International Medical Graduates Resources

Hey everyone, I’m Dr. Rajeev Iyer, and today we’re unpacking a big question for international medical graduates (IMGs): Is the MRCS Qualification Recognized in Canada for Medical Practice? In other words, Is the MRCS degree from the UK your golden ticket to practice medicine in Canada? Let’s dive in and clear the air. What is MRCS, and what does it signify for a surgical trainee? MRCS, or Membership of the Royal College of Surgeons, is an esteemed qualification in the field of surgery, predominantly recognized in the UK and Ireland. It’s a hallmark of excellence for those on the surgical career path, indicating that a trainee has successfully demonstrated a certain standard of knowledge and skills. In the UK, obtaining MRCS is akin to completing your surgical core training; it’s an affirmation that you’re primed for the next stage: specialty training. However, it’s crucial to understand that MRCS isn’t an endpoint but a juncture in the journey of becoming a consultant surgeon. Can MRCS enable independent medical practice in Canada? The straightforward answer is no. In Canada, medical practice standards and certifications are regulated by provincial colleges, and they require qualifications that are in line with Canadian postgraduate training. While MRCS is a reputable qualification, it doesn’t equate to the Canadian standards for independent practice. Canadian authorities don’t recognize MRCS as a standalone qualification for licensure. It’s crucial for IMGs to understand that each country has its unique medical regulatory environment, and qualifications are not universally interchangeable. Is pursuing an MRCS worth it for those aiming to practice in Canada? If your end goal is to establish a medical career in Canada, the MRCS may not be the best investment of your resources. Instead, it’s wiser to direct your efforts toward activities that enhance your portfolio for Canadian medical boards, like securing relevant clinical experience, participating in research, and passing the Medical Council of Canada Evaluating Examination (MCCEE) or its successor exams. These steps align more closely with the requirements you’ll face and improve your competitiveness in the Canadian healthcare landscape. Then, who actually benefits from having an MRCS? There are specific scenarios where an MRCS could be advantageous: Those who aim to practice within the UK or other countries where MRCS is a recognized and respected credential for career advancement in surgery. Individuals who find value in the educational experience and the global networking opportunities provided by membership in a Royal College. Surgeons who may not necessarily be looking to practice in Canada immediately and are open to working in the UK or other nations where the MRCS is esteemed, before potentially transitioning to Canada. What’s the better strategy for IMGs determined to practice in Canada? If Canada is your destination, the focus should shift from MRCS to the completion of Canadian qualifying examinations and obtaining Canadian clinical experience, which are pivotal. The MCCQE1 would be the benchmark to aim for. Networking with Canadian healthcare professionals, understanding the healthcare system, and potentially participating in observerships or clerkships can make a significant difference. What are the real advantages of being an MRCS-certified specialist in Canada? Q: What are the real advantages of being an MRCS-certified specialist in Canada? A: While MRCS itself may not open doors in Canada, if you complete your specialist training in the UK and achieve the status of a consultant with a Certificate of Completed Training (CCT), your expertise is more likely to be recognized. With a CCT, you may be eligible for the Royal College of Physicians and Surgeons of Canada certification without the need for residency in Canada, which is a more direct and favorable pathway to practice. How can IMGs navigate the process to become licensed physicians in Canada? Canada offers several routes for IMGs to enter the medical profession. This includes passing exams like the Medical Council of Canada Qualifying Examination (MCCQE) Part I and Part II, and obtaining a residency position through the Canadian Resident Matching Service (CaRMS). Another pathway is through the Practice Ready Assessment (PRA) programs for family physicians and specialists, which is province-specific and requires applicants to demonstrate clinical skills and knowledge comparable to Canadian-trained physicians. Dr. Rajeev Iyer MBBS, MD, FASA Associate Professor of Anesthesiology & Critical Care Medicine, University of Pennsylvania, Philadelphia, USA The opinions in this article are author’s own and does not represent the opinions of the University of Pennsylvania or any other organization I want to work with Dr. Rajeev Iyer

We had the privilege of interviewing Dr. Prakash Vishnu, an exceptionally accomplished International Medical Graduate (IMG) with extensive experience in the United States. Dr. Vishnu is a highly respected hematologist, and we are fortunate to have him here with us today on IMG Secrets. He generously shared his remarkable journey, which took him from India to New Zealand and eventually to the USA. In this article, Dr. Vishnu provides invaluable insights into how you can replicate his path, starting from your home country and making your way to New Zealand. He provides insights into the various pathways available in New Zealand, and if your ultimate goal is to move to the USA or Canada, you’ll find comprehensive answers to guide you on this remarkable journey. Home Country to New Zealand Dr. Iyer: Could you please share your journey of relocating from India to New Zealand and provide insights for other international medical graduates (IMGs) on how they can replicate your path? Dr. Vishnu: We relocated to New Zealand almost two decades ago. Both New Zealand and Australia