- Postgraduate training -

Personnal accounts – United Kingdom

United Kingdom (Oxford)

RESPIROLOGY (CLINICAL RESEARCH)

ACADEMIC
Start	Internal Medicine R4
Support	Two mentors at University of Sherbrooke, where he will be practising They recommended three researchers to him—two in the U.S., and one in Europe
Choice of site/specialization	He wrote to the three researchers, with a cover letter, resumé, and three letters of reference The choice of specialization was intended to ensure succession in research and treatment of asthma An asthma specialist has since been hired, but on returning to clinical research the candidate will replace a retiring doctor. To ensure that physician’s succession, the candidate agreed to conduct laboratory experiments during his fellowship and to complete a Master’s (classes and thesis) at Oxford, for which he will be released from his fellowship activities
Interview	One interview for each site: two via Skype, and one at a conference In each case, he mentioned that he would be going on a fellowship with his spouse, who wanted to perform a fellowship in Clinical Psychiatry The three sites put him in touch with their HR departments, so he could see how practice permits would be considered for a research or customized clinical fellowship The researchers he met with also put them in touch with Psychiatry professors Finally, the UK proved to be the simplest choice in terms of red tape. The candidate’s dual French and Canadian citizenship facilitated the process for Europe
Exams required	International English Language Testing System (IELTS) English exam
Pay/bursary	University of Sherbrooke Society of Physicians (SMUS) guarantees the salary of any future professor going away on a fellowship This was a key element in his application process The fellowship host site has nothing to pay
Prior rotation	Not required
Work permit/visa	Aside from Diagnostic Radiology, no Royal College specialty is recognized directly in the UK You have to obtain a full licence to practise from the General Medical Council, so you can work as a resident For a fellowship of no more than two years’ duration, you can take the Medical Training Initiative (MTI) route to obtain a Certificate of Sponsorship from one of the royal colleges in the UK. This can be combined with sponsorship for a Tier visa. This is the simplest route for a Canadian doctor. BEWARE: If you apply for a permit to practise and are already on site, you will have to take the Professional and Linguistic Assessments Board (PLAB) test
Visitor’s visa	As a holder of dual French and Canadian citizenship, the candidate is an European Economic Area (EEA) National, and that simplified matters. But beware, the process took more than a year even so He had to prove that the MD took five years Also, clinical clerkships are not fully recognized. So candidates have to demonstrate that they have continued to acquire certain competencies during their years of residency You can also have your medical permit recognized by another nation that is recognized directly (e.g., a pediatrician who has done the U.S. exams may be recognized directly)
PERSONAL
Health insurance	In the UK, proof of residence provides access to the National Health Service (NHS) If you are Canadian and have a Tier visa, you will pay a Health Surcharge of around $500 and have the same access to the NHS as any UK resident You will still need good travel insurance, though
Car	NO, cost is prohibitive, at £1,500 a year per driver Cycling and public transit work very well
Bank account	The candidate and his spouse opened an account with HSBC Canada, and took steps to open an HSBC UK account remotely They can carry out no-fee account-to-account transactions It can be worthwhile taking a travel credit card with no currency conversion. While this costs a little more, it avoids any headaches Power of attorney and a mandate in anticipation of incapacity were signed before leaving Quebec
Accomodation	They used the Zoopla app to find accommodation Warning: “Fully furnished” refers only to furniture. It does not include dishes, utensils, etc. They also had to advance six months’ rent before arriving (beware of fraudsters)
Driver’s licence	They obtained International Driving Permits before they left, and use Co-wheels pay-as-you-go car hire, which recognizes their driver’s licences
Quebec Health Insurance Board (RAMQ)	Before leaving, both fellows completed the waiver application for stays outside Quebec for training
Telephone	Don’t forget to have your cellphone unlocked before leaving. In their case, they had a SIM card delivered to their home in Quebec before leaving, using the GiffGaff website. No contract, no credit check, and the phone works as soon as you get off the plane
Mail	Don’t forget to have your mail redirected by Canada Post before you leave Quebec
SPOUSE
His psychiatrist spouse was able to apply under the MTI only if she did not apply to immigrate via her spouse’s European passport She had to wait several months before her Tier 5 visa was issues (they keep the passport during the entire process). Costs can be as high as $1,000 Suggestion: Associate the MTI with a Tier 2 visa, if possible In all cases, ask for the visa to be issued for two years, otherwise you’ll have to repeat the whole process for the second year As Brexit approached, it was discovered that the candidate’s spouse could apply via a special program protecting the families of EEA Nationals already on site in the UK, at no cost

United Kingdom (Oxford)

RESPIROLOGY (ASTHMA)

