appli­ca­tions fees are paid once, you can apply for both once you pay before the dead­line of the first iteration. For the sec­ond iter­a­tion, you will just be pay­ing fees for each pro­gram you apply to. The fees are around 25 dol­lars for each pro­gram. For the appli­ca­tion fees, you get 4 pro­grams to apply for with­in those fees. Please review the web­site for any updates or changes to those fees.

What Is Tough About Applying For Residency Match?

As men­tioned, it is the most straight­for­ward process, and it gives you Cana­di­an train­ing ( or Amer­i­can ), so you are a grad­u­ate of well-rec­og­nized res­i­den­cy pro­gram with all the advan­tages this entails. Yet, it is very competitive. You are com­pet­ing with thou­sands of like­wise immi­grants. You are also com­pet­ing with hun­dreds of Cana­di­an-born stu­dents who stud­ied med­i­cine over­seas and are apply­ing to return to Cana­da. The com­pe­ti­tion with the lat­ter group is the most chal­leng­ing and most unfair com­pe­ti­tion you might have. Assum­ing you had fin­ished all your exams prompt­ly, the chal­lenge is con­tact­ing any pro­gram to arrange observer­ship or help out in research to present yourself. The Cana­di­an stu­dents com­ing from over­seas usu­al­ly have allo­cat­ed time in their last 2 years for elec­tives. So they con­tact these pro­grams offi­cial­ly through their med­ical school and have rota­tions set up. Yet, the reg­u­lar inter­na­tion­al med­ical grad­u­ate has to fight to present him/herself, and some­times those requests get reject­ed for dif­fer­ent reasons. It depends on what you are apply­ing for; you would notice how hard the com­pe­ti­tion is and the num­ber of spots available. There is only one spot avail­able in some pro­grams, while there might be a few more in oth­ers. The num­ber of appli­cants on aver­age for each spot post­ed is between 150–200 ( rough esti­mate ). For each spot, usu­al­ly, 15–20 are called for an inter­view. Your goal is to be at least on this short­list. The writer was on the short­list for few pro­grams over few years of try­ing and was basi­cal­ly in most of these inter­views the only non-Cana­di­an-born applicant! So ? Do your exams quick­ly, focus on few pro­grams you plan to apply for, con­tact these pro­grams to do some work with them ( prefer­ably with the pro­gram direc­tor or one of the selec­tion com­mit­tee ), leave a good impres­sion and hope for the best! And ….. Do not give up! Do it right; It might take few attempts to achieve your goals.

2- Practice Ready Assessment (Mostly For Family Medicine Practice)

Most provinces in Cana­da have assess­ment exams for gen­er­al prac­tice since there is a short­age of fam­i­ly doctors/ gen­er­al prac­ti­tion­ers in all provinces. You do not have to be a fam­i­ly doc­tor to apply; basi­cal­ly, you can have any back­ground if you meet the cri­te­ria. These exams dif­fer in their eli­gi­bil­i­ty cri­te­ria, so they are not for everyone. One of the most chal­leng­ing and deter­min­ing fac­tors to be eli­gi­ble is the dura­tion you have been out of prac­tice ( hence we advised in part one of this arti­cle to fin­ish the exams as soon as pos­si­ble while you are still in practice ). Some provinces require a max­i­mum of 2 years out of prac­tice while oth­ers allow 3 years; you need to read the cri­te­ria as they often change. Also, some of these exams do not accept appli­ca­tions every year; actu­al­ly, one of them was almost shut down for years. Once the province finds they cov­ered most of the short­age, they inform the col­lege to keep this exam on hold. Please review Prac­tice-Ready Assess­ment — Med­ical Coun­cil Of Cana­da. On the right-hand side, there is a list of those exam­i­na­tions. Please review the eli­gi­bil­i­ty cri­te­ria and find if it fits you. Basi­cal­ly, those exam­i­na­tions are not pass/fail exams. They are an assess­ment of how ready you are to prac­tice in Cana­da. Upon com­ple­tion, you will be giv­en a defined license to prac­tice in this province ONLY and under cer­tain conditions. After 2 years of your inde­pen­dent prac­tice, you may be eli­gi­ble to apply for and write the col­lege of fam­i­ly med­i­cine exam.  If you pass this exam, then you can prac­tice as a fam­i­ly doc­tor any­where in Canada. This route is less chal­leng­ing than the res­i­den­cy one, yet you have to ful­fill the cri­te­ria. The most impor­tant is not being out of prac­tice for a long time. We can not stress enough the impor­tance of start­ing your exam­i­na­tions before arriv­ing in Canada. One oth­er issue is the fees for those exams. We recall how expen­sive they were, espe­cial­ly for a new­com­er and if you plan to try a cou­ple of them to increase your chances.  Some appli­cants had tried the same exam more than once, which can be very cost­ly. In some provinces ( yet not as com­mon now ), there are assess­ment exams for spe­cial­ties. This was more com­mon in the past due to the demand for cer­tain spe­cial­ties. You need to check each uni­ver­si­ty web­site to find out if they offer those assess­ments and their criteria. You can still use the same link… Prac­tice-Ready Assess­ment — Med­ical Coun­cil Of Cana­da, But go to each uni­ver­si­ty web­site and search for spe­cial­i­ty assess­ments, if any.

