- Postgraduate training -

Personnal accounts – Canada, Ontario

ONTARIO (HAMILTON)

R6 - General Internal Medicine

ACADEMIC
Start	GIM R4
Support	Department head put him in touch with staff physicians in the sites identified Little subsequent help Each fellowship is different Staff physicians often have no idea of procedures in other sites It’s up to the candidate to take his own steps
Choice of site/specialization	Recruited by a group of internists in a university setting Discussion on site orientations and the candidate’s interests Choice: thrombosis Evaluation of different sites Two separate applications made
Interview	In person on site Possibility of Skype interview, but less helpful Being on site means you can see the facilities and meet with staff physicians and fellows
Exams required	None RCPSC certification only
Pay	Quebec Association of Internal Medicine Specialists (ASMIQ) bursary Bursary from the hospital where the candidate holds her PEM Possibility of working as a clinical scholar Moonlighting (possible in Canada through permit portability) Candidates are usually asked to demonstrate that they have enough money to meet their needs during their fellowship
Prior rotation	Not required
Work permit/visa	Not necessary/Apply to College of Physicians and Surgeons of Ontario (CPSO) for permit
Visitor’s visa	N/A
PERSONAL
Health insurance	Insurance through Quebec firm associated with the FMSQ in addition to Quebec Health Insurance Board (RAMQ) coverage
Car	Yes, as public transit in Hamilton is limited Automobile insurance is a real headache Ontario driver’s licence and address are required to obtain Ontario auto insurance So provincial coverage is very costly Shopped around a lot, and had to return to Quebec every 60 days to comply with coverage conditions
Bank account	Make sure you have a card from a bank that has a branch on site (harder with Caisse Desjardins) Just open an account and ask for an ATM card
Accommodation	Complex Search on several websites Found a furnished apartment, and someone was able to visit it for her before she signed the lease
Driver’s licence	Quebec driver’s licence accepted on certain conditions
Quebec Health Insurance Board (RAMQ)	Usually transferable from one province to another

ONTARIO (UNIVERSITÉ DE TORONTO, HÔPITAL SUNNYBROOK)

Abdominal Radiology

ACADEMIC
Start	End of R3 year
Support	No help from his staff physicians
Choice of site/specialization	His own personal choice of subspecialization Applied wherever the training was given in Canada Information found on the position https://jobs.car.ca/search
Interview	On site
Exams	None required
Pay/bursary	Yes. Received a salary in line with Ontario resident doctors’ collective agreement, but paid by hospital radiologists
Prior rotation	None required
Work permit/visa	N/A
Visitors’ visa	N/A
PERSONAL
Health insurance	Additional health insurance through Sunnybrook Hospital, affiliated with the University of Toronto
Car	Sold his car
Bank account	Desjardins Group
Accommodation	Researched on condo.ca
Driver’s licence	No Public transit is adequate and preferable
Quebec Health Insurance Board (RAMQ)	Reciprocity between Canadian provinces

ONTARIO (UNIVERSITY OF OTTAWA)

Thrombose (1-year clinical fellowship)

ACADEMIC
Start	Spring/summer 2018 for a fellowship starting in July 2019 He talked at that time with different sites offering fellowships in thrombosis (McMaster and Ottawa) He had a telephone interview with Ottawa in fall 2018, and received a positive response from them shortly afterward
Support	A staff physician put him in touch with the fellowship program directors at McMaster University and University of Ottawa He took the remaining steps on his own
Choice of site/specialization	From personal interest and in line with the needs of his future practice site (his future site was flexible as to his choice of subspecialization) The site’s worldwide reputation in the thrombosis field, positive contacts with staff physicians in the interview, financial contribution from the fellowship site, proximity of his home town, and possibility of living in Quebec while working in Ottawa
Interview	Telephone interview He did not visit the site before starting his fellowship
Exams	None required Ottawa is a bilingual environment, and no English test is required
Pay/bursary	He is paid by his fellowship site in the form of a bursary He also received a bursary from the Quebec Association of Internal Medicine Specialists (ASMIQ) He moonlighted for several days during the year His fellowship director put him in touch with the head of the Internal Medicine department so he could do several days’ moonlighting during the year He had to obtain a permit to practise (independent practice) from the College of Physicians and Surgeons of Ontario (CPSO) as well as the necessary liability insurance coverage (see below) He took steps to obtain practice privileges at the Ottawa Hospital
Prior rotation	No
Work permit/visa	A permit to practise from the College of Physicians and Surgeons of Ontario (CPSO) is required to practise in Ontario. The procedure for obtaining it is relatively straightforward. He had to take out malpractice insurance (CMPA) at his own expense
Visitor’s visa	N/A
PERSONAL
Health insurance	He was able to be covered under his spouse’s drug insurance plan, which she has through her job. Since she was on unpaid leave, the cost was higher (loss of her employer’s contribution)
Car	No change
Bank account	No change
Accommodation	Apartment in Gatineau Visited Gatineau-area apartments in spring 2019 The proximity of Montreal meant they were able to visit the apartment before renting. The cost of accommodation is lower in Gatineau than in Ottawa
Driver’s licence	No change (SAAQ)
Quebec Health Insurance Board (RAMQ)	Since he lives in Quebec, there is no change to his RAMQ coverage
SPOUSE
His spouse went with him. She took a year off without pay to do so No visa was necessary She would have had the opportunity to work as a teacher in the region
OTHER
Performing a fellowship in Ottawa means being able to live in Quebec (Gatineau), cutting red tape (RAMQ, SAAQ, etc.)

