Info on working in the USA?

[RuralDoc]

Hi,

 

Does anyone have any links to info specifically for Canadian physicians who are considering working in the USA? I am interested in job postings and what help is offered in getting the required Visas. I am also interested in what previous physicians' experiences have been and which states are best for finding work as a family physician. Finally, is there really a major difference in salary when comparing an Ontario family doctor's corporation to a family doctor's salary in the States? One of my main reasons for looking at the states is the southern climate. If money was the motivating factor, I would move up to northern Canada!

 

Thanks,

 

PS I am also considering work in international locations such as Costa Rica.

[Ian Wong]

Hi,

 

Does anyone have any links to info specifically for Canadian physicians who are considering working in the USA? I am interested in job postings and what help is offered in getting the required Visas. I am also interested in what previous physicians' experiences have been and which states are best for finding work as a family physician. Finally, is there really a major difference in salary when comparing an Ontario family doctor's corporation to a family doctor's salary in the States?

 

That's a huge topic, and there isn't really one specific answer. The first thing to do is visit this website, and use it to find the American Board that corresponds with your specialty.

 

http://www.abms.org/About_ABMS/member_boards.aspx

 

For instance, if you are in Family Medicine, the above link will take you to the website for the American Board of Family Medicine, located here:

 

https://www.theabfm.org/

 

From this point, you can research the requirements for obtaining US board certification.

 

https://www.theabfm.org/cert/cert.aspx

 

Whether that takes the form of doing your residency training in the US, or having Canadian training converted over to US training is dependant on your prior medical training. The reciprocity agreement for Canadian residency-trained physicians is here:

 

https://www.theabfm.org/cert/reciprocity.aspx

 

The American Board of Family Medicine has reciprocity agreements with the College of Family Physicians of Canada...

 

College of Family Physicians of Canada

 

The following two options are available:

 

1. Physicians who have satisfactorily completed two years of training in a Family Medicine residency program accredited by the College of Family Physicians of Canada may apply for certification by the ABFM upon the successful completion of a third year of accredited Family Medicine residency. The third year of training must be satisfactorily completed in an ACGME-accredited Family Medicine program or, if taken in Canada, must be approved by the College of Family Physicians of Canada. The third year must have prior approval of the American Board of Family Medicine and bring the total residency experience into compliance with the ACGME "Program Requirements for Residency Education in Family Practice." The request must be accompanied by documentation of satisfactory performance of the first two years of training (including a description of the curriculum) signed by the Program Director.

2. Physicians who have passed the College of Family Physicians of Canada Certification Examination in Family Medicine may apply to sit for the American Board of Family Medicine Certification Examination, if they:

* are members in good standing of the College of Family Physicians of Canada;

* have completed two years of post-graduate residency training in family medicine accredited by the College of Family Physicians of Canada;

* have been residents of the United States for at least six (6) months;

* hold a valid and unrestricted license to practice medicine in the United States; and,

* are actively involved in Family Medicine in the United States.

 

You also need to obtain a state medical license, the requirements for which vary with each state. Therefore, you need to determine which states you might be interested in working in, and then visit the corresponding state medical board to see how you might be eligible for that license.

 

http://www.ama-assn.org/ama/pub/category/2645.html

 

For someone who graduates from a US medical school, and then attends a US internship/residency, the typical requirements for a full state medical license include medical school graduate, passage of USMLE Steps 1, 2 and 3, and successful completion of your PGY-1 year.

 

The more you deviate from the above pathway, the more complicated things can become. However, since all Canadian medical schools are LCME-accredited, and the Canadian residency programs are very stringent, many states will accept Canadian medical school graduation and completion of the MCCQE Parts 1 and 2 as equivalent.

 

The important point here is that you need to check with each state's medical board to see what hoops you'd need to complete.

 

The next hurdle is the INS, now known as USCIS (US Citizenship and Immigration Services).

 

http://www.uscis.gov/portal/site/uscis

 

In order to live and work independantly as a physician involved in clinical duties in the US, you either need to have a work visa, or else a green card (aka permanent resident status), or be a US citizen.

 

The H1B visa is the typical visa required by physicians to practice clinical medicine in the US.

 

The TN visa (a NAFTA-based visa which can be used for many other occupations to work in the US) does not apply to physicians performing clinical duties.

 

The O-1 visa is a visa reserved for exceptional individuals who are leaders in their field, so your odds of getting this visa as a generic Canadian physician who wants to work in the US is slim to none.

 

The J-1 visa is a student exchange visa that is used for residency/fellowship training purposes, and cannot be used to practice medicine independantly.

 

If you have a green card or are a US citizen, then you are set. However, if not, then you'll likely get underway using the H1B visa, and for that, I would highly recommend talking to a US immigration lawyer, as this stuff is relatively complex.

 

As far as your last questions, if you want to practice a wide range of Family Medicine, that will be easiest wherever there are relatively fewer physicians/specialists. This is typically in rural or underserved areas.

 

As you get into more urban areas, the increasing number of physicians, and specialized or subspecialized ones at that, tends to erode away the types of patients and procedures that you can see and do. In the US, family physicians are also competing with internists, OB/GYN's, and pediatricians who are all much more heavily involved with primary care than they are in Canada.

 

In the US, it is entirely common for a general internist to be the primary care provider for a completely healthy 40 year old, or for an OB/GYN to be the primary care provider for a healthy 28 year old, or for a general pediatrician to be the primary care provider for a healthy 9 year old. This is much less likely to be the case in Canada, where there is a relatively short supply of these other fields.

 

In addition, malpractice issues dominate the US healthcare system, and choosing a state which has relatively less medicolegal intrusion by the lawyers is a key factor for many physicians in where they'll practice.

 

The following states are the ones that the AMA believes have the most favourable malpractice climates for US physicians: California, Idaho, Colorado, New Mexico, Texas, Louisiana, Wisconsin, and Indiana.

 

http://www.ama-assn.org/ama/noindex/category/11871.html

 

Here's a link to an article which lists the top five "physician-friendly" states as: Indiana, Michigan, Wisconsin, Oklahoma, and South Carolina:

 

http://www.clarian.org/physicianrecruitment/includes/physicianFriendlyArticle.pdf

 

As far as money goes, there is the potential to make that anywhere. I think the potential is probably higher in the US, where you can hire physician assistants and nurse practitioners to act as extenders, often literally doubling or tripling the amount of patients you can see in a day. However, the US also has a lot more hostile medicolegal climate, and a LOT more defensive medicine, which makes work significantly more frustrating in a lot of ways.

 

If you are a physician who is willing to move, work hard, and spend the time to become business-savvy, I think a highly successful practice is obtainable on either side of the border.

 

Still, if you are looking for money, probably the best thing you can do for yourself is choose your specialty carefully. Certain specialties will always have intrinsic advantages in making more money than other specialties, whether that be the ability to form cash-based cosmetic practices (eg. Plastics, ENT, Derm), highly reimbursed high volume procedures (eg. Cardiology, GI, Ophthalmology), lack of overhead (Radiology, Anesthesiology, Emergency Medicine), or other factors.

 

Hope this helps.

 

Ian

[mhtoto]

"However, since all Canadian medical schools are LCME-accredited, and the Canadian residency programs are very stringent, many states will accept Canadian medical school graduation and completion of the MCCQE Parts 1 and 2 as equivalent."

 

I have been told that for Canadian residency graduates it is extremely difficult to do US fellowships if they have not taken the USMLE because they cannot get a billing code to fund the fellowship. If most of the states see Canadian licensing as equivalent, why can these potential fellows not get state licensure?