General practice in British Columbia

The job

I work as a family physician in an office with eight other doctors. The local hospital has an emergency department and about 20 inpatient beds. Family physicians who work locally are responsible for covering the emergency room and patients on the ward. Patients who are admitted to the ward tend to have chronic rather than acute problems and most acute patients are transferred out to the nearest hospital for specialist input and treatment. So life here as a general practitioner (GP) is very different to what I was doing back in Croydon.

Getting a visa

The process of obtaining a working visa is very long winded. My hunger for the outdoors and determination to experience a different health system helped me to survive all the red tape. There are two very good websites with more information about job opportunities for physicians and nurses in British Columbia (BC) (see box). These recruitment agencies are non-profit organisations funded by the government of BC. They are a great source of information but responses can be very slow and tedious. Once you have identified a suitable position I recommend visiting that community and getting to know the doctors who work there before making any firm commitments.

Positions vacant

As an overseas doctor I am geographically restricted to an “underserved area” until I successfully complete the Canadian examinations. Positions have to be advertised for a significant length of time within Canada before they can be opened up to overseas doctors. The vacant positions tend to be in rural or semi-rural communities. They may involve some commitment in the local hospital, although this is becoming rarer.⇓

Getting temporary registration

Once you have accepted a position, the next step is to apply for a temporary registration to practise medicine in BC from the College of Physicians and Surgeons of BC (CPSBC). This process can take anything from several weeks to several months. See the CPSBC website (www.cpsbc.ca) for the documentation required by the review panel when applying for a temporary registration to practise medicine in BC. If you do not have the appropriate experience or documentation, the CPSBC will make specific recommendations that you will need to provide before they take your application any further. By the way, the review panel only meets every two to four weeks, which adds further delay to the already slow process. I guess the only advice I can give here is to have all the necessary documents from the very start.⇓

The CPSBC will generally grant temporary registration for a year; an extension to this is considered after successfully completing the Medical Council of Canada Evaluating Examinations within the first year of practising in BC. Subsequent extension in licensure is contingent upon progress in obtaining the examinations of the Medical Council of Canada leading to the Licentiate of the Medical Council of Canada (LMCC).

The health system

The Canadian health system is based on a fee-for-service system. The MSP billing number is used to bill the government medical insurance plan for services rendered to patients. Patients can go to any doctor who is accepting new patients and register with them. They are not geographically restricted to GPs within a certain area, unlike the United Kingdom. They also have the option of being seen in any of the many walk-in clinics; these are similar to the NHS walk-in clinics in the United Kingdom but are manned by doctors rather than nurse practitioners.

Social insurance

Anyone working in Canada, whether Canadian, a permanent resident, or on a work permit, is required to have a social insurance number (SIN), similar to the national insurance number in the United Kingdom. You can apply for this at any Human Resources Canada Centre (see box for their website address).

An application must also be made for personal medical insurance (MSP) for physicians and family members. This will take three months to process so ensure that you have adequate travel insurance to cover this period. Application forms can be downloaded from the website address given in the box.

Professional insurance and societies

Medical indemnity is mandatory in Canada and can be arranged from the Canadian Medical Protective Association. This organisation is comparable to the Medical Protection Society and Medical Defence Union in the United Kingdom.

Membership of the British Columbia Medical Association (BCMA) is voluntary and currently represents 75% of doctors practising in BC. The role of the BCMA is similar to that of the British Medical Association in the United Kingdom.

Information on spousal employment can be obtained from the Citizenship and Immigration Canada (CIC) website. The CIC have prepared a Welcome to Canada information booklet for newcomers to Canada. It contains useful and practical information regarding health insurance, education, taxes, and other advice to help in the adaptation to a new country and culture.

Worthwhile

Working in Canada as a general practitioner can be as exciting and rewarding as you want it to be. Coupled with the beautiful outdoor lifestyle and great standard of living, I think it's been worth my while relocating to BC. We will certainly explore the health system and the country for another two years before deciding whether this is a permanent or temporary move. If you have any further questions please feel free to email me.