Working Abroad as a Medic
Author: Dr. Abeyna Jones, Director of Medic Footprints, London
When I informed my family I was moving to South Africa, they thought I was mad.
A single female going to live and work in a country with one of the most notoriously prominent crime rates in the world was not something a mother could easily condone.
By then, the stigma and stereotype regarding the dangers of South Africa had already disappeared from my mind having spoken to several like-minded individuals who had worked there themselves expressing it was one of the most rewarding experiences of their career. I think this is true for most destinations, exemplified by the tribe of doctors who emigrate and simply do not return.
Reasons to work overseas
Statistics obtained from the GMC indicated that over 6000 doctors in the UK were planning a move overseas in 2013. This number is likely to increase over future years with more doctors considering alternative career options within or outside medicine, in combination with finding an opportunity to have an improved work-life balance considering the stresses and strains of the current NHS.
It is not clear how many people eventually return to the UK, however it is evident that the concept of working overseas is now widely supported amongst several institutions and organizations in the UK. The outcome of working overseas can be extremely valuable for career development; below are a few reasons why individuals would want to go;
- Taking a natural break from medicine in the UK
- Developing a specific skill, knowledge or specialist interest (i.e. Fellowships)
- Experience the cultures and extra-curricular opportunities of another country whilst practicing medicine
- Lucrative salary packages with potential added benefits
- Improved work / life balance
- Warmer weather
- Moving with or to be near family / loved ones
- Learn how to manage specific pathological conditions
- Academic reasons; courses or research
When to go overseas
One can go at any point in their career from graduation to retirement and beyond! There are however, several natural breaks within the training system, which are quite popular for overseas travel amongst doctors;
- After F2
- After core specialist training
- After CCT – 1 year Fellowships are commonly taken overseas in countries such as Canada or Australia before doctors commence Consultant Posts, usually for sub-specialty training.
- During Consultancy and beyond – There are GP and specialist doctor shortages in several regions of the world. It is worth exploring where these are to focus your efforts on addressing this gap if you are considering moving overseas.
It is also possible for doctors to work overseas during a training programme. With an National Training Number (NTN) you can either apply for an Out of Programme Experience (OOPE) or Out of Programme Training (OOPT). These are usually prospectively approved by your Training Programme Director (TPD) and Specialist College. There is also a case for having overseas experience or training retrospectively approved, which is heavily reliant on the evidence you provide. Please see the Gold Guide for further information.
Some deaneries or schemes may offer an additional year of approved training overseas in certain countries, ie. Rural posts in South Africa for General Practice trainees.
If you have more experience in your specialty, it is likely that you will be given greater autonomy in your post overseas, which can be extremely rewarding. Most places will only accept UK doctors after they have completed their foundation years, however you should check specifically with each country's requirements.
Things to consider before moving overseas
Whatever the reason, there is a substantial amount of planning that is required before booking your plane ticket.
- What is your nationality?
Will your passport allow you to easily get a visa for the country that you are looking to work in?
- Is your professional registration up to date?
You will need a Certificate of Good Standing (CGS) from the GMC as one of the several documents required for registration in another country. You will need this and evidence of your current registration.
- Do you have evidence of your primary medical degree?
Essential for any registration.
- Your current health status
Are you fit and healthy to travel and work overseas? Will your chosen destination be able to cater for any chronic health problems? A medical report is usually required for most immigration applications. Most hospitals and clinics in developed countries will be equipped and work in a similar way to those in the UK (and of course there will be no language barrier). Several hospitals in major cities in developing countries can maintain a high level of quality care which parallel those in developed countries.
- How long are you planning to move overseas for?
Most salaried posts will offer a minimum of 6 months contract, however the average is at least a year. If you cannot afford that much time, short term voluntary posts should be taken into consideration.
- Know your country!
Research your chosen destination thoroughly by connecting with others who have worked there, currently living there or planning a similar trip. It will certainly be difficult in the first few months whilst you are adapting to a different culture and health system.
