Pathology in Canada

[Substance]

The prevailing opinion in this forum about pathology is that in the USA, jobs are hard to come by and the future isn't rosy. But what about Canada?

Does anyone have any idea about the working environment and future of pathology in Canada? I've recently obtained an interest in it and am thinking about taking that route, but I want to make sure that I have stability when I'm certified. I've been hearing conflicting accounts everywhere else; on one side I have people and articles telling me that pathology is the best-paying and most-stable gig in medicine and will be that way in the coming years, and on the other side I have people and articles telling me that you have no autonomy in path and to get a job in larger centers is near impossible.

If anyone can chime in about the Canadian pathology environment, remuneration, and future, please do.

I've also tried asking on the Canadian medical forums at premed101 but nobody over there knows much about path...

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[earmuff]

What I do know is that "healthforceontario" is a recruiter for Ontario, they advertise finding work for American physicians there. Ontario has recently relaxed it's rules to allow American Board Cert'd docs to work with minimal additional supervision (and no exams!).

I also know that pathologists do earn a decent wage in Ontario. I believe the starting salary to be ~$300,000 Canadian.

That being said, the flood gates were opened. American docs have been absconding to Canada like rats leaving a sinking ship (this is purely speculation and hyperbole, however).

Path jobs may be in short supply in Canada as well. If you are boarded, contact the above recruiter, and if there is work, they will likely find it for you.

Good luck! Pack earmuffs 🙂

 

[sbp]

I can add that in ontario pathology is still a 5 year residency with somewhat different structure than what we have here. So a ap/cp 4 year resident with no fellowship can't get a job there because he has not finished residency yet.

also if there are jobs available, canadian trained doctors and canadian citizens take priority over US grads.

The healthforceontario recrutment seems to me to be just politics and not real recrutment. They make you work for a year under supervision and only then do you become eligible if you qualify to get a licence. and there are many other hurdles.

I know of one person who did get a family medicine position somewhere close to the north pole, not in a city like toronto or hamilton.

Also taxes there are crazy over 50% income tax and 15% sales tax. so your income disapears pretty quickly, I guess we may be headed that way here in the US if the *****s get their way with this ******ed health care

 

[earmuff]

I can add that in ontario pathology is still a 5 year residency with somewhat different structure than what we have here. So a ap/cp 4 year resident with no fellowship can't get a job there because he has not finished residency yet.

also if there are jobs available, canadian trained doctors and canadian citizens take priority over US grads.

The healthforceontario recrutment seems to me to be just politics and not real recrutment. They make you work for a year under supervision and only then do you become eligible if you qualify to get a licence. and there are many other hurdles.

I know of one person who did get a family medicine position somewhere close to the north pole, not in a city like toronto or hamilton.

Also taxes there are crazy over 50% income tax and 15% sales tax. so your income disapears pretty quickly, I guess we may be headed that way here in the US if the *****s get their way with this ******ed health care

My understanding was that if you are board certified you are considered equivalent to a Canadian trained doc. No further training or exams necessary. although some additional supervision...

I agree that Canadian citizens and permanent residents will have priority and in other provinces you may have to undergo additional training. Ontario has a different set of rules than say, BC.

Most of the job openings will be for GP's in rural areas, but how often do you see truly rural pathologists?

Don't get me started on the tax stuff...

 

[earmuff]

Pathway 3: Canadian or US Medical Degree with US Postgraduate Training and Certification


The Registration Committee may direct the Registrar to issue a certificate of registration to an applicant who has a medical degree from a medical school in the US which is accredited by the Liaison Committee of Medical Education or a medical degree from a medical school in Canada accredited by the Council on Accreditation of Canadian Medical Schools, if the applicant has:

1. successfully completed a residency program accredited by the Accreditation Council for Graduate Medical Education;
2. been certified by a US Specialty Board;
3. successfully completed the US Medical Licensing Examination or successfully completed an acceptable qualifying examination; and
4. an independent or full license or certificate of registration to practise without restrictions in the US or Canada.

The following conditions will be placed on the certificate of registration:

1. The physician must practice with a mentor and/or supervisor until he or she has successfully completed an assessment.
2. The physician must undergo an assessment after completing a minimum of one year of practice in Ontario. The certificate of registration automatically expires 18 months from the date of issuance, but may be renewed by the Registration Committee, with or without additional or other terms, conditions and limitations.

How Barriers are Reduced

This policy adds another pathway to licensure for applicants who are not certified by the RCPSC or CFPC. Under this policy, eligible candidates now have a route to independent practice certificate of registration, subject to an initial one-year period of practice under supervision (or a mentor) and successful completion of an assessment after the first year of practice. Unsuccessful completion of an assessment would result in expiry of the certificate of registration unless it is renewed by the Registration Committee, with or without additional or other terms, conditions and limitations.
Unlike the College's policy for ACGME-trained specialists,<SUP>3</SUP> this pathway does not require that the ACGME residency be comparable in content and duration to a Canadian training program in the same discipline.
Eligible applicants also have the option of completing the Registration through Practice Assessment (RPA) program before being approved to practise medicine in Ontario, instead of applying under this new policy.