3- Fellowship ( Specialists Re-Entry )

This route is a provin­cial­ly based pro­gram and changes from time to time. There­fore, you should review the provin­cial col­lege guide­lines and plan accordingly.

How?

In most cas­es, you would require a let­ter from an aca­d­e­m­ic super­vi­sor to sub­mit to the col­lege to write the roy­al col­lege pro­gram. You can not just apply to a re-entry pro­gram on your own; oth­er­wise, all Inter­na­tion­al Med­ical Grad­u­ates would be able to use it, and it would be an acces­si­ble route. Yet, the col­lege offer­ing the re-entry pro­gram is look­ing for those who have offi­cial approval from an aca­d­e­m­ic physician. The only way to do so is to be a clin­i­cal fel­low with­in an aca­d­e­m­ic facil­i­ty so you can get this sup­port while apply­ing to this route. If you are lucky to be accept­ed for a fel­low­ship pro­gram in your spe­cial­ty, that’s a great accom­plish­ment. Usu­al­ly, a fel­low­ship would need a spon­sor ( to pay your salary ) if you are a for­eign-trained physi­cian. Yet, some pro­grams with a short­age of fel­lows might try to find funds for a spot if that’s for you great because you would hold a license. I had seen few suc­cess­ful sto­ries in that route. Most if not all of them had applied and got accept­ed in fel­low­ship while they were still in their home coun­try. But of course, you can start this any­time while you are in Canada. How to start this? Again, do all exams and the lan­guage test prompt­ly, check which provinces offer this route, apply to sev­er­al fel­low­ship pro­grams, work hard for 1–2 years as a fel­low to present your­self, dis­cuss your plan with the super­vi­sor and apply! Again, please review each provin­cial col­lege cri­te­ria as this route changes a lot, and the writer nev­er tried this route nor checked the most updat­ed cri­te­ria in each province. Still, we want­ed to share a path where we had wit­nessed oth­ers suc­cess­ful­ly went through and cur­rent­ly; they are prac­tic­ing in Canada. That’s a link for the approved res­i­den­cy pro­grams. It is a start to con­tact pro­grams ask­ing for fel­low­ship. Accred­it­ed Res­i­den­cy Pro­grams — The Roy­al Col­lege of Physi­cians and Sur­geons of Canada

4- Re-Entry To Medical School

Some uni­ver­si­ties offer a pro­gram for inter­na­tion­al med­ical grad­u­ates to re-enter med­ical school. This is usu­al­ly for the last 2 years of med­ical school, so you only do 2 years as a stu­dent. Then you are allowed to apply for the Cana­di­an res­i­den­cy spots. How­ev­er, you can not apply to all spe­cial­ties. There is a list of spe­cial­ties you can apply for; then, you work in remote areas for few years as per the con­tract you sign. Most of these pro­grams still require pass­ing the LMCC exams plus the NAC exam. This pro­gram is becom­ing very com­pet­i­tive, and it usu­al­ly has very lim­it­ed spots in each uni­ver­si­ty per year.

5- Alternatives

For sure, not every­one would suc­cess­ful­ly go through these routes to the end for sev­er­al rea­sons. There are still oth­er oppor­tu­ni­ties to work in the med­ical field, either as a physi­cian or in oth­er posi­tions ( research, tech­ni­cians, etc.). For physi­cian oppor­tu­ni­ties, sev­er­al provinces are offer­ing a posi­tion called Clin­i­cal Asso­ciate / Assis­tant. This posi­tion basi­cal­ly is a physi­cian work­ing with­in a cer­tain depart­ment under a defined license. You would be a Doc­tor, yet only with­in this facil­i­ty as your license is only valid under that super­vi­sion. Usu­al­ly, your respon­si­bil­i­ties would be tak­ing care of the inpa­tients, their med­ical man­age­ment, trans­fer orders, con­sult­ing oth­er ser­vices etc. Usu­al­ly, it is a well-paid posi­tion and a great start to have your feet in the sys­tem. Also, it is a great per­ma­nent job if you couldn’t get into one of the pre­vi­ous­ly men­tioned routes. Those oppor­tu­ni­ties are usu­al­ly avail­able on the hos­pi­tals’ web­sites and/or the provin­cial col­lege website. This arti­cle was writ­ten by Dr. Islam Elna­gar. Dr.Elnagar had immi­grat­ed to Cana­da years ago as a For­eign Med­ical Grad­u­ate, and cur­rent­ly, he is a Cana­di­an Ortho­pe­dic Surgeon.

In summary 

There are few routes for prac­tic­ing med­i­cine in Cana­da / the USA. It all depends on your spe­cial sit­u­a­tion and your back­ground. You will need to care­ful­ly read through this and decide which way you would have more suc­cess. You could for sure seek 2 or 3 dif­fer­ent routes and see which one would work out for you.  
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