US Anesthesia Critical Care to Canada Critical Care

[labhras]

Canadian IMG, did school in Europe. PGY3 applying for Critical Care training in USA. My question is, can I work in Canada as an Intensivist after completing fellowship in USA, or will I have to do extra training? Wondering if it is worth doing CC fellowship here if I can't even do CC in Canada!

General Canadian question: to do Critical Care in Canada (from IM, EM, Anes etc) do you have to do the 2 year Critical Care residency, or can you become boarded by doing fellowships offered by different hospitals? Can't find tonnes of information out there.

Wondering what the best options are. Anyone in the same boat?

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[CCM-MD]

Canadian IMG, did school in Europe. PGY3 applying for Critical Care training in USA. My question is, can I work in Canada as an Intensivist after completing fellowship in USA, or will I have to do extra training? Wondering if it is worth doing CC fellowship here if I can't even do CC in Canada!

General Canadian question: to do Critical Care in Canada (from IM, EM, Anes etc) do you have to do the 2 year Critical Care residency, or can you become boarded by doing fellowships offered by different hospitals? Can't find tonnes of information out there.

Wondering what the best options are. Anyone in the same boat?

I can comment on this. Obtaining an independent practice license in Canada requires 3 main things:

#1 - Canadian Citizenship or Permanent residency

#2 - LMCC (Licentiate of the Medical Council of Canada) - this requires passing of the MCCQE1 and MCCQE2 exams - these exams are similar to the USMLE Steps 1-3.

#3 - Passing the respective specialty examination from the Royal College of Physicians & Surgeons Canada (RCPSC). To be eligible to take the anesthesiology examination requires completion of 5 years of RCPSC accredited anesthesiology residency training in Canada.

ACGME training is considered equivalent to RCPSC training in most situations, but you will need to complete the same duration of training - in the case of anesthesiology, training in the US is 4 years, so to be eligible to take the RCPSC anesthesiology exam you would need to complete a 1 year ACGME accredited fellowship.

CCM fellowship training in Canada is 2 years in duration irrespective of your base specialty - so 5 years of anesthesiology plus 2 years of CCM. In general, this would make one eligible to take the RCPSC examination in CCM from anesthesiology.

There are exceptions to the above points - some provinces have additional pathways and it would be hard to summarize everything in this one post. To answer your question simply, doing a 4 year anesthesiology residency and a 1 year CCM fellowship will probably not allow you to practice as an intensivist in Canada. I am happy to answer other questions you may have.

 

[labhras]

I can comment on this. Obtaining an independent practice license in Canada requires 3 main things:

#1 - Canadian Citizenship or Permanent residency

#2 - LMCC (Licentiate of the Medical Council of Canada) - this requires passing of the MCCQE1 and MCCQE2 exams - these exams are similar to the USMLE Steps 1-3.

#3 - Passing the respective specialty examination from the Royal College of Physicians & Surgeons Canada (RCPSC). To be eligible to take the anesthesiology examination requires completion of 5 years of RCPSC accredited anesthesiology residency training in Canada.

ACGME training is considered equivalent to RCPSC training in most situations, but you will need to complete the same duration of training - in the case of anesthesiology, training in the US is 4 years, so to be eligible to take the RCPSC anesthesiology exam you would need to complete a 1 year ACGME accredited fellowship.

CCM fellowship training in Canada is 2 years in duration irrespective of your base specialty - so 5 years of anesthesiology plus 2 years of CCM. In general, this would make one eligible to take the RCPSC examination in CCM from anesthesiology.

There are exceptions to the above points - some provinces have additional pathways and it would be hard to summarize everything in this one post. To answer your question simply, doing a 4 year anesthesiology residency and a 1 year CCM fellowship will probably not allow you to practice as an intensivist in Canada. I am happy to answer other questions you may have.

Thanks for the reply.
#1 is covered
# 2 will be fine to do.
#3 I have seen that I need to do the licensing exams and i figure i will try do them during fellowship year.

Hope to go back to Ontario specifically. I have seen the different pathway options for going back as Anesthesia. Do you know of any options of doing CCM also and getting training recognized? Happy to do extra training, have also toyed with dual CCM-Cards training, or even making up extra time in Canada with CCM fellowship. Seems like spots for CCM in Canadian residencies are tight.

Did you transition from US to Canadian practice? Are you able to comment if there are any major work differences apart from the lack of CRNAs in Canada?

 

[CCM-MD]

Thanks for the reply.
#1 is covered
# 2 will be fine to do.
#3 I have seen that I need to do the licensing exams and i figure i will try do them during fellowship year.

Hope to go back to Ontario specifically. I have seen the different pathway options for going back as Anesthesia. Do you know of any options of doing CCM also and getting training recognized? Happy to do extra training, have also toyed with dual CCM-Cards training, or even making up extra time in Canada with CCM fellowship. Seems like spots for CCM in Canadian residencies are tight.

Did you transition from US to Canadian practice? Are you able to comment if there are any major work differences apart from the lack of CRNAs in Canada?

I am CCM trained via IM. Being from Canada originally, I considered returning there but ended up staying in the US as there were better opportunities - CCM is saturated in most large Canadian cities (as are most specialties), and most of the large tertiary care hospitals are academic institutions filled with residents and fellow. As a result of this lack of opportunities, many Canadian CCM physicians spend a good amount of time working in their primary specialty (typically IM). This might come to you as a surprise but there is a relative oversupply of subspecialists in Canada, especially in cities.

When I applied for fellowships I went through CaRMS in addition to applying to US programs CCM fellowships. I wasn’t expecting to get invited to any interviews in Canada, but to my surprise, I received multiple invites. I encourage you to apply to the Canadian fellowships if you are considering an eventual return to Canada - depending on how strong of a candidate you are, you may end up getting a position there directly. It will make the transition much easier and it will be easier to eventually get a job there. The path to returning to Canada is extremely painful and the sooner you get into the Canadian “medical system”, the less painful it will be.

