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.
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.
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 a 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 passed/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.
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
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.
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.
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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