*note bolded text

 

[Parts Unknown]

Also taxes there are crazy over 50% income tax and 15% sales tax.

I was just looking at income tax rates in Canada. In 2009 the Federal marginal rates ranged from 15-29%, with provincial marginal rates ranging from 4%-17.5%. Sales tax range from 5-15.5%.

Of course a one-to-one comparison against taxes in the US is difficult, since neither you nor your employer will have to pay health insurance premiums in Canada. If you considered that a form a US taxation then the comparison would not look so favorable for us. If you have children then you should likely consider the comparative cost of a university education.

I believe you do have to fund your own dental care and pharmaceuticals up North, however, and car insurance is apparently quite expensive.

Bottom line: individual results will vary.

 

[sbp]

My wife is canadian from toronto and I actually initiated the process to look for a job there and they told me that I would need to do more training. I know what it says in bold but what they actually tell you is that you need more training, more than just the supervision year.

 

[earmuff]

not sure how to reconcile the difference between what's posted on the HFO website and your personal experience. chances are I won't be able to.

it says resident in your description so I assume you are not boarded? that would indicate a need for more training.

 

[Giemsa]

My understanding was that if you are board certified you are considered equivalent to a Canadian trained doc. No further training or exams necessary. although some additional supervision...

There's an assessment of your competence at the end of the supervision period. I don't know what it entails, because I've never met anyone who has gone through the third or fourth pathways. I don't know if it is a written/oral exam, but you are required to successfully complete it, whatever it is.

Most of the job openings will be for GP's in rural areas, but how often do you see truly rural pathologists?

It gets pretty rural, actually.

One of the jobs I turned down was in a rural town of 17,000 approximately 350 km (3 hours drive) from the nearest city of 200,000. One pathologist, one radiologist, two internists, a handful of family docs. You probably know the sort. Salary was 250 (Canadian).

This is an extreme example, of course, but the third/fourth pathways are undoubtably a way for the Ontario government to fill the jobs that the Canadians don't want. You might find most of them perfectly acceptable, but they probably won't be in desirable areas of the country (e.g. Vancouver, GTA, Montreal).

Pathology is gaining popularity in Canada (all of the lifestyle specialties are) but none of the people I graduated with have had much trouble finding jobs.

 

[pilomatricoma]

Could anyone here, who has hopefully gone through the process, perhaps clarify what's required for a US trained pathologist to be able to practice in Canada? How about in provinces other than Ontario? If you're licensed in the US, how do you go about getting licensed in Canada? Has anyone here done that? Did you have to take some Canadian exams? Did you have to take your Canadian specialty boards? Or just the LMCC exams? Did you even have to do that?

I've seen some stuff about other specialties, and heard a few anecdotal stories about US boarded physicians going up to Canada to practice with the minimum of issues. On the other hand, I hear horror stories from Canadian's who are going through residency in the US, and the daunting task facing them if they want to go back. And for the life of me, I can't find any info about pathology. I've read lots of stuff on the various Canadian websites (Health Canada, Royal College, CPSO), but they all seem to be mostly directed towards IMGs, but somehow exclude US trained grads. Only Ontario seems to somewhat spell it out, but it's still confusing.

PM me, if you'd rather not share on here.

Thanks!!

ps. Before we derail this thread into some sort of "took er jobs" or socialist health care agenda... I'm doing it for Women's hockey. 😀

 

[Giemsa]

I've met several pathologists who come from abroad (US, UK, Europe, S. Africa, etc. etc.) and are now working in Canada.

I've never met anyone who has made use of the third pathway through Ontario, although this may be because the pathway is still new.

The conventional approach is:

- find a job that needs filling (you will need to have completed a fellowship year because pathology residency training in Canada is five years)
- you hook up with the local hospital recruiter, and get hired
- the hospital works out a "defined" or "restricted" license for you with the provincial College of Physicians and Surgeons so that you can practice
- they also start the process of your becoming a citizen (eh!)
- you must pass your LMCCs and RCPSC exams within a set period of time after being hired (2-3 years)

Obviously, the rate limiting step is the first one: finding a job that is willing to go through the rigamarole of hiring someone who doesn't have RSCPC certification upfront.

To get a foot in the door, provinces such as Saskatchewan (rural/northern) and particularly New Brunswick (rural) tend to be desperate for all physicians. If you speak French fluently, try rural/northern Quebec (no, there is no pathologist shortage in downtown Montreal 🙂)

For answers to specific questions on licensing, contact the College of Physicians and Surgeons of [the province in question] - this is the body ultimately responsible for licensing physicians. Refer to the information for IMGs - yes, Americans are international).