What impact will moving overseas have on your career plans?
Consider your NHS pension, loans, mortgages and financial commitments. Will you have sufficient income in your home bank account to cover for any emergencies whilst overseas? If you remain to be paying your Student Loan, you will have to inform them of your new salary to determine what your monthly repayments will be.
- Family / Children
If you have or planning a family, will the place you are going to live be conducive for your partner and/or children? What is the cost of childcare and/or quality of schooling for your children? Do you have enough evidence to prove that your partner is your partner? Check the country's website for specific rules for immigration purposes.
- Indemnity Insurance
Will this cover you overseas? Some insurers can arrange for this if you check before leaving
- Costs of registering
Registration and visa costs can cumulatively be very costly.
- Cost of moving
If your visit is temporary, it is advised to ship over as little as possible, otherwise this can put a dent in your pocket.
- Plans to return
Will a post still be available for you when you return, or are you planning to apply for posts whilst overseas? Ensuring your employer is aware of your plans helps you facilitate the process when flying home for short notice interviews.
- Travel Plans
Its common to want to spend some of your time overseas travelling before or after you start your post, hence this needs to be factored in with your start and end date
Moving overseas as an individual can potentially be nerve-wracking, especially as a female, however most places will either have an expat community or a support system to help you familiarize yourself with the culture. Most places are safe and accepting of women, contrary to the stereotypes – see our countries section below.
How to get started
Taking into account your professional and personal requirements, once you've identified a country and/or location, you have several options;
1. Contact the hospital directly
|• Word of mouth if powerful. If you know someone that's worked there previously it may work to your advantage
• You may have knowledge of jobs before they are formally advertised
• Direct contact with medical staff to get in-depth knowledge into the advertised vacancy
|• Some hospitals may prefer to work directly with agencies / organisations
• Your responsibility to keep checking to see if a vacancy becomes available
• No structured support with registration and immigration advice which you may get with an agency
• No further support for finding a placement if unsuccessful
2. Apply through a recruitment agency
|• Specialists in overseas placements for doctors
• Usually several links to job vacancies
• Support with registration applications and immigration visas
• Ongoing support to find placement if unsuccessful
|• Jobs only available in select hospitals / areas potentially limiting your choice.
• May not have medical knowledge on type of work you will perform
• Post placement support may be limited
|• Word of mouth advice leading to several potential contacts
• Honest accounts of working experience
|• No guarantee on vacancies
• Biased viewpoints
• Information may not be up to date
4. Check local job boards
|• Recent vacancies for hospital / region of choice||• Other potential vacancies may not be advertised
• Local doctors likely to get preference over foreign graduates
Receiving a job offer is perhaps the easiest step of the process. All that follows can be extremely time consuming and financially costly; applying for your registration and immigration documents, are usually the greatest rate-limiting factors.
Each country has different requirements depending on your nationality, where you graduated for your primary medical degree and where you gained your Specialty Training (if relevant). See below for further details.
Specialty Training overseas
If you're planning on starting or continuing your training overseas, you will need to check with the country where you're planning a move. Some destinations will require at least a year or more's experience working in the country before you can apply. Other factors taken into consideration include the level of application, citizenship and proof of previous competencies.
We have expanded below on some of the most popular destinations for doctors (all of which we actively organise placements for):
Australia is one of the most popular destinations for UK doctors going overseas. Great weather, a better work-life balance, a similar culture and great pay all make it an attractive option. In terms of a woman going to work there, it is a safe destination with good career prospects for women.
Australia is popular for fellowships in several specialties because of a paralleled healthcare system with the UK. Plenty of doctors will commonly choose to stay on and work as Consultants in this country.~
- New Zealand
New Zealand is a safe destination for women and a thriving multi-cultural society, offering a mild year round climate and an excellent quality of life. You will always be close to nature (New Zealand has some truly spectacular scenery), meaning that it is so easy to spend time outdoors and lead a more active life.
