Immigration is a huge step in one’s life and should be considered carefully. Obviously, when someone immigrates, he/she is looking for a better/different quality of life.Immigrating to Canada or the United States of America could be a lengthy process, yet it is a dream for most people who are planning to relocate. Once you land and get your permanent resident status, that’s only the start, not the end. That start is not always easy, nor the path down the road is.Physicians who had finished medical school in their home country could find it very challenging to continue the same path in Canada or the US if they plan to pursue the same career.Obviously, some physicians plan to switch careers or start a new business once they immigrate. This category doesn’t have to go through lots of loops to continue practicing medicine.We will try to explain and advise regarding the medical path in both US and Canada with a main focus on the latter as the writer has experience in Canada.Depending on your stage in this process, please pick up the tips that suit you as we are hoping to cover most steps in the whole process, even before landing as a permanent resident.
Hardship, Is it Hard To Be a Physician In The US/Canada?
Yes, it is hard even if you were born and raised here, let alone if you come from overseas. Local students have to grade high in their undergraduate studies and in college, etc. They should have a strong application to be accepted in medical school. Therefore, you are expected to work hard as well, actually way harder!
Why Is It Hard For Foreign-Trained Physicians?
Lots of reasons…
Your medical school has to be recognised by the country you are moving to. - Here are links to check your school
In the last link, you will find directions for both Canada and the USA : - MCC ( Medical Council of Canada )- ECFMG for the USA ( the Educational Commission for Foreign Medical Graduates is “the authorized credential evaluation and guidance agency for non‑U.S. physicians and graduates of non‑U.S. medical schools who seek to practice in the United States)If your medical school is not recognised, you have no chance other than going to medical school again where you had landed.
- ExamsThe first step is finishing the exams as soon as you can. It is NEVER too early to do that even if you are still in medical school (i.e. before immigrating if you know you will move to Canada/US ).As we mentioned, the immigration process is lengthy, so why not use this time?If you are still a student (i.e. immigrating with your family ), you should do those exams while you are still fresh with basics knowledge, especially the USMLE step 1, which only covers the basics. This step is kind harder for physicians who had finished medical school years ago and never re-read those basics ( why would they anyhow ? ).If you are a practicing physician waiting for your immigration papers, you should save some time to start those exams. It is really worth it when you land with those exams done or at least part of them. If you can, you can always consider landing then going back to your home country to finish your exams while still in practice.Being out of practice for a long time is against you. So why land, then wait 1–2 years till you finish the exams while not working as a physician if you can start that earlier.The LMCC and USMLE in Canada and the US, respectively are paramount in starting your path. The exams are kind of a tool for the licensing authority to test your knowledge. They are the same exams the local students write after finishing medical school. Those exams can be challenging according to the educational system you had in your medical school. They are multiple-choice questions, so if you were used to some other format ( long/short answers questions ), you would need lots of training on the new style. It is not only the knowledge you have; it is the strategy you need to gain to answer the questions. You might know the topic by heart but won’t be able to pick the correct answer from few options.Your exams journey starts here…
The last step in both exams ( LMCC and USMLE ) is a clinical test with simulated patients. This needs practice and being familiar with the medical system. It is not only a test of knowledge but also communications, ethics, professionalism and decision making.This last step is only offered in Canada/the USA, while other steps can be done in most countries.Once you arrive, our advice is to participate in a studying group and gather as many old materials as possible for practice. If you plan to start early on before you arrive ( which is better ), you should find centers in your country that offer courses for that or participate in online forms.
- Choosing A pathway…There are several pathways in each country, none of them is easy, but one may be relatively easier than the other according to your situation.We will discuss this in separate article ( Part 2 ) For sure, each path is hard enough, and you need to be well prepared.
- Selling Yourself…That was a new term to the writer once he arrived in Canada years ago.Yes, you need to appropriately sell yourself while keeping your personality unique yet improving your skills. This mostly applies to the residency pathway.Remember, thousands are competing with you for a smaller number of spots. Your application would be just a bunch of papers ( even if you had passed the exams with high scores ) unless the decision-makers had seen your face. You should do some work with the group before you apply. This can be observership, elective rotation or research.Being part of the selection committee, we receive hundreds of applications. It is not easy to review all these applications, nor it is fair for the applicants who had already spent time working with us if they had proved to be a good fit. So we review the files of those applicants, select the ones we think would be a good fit and offer them an interview. If there is room to interview more applicants we review the faceless applications ( people who we never met ), select who we think might be a strong applicant and offer an interview.For example, if there are 2 spots posted for residency, most programs will invite around 15–25 applicants for an interview.Guess what? The number of applications could surpass 200 in some programs!If the applicants who worked with us and we liked their work is less than that target, then we divide the 200 applications among a few staff so each can select one or two for an interview. So it is close to a gamble if you had not showed your face because the application might not well present you.Again, that’s by far in most programs. Some residency programs do not receive many requests to work with the group ahead of time ( most commonly Family medicine residency program ). These programs usually review all the applications among several staff members, so you might have luck if your application is strong ( All exams done with a high score, did some research, have solid reference letters from Canadian physicians, your background matches the program you are applying for )There are less competitive programs with more numbers spots offered and fewer applicants who did work ahead of time with the group, but still not easy. It is just easier….Internationally, to be accepted into family medicine residency or psychiatry is easier than getting into orthopaedics or plastic surgery. Yet, watch for the term easier, not easy….So, you should still follow our advice of working with the committee ahead of time.
Other Factors To Consider When Applying
- Age :
Sorry to say your age can sometimes determine if you will be accepted or no. Depends on the route you seek, age might play a role.The most common route where higher age might be against you is the residency path. The residency programs usually look for someone to train, someone malleable and ready to do things the way they do. They are not looking for someone who is an expert or has years of experience.This sounds like age racism, but it is the reality even if no one says it loudly. For example, if you are 50 years old ( 50 is not old, age is just a number ), your chances of joining residency are slim to nil. Most residents are in their 20s which is half that age.Plus, residency training costs the government lots of money to train you, pay your salary, medical insurance etc. They expect you to practice for years serving the community. If you finish training in your mid-fifties, you have only a few years to help the community. This age factor is less of a challenge in other practice routes ( please review part 2 ).
- Interview Skills :
If you are successful in being on the interview list, you need to practice this skill. You should be well dressed, well presented, fully awake and pleasant. Maintain eye contact with the panel ( if more than one person interviewing you ). Once asked a question, keep eye contact with the person talking to you, then once it is time to answer, you should start by keeping eye contact with this person, as you talk keep looking to others till you finish at that one you started at.Always have a small smile on your face as you talk. You do not have to shake hands as you entered the room ( most foreign graduates believe they should do so, not really ). Always thank them at the end and try to send an email once you are home.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 :
Immigration for physicians is a huge step, especially if they plan to practice medicine after immigrating. You should start preparing for and doing the exams as soon as possible, even before you land in your new home country. Examinations style could be different from what you were used to, so gather as many materials as you can and try to be part of a study group, even if just online. Be familiar with the medical system, try to get medical experience and references once you land and finally choose a path where you think you would have higher chances.