ONTARIO

Colorectal Surgery

ACADEMIC
Start	End of R4 year (April)
Support	Helped by staff physicians in the site where she will be coming to work, and her program director
Choice of site/specialization	Associated with her interests and strengths in the area Also on the basis of positions available and the work team The offer from the fellowship site matched her academic interests, and she appreciated her colleagues, and the overall work atmosphere
Interview	She had to undergo interviews across Canada before being selected
Exams	No English test required, because the fellowship was in Ottawa (bilingual city) She was also selected elsewhere in Canada, and the English test would have been mandatory in the other provinces
Pay/bursary	Paid by the Ontario government as an R6 and R7 belonging to PAIRO
Prior rotation	Yes, a 1-month optional rotation, without which she is not sure she would have been given the position
Work permit/visa	She has to have a permit to practise issued by the College of Physicians and Surgeons of Ontario
Visitor’s visa	N/A
PERSONAL
Health insurance	Took no special steps
Car	Kept her car
Bank account	Kept the same account
Accommodation
Driver’s licence
Quebec Health Insurance Board (RAMQ)	No special steps
SPOUSE
Her spouse will not go to Ontario, but will stay in Quebec for the two years of her fellowship

TORONTO

Ehlers-Danlos Syndrome (GIM)

ACADEMIC
Start	Certified in Internal Medicine and General Internal Medicine. She received her 2nd certification during the fellowship She began the process 15 months ahead of time
Support	On request, a former colleague gave her the email address of a key person for her fellowship
Choice of site/specialization	She spent a long time searching the Internet to find a clinic specializing in Ehlers-Danlos She got in touch with the Toronto clinic after finding the name of a contact person on their website She chose the specialization after talking with her recruiting site, but she completed all the steps herself
Interview	Telephone interview She also travelled to the site to meet the team in person, although this was not required
Exams	None required She thought she needed to take the English test, but it was not required
Pay/bursary	Unpaid (no call duty) Quebec Association of Internal Medicine Specialists (ASMIQ) bursary/CHUM Internal Medicine Department bursary Other bursary possibilities include CHUM Foundation, medical faculty, and Royal College
Prior rotation	None required
Work permit/visa	The Ontario (CPSO) permit to practise is required
Visitor’s visa	N/A
PERSONAL
Health insurance	None required
Car	She left her car for her spouse in Montreal (no need for it at all in Toronto)
Bank account	N/A
Accommodation	Searched for accommodation using websites and on weekend visits in person Many people moving to Toronto use an agency, though There are also Facebook groups for fellows in Toronto that can be helpful for networking/finding an apartment, furniture, etc. (Groups : University of Toronto PGME Fellowship Forum et Fellowship in Toronto)
Driver’s licence	N/A
Quebec Health Insurance Board (RAMQ)	See section on health insurance above
SPOUSE
The candidate will go to Toronto on her own
OTHER
Even when you stay in Canada, the procedure is quite lengthy for malpractice insurance, registering at the University of Toronto, applying for a permit to practise, finding an apartment, etc. It’s best to start the process ahead of time, and ask for help from people already on site

TORONTO

Hematology and Medical Oncology

ACADEMIC
Start	End of R5 year, once the PEM was confirmed
Support	Physician in the program
Choice of site/specialization	Very simple A physician in the program who knew a Toronto doctor well made the first contact. The candidate then contacted the doctor in question, and the interview confirmed the fellowship The choice of specialization was strongly suggested by the recruiting site
Interview	On site
Exams	None required
Pay/Bursary	Paid by the facility from a research budget
Prior rotation	Not required
Work permit/visa	Not needed
Visitor’s visa	Not needed
PERSONAL
Health insurance	Supplementary personal health insurance
Car	Not yet confirmed
Bank account	Quebec account is sufficient
Accommodation	Very expensive, between $2,500 and $3,500 per month for a furnished 3½ via airbnb. Nothing can be reserved far in advance Need to reserve 4-8 weeks before the fellowship begins
Driver’s licence	Valid Quebec licence
Quebec Health Insurance Board (RAMQ)	Health insurance recognized in Ontario Notify RAMQ ahead of time

