Pulmonology (Respirology)/Critical Care Combined Fellowship in the US

[bluejay33]

Has anyone done a pulm/CC fellowship in the US and returned to Canada to practice? What additional training is needed to meet requirements to allow you to sit for both the CC and respirology RCPSC exams? Is there something akin to the pathway taken by IM residents who trained in the US and do a fellowship to fulfill that 4th year requirement needed to take the RCPSC exam in IM (something like sleep, interventional pulm etc). I tried reaching out to college directly to get an answer and they were pretty vague in telling me that I can submit my training after it is complete for them to evaluate what additional training would be needed or submit a "proposed curriculum" for them to evaluate before I start (however, by then I have already committed to a program and am unable to back out if Canada says they won't accept that training). 

I really do enjoy pulm/cc but also do not want to practice in the US longterm (yes, I am aware the job market isn't great and that I will likely be taking a pay cut and have to work in the more rural/community settings and I am ok with all of this). I was just hoping to get some guidance from someone who has done this. I want to know if it is even possible? 

[ACHQ]

18 hours ago, bluejay33 said:

Has anyone done a pulm/CC fellowship in the US and returned to Canada to practice? What additional training is needed to meet requirements to allow you to sit for both the CC and respirology RCPSC exams? Is there something akin to the pathway taken by IM residents who trained in the US and do a fellowship to fulfill that 4th year requirement needed to take the RCPSC exam in IM (something like sleep, interventional pulm etc). I tried reaching out to college directly to get an answer and they were pretty vague in telling me that I can submit my training after it is complete for them to evaluate what additional training would be needed or submit a "proposed curriculum" for them to evaluate before I start (however, by then I have already committed to a program and am unable to back out if Canada says they won't accept that training). 

I really do enjoy pulm/cc but also do not want to practice in the US longterm (yes, I am aware the job market isn't great and that I will likely be taking a pay cut and have to work in the more rural/community settings and I am ok with all of this). I was just hoping to get some guidance from someone who has done this. I want to know if it is even possible? 

I'm not in ICU or Resp (I'm a 4 year GIM, just about to finish residency), but have a *little* bit of insight in terms of credentialing/licensing.

The CPSO (or equivalent provincial body CPSQ, CPSA, CPSM etc...) are the ones that will grant you a license. As long as you passed your royal college exams and have completed a royal college certified specialty training program. They get that notification directly from the royal college.

The royal college has to both certify your training AND "allow" you to take the exam (but I believe both are the same process). You have to literally fill out an application and submit a fee for them to do this (even Canadian residents at Canadian institutions do this). I think if you are at an U.S. institution they do it the same way or it requires another application/more info etc... but the concept is the same. Now this is where it gets merky for you. The royal college can unilaterally say "NO you cannot sit for this exam because you don't meet some random requirements" and then you can't even take the exam and there ergo can't get the license to practice.

With all that being said though there are some bright spots:

1) I think IN GENERAL (don't quote me), that they will allow you to take the CCM royal college exam, I have NO idea about the respirology one.

2) Even if you don't get approved to write these exams, you can always write the royal college internal medicine exam (which you probably have to do anyways to get licensed first in Internal medicine), and then manage it so that you still practice CCM/Resp without being royal college certified/licensed as long as the institution you work at is OK with that (some will be ok with it as long as you are US board certified), again don't quote me on that but that is my limited understanding. You could only bill as an IM, but ICU bill using IM codes and G codes (which are not restricted to them anyways), but if you wanted to bill as resp you could not...

3) I even think that the provincial body(ies) may grant you a license if you are US board certified (however don't quote me on that one), which allows you to practice anyways as long as you have a way to track CME (which can be done via a membership through your US body)

Did you want to just practice ICU? if so you will probably be OK (understanding that the job market is horrible), but if you wanted to Resp, or BOTH ICU/Resp, might be more tricky...

[bluejay33]

Thanks for the insight! I would actually hope to do both; I'm very interested in ILD and I really would like to focus my practice on that. I also really love the CCM aspect of things and would not be willing to give that up. I was just wondering what do US certified PCCM doctors who move to Canada (for whatever reason) do? I am sure there is a pathway for them to practice to their full capacity (i.e. in pulm and CCM). Do they need to redo their training in Canada? Or will doing an additional year of training in a pulm sub-speciality suffice the RCPSC requirements for board certification? 

[ACHQ]

11 hours ago, bluejay33 said:

Thanks for the insight! I would actually hope to do both; I'm very interested in ILD and I really would like to focus my practice on that. I also really love the CCM aspect of things and would not be willing to give that up. I was just wondering what do US certified PCCM doctors who move to Canada (for whatever reason) do? I am sure there is a pathway for them to practice to their full capacity (i.e. in pulm and CCM). Do they need to redo their training in Canada? Or will doing an additional year of training in a pulm sub-speciality suffice the RCPSC requirements for board certification? 

That sounds like a sweet gig. Where were you thinking of going in terms of location and what type of practice setting (academic vs community)? I can't speak to any other parts of Canada (or even the rest of Ontario), but within the Toronto academic setting very very few do both, (actually I was told by one that at some point 10-15 years ago they literally made them choose to do one or the other).  Those that do both are either too senior/boss like to have been kicked out of either department. In the community in the GTA you will still find some that do both. They are usually mid to late-career (been working 15+ years), when the combined fellowship existed in Canada. Whether you do academics or community you have to have buy-in from each department (Critical Care and Respirology), which sometimes isn't the easiest thing to achieve.

Unfortunately I don't have the answer to those  other questions. I highly doubt they would make you do complete re-training (which here would be 4 years, 2 for CCM and 2 for resp). You will have to find someone who did their training in the US and then came back and what steps they went through (in the location and practice setting you wish to end up in). TBH it was probably easier to do when the combined fellowship existed in Canada then now. I would contact the royal college credentialing and send them your program curriculum and see what they say. I would also get licensed/board certified in the US in both CCM and Resp, as well as royal college certified in IM in Canada, which might make things slightly easier.