With regards to the specifics about CT/CCM combo and RCPSC exam eligibility - it’s probably best to give them a call directly. In my experience, they are responsive over the phone and will be able to provide more accurate information than any forum. Happy to answer any more questions you have.

 

[labhras]

I am CCM trained via IM. Being from Canada originally, I considered returning there but ended up staying in the US as there were better opportunities - CCM is saturated in most large Canadian cities (as are most specialties), and most of the large tertiary care hospitals are academic institutions filled with residents and fellow. As a result of this lack of opportunities, many Canadian CCM physicians spend a good amount of time working in their primary specialty (typically IM). This might come to you as a surprise but there is a relative oversupply of subspecialists in Canada, especially in cities.

When I applied for fellowships I went through CaRMS in addition to applying to US programs CCM fellowships. I wasn’t expecting to get invited to any interviews in Canada, but to my surprise, I received multiple invites. I encourage you to apply to the Canadian fellowships if you are considering an eventual return to Canada - depending on how strong of a candidate you are, you may end up getting a position there directly. It will make the transition much easier and it will be easier to eventually get a job there. The path to returning to Canada is extremely painful and the sooner you get into the Canadian “medical system”, the less painful it will be.

With regards to the specifics about CT/CCM combo and RCPSC exam eligibility - it’s probably best to give them a call directly. In my experience, they are responsive over the phone and will be able to provide more accurate information than any forum. Happy to answer any more questions you have.

Thank you for the input again.
Job market was something I was worried about for sure. I will have to think more about where I would like to end up. I want to stay in a large city and in an academic setting, and would be happy splitting time between anesthesia and CCM. I have heard that a lot of Canadian trained docs don't go back for the reasons you mentioned, and others, I just never thought I would be one.

Which exams did you have to do to apply for CaRMS? Just NAC OSCE, MCCQE1 and MCCQE2?
I will definitely contact RCPSC directly about the eligibility, I need to be as informed as possible about this.

 

[CCM-MD]

Thank you for the input again.
Job market was something I was worried about for sure. I will have to think more about where I would like to end up. I want to stay in a large city and in an academic setting, and would be happy splitting time between anesthesia and CCM. I have heard that a lot of Canadian trained docs don't go back for the reasons you mentioned, and others, I just never thought I would be one.

Which exams did you have to do to apply for CaRMS? Just NAC OSCE, MCCQE1 and MCCQE2?
I will definitely contact RCPSC directly about the eligibility, I need to be as informed as possible about this.

I had done the MCCQE1 & 2. I did not take the NAC OSCE.

 

[Suture15]

I had done the MCCQE1 & 2. I did not take the NAC OSCE.

Hello, thanks for all the information. I am in a similar boat, albeit only a PGY2 IM resident. Not interested in CC, but perhaps ID. More importantly, I would like to return to Ontario (I'm a Canadian citizen, Caribbean IMG), for personal reasons.

I have not done the MCQEE1 and 2. My understanding however was that if I do the equivalent amount of training (4 years of IM or 3+2 years of fellowship), I would only have to write the royal Canadian licensing exam for either IM or the subspecialty field?

Is the MCQEE 1 and 2 absolutely necessary? I have also heard you can get a restricted license if you go through pathway 4 (which does not involve the above 2 exams). Any insight on this?

Thank you once again.

 

[CCM-MD]

Hello, thanks for all the information. I am in a similar boat, albeit only a PGY2 IM resident. Not interested in CC, but perhaps ID. More importantly, I would like to return to Ontario (I'm a Canadian citizen, Caribbean IMG), for personal reasons.

I have not done the MCQEE1 and 2. My understanding however was that if I do the equivalent amount of training (4 years of IM or 3+2 years of fellowship), I would only have to write the royal Canadian licensing exam for either IM or the subspecialty field?

Is the MCQEE 1 and 2 absolutely necessary? I have also heard you can get a restricted license if you go through pathway 4 (which does not involve the above 2 exams). Any insight on this?

Thank you once again.

Obtaining an independent practice license in most provinces (including Ontario) would require MCCQE1 & 2 in addition to the RCPSC specialty exam. Passing the RCPSC exam alone would not allow you to obtain a license to practice independently. British Columbia is the only exception to this rule - it also accepts USMLE steps 1-3 instead of the LMCC. To summarize, LMCC and USMLE for BC but LMCC and RCPSC for pretty much all of the other provinces.

Pathway 4 is specific to IMGs with ACGME accredited training done in the US who want to return to Ontario. Basically in addition to some other requirements, you spend 1-2 years practicing under the “supervision” of a fully licensed Ontario physician of your specialty (not an easy task, unless you have some personal connections). After this time period, provided your supervising physician gives you a good evaluation, you would be able to obtain an independent practice license. Just keep in mind, specialist jobs are tight (including general IM and most of it’s subspecialties) and employers will most likely prefer to hire those who are Canadian trained and RCPSC certified than those who are not. To summarize, pathway 4 can get you a license in Ontario but may not get you a job in the location of your choice.

 

[deleted697535]

What you guys do in the end? I'm debating applying for icu in Canada, but hear the same that theres not many jobs etc...
I'd love to have that string to my bow though...

 

[leviathan]

The best answer is to simply contact the Royal College directly to figure out how to obtain certification for Critical Care. For IM you simply need 4 years of ACGME-accredited training.

As for ICU positions, there are still some gems out there including academic centres, if you're willing to relocate. My 14-bed and soon to be 24-bed ICU which is somewhat academic (regular residents+occasional ICU fellows) is hiring 3 new intensivists, for example.