are part of the Commonwealth Consortium of health systems, which closely resemble the healthcare systems of the UK and Canada. They adhere to various medical colleges, such as the FRACP (Fellowship of the Royal Australasian College of Physicians), surgeons, anesthetists, and others. If you obtain certification from any of these Commonwealth Health Consortium colleges, you can practice medicine in New Zealand. Let’s discuss two aspects here: one, for individuals who wish to move to New Zealand, reside there, and practice medicine, and the other, for those who intend to use New Zealand as a stepping stone to the United States. Dr. Iyer: That sounds great. Dr. Vishnu: Indeed, we chose the latter path. We moved to New Zealand, where I pursued my master’s program at the University of Auckland. While I was studying for my master’s, I also took the USMLE exams, and the research I conducted during my master’s program proved beneficial in facilitating our subsequent move to the United States. Pathways from Home Country to New Zealand Dr. Iyer: Alright: Could you please explain the pathway you opted for when transitioning from India to New Zealand? Dr. Vishnu: I initially entered New Zealand as a student by enrolling in a graduate program, which is a step I highly recommend to any medical graduates from India. This approach provides an opportunity to immerse oneself in the healthcare system, gain a deep understanding of its functioning, establish valuable connections, and network with medical institutions affiliated with the university. Additionally, engaging in research during this time can significantly enhance your application for further postgraduate training programs or employment in the country. My experience with the Master’s program in molecular medicine at the University of Auckland was exceptionally beneficial. While pursuing my master’s degree, I had the privilege to work as a research associate in a laboratory dedicated to studying the genetics of Crohn’s Disease. This opportunity allowed me to actively participate in a genetics gastroenterology clinic, providing me with valuable exposure to the clinical aspects of medicine in New Zealand. Subsequently, after successfully completing all the USMLE steps—Step 1, Step 2, and Step 3—I was able to make the transition to the United States. What visa is required for New Zealand? Dr. Iyer: Before getting into the discussion about your move to the United States, could you please share the type of visa you used to relocate to New Zealand and discuss any significant implications or considerations associated with it? Dr. Vishnu: Visa policies are subject to change, and when my wife and I made our move, we were fortunate to obtain permanent residency status in New Zealand, which is akin to the Green Card in the United States. At that time, New Zealand operated on a point-based system, allowing us to apply directly from India. This presented us with the opportunity to relocate to New Zealand. I believe this system still exists today, offering individuals the chance to move to New Zealand based on their combined qualifications and corresponding point score. Another option is entering New Zealand as a student, particularly at prestigious universities such as these University of Auckland, The University of Otago in Dunedin, and The University of Wellington. Among these, two medical schools stand out: The University of Auckland and The University of Otago. Both institutions offer exceptional medical and paramedical programs, including Health Informatics, Molecular Medicine, Nutrition, Genetics, Sports Medicine, and Occupational Medicine. These courses provide a solid foundation for transitioning back into clinical medicine. It’s worth noting that New Zealand’s permanent residency system resembles Canada’s, as both countries employ point-based systems. So, for international medical graduates (IMGs) interested in New Zealand, you now have insight into the pathway to securing permanent residency. What happens after Master’s in New Zealand? Dr. Iyer: After completing your Master’s degree in New Zealand, did you pursue a residency program in New Zealand, or did you take a different path?” Dr. Vishnu: After completing my Master’s in New Zealand, I did not pursue residency training in the country. Instead, I focused on preparing for and successfully completing USMLE Step 1, Step 2, and Step 3, with the ultimate goal of securing a residency position in the United States. However, if I had chosen to continue my medical journey in New Zealand, there are established pathways available. One such route is the vocational training course, with an emphasis on primary care, much like in the United States. General Practitioners make up a significant portion of the medical workforce, and there are also opportunities for subspecialty training through the vocational subspecialty training pathway. This pathway typically involves progressing from a junior house officer to a senior house officer and eventually a registrar. Depending on the available positions and your training progress, you can ultimately attain the status of a consultant or specialist. If you intend to pursue further postgraduate training in New Zealand, the system closely resembles that of the United Kingdom. You start

