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Working Overseas

Definition

Many doctors are happy practicing medicine in their chosen speciality but are keen to explore new working environments. Working overseas can offer this opportunity either as a trainee or a qualified practitioner. Doctors share the fantastic opportunity that their skills are often transferable across the world.

Many doctors and trainees opt to work in English speaking countries such as Canada and Australia where working conditions and opportunities can mirror those in the UK.

However there are number of options for working in the developing world either via short or longer term projects to help build up local knowledge and develop sustainable infrastructure. Agencies such as Medicin san frontiere and Merlin are able to help with planning and visa arrangements for your trip if you want to work in the developing world (visit our section on Volunteering Abroad).

Careful consideration to your country of choice, for example if it is within the European Union, will also impact on the time taken to organise your placement, as explained below.

Six months or six years abroad can add a whole new dimension to your CV.

Preparation: Checklist

  • Talk to your postgraduate dean, royal college and PMETB if you want their overseas work to count towards their training in the UK.
  • Taking time out of specialty training has to be agreed with the postgraduate dean. It will not normally be agreed until a trainee has been in a programme for at least one year.
  • Specialty registrars must establish whether their NTN will be held for them. Prospective training approval must be received from PMETB and the requirement for annual review must be satisfied.
  • A doctor working abroad will have to take out separate indemnity insurance. UK-based defence bodies can advise you about the overseas cover they offer.
  • A doctor going to work in a foreign country must protect their pension in the UK. They should talk to their current HR team or, if a BMA member, read advice on its website.
  • It is also worth checking with their GP on what immunisations are required, and consider private health insurance if not included in terms and conditions of employment.

Training

You can undertake some or all of your training overseas. Once you have a National Training Number (NTN) you can apply for an Out of Programme Experience (OOPE) and if you have your training overseas prospectively approved by your UK College and PMETB it can count towards your time in training. For training not approved, you can still work abroad but you will then need to seek approval if you wish to retain your training number, and the time will not count towards your CCT.

Immigration, Registration, Indemnity
As when practising in the UK, you will need to have:

(i) appropriate immigration status to work
(ii) registration with the equivalent GMC body in your new country of choice

Both of these aspects can appear daunting but there a number of agencies that are able to simplify and ease the process. The main constraint will be the length of time that the process itself can take. Careful planning ahead is essential.

Consider also the country of choice. Each will differ in its criteria and regulations. We discuss some common destinations below.

Additionally, you will need to consider your medical indemnity. This can occasionally be provided by UK-based medical defence organisations, depending on the location, nature and duration of work. Local agencies may also be able to help direct you to the correct bodies.

Mike Broad discusses the registration and immigration conditions for doctors that apply to some common destinations:

Working in Australia

Registration without conditions enables doctors to practise unsupervised. It is only available to UK trainees who have applied for migrant status and have completed the Australian Medical Council examinations and a period of approved training.
Registration with conditions is available to overseas medical graduates who will be temporarily in Australia to work in one of the following areas: postgraduate training, supervised training, teaching or research, public interest or areas of need, such as positions or locations where there are shortages. The types of conditions vary depending on the category of registration and the individual doctor.

The preferred temporary visa pathway for doctors is the Temporary Business (Long Stay) visa (Subclass 457) which has a streamlined application process. In order to apply for a visa you must first find a post, you will also need to provide evidence that you are eligible for registration with the appropriate State Medical Board.

Working in New Zealand

In New Zealand there are no registration categories. Instead, doctors are registered in a ’scope of practice’. Your scope of practice will depend on your qualifications, experience and the purpose and duration of your employment in New Zealand.
All new registrants, regardless of seniority, must work under supervision for at least their first 12 months in New Zealand to become familiar with the culture.

Registration is only granted when a doctor has a confirmed job offer under supervision in an approved hospital, practice or educational institution. The registration application should be submitted to the prospective employer, who will check it and send to the Medical Council of New Zealand with a supporting application.
Registration and the NZREX examinations – which doctors have to sit if they don’t meet the scope of practice – are regulated by the MCNZ. If the doctor intends to stay less than three years in New Zealand, they should apply for a temporary work permit.

