NB. A good introduction to training and working in the USA can be found in the BMA Working Abroad Guide, available to download from the BMA website.

Key Organisations

AAMC               American Association of Medical Colleges

ECFMG            Education Commission for Foreign Medical Graduates

Education and Training in the USA

•  Medical education in the USA is at graduate level after students have completed a college degree, and comprises 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.

• The MD plus residency comprises a trainee’s graduate medical education (GME).

• As part of their GME, trainees must pass the Universal Licensure Examinations (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 medical licensure in order to practise within 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:

• ERAS (Electronic Residency Matching Programme) is a service offered by AAMC (Association of American Medical Colleges) which enables 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. See www.aamc.org/eras for more information.
• There is also the NRMP (National Residency Matching Programme): applicants and programme directors can both register onto the system. Applicants then rank their programme preferences and programme directors rank applicants. An algorithm is then used to match applicants to programmes. See  http://www.nrmp.org/.

International medical graduates wanting to train in the US

• International medical graduates wishing to train in the US must obtain certification from the Education Commission for Foreign Medical Graduates (ECFMG) in order to be eligible to enrol in 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.
• Applicants can apply to as many residency programmes in as many specialties as they wish, although there are fees for entering some of the matching programmes.
• IMGs 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 & Residency Electronic Interactive Database Access) which allows you to access key information about the programmes such as resident: faculty ratio, research focus etc to assist the choice of programmes
• The ECFMG do not stipulate an optimum transfer stage but they do offer advice on eligibility for applications

NB. A good introduction to training and working in Canada can be found in the BMA Working Abroad Guide, available to download from the BMA website.

Education and Training in Canada

• Medical training is undertaken by graduates following a 2-4 year undergraduate degree. The medical degree is 3-4 years long and the final one or two years of the course are 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 practice.
• The Canadian Resident Matching Service (CaRMS) matches doctors to residency training programmes. See http://www.carms.ca/ for more information.

NB. A good introduction to training and working in Australia can be found in the BMA Working Abroad Guide, available to download from the BMA website.

Education and Training in Australia

Working in Australia

• The easiest way for a UK trained doctor to work for a time in Australia is to work as a ‘hospital non-specialist’ in ‘an Area of Need’. This way you can 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) are included in the table below:

• A postgraduate or occupational trainee position must be designed specifically to add to or enhance the overseas trained doctor’s (OTD’s) level of skill in their present occupation or area of expertise.
• 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 programs 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 special occupational trainee visa.

Finding medical work in Australia

• Identify an appropriate job in an Area of Need. An Area of Need (AON) is any position/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 you will need to get full AMC registration which involves exams).

• The employer (the hospital), will determine your suitability for the position, including your English language proficiency. If they are satisfied, the employer will sponsor you for immigration purposes and support your application to the State / Territory medical board for Conditional Medical Registration for the position.

• Apply to the relevant State/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 between them.

• 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. Once you have received registration for a particular position, you may not change jobs without reapplying for medical registration and your visa.
• Apply for a visa and pass required character/police and medical checks.

Further Information

If you want to work as a GP, specialist or want to migrate permanently, please see http://www.doctorconnect.gov.au/ for specific requirements. 

NB. A good introduction to training and working in New Zealand can be found in the BMA Working Abroad Guide, available to download from the BMA website.

Education and Training in New Zealand

• Medical degree programmes are usually 6 years long, with the sixth year being spent as an intern in order to receive initial registration.
• Trainees then work as ‘house surgeons’ to get experience before receiving full registration, which must include at least 6 months of medicine and 6 months of surgery.
• After two years as a house surgeon, doctors can then apply to become a Registrar – either working without being on a specific training programme, or applying for specialist training.

• Specialist training usually takes 5-6 years.

Finding medical work in New Zealand

• Posts are often advertised in UK medical journals such as the BMJ or the careers section of the New Zealand Medical Journal available at: http://journal.nzma.org.nz/journal/vacancies.html

• Posts are also advertised in New Zealand Doctor and New Zealand GP and there are agencies which can help find employment in New Zealand.

• The New Zealand Rural GP Locum Scheme arranges locum placements for rural general practitioners. More information is available from the New Zealand Medical Association website http://www.nzma.org.nz/

Registration

• 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.

• 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 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 will be assessed by senior colleagues. They will be required to complete certain requirements to be registered within a general scope.

• Doctors who satisfy the requirements for admission to a branch/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 at www.mcnz.org.nz

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.

For detailed information see the latest BMA report: Broadening your horizons: A guide to taking time out to work and train in developing countries (March 2009).

• 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.

• See our resources section for organisations you can contact for work in developing countries.