ACADEMIC
Start	Autumn 2022 – first contact made with the department head who was known to a physician at Sacré-Cœur. Concrete steps to be taken after Christmas 2022, with an anticipated departure date of August 1, 2023.
Support	The easiest process for going to the UK as a Fellow is through the Medical Training Initiative offered by the Royal College of Physicians – it’s a slightly long process consisting of many steps, but it is well structured, and they provide fairly good support. In terms of requirements, not much apart from a letter from the program director and two referees who support the purpose of the training and the competencies – a document with the required competencies can be found on the UK college website; my referees simply indicated that I met all the requirements as per the document without any further details. A notarized copy of my medical diploma was required, but as part of the process, it is suggested to call upon a company that will do everything remotely. As far as the steps themselves, and the organization, I received help from several colleagues, including respirology residents – a colleague in another setting a few months before me, and a colleague in the same setting, but who had been there during the pandemic. There’s a group of resident doctors who are going on fellowship in the UK, with several of the residents who are there now, as well as alumni for people with questions.
Choice of site/specialization	Excellent recommendations from physicians in my department and from colleagues who completed their fellowship there or who know the physicians within this department.
Interview	Very basic for my department – if the candidate is receiving external funding, departments in the UK appear very keen in welcoming extra fellows.
Exams required	In theory, I don’t think the English exam (IELTS, which is quite difficult) is necessary since it is possible to apply for an exemption. The criterion is to have been trained in a country where English is the official language. In my case, I’d already completed the test, but I still applied for an exemption on principle to see if it would work, and it did. However, I am unsure if it would work for everyone, particularly in the case of a degree from a French-speaking university. If you can cope with uncertainty, you might consider it, but for your sanity, I imagine you’re better off doing it or at the very least allowing yourself ample time in case you apply for an exemption and the latter is declined, particularly given some people have had to retake the test (with the minimum passing mark being quite high).
Pay/bursary	CIUSSS-NIM bursary – irrespective of the amount, it helps to have something “on paper” that confirms you’re making at least 35,000–45,000 pounds, which makes it much easier to find housing rather than telling them you have a line of credit.
Prior rotation	Not required
Work permit/visa	If you’re under 30, you can apply for a Youth Mobility Scheme visa, valid for 2 years – as long as you come into the country before the age of 30, it will remain valid thereafter. Alternatively, the Royal College of Physicians supports the process of obtaining a Tier 4 visa in the context of the Medical Training Initiative application.
Visitor’s visa	Same as work visa
PERSONAL
Health insurance	For all people arriving on a long-term visa, there is an annual NHS fee which offers coverage for medication and hospitalization. It’s very easy to register for a family physician, who can refer you to specialists free of charge if necessary. Drug coverage is excellent, and there are no strings attached, even for biologics or monoclonal antibodies (however, these usually have to be prescribed by a specialist, so remember to have a prescription on hand while you find a family physician, have the latter refer you, and wait to see the specialist and for the NHS to process all the paperwork). As a healthcare worker, all these expenses qualify as fully reimbursable!
Car	I don’t have one, everything is done by bike, but it’s very easy to rent a car.
Bank account	It’s easy to open an account when you arrive, but otherwise I pay all my bills using a Canadian credit card with no conversion fees, so it’s almost as easy as in Canada. Some expenses require direct debits from an account, but you can usually wire money from your bank in Canada should you prefer not to open an account there.
Accomodation	More complex – there are many real estate rental agents, but it’s sometimes difficult to obtain a virtual visit, particularly if you contact the agents by email. Much higher chance of success by phone (it’s possible to use an app allowing you to make international calls by redirecting your call to a local number like Rebtel, a much cheaper option than using your own plan). Real estate agents are much less motivated than in Quebec – expect to have to chase them down frequently to get your file moving, even with the date of occupancy nearing. For my part, I only made an advance payment for the first month, but some people have been asked to pay several months’ rent in advance. Of note, the municipal tax (Council Tax) in the UK, unlike here, is paid by tenants, and via monthly instalments.
Driver’s licence	I already held an international permit, but I had no problem renting a car even with only a Quebec permit.
Quebec Health Insurance Board (RAMQ)	Simply make a request to avoid losing your eligibility during your time outside the country. Since your stay is tied to pursuing training abroad, you can ask for a waiver which will not count towards Quebec’s 7-year provision.
Telephone	Several companies offer excellent bundles, considerably cheaper than in Canada, and this goes for the Internet as well.
Mail	Have all mail redirected to family/friends, bearing in mind that you also need to do this for your bank/university (they will send you your diploma within a year of completing your training, probably during the course of your fellowship), as well as your last home hospital (for your income tax receipts).
SPOUSE
Spouse completing her fellowship in Switzerland during the same period.