Medical experience outside the EEA

Medical training routes vary from country to country. This has implications for UK doctors wishing to continue their training abroad or work overseas.

Below is a brief summary of the medical training routes in some common destinations.  For further detailed information the BMA's Your Guide to Working Abroad is a useful resource.

In addition you will also need to consider: immigration rules, visa requirements, conditions of employment, immunisations and other health preparations.

Below are information about Australia, Canada and the United States, developing countries and New Zealand.

  • Education and training
    • the medical education and training system in Australia is similar to that in the UK. After an undergraduate or graduate entry medical degree (four to six years), trainees must complete a 12-month internship in order to be granted full registration with the relevant State Board or Council.
    • once they are fully registered, trainees work as a resident medical officer (RMO) or hospital medical officer (HMO) for a couple of years to acquire more experience, before applying for a vocational training programme for specialist training.
    Working in Australia
    • the easiest way for a UK-trained doctor to find employment in Australia is to work as a ‘hospital non-specialist’ in ‘an Area of Need’. This allows you to get ‘Conditional Medical Registration’ with the Australian Medical Council, which means you won’t have to sit any exams.
    • a hospital non-specialist refers to a doctor without postgraduate medical qualifications who receives a government salary for the delivery of non-specialist healthcare services in a public hospital to public patients.
    • the kind of public hospital positions that would be available to an overseas-trained doctor (OTD) include:
      • internships - typically this is the one year of supervised training required by the Medical Registration Boards to achieve full medical registration, so could be suitable for Foundation doctors
      • resident medical officers or hospital medical officers - doctors in their second or third year of training
      • registrars - specialists-in-training

    These positions are only for doctors seeking to upgrade their skills for use on return to their home or another country on completion of training and are not intended for doctors seeking work in Australia.

    These training programmes are workplace-based and are available in some Australian hospitals.

    Entry to Australia to take up one of these training positions should be on a training and research visa.

    Finding medical work in Australia
    • identify an appropriate job in an Area of Need. An Area of Need (AON) is any position or location in which there is a lack of specific medical practitioners or where there are medical positions that remain unfilled even after recruitment efforts have taken place over a period of time. (If you want to choose exactly where you work in Australia you will need to get full Australian Medical Council (AMC) registration which will involve taking exams)
    • the employer will determine your suitability for the position, including your English language proficiency. If satisfied, the employer will sponsor you for immigration purposes and support your application to the State or Territory Medical Board for Conditional Medical Registration, to enable you to take up the position
    • the Medical Board of Australia has details about registration. Apply to the relevant State or Territory Medical Board for Conditional Medical Registration. It is important that you check the registration requirements of the Medical Board for the particular State or Territory in which you are applying as requirements may vary
    • the Medical Board will notify the hospital of their decision, and the hospital or medical recruiter will advise you of the outcome. Conditional Medical Registration is job specific. The Australian Health Practitioner Regulation Agency (AHPRA) gives further details of the registration process
    • you will need to apply for a visa and pass required character/police and medical checks
     Further information

  • Canada - education and training

    • medical training is undertaken after completing a two- to four-year undergraduate degree. Medical training consists of a three- to four-year degree with the final one or two years of the course spent working in a hospital
    • after completing the medical degree, students apply for residency programmes (equivalent to specialty training) before passing final examinations to receive their licence to practise
    • Canadian Resident Matching Service (CaRMS) matches doctors to residency training programmes
    • a good introduction to training and working in Canada is available on the BMA website

    United States - education and training

    • medical education in the USA is at graduate level after students have completed a college degree. The first stage of graduate medical education (GME) is a four-year Doctor of Medicine degree (MD)
    • after obtaining an MD, trainees must then apply for residency, which is the equivalent of specialty (and sub-specialty) training in the UK
    • as part of their GME, trainees must pass the United States Medical Licensing Examination (USMLE). There are three stages to these examinations: two take place pre-MD and the third during residency, with part three being required to obtain a licence to practise medicine in the designated state or jurisdiction
    • international medical graduates have to sit the same examination to train in the US
    • residency programmes can last between three to five years, with sub-specialty training lasting between one to three years

