A career as a Canadian psychiatrist
Authors: Amin Muhammad Gadit
Publication date: 21 okt 2006
Amin Muhammad Gadit reckons moving to North America was right for him
Ivisited the United Kingdom last month to attend a meeting and had the opportunity to meet many old colleagues now working as consultant psychiatrists in different NHS trust hospitals. These colleagues were mainly international medical graduates who had come to the UK, sat the Professional and Linguistic Assessments Board tests, completed their training and membership exams, and taken up posts as consultants with the intention of not returning to their country of origin.
I have always admired the working system in the UK, where one can cherish the learning experience with a background of a peaceful and good quality life. To my surprise, all of them expressed disapproval of their current circumstances. There were complaints about cut backs, a reduction in authority as trusts appointed managers to take over policymaking and decisions, escalating living costs, differences in salary packages, discrimination following recent attacks on the underground system, and many other problems. They painted a sad picture which compelled me to consider whether I had made the right decision in choosing to go to Canada instead of taking up a position in the UK when I had offers from both countries.
Canada has the flavour of both the United States and Britain, and many international medical graduates are attracted to this country. Twelve years ago, many international medical graduates opted to go to Canada from Ireland in preference to the UK, probably because of the attractive salary packages. I met several of these doctors in Canada, where they are happily settled.
Licensure in Canada
In Canada, each province has about 10 different registration authorities, and all these bodies enjoy autonomy and have their own registration rules. The Medical Council of Canada prefers three exams from international medical graduates: the evaluation exam, the Medical Council of Canada Qualifying Examination (MCCQE) part I and part II, and the specialty exam of the Royal College of Physicians or the Royal College of Surgeons of Canada (FRCPC or FRCSC). However, many of the authorities give a provisional licence to international medical graduates without any of these exams, with instructions to take them within the next three to five years. Such licences are issued to psychiatrists with British, Irish, or US qualifications and training. Many of the US trained “board eligible” doctors are absorbed into the system, which is strange in view of the fact that board eligibility is not a qualification. In some cases minor overseas qualifications are accepted in areas of need. About 4000 psychiatrists work in Canada, yet there is still a great need for these specialists. Many of the psychiatrists continue to work on provisional licences until retirement, without bothering to sit the local Canadian exams. The province of New Brunswick is liberal in issuing a full licence within a year subject to satisfactory performance and formal assessment by the royal college, thus obviating the need for any of the local exams. Few authorities demand a certificate of completion of specialist training (CCST) or eligibility for specialist registration by the Postgraduate Medical Education and Training Board (PMETB) along with membership of the Royal College of Psychiatrists (MRCPsych). In the UK, there is one registration authority, the General Medical Council, which regulates all practitioners, and the newly formed PMETB determines specialist status. Hence the process is smoother and more appealing and in many ways better than that in Canada. Multiple registration authorities in one country is not practical in many ways.
Appointment of psychiatrists
There are no general advertisements at international level, and only a few are seen in local medical news-papers and journals. Health authorities place information about vacant posts on websites. Many of these posts are for poorly served areas that do not attract Canadian psychiatrists. International medical graduates submit a curriculum vitae and application form, and if the hospital authority is interested the relevant registration authority will forward advice about eligibility and type for licensure. The doctor is then invited with his or her spouse for a visit, formal interview follows, and, if all goes well, the human resources department is approached for determination of labour market need. A letter with a job offer is then sent with other necessary papers for a work permit and necessary visas. Some provinces offer help in getting permanent residence in Canada through their provincial nomination programme.
The UK system is more or less similar, except the permanent residence option through the NHS. However, advertisements for UK posts are more visible. The recent international recruitment scheme attracted many psychiatrists from developing countries. With support from the Department of Health, this scheme has offered attractive terms for employment and has facilitated the settlement of these psychiatrists. However, the scheme came under severe criticism from many quarters.
Packages and incentives for psychiatrists
Two types of appointments exist: salaried and fee for service. The salaried package varies from $C160 000 to $C225 000 a year. Fee for service physicians in a province such as Alberta can go up to $C400 000 a year. For example, in New Brunswick a certified psychiatrist of senior stature gets about $C180 000 plus 10% in lieu of medical and basic insurance, pension, and so on. On-call services carry extra remuneration monthly and there is a $C40 000 relocation incentive and $C7500 for relocation expenditure. In addition to this, up to $C40 000 a year of full fee for service work is also allowed. The NHS trust has a negotiable range, and many of the international medical graduates get between £65 000 and £80 000 a year and other relevant incentives. The packages in Canada appear more attractive in view of the growing economy of the country. It is important to note that the tax levels are high in Canada, with a 15% goods and services tax in some provinces.
Canada is a good place to settle. It has a well developed system of psychiatric services, though there is a shortage of psychiatrists in many areas. Ample opportunities exist for advanced learning as flavours of both British and American psychiatry are available. Life is generally peaceful, racial discrimination is negligible, and education and basic health care are free. It is expensive to live in Canada, but compared with the UK it is still within reasonable limits. Housing and cars are cheaper than in the UK, but air fares are expensive even within Canada. There is a great road network, and hence travelling by road is a cheaper option.
Options for psychiatrists
Canada welcomes psychiatrists in view of the acute shortages in many parts of the country. Living and working in Canada is a rewarding experience, and there is excellent growth opportunity and incentive. I definitely made the right choice and have no regrets about choosing this option. However, my emotional ties with the UK and Ireland, where I have also worked, will always remain strong. ■
Amin Muhammad Gadit professor of psychiatry Memorial University of Newfoundland, St John's, Canada Amin.Muhammad@med.mun.ca