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I have been reading through these forums for the better part of the month and decided to bite the bullet and ask the questions that I have. Thanks in advance for your assistance. 

I am a Canadian born, UK-trained doctor hoping to settle back home in the GTA. I have completed internal medicine training (4 years) in the UK and initially was going down a very academic haem-onc path. However, I have recently realised that the passion I thought I had for research and haem-onc as a whole does not exist and what I really love about being a doctor is seeing and treating sick patients, while keeping it quite general.

In terms of exams and licensing I have done the following: 1) Completed MCCEQ1 (hoping to do the Q2 early 2021 if I can get a spot), 2) Had my internal medicine training verified by the Royal College and have been deemed eligible to sit the royal college internal medicine exams which I plan to do in 2022. (for what it's worth I have done the UK MRCP, but don't think that means much in Canada). 

Due to family and person reasons I cannot come back to Canada until 2025. I am planning on doing a family medicine residency ((MRCGP) in the UK which will take 2.5 years and is directly recognised by the CFCC without any further exams needed. After that I plan to either work as an internal medicine middle grade doctor for 1.5 years/do some locum GP work in the UK. I then plan on doing one of the University of Toronto internal medicine hospitalist fellowships either at TGH or Sunnybrook. Ultimately, I like internal medicine but not so much GP. My main reason for doing family medicine training is to guarantee I can find a job of some description in the GTA, and I have got about four years of time to kill in the UK. My questions were:

1) How difficult do you think it would be for me to get a job as an internist based out of a hospital in the GTA with my credentials (my main concerns is not having done general internal medicine sub-specialty training although I will have done a 1-year Toronto fellowship)?

2) My dream job (if such a thing exists) would be to work as an internist with possibly a special interest in cardiology, mixing my time between hospital medicine and outpatient clinic. Financially, would that be more lucrative than being a family doctor who does some locum internal medicine shifts on the side? 

3) How confident in critical care would a GTA-based internist need to be? I can recognise and treat sick patients and escalate to ITU as needed, but have very minimal experience in intubation/inotropic support/haemofiltration. That is a skill-set I hope to expand on during my year of fellowship at UofT.

Thanks. 

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  • 3 weeks later...
On 12/10/2020 at 11:22 AM, UKdocCadborn said:

I have been reading through these forums for the better part of the month and decided to bite the bullet and ask the questions that I have. Thanks in advance for your assistance. 

I am a Canadian born, UK-trained doctor hoping to settle back home in the GTA. I have completed internal medicine training (4 years) in the UK and initially was going down a very academic haem-onc path. However, I have recently realised that the passion I thought I had for research and haem-onc as a whole does not exist and what I really love about being a doctor is seeing and treating sick patients, while keeping it quite general.

In terms of exams and licensing I have done the following: 1) Completed MCCEQ1 (hoping to do the Q2 early 2021 if I can get a spot), 2) Had my internal medicine training verified by the Royal College and have been deemed eligible to sit the royal college internal medicine exams which I plan to do in 2022. (for what it's worth I have done the UK MRCP, but don't think that means much in Canada). 

Due to family and person reasons I cannot come back to Canada until 2025. I am planning on doing a family medicine residency ((MRCGP) in the UK which will take 2.5 years and is directly recognised by the CFCC without any further exams needed. After that I plan to either work as an internal medicine middle grade doctor for 1.5 years/do some locum GP work in the UK. I then plan on doing one of the University of Toronto internal medicine hospitalist fellowships either at TGH or Sunnybrook. Ultimately, I like internal medicine but not so much GP. My main reason for doing family medicine training is to guarantee I can find a job of some description in the GTA, and I have got about four years of time to kill in the UK. My questions were:

1) How difficult do you think it would be for me to get a job as an internist based out of a hospital in the GTA with my credentials (my main concerns is not having done general internal medicine sub-specialty training although I will have done a 1-year Toronto fellowship)?

2) My dream job (if such a thing exists) would be to work as an internist with possibly a special interest in cardiology, mixing my time between hospital medicine and outpatient clinic. Financially, would that be more lucrative than being a family doctor who does some locum internal medicine shifts on the side? 

3) How confident in critical care would a GTA-based internist need to be? I can recognise and treat sick patients and escalate to ITU as needed, but have very minimal experience in intubation/inotropic support/haemofiltration. That is a skill-set I hope to expand on during my year of fellowship at UofT.

Thanks. 

1) Don't think it would be that hard, there are plenty of jobs, certainly you could get a hospitalist job, because that requires family medicine training alone. Do you have a UK IM license? Does 4 years of training get you fully certified in IM that would be recognized as equivalent to the Canadian FRCPC IM?

Getting a job as an internist may be not possible without a license in internal medicine (either UK full IM license or Canadian FRCPC IM). Your pay would likely be a hospitalist's pay and you would bill as a family physician in that case.  

2) All this depends on if you are a licensed Internist or a licensed GP. 

3) You would need to be quite confident, in the GTA, there are limited critical care jobs and even fully trained ICU doctors have trouble finding ICU time. The fellowship you are asking about doesn't sound like it would provide you with any ICU experience. It doesn't have call either, so it really would be mostly for you a chance to network and get your foot in the door and see how the Canadian system works. I doubt you would learn much. 

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Thanks very much for your reply. 

To reply in line: 

1) Yes I do have a UK IM license. Once I pass the Royal College IM exams (which I have been deemed eligible to sit based on my UK training), I will be eligible for the Canadian FRCPC IM. This is what the royal college have told me. 

2) I should be a licensed internist in that case. 

3) This was exactly my concern and thanks a lot for answering that so honestly. I can definitely still skill up here in the UK in critical care. There is no shortage of critical care fellowships atm, due to Covid. But, I think that fellowship at UoFT is not going to be great for my training as you said. 

I think I have come to the rather painful conclusion, that ultimately to reach my goals in the safest and most confident way is to bite the bullet and apply for PGY-1 IM residency this year. Maybe I get 6 months to a year credit for my previous training (as some colleagues I know have) or I don't but I guess that way I will be Canadian trained and feel confident in my skills to pursue whichever specialty I like within internal medicine. 

Thank you so much for your helpful reply. 

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