    How the US applications and matching processes work

    • the ERAS (Electronic Residency Application Service) is offered by AAMC (Association of American Medical Colleges) to enable medical students to search for training programmes by specialty and state, and to submit customised applications. Candidates only have to complete one application and submit one set of supporting documents, which can then be customised for submission to individual programmes
    • there is also the National Resident Matching Program where applicants and programme directors can both register on the system. Applicants then rank their programme preferences and programme directors rank applicants. An algorithm is then used to match applicants to programmes

    International medical graduates who wish to train in the US

    • if you wish to train in the US you must obtain certification from the Education Commission for Foreign Medical Graduates (ECFMG) in order to be eligible to enrol on a GME programme
    • the ECFMG sponsors the training of international medical graduates in the J-1 immigration category. NB All J-1 physicians must return to their home countries for two years on completion of training. The website of the Education Commission for Foreign Medical Graduates (ECFMG) has a useful J-1 visa sponsorship factsheet
    • applicants may submit a list of 15 programmes, with the option of adding more for an additional fee. It is generally not necessary to submit more than 15 programmes unless you are applying to a competitive specialty. However, the more programmes you submit, the better your chances of being matched. More information can be found on the American Medical Association (AMA) website
    • international medical graduates are advised to take part in ‘observerships’ in clinical settings before applying for residency programmes. This enables trainees to get an insight into US clinical practice and to identify potential referees for residency applications
    • there is an interactive database called FREIDA (Fellowship and Residency Electronic Interactive Database Access) which allows you to access key information about the programmes, such as resident: faculty ratio and research focus to help you with your choice of programmes. Further information can be found on the BMA website under the section ‘finding a position’.
    • the Education Commission for Foreign Medical Graduates (ECFMG) offer advice on eligibility for applications.
    • the ECFMG has produced an Exchange Visitor Sponsorship Program Reference Guide. This has details of the regulations governing sponsorship of the J-1 visa and the initial application process.

    Further information

    • a good introduction to training and working in the USA is available on the BMA website

    • just as with any overseas experience, you need to be very clear about why you want to take the time out and what you hope to gain from the experience
    • you should be aware that some of the opportunities available within developing countries, such as working with a health relief agency, may not necessarily count towards your Certificate of Completion of Training (CCT), despite being a worthwhile and rewarding experience
    • in order to work in a developing country, you may require a specific amount of experience, e.g. three years' postgraduate work. Depending on the organisation you choose to work with and the amount of experience required may differ
    • the BMA website has brief information on volunteering in developing countries and how this can help doctors at any level with their professional and personal development

     

  • Education and training in New Zealand

    • medical degree programmes are usually six years long. The final year is spent as an intern to enable trainees to gain initial registration
    • trainees then work as ‘house surgeons’ to get experience before gaining full registration. This experience must include at least six months of medicine and six months of surgery
    • after two years as a house surgeon, doctors can then apply to become a registrar by either working without being on a specific training programme, or applying for specialist training
    • specialist training usually takes five to six years

    Finding medical work in New Zealand

    Registration

    • 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 forms of registration are granted only 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 it to the Medical Council of New Zealand (MCNZ) with a supporting application
    • 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. During this time they are registered within a provisional general scope of practice and their performance is assessed by senior colleagues
    • doctors who satisfy the requirements for admission to a branch or sub-branch of medicine (specialties) can apply for vocational registration. In New Zealand, general practice is considered a branch of medicine, therefore GPs can apply for vocational registration
    • registration is regulated by the MCNZ and full details can be found on its website

    Immigration

    • if you intend to stay less than three years in New Zealand, you should apply for a temporary work permit. You will need to show your eligibility for registration, evidence of a job offer and confirmation from your employer that the vacancy could not be filled by a New Zealand resident
    • for periods longer than three years, you will need to apply for a residence visa, probably under the category General Skills. Like the Australian system, this also operates on a points basis. Further information can be obtained from the New Zealand High Commission in London or the consulates in Belfast and Edinburgh

    Further information

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