If anyone has gone through the process more recently (within the last five years), I'd be interesting to hear how the process is working in very recent times.

 

[earmuff]

Nice post.... Thanks.

 

[APCPBBNP]

Don't forget that all US citizens working abroad are subject to federal tax in case they make more than $80,000/year.

 

[pilomatricoma]

If anyone has gone through the process more recently (within the last five years), I'd be interesting to hear how the process is working in very recent times.

I second this.

 

[green mantis]

also if there are jobs available, canadian trained doctors and canadian citizens take priority over US grads.

I'm not sure why anyone would go to Canada to take a position that Canadians don't want. Why not take a job in the US that most Americans don't want?


----- Antony

 

[path24]

I'm not sure why anyone would go to Canada to take a position that Canadians don't want. Why not take a job in the US that most Americans don't want?


----- Antony

Where is that job? Like the one in rural mn that got 50+ applicants.

I agree with you, but where are these jobs?

 

[JPR22]

Canada doesnt need nearly as many pathologists as the US, so there's not that many jobs to begin with. Furthermore, there's already a number of training programs in Canada, producing residents. In fact, training programs in Canada have had to significantly decrease their intake as a result of the decreased demand. Combine that with the ex-pats, who trained in the US, and the result is a similar competition for jobs as is currently being seen in the US.

 

[schrute]

If you are boarded, contact the above recruiter, and if there is work, they will likely find it for you.

At first I thought you wrote "bearded," which RE pathology, would also make sense.

 

[Adrian Cocot]

America: Canada's Mexico.

 

[sbp]

I have made comments before about the process I have clarified it with an agent of HFO.

Once you are boarded then you can start the process, if you don't pass the boards it is much more difficult. The other issue is that you also have to get residency status, and that takes several months. But it isn't like the US that it is very difficult to get a green card, it is pretty simple you will get it but it just takes time.

So if you take the boards in spring of 4th year you can't start right away in July. So if like most of us you are doing a fellowship and you pass you can start the process after you find out that you pass. So it is possible to get a job out of fellowship if you start early enough.

Also the 1 year of supervision is in part to make sure the differences in residency training doesn't cause you to be a "lesser" physician. On the bright side you get paid the same during that first year as you would the next. Also it doesn't seem to be that difficult to get through that year but I guess that is dependent on who is your supervisor.

The other issue is that there aren't that many jobs out there, just like there aren't that many here in the US.

I am sorry if I made it sound like it is impossible, but again it isn't easy either.

 

[sohsie]

Homer: "Canada? Why would I want to leave America just to visit America Jr.?"

 

[Napoleon1801]

What about the jobs in Mexico guys? Why freeze your butt off in Canada when you could be laying on the beach with a pocket full of pesos?

 

[OntarioPractice]

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[mlw03]

Don't forget that all US citizens working abroad are subject to federal tax in case they make more than $80,000/year.

I've been told that the US and Canada have an agreement that allows citizens of one country to take a job in the other, and pay income tax only in the country of employment. That is, no double taxation as I understood it. An additional factor to consider financially is that most consumer goods and day to day products (ie, groceries) seem to be more expensive in Canada. Someone considering a position there needs to do the math to see how much or little real money a particular job would provide (something I think anyone should do for any job in any location).

 

[Gorlum]

Does anyone have any idea about the working environment and future of pathology in Canada?.

I work in Canada as a forensic pathologist but can tell you a bit about regular path jobs. It is quite hard to find a job in academical institution but it is easy to get a position in a community practice in the middle of nowhere. BUT, there is always BUT, isn't it🙂? You'd better be a permanent resident or a citizen of Canada (your status in the US doesn't matter) since the priority is given to us. AND, licensing is a pain in a backside. Most of the provinces won't give you a full license ever if you don't have Canadian "steps" (USMLE-like exams, I don't remember the name) and Royal College Exam (AKA boards). Ontario is a bit different and will give you a license eventually but not right away. There are several pathway to get licensed depending on there your medschool and residency were. If you are an IMG trained in the US, it is called "pathway 4". It takes 4 months to obtain a license, and you have to be board-certified in the US, have full license in the US, have a job offer in Canada, etc. - I've submitted over 40 documents from different organizations, and it cost me 2500 CAD, which I got back from the hospital soon after the beginning of my employment. Pathway 4 is a restricted license - there is no restriction on what you do, but you can't change the employer. In 1 year I will apply for a full license, which is transferable to any province. In order to get a full license, Canadian boards are required (I passed 'em in May).
In terms of working conditions, it is much better than in the US (I'm comparing with my fellowship place and friends' offices): the pay is twice higher than in the US, and even with all taxes I'm much better off here + very 50K benefit package (retirement, disabilities, all that BS for which my American friends are paying out of their pockets); 4 weeks of vacation + 2 weeks for conferences/education, good educational fund