Advice for hospital doctors wanting to work abroad

One of the great benefits of being a doctor is the development of geographically transportable skills. UK-trained doctors are often in demand in other countries, and many will consider working overseas - at least temporarily - at some point in their medical career.

Not only does it benefit the health system of country being visited, but it broadens the doctor’s experience and contributes to raising standards in the NHS upon their return. But it isn’t for everyone and there are many issues to consider when looking to work overseas:

1. Doctors should be clear in their own minds why they want to work abroad, which country would suit them and what role they want to perform? It makes finding the right job a lot easier. They should remember that less popular medical jobs in that country are going to be easier to secure.

2. Talk to another doctor who has been there and done it.

3. Research the move abroad thoroughly before signing up. Understand the medical system in the country you’re visiting and where you would fit in. UK training grades may not have an exact equivalent in another country. Get as much information as possible about the duties and responsibilities of the position and training structure.

4. Assess the procedural requirements of working in that foreign country - they vary a lot and can be extensive (see below).

5. Check the terms and conditions of employment. The last thing a doctor needs when they turn up in another country is a series of nasty surprises about pay, working hours, rotas and holiday entitlement. Get everything in writing first.

6. Doctors should assess the implications for their careers of working abroad. Doctors are generally advised to complete foundation years one and two sequentially before working abroad. Specialist and general practice training programmes in the UK are only open to those who have acquired and demonstrated foundation competencies.

7. Where should a doctor look for a job overseas? Check the jobs websites in the UK, such as the BMJ; check the international organisations that facilitate overseas recruitment; and check the recruitment agencies and jobs boards in the country of destination, for example the Medical Journal of Australia. 

So, a hospital doctor works through these issues, applies for a job abroad, gets it and then makes ready to go. What do they have to do before they go overseas?

1. Junior doctors should talk to their postgraduate dean, royal college and PMETB if they want their overseas work to count towards their training in the UK.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

Immigration requirements

Enquiries about immigration should be addressed to the appropriate High Commission or embassy in the UK. A directory of foreign embassies in the UK is available from the Foreign and Commonwealth Office.

What is generally required before starting an overseas job?

1. A visa allowing the doctor to work in the country. 

2. A medical. 

3. Evidence of current registration.

4. Certificate of good standing from current and previous registration boards.

5. Degree certificates.

6. References from senior medical colleagues. 

7. An English language test. 

8. Registration with the country, state or territory Medical Council or medical licensing authority.

9. A letter of appointment from your new employer. 

Australia - registration and implementation

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.

There are lots of locum agencies specialising in employment in Australia. Many doctors find that once they have been offered a post, the employer will organise their registration and a visa for them.

For further information visit: the Department of Immigration and Citizenship’s website and Doctor Connect.

Other sources of jobs include:

Mediventure; Queensland; Tasmania; Flying Doctor; Seek jobsite

Canada - registration and immigration

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.

New Zealand - registration and immigration

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.

Jobs are advertised in the New Zealand Medical Journal.

USA - registration and immigration

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. Read more

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).

Developing world - useful links 

The Department of Health’s code of practice for the international recruitment of healthcare professionals.

Médecins Sans Frontières is an independent humanitarian medical aid agency providing emergency medical relief to the victims of natural and non-natural disasters.

Médécins du Monde UK is a medical, humanitarian, non-governmental organisation which relies on volunteer health professionals to participate in its projects throughout the world.

Medical Emergency Relief International’s aim is to improve the health of populations affected by conflicts, natural disasters, epidemics and health systems collapse.

RedR builds the skills of local people and communities in areas of disaster.

VSO is an independent development charity that works through volunteers.

Europe

For information on working as a doctor in Europe read the BMA guide Opportunities for doctors within the European Economic Area.

Further sources of advice:

The BMA’s guide to working abroad

Support4Doctors

Advice from Southampton University Hospitals NHS Trust

Tags: Overseas recruitment, Working abroad