Hi, I’m a US-trained otolaryngologist who is practicing in New Zealand.  Prior to medical school, I lived abroad for a few years, so the idea of doing it again after training was something I had been considering.  If the thought of practicing outside your home country interests you, allow me to share a few tips that may make the process a bit easier – or at least help you understand a few of the hurdles you may face.  This may be the first in a series of brief articles and is tailored to the resident, fellow or new attending.

Practicing outside your country of training has the potential to be a rewarding experience for the right person, but the nuts and bolts of making it happen can be daunting.  Using a locums company may be the easiest approach, but in my case, I found a permanent job on my own, so my advice is relevant to those who may want to move permanently, though some of it will be useful for locums-bound doctors as well.

Preparing To Practice Outside of America

Moving countries to practice is a process that may take several years, and you can begin during training.  If you’ve spoken with international medical graduates in the US, you may be aware of the daunting process of obtaining US medical licensure – taking USMLE step exams, doing residency, providing evidence of prior training, etc.  Some countries may accept aspects of your US medical training, but you will need to provide documentation that supports your application for medical licensure in another country.  You can expect your training to be scrutinized, so as a resident and/or fellow, keep copies of your training schedules to show which services you rotated with and the dates of these rotations.  Retain copies of syllabi / department handbooks that illustrate your training regimen as your training and rotations will be compared to those of doctors in the country to which you will be moving. 

The US medical education process is just one approach of many used worldwide, and you may find that another country does not view your training as highly as someone who went through a system that’s closer to their own.  You will need to demonstrate to them the adequacy of your unusual training.  The above training-dependent documents are much easier to file away as you get them rather than to try to resurrect after you’ve graduated from your program.

Gaining Credentials Abroad

For credentialing, keep logs of your procedures in a format that can easily be shared digitally – this is true even if you plan to stay in the US.  This is easy for those of us who did procedure-based residencies and fellowships, but after fellowship, it’s also important to keep a digital logbook that you can send to prospective medical councils and employers.  I use the Tribble app on my iPhone to log cases and generate de-identified logs, but this was just one of the first apps I tried, and there may be others out there worth considering – or you could maintain your own system. 

It’s important to log not only operating room procedures, but also ones you may do in clinic, even if they seem relatively minor.  A second option is to get your practice’s business manager or biller to generate a CPT-based log of procedures you’ve billed for, but I’ve found that it’s better to maintain your own log rather than rely on someone else and/or the capacity of an EMR to generate reports that accurately capture what you’ve done.

Building An International Resume

As a resident, you will want to develop your CV and continually update it as you advance in training, publish papers, and attend courses.  Keep a file (digital if possible) of course certificates if you’ve done any additional training, either within or outside your home program.  In my case, I attended various national advanced courses on endoscopic sinus surgery, anterior skull base surgery, cochlear implantation, management of facial trauma, allergy, rhinoplasty, etc.  Attending courses is a common feature of many training regimens worldwide, and you may be asked to provide evidence of any courses you’ve taken.  The same goes for presentations at national or international conferences.

You can expect to need letters of recommendation from your training program’s faculty as well as current coworkers if you’ve been practicing independently.  Cultivate relationships with potential references whom you would trust to write letters on your behalf.

Each country will have a unique evaluation process that may include interviews, review of credentials, references, and even assessment of ability either in a formal testing environment or a period of probation that is supervised to varying degrees.  You may also be expected to function in the public sector for a period of time before gaining private practice eligibility.  Your ability to describe the comprehensiveness of your training may impact the duration of such probationary periods.

Lastly, as a resident/fellow, consider making a digital portfolio of important licenses and certifications.  This includes digital copies of any state medical licenses, your medical degree, residency and fellowship certificates, and once available, your board certificate.  Many countries utilize credential validation services to which you upload these important documents for verification.  Having them all in a convenient location in digital format will simplify the process.