Tennessee breaks all barriers and let international medical graduates (IMGs) come into the USA and practice as fully licensed physicians without having to do residency in the USA. Tennessee has taken significant steps to remove obstacles faced by IMGs when it comes to practicing medicine. Tennessee has implemented measures or policies that are favorable and supportive of IMGs in their pursuit of practicing medicine within the state. This implies a positive development that highlights inclusivity and opportunities for IMGs in Tennessee’s healthcare system. Let’s jump to find out more about this, who is eligible and how you can apply for this. Why did Tennessee allow IMGs to practice without a US residency? Welcome to the enchanting state of Tennessee, known for its breathtaking landscapes and vibrant culture. The capital city is Nashville, a hub of creativity and music. Tennessee shares its borders with eight neighboring states, creating a diverse and interconnected region. However, a pressing concern looms on the horizon: a projected shortage of approximately 6,000 doctors by the end of 2030. While the shortage predominantly affects family practice, other specialties also face significant shortages. It’s important to note that Tennessee is not alone in grappling with this issue; numerous states across the country are confronting similar challenges. To address this, a new law has been introduced to offer potential solutions. This law aims to benefit IMGs by providing them with an opportunity to work directly in Tennessee for two years, subsequently leading to a full state license. In my opinion, this pathway offers IMGs the freedom to pursue careers in academia or private practice. However, specific details regarding this path are still being clarified. The implementation of this law holds promise for alleviating the physician shortage and creating a more favorable environment for IMGs in Tennessee. As the state progresses in this endeavor, it aims to attract and retain talented healthcare professionals who can contribute to the well-being of its residents. https://videos.files.wordpress.com/DQGBRvLi/video-law.mov What are the eligibility requirements to work in Tennessee without US residency? Now, let’s discuss what this means for you as an IMG.  First and foremost, it is crucial that your Medical College is recognized by the World Health Organization (WHO). This recognition is a requirement that you must fulfill. You can check your medical college/school by clicking this link. Second, you must complete your residency or postgraduate training in your home country. You should be a licensed physician in your specialty issued from your home country.  To be eligible for job opportunities in Tennessee through this pathway, it is important to adhere to these basic requirements. Understanding and fulfilling these criteria will enhance your chances of success. Moving forward, the next step is to identify programs within the state of Tennessee that offer ACGME-accredited residency programs. It is important to note that, to my knowledge, being affiliated with an academic institution, specifically with an ACGME-accredited Residency, is a prerequisite to be eligible for this particular pathway. In my opinion, an ACGME-accredited Fellowship program should also be eligible to hire these IMGs.  By following these guidelines, you can ensure that you are on the right track towards pursuing opportunities in Tennessee and making informed decisions about your career as an IMG.  https://videos.files.wordpress.com/h7xtX0No/video-residency.mov How crucial is the Year of Graduation (YOG) for this pathway? In contrast to applying for residency, the conventional consideration of the year of graduation may not hold as much weight within this pathway. In this case, hospitals are likely to prioritize the experience of IMGs over their year of graduation. It is reasonable to assume that hospitals would favor more experienced IMGs over those with less experience. This is because, through this pathway, after two years of working in Tennessee, IMGs will have gained valuable experience and be ready to practice as consultants/attending physicians in the state of Tennessee. Given the accelerated timeline of this pathway, hospitals are more likely to value the expertise and practical skills acquired through experience rather than solely focusing on the year of graduation. Consequently, as an IMG on this pathway, having additional experience under your belt can be advantageous in securing a position. However, it is important to note that individual hospital preferences may vary. Therefore, it is advisable to conduct thorough research and stay informed about specific hospital requirements and preferences during the application process. What is the application process for IMGs seeking positions in Tennessee? The specific position you should apply for within this pathway may still require further clarification. However, based on my understanding, it is likely to be a fellowship or a specialized position. Alternatively, you can directly contact the hospital and express your interest in pursuing this particular pathway, where you would undergo two years of training and subsequently become a fully licensed physician in the state of Tennessee. Let’s consider a few examples to illustrate this further.  An IMG who has completed a residency in Internal Medicine from their home country can apply directly to an Internal Medicine Department for a fellowship or specialized position through this path.  Similarly, if an IMG has completed super specialization (DM/Fellowship) in Cardiology from their home country, they can directly apply for a cardiology fellowship in order to enhance their knowledge and skills in the sub-specialty. For individuals who have completed an anesthesia residency followed by a pediatric anesthesia DM/fellowship from their home country, they can explore opportunities to apply directly as a fellow in anesthesia or pediatric anesthesia. It’s worth noting that applying for specialized positions may offer a higher chance of acceptance due to the specific demand for these sub-specialties. https://videos.files.wordpress.com/mFYbn9DQ/video-medicine.mov What are the next steps after completing two years of training in Tennessee? Once you complete the two years of supervised training within this pathway, you can anticipate functioning as a fully licensed specialist, such as a cardiologist or a pediatric anesthesiologist, within the state of Tennessee. At that point, you would apply to the Tennessee State Medical Board to obtain a full license, with the eligibility requirement being the successful completion