All new registrants, (all levels) must work under supervision for at least their first 12 months in New Zealand to become familiar with the culture. Specialists such as Radiologists, Anaesthetists, Surgeons and Psychiatrists are in high demand. Emergency Medicine is a competitive and popular specialty with reputable training.
Canada is a safe place to live and one of the most desirable destinations for immigrants. Since 1994, Canada has been ranked in the top ten places to live in the world. Consistently recognized for its high standard of living, low mortality rate, good education and health system, low crime rate and beauty. It is a country that welcomes ethnic diversity and has active policies to encourage immigration of skilled workers.
Many doctors work in Canada either towards the end of their training, as part of a Fellowship or as a Consultant. There are plenty of lucrative options for doctors with excellent work/life balance.
Vacancies for international medical graduates in the UAE tend to be more popular with post CCT specialists and GPs. Whilst this may be the common trend, this doesn't mean it is impossible for more junior doctors to emigrate there.
The standard of living and the salaries in the UAE are high. It is not unusual to receive the equivalent of GBP 8,000 – 9,000 per month. Of course, this is also tax free, making it that much easier to save money. Expats tend to live in expat communities, where accommodation is of a high standard and they can have a great quality of life. Contrary to ongoing stereotypes, cities like Dubai and Abu Dhabi cater for more of a western lifestyle in comparison to the rest of the Middle East.
The UAE has public and private medical care but the majority of care is private. UK and EU doctors are more expensive then doctors from India or Africa, so they tend to work in the hospitals which are covered by the higher cost insurance brackets.
The UK is on the approved physician's list, meaning that it is not necessary to undertake any further exams.
- South Africa
Although South Africa cannot be classified as one of the safest countries to live in, those who choose to come and work in South Africa have an unbelievable quality of life. You can easily afford to live in a spacious house with its own swimming pool and maid on a doctor's salary in rural South Africa.
The access to nature both in South Africa and surrounding African countries is superb. Trips can be made to the Drakensberg, Lesotho or Mozambique, and flights to Namibia, Botswana or Zimbabwe. There are plenty of unrivalled safari opportunities in the local game parks and great nightlife.
Most foreign doctors work in South Africa to consolidate or develop their skills in either Trauma, General Surgery, Obstetrics and Gynaecology, Emergency Medicine or Rural Medicine. Majority of locally trained doctors will work in the major cities, leaving very few vacancies accessible to foreign medical graduates. Many rural hospitals are reliant on foreign medical graduates and locally trained healthcare professionals who are obliged to spend time in these areas in their third year of postgraduate training.
Singapore is a popular destination for expats. The good weather, multi-ethnic society (yet quite westernised), good transport network and low crime rate make it an attractive choice. Accommodation is expensive but you get good value for money and apartments tend to be spacious.
Consultants are in high demand, and many foreign doctors are employed into the highly skilled workforce. Excellent remuneration packages are available for most posts.
Ireland is an attractive choice for UK/EU doctors that want to stay close to home but still want a change of scenery and better pay prospects than currently offered under the NHS.
There are several charitable organisations of various sizes and influences which recruit healthcare professionals on a temporary or permanent basis. Voluntary work is very popular amongst doctors requiring less commitment than a salaried post, and allowing them to work in areas of need for basic healthcare provision.
Doctors who benefit from these positions are from a range of specialties, but usually those with experience in Emergency Medicine, Trauma, General Practice and O&G are well sought-after.
Further Useful Links
Medic Footprints – http://medicfootprints.org A new organization which provides an international placement service for salaried and voluntary posts in parallel with a free resource of information about working overseas. (Website due to launch June 2014)
BMA Guide to Working Overseas - http://bma.org.uk/developing-your-career/career-progression/working-abroad . Comprehensive technical advice on working overseas including checking overseas contracts.
Medical Careers - http://www.medicalcareers.nhs.uk/ - Have a section on working abroad in developed and developing countries, plus voluntary placement advice.
Authors: Dr Abeyna Jones and Sara Sabin – Directors of Medic Footprints