Working in the USA

UK trained doctors need certification from the Educational Commission for Foreign Medical Graduates (ECFMG) in order to be eligible to enrol in a GME program and eventually apply for licensure to practice medicine.
To proceed towards ECFMG certification, the doctor’s medical school and the year that they graduated must be in the International Medical Education Directory.

The doctor will need to satisfy a Medical Science Examination Requirement and Clinical Skills Requirement. Visit the ECFMG website for full details.

Employment visas are usually not issued until you have obtained ECFMG certification. Temporary visas are available as an Exchange Visitor (J1), for those taking an appointment under an officially approved programme and sponsored by an educational institution, and as a Temporary Worker (H1), for those working in a highly skilled job for which there is no US worker available. This must have prior approval by the Immigration and Naturalization Service. The ECFMG is authorised to sponsor foreign national physicians for the J-1 visa.

They are only issued to doctors who have a letter from the Department of Health, confirming that they will return to the UK on completion of their training. Visit the AMA website for comprehensive information.

More detailed information on residency programs is available from the AMA’s FREIDA Online database (Fellowship and Residency Electronic Interactive Database Access).

Working in Canada

British medical graduates must establish professional competence. Each province has a licensing authority, which will require UK doctors to pass the Medical Council of Canada Evaluating Examination (MCCEE), administered by the Medical Council of Canada (MCC). This is an exam for international medical graduates which tests general clinical competence in comparison with graduates from Canadian medical schools.

Employment authorisation and a work permit are needed from the Canadian High Commission and doctors have to have a medical examination.

Once the MCCEE is passed, doctors can take the MCC Qualifying Examination (MCCQE) Part 1. This is a one-day computer based test assessing an individual’s competency for entry into supervised clinical practice in postgraduate training programmes.
Quebec has separate immigration procedures.

Transferable Skills

Clinicians offer favourable transferable skills including:
Medical knowledge and clinical management in all branches of medicine and surgery are transferable; people are people the world over.

While facilities and processes vary from country to country most hospitals and clinics in Europe, USA, Canada, Australia and New Zealand will be equipped and work in a similar way to those in the UK.

Facilities in the developing world vary greatly and you may find techniques differ greatly from those in the UK.

You may need to sit an equivalence examination to work in some countries – you will need to check with the relevant licensing board (links below)

Pay

Pay varies depending on where you work and at what level. Working in the developing world is often voluntary or paid at local rates. Training pay in the USA is lower than in Europe but the scope for earning increases significantly post qualification.

Hours

The European working time directive limits working hours to 48 per week in Europe, the USA and Australasia have similar directives limiting working time to under 80 hours in the USA and under 40 hours in Australia.

Lifestyle

As in the UK, working overseas can be just as demanding, but this will ultimately depend upon your speciality and location. The rewards, monetary and personally, will differ but particularly when undertaking work in the developing world, they can be extremely invigorating.

Attributes

As with the UK, a well-rounded portfolio and evidence to support your CV/ application is essential for success overseas.

Getting ahead

Any unique selling point will help with making it to the top of your profession both at home and abroad. If you are aiming to work in an international centre of excellence for example: a suitable interest in the relevant research would be a great help.

Additional qualifications and retraining may be required depending upon where you are intending to work. For example, to work in the United States of America you will be required to pass the United States Medical Licensing Examinations (USMLE).

Further Info

The Federation of State Medical Boards
Australian Medical Council
Medical Council of New Zealand
Medical Council of Canada

Other Guidance

www.hospitaldr.co.uk/guidance/tips-for-doctors-wanting-to-work-abroad

www.bma.org.uk/international/working_abroad/overseas

Before Starting your New Job: Checklist

  • A visa allowing the doctor to work in the country.
  • Registration with the country, state or territory Medical Council or medical licensing authority.
  • A medical
  • Evidence of current registration
  • Certificate of good standing from current and previous registration boards
  • Degree certificates.
  • References from senior medical colleagues.
  • An English language test.
  • A letter of appointment from your new employer.

(reproduced with kind permission from M Broad, HospitalDr)

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