ONTARIO (UNIVERSITY OF TORONTO)

Second fellowship in a medical specialty program

ACADEMIC
Start	R4 The candidate was offered the position by his training site at the start of his R4 year First he performed a rotation in this medical specialty in a Quebec university, then decided to continue his training in that specialty He suggested his approach to his recruiting site, and it was accepted He applied alongside the CaRMS process, since the training is offered via CaRMS. He had to meet the same requirements and deadlines as for the medical subspecialty matching process, but without using the platform as such. This process was carried out in the fall of his R5 year
Support	To access a second-fellowship position in a medical faculty in Canada, it is mandatory to submit your application via the postgraduate education program in which you are registered It is necessary to consult the program director, who handles internal follow-up The candidate enjoyed the support of two staff physicians in his recruiting site
Choice of site/specialization	The choice of specialty corresponded to a special interest of the candidate’s, and not to a specific request from the site recruiting him
Interview	The interview was conducted in person but could have been done via Skype
Exams	No additional exam is required, since the fellowship is being carried out in Canada and specialist certification is recognized in all provinces But it will necessary to pass another Royal College exam once this second fellowship is completed
Pay/Bursary	Pay for second fellowships carried out in Canada is covered by the collective agreement of the body representing resident doctors in that location, in this case the equivalent of an R6 and R7 belonging to the Professional Association of Residents of Ontario (PARO). The candidate thus enjoys the benefits of the PARO collective agreement, including work conditions, liability insurance, etc. He is also receiving a bursary from his professional association
Prior rotation	Not required
Work permit/visa	Not needed, but, to moonlight in Ontario, a permit to practise in that province is mandatory
Visitor’s visa	N/A
PERSONAL
Health insurance
Car	Using a car is not recommended. It is rarely required in Toronto Most hospitals are located downtown You can keep your Quebec driver’s licence
Bank account
Accomodation	Housing costs in Toronto are rather high The search for accommodation must be carried out 4 8 weeks before the move. Any earlier is too soon There is good availability
Driver’s licence
Quebec Health Insurance Board (RAMQ)	RAMQ covers healthcare (outside Quebec for studies). You just have to notify them Healthcare services are reimbursable in all provinces, at the rate paid by RAMQ

ONTARIO (UNIVERSITY OF TORONTO)