Obtaining a medical license can vary significantly, ranging from 2 years to 9 years or more, depending on your background and the specialization you desire.  With regard to this matter, I would like to share my perspective, taking into consideration three crucial factors regarding how you enter Canada: Residency Province-based specialization Royal College pathway Let’s jump to find out more.  How Long Does It Take To Get a License as an IMG Through Residency? To obtain a license in Canada as an International Medical Graduate (IMG) through residency, several steps need to be followed. I am giving you a high level overview.  You must complete medical training from a WHO-recognized school You must be a Licentiate of the Medical Council of Canada You must become a Canadian permanent resident You will need to take the MCCQE1 examination You must take the National Assessment Collaboration Finally, you must successfully match into a Canadian Residency program. Based on my experience with IMGs, the best-case scenario is that this entire process typically takes around two to three years. Afterward, you can pursue your desired residency program. For instance, if you choose Family Medicine Residency, the duration of the residency would be two years. Hence, in total, you can expect to obtain your license within a span of approximately five years. Of course, there are IMGs who take more and also who take less. How Long Is Residency in Canada? IMGs embark on their journey into the R-1 Royal College program through residency, which varies in duration based on the chosen specialization. Residencies can range from 2 to 6 years in length. To provide clarity, here’s a comprehensive list of residencies along with their respective durations.  [table id=38 /] It’s worth noting that if an IMG opts for sub-specialization training, additional years will be added to the overall training program.  For example, anesthesia residency is 5 years long. A super specialization in Pediatric Anesthesia would take one more year after anesthesia residency for a total of 6 years.  How Long Does It Take To Get a License as an IMG Through Province Based Specialist Path? If an individual chooses to pursue the province-based specialist pathway, the most favorable outcome would involve them undertaking a clinical fellowship lasting two to three years.  Consider a scenario where they spend three years in fellowship and subsequently secure employment as a consultant through the province-based specialist pathway. The hospital would grant them a generous timeframe of 7 years to complete all the necessary requirements before their license becomes unrestricted. Consequently, the best-case scenario for an IMG to obtain a full license via the province-based specialist pathway spans a duration of 10 years.  Although this timeframe may appear lengthy, it’s important to note that during this period, the IMG would be working as a consultant, receiving compensation accordingly, and would not be required to repeat the entire residency program. How Long Does It Take To Get a License as an IMG Through Royal College Pathway? Lastly, let’s discuss the Royal College pathway for IMGs. In this pathway, certain IMGs who have received training in specific countries are granted direct eligibility by the Royal College to take the certification exam. They are given a maximum of five years to obtain the Royal College certification.  Based on my experience, IMGs following the Royal College approved jurisdiction route have typically achieved certification within one to two years. This represents the most favorable outcome in Canada. However, it’s important to note that these individuals have already completed their postgraduate or residency training in other countries before moving to Canada. When factoring in the duration of their residency training abroad, the overall timeline would still range from seven to ten years or longer, depending on their chosen specialization. It’s crucial to keep in mind that these estimates may vary based on the specific field of specialization, but overall, this is the general timeframe to expect. What is the Time Line if the IMG is a Canadian Citizen? The timeline for a Canadian citizen pursuing a medical career varies based on the chosen pathway and residency specialization. However, it’s important to highlight that the previously mentioned timelines apply to all IMGs, regardless of their immigration status. Whether individuals are Canadian citizens, permanent residents, or have moved to Canada on a work permit, the timelines for obtaining licenses and achieving certification remain consistent. Of course, there may be some exceptions.  The author Dr. Rajeev Iyer, MBBS, MD, FASA is an experienced IMG and has helped many IMGs, American & Canadian Medical Graduates be successful. He is an Associate Professor of Anesthesiology at the University of Pennsylvania in Philadelphia, USA. The opinions expressed in this article are solely those of the author and do not reflect the views or opinions of the University of Pennsylvania or any other institution. Book an appointment with Dr. Rajeev Iyer

Becoming a surgeon in Canada as an International Medical Graduate (IMG) involves several steps and requirements. There are many different pathways IMGs can take. The process can be complex and competitive, but with dedication and persistence, it is possible to achieve your goal. In this article, I will tell you the general steps and tips to match into surgical residency. Let’s jump on this right away! What Are the Steps to Become a Surgeon in Canada? Assess your eligibility: Verify if you meet the basic requirements to work as a physician in Canada. This includes having completed medical school from a WHO recognized institution, holding a valid medical degree, and almost always having completed postgraduate training in your home country. You can check the status of your medical college/school by clicking here.  Document evaluation: Have your medical degree and postgraduate training evaluated by the Medical Council of Canada (MCC) to determine their comparability to Canadian standards. This step will help you receive a letter from MCC stating that your credentials are evaluated. Submit your documents for verification here.  Complete the Qualifying Examinations: Medical Council of Canada Qualifying Examination (MCCQE 1) is a computer based exam consisting of a written component. As an IMG, your focus should be to not just pass, but to obtain a score of 260 or higher. There is an objective structured clinical examination called National Assessment Collaboration (NAC). These exams assess your clinical skills and knowledge. Passing both parts is necessary to be eligible for licensure. You can find out more information about MCCQE1 by clicking here and about NAC here.  Language proficiency: Demonstrate proficiency in either English or French by passing the International English Language Testing System (IELTS) or the Test d’Évaluation de Français (TEF). To book an IELTS test, click here. To book the French test check here.  Postgraduate training in Canada: Apply for a residency program in surgery through the Canadian Resident Matching Service (CaRMS). The competition for residency positions can be intense, so it’s important to have a strong application, including letters of recommendation, research experience, and clinical rotations. I will provide you some specific tips below to increase your success of matching into a surgical specialty residency program. Explore the details of CaRMS by clicking here.  Complete residency training: Successfully complete the residency program in surgery, which typically lasts five years. The surgery residency is offered in 17 Universities across Canada and you can access the details by clicking here. This involves gaining practical experience and acquiring the necessary skills under the supervision of experienced surgeons. Royal College of Physicians and Surgeons of Canada (RCPSC) certification: After completing residency training, you must pass the Royal College Examination in General Surgery to obtain certification as a specialist in surgery in Canada. This is the final exit exam after residency and consists of a written and a oral component.  Licensure: Apply for licensure from the provincial medical regulatory authority in the province where you intend to practice. Although, each province may have its own specific requirements for licensure, once Royal College certified getting a licensure should be straight forward. For e.g., in the province in Ontario, this is College of Physicians and Surgeons of Ontario.  If you are someone who is experienced and certified from an approved jurisdiction or otherwise eligible, there are options to become a consultant without having to repeat residency all over again. You can check the article about this by clicking here. It’s important to note that the process may vary slightly depending on the province, and there may be additional requirements or assessments specific to certain provinces. If you browse the website of College of Physicians and Surgeons website in each province or contact the medical regulatory authority in the province where you plan to practice, you will find detailed information about the process. Can I Become a Surgeon In Canada? How to Match Into Surgical Specialties in Canada as an IMG? 1. Dedication & Passion First and foremost, it’s crucial to understand that programs in Canada seek individuals who are genuinely dedicated and passionate about their chosen specialty.  Let’s take cardiac surgery as an example. It’s important to showcase prior experience as an IMG in cardiac surgery to demonstrate your commitment. This means you either have worked in Cardiac Surgery or have completed specialization in the specialty. Programs want to avoid situations where a resident decides to quit after being hired, so they are particularly interested in applicants who already have some exposure and experience in their desired field. https://videos.files.wordpress.com/MCAA4vSa/video-cardiacsurgery.mov 2. Know The Specialty  Secondly, it’s vital that you have a clear understanding of what you’re getting into. For instance, if you aspire to pursue neurosurgery, you must be aware of the demanding nature of the specialty, with long working hours and a heavy clinical workload. It is essential to showcase your commitment and provide evidence of your experience in the specific specialty you’re interested in.  https://videos.files.wordpress.com/McCSTIoK/video-neurosurgery.mov 3. Demonstrate Research Experience in Your Sub specialty Thirdly, having research experience in your chosen subspecialty can be highly beneficial. As an IMG, you often have a couple of years before entering a program in Canada. Utilize this time effectively by engaging in productive research. Seek positions as a research fellow, strive to publish abstracts and papers in your area of interest, and actively contribute to the academic community. Show initiative by proposing ideas for book chapters, case reports, systematic reviews, or meta-analyses. Building a strong research portfolio alongside Canadian consultants will significantly enhance your CV. https://videos.files.wordpress.com/ZiiUpEhG/video-research.mov 4. Volunteer in your desired specialty  If finding a job proves challenging, consider volunteering in your desired specialization. Voluntary work can help you establish connections, gain insight into the Canadian work culture, and closely interact with Canadian consultants. When applying for a program and going through interviews, you’ll be able to draw upon your experiences to discuss both the similarities and differences between the Canadian program and your home country’s. Here is a guide on how to look for paid jobs in Canada.  5.