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…
  • First
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 USAthe 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.
  • Sec­ond 
- Exams The 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.
  • Third 
- 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.
  • Forth 
- 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.  
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