Onco-nephrology

ACADEMIC
Start	During her R4 year She completed her Nephrology residency on June 30, 2019 She took the Royal College Nephrology exam in September 2019 She worked as a nephrologist at the site which hired her until she left on her fellowship in January 2020
Support	Support from the entire Nephrology team at the hospital that hired her (Sacré-Cœur) Several colleagues took some steps on her behalf, including getting in touch with resource persons they knew in Toronto to initiate a contact Quickly, she was able to meet the person in charge of Nephrology fellowships in Toronto and organize her fellowship For some more technical details after that (completing registration forms at the University, applying for a permit from the College of Physicians and Surgeons of Ontario, looking for an apartment, etc.), she was helped by friends who had previously done fellowships in Toronto
Choice of site/specialization	The subspecialization was a personal choice which she proposed to her home site, and they accepted right away The choice of site arose organically, because it is one of the few sites, if not the only one, to offer a fellowship in that subspecialty, and the candidate had the advantage of having colleagues with contacts in Toronto Potentially, there were two other options, one in New York City (a nephrologist practising in Montreal had done that training a few years ago), but the procedures are more complex for leaving Canada, and the cost of living is higher, and one in France (in a site that conducts research, but had never hosted a fellow and had no fellowship program as such)
Interview	An in-person breakfast meeting with the head of the host site, at the fall 2018 American Society of Nephrology Conference Since this is the most important conference, most nephrologists from Canada and the U.S. attend, and it is a good time to meet. It was a somewhat informal get-together, to discuss her expectations concerning the fellowship, rather than a formal interview
Exams	None required. Since the Royal College exams are Canada-wide, there are no additional exams to be taken. The University of Toronto and the College of Physicians and Surgeons of Ontario have access to your records and results via inscriptionmed.ca No English test was required, either, for Canadian fellows, even if you come from Quebec
Pay/Bursary	She chose not to be paid by her training site, so as to be able to concentrate on her fellowship and not to have to cover General Nephrology. When paid by the site, you are an R6 and have to cover call duty and General Nephrology duties, and this cuts into the time allocated to the subspecialty She received a bursary/financial assistance from her team at Sacré-Coeur Hospital. She was also able to work as a nephrologist at her practice site for a few months before leaving on the fellowship, allowing her to repay her student debt and be more financially comfortable when she left
Prior rotation	No
Work permit/visa	A permit from the College of Physicians and Surgeons of Ontario (CPSO) is required A postgraduate education certificate is required in order to have practice privileges in the fellowship site only (equivalent to a training card), or a regular permit to practise medicine if you want to perform moonlighting in Ontario during the fellowship She chose to apply for a certificate for fellows only, since she had no intention of working or moonlighting in Toronto during her fellowship
Visitor’s visa	N/A
PERSONAL
Health insurance	Through interprovincial agreements pursuant to the Canada Health Act, healthcare in Ontario is covered by RAMQ. They have to be notified after three months’ residence in another province
Car	She left her car in Montreal She uses public transit in Toronto, walks, or cycles for her daily commute (the hospitals are all downtown, and public transit is highly developed) For weekend trips to Montreal or vacation, the train is really great. It is also easy to fly from downtown Toronto For those wishing to keep their car with them anyway, accommodation with parking can be found, but would obviously cost more. Also, auto insurance is very expensive in Toronto. She does not recommend it
Bank account	She had an account with a bank that has a presence in Ontario, so she did not have to change anything. Nothing to be done on this front
Accomodation	In Toronto, you need to use an agency to rent an apartment. They can provide access to specialized sites, enabling you to select apartments to visit in line with your criteria It is best to plan one or two weekends on site to visit the selected apartments in person with the agent. Available apartments are usually listed at most 1-2 months in advance But there are many steps to be completed with the agent before you can make any visits (forms to be filled out, Equifax credit check, letters of reference, proof of employment, etc.). So it is best to contact the agent a few months in advance and complete all the necessary papers, then 1-2 months before the fellowship begins, confirm the apartment visits. Thus, once on site, you will be able to make an offer immediately if an apartment interests you There are many apartments available in Toronto, but also high demand and price wars at certain times of year. So you have to be ready, and have a good credit record
Driver’s licence	She kept her Quebec driver’s licence
Quebec Health Insurance Board (RAMQ)	See above
SPOUSE
Her spouse is staying in Montreal for the first six months of her 1 year fellowship, and will join her for the second half. He is a teacher, and was able to take a sabbatical term in the fall to join her. He plans to work on personal projects, and will not be looking for work in Toronto. Since he is Canadian, too, he obviously will not need a visa
OTHER
Do not forget to take out liability insurance through the Canadian Medical Protective Association (CMPA) before starting your fellowship. Proof of coverage is required by the University of Toronto and the College of Physicians and Surgeons of Ontario (CPSO)

ONTARIO (UNIVERSITY OF OTTAWA)

Knee Reconstruction Surgery

ACADEMIC
Start	R4
Support	His program director helped him obtain an optional rotation in Ottawa
Choice of site/specialization	This training site offered the only fellowship of its kind in Canada Proximity to Montreal Combination of personal interest and requirement of the site where he will be working with respect to the subspecialty
Interview	There was no formal interview because he did a 4-week optional rotation at the site
Exams	No exam required
Pay/Bursary	Pay set by University of Ottawa Bursary from University of Montreal Surgery Department
Prior rotation	The rotation is not required, but helps in getting to know the fellowship staff physicians and obtaining the position
Work permit/visa	Regular permit to practise from College of Physicians and Surgeons of Ontario (CPSO)
Visitor’s visa	N/A
PERSONAL
Health insurance
Car	Insurance to be checked
Bank account
Accomodation	Steps needed to find accommodation in Ottawa
Driver’s licence
Quebec Health Insurance Board (RAMQ)	Covered in Ontario under interprovincial agreements

ONTARIO (UNIVERSITY OF TORONTO)

Psychiatry – Drug Addiction

ACADEMIC
Start	Beginning of R5 year
Support	Support from a staff physician who had herself completed the fellowship 2-3 years ago
Choice of site/specialization	Personal interest
Interview	In-person interview (she was offered a Skype interview, but preferred to meet them in person)
Exams	None required
Pay/bursary	Paid by the training site
Prior rotation	No
Work permit/visa	Regular permit to practise from the College of Physicians and Surgeons of Ontario
Visitor’s visa	N/A
PERSONAL
Health insurance
Car	No car
Bank account	Bank account in Quebec
Accomodation	Some colleagues referred her to a housing agency to help her find an apartment
Driver’s licence
Quebec Health Insurance Board (RAMQ)
SPOUSE
Her spouse will accompany her for a few months He will not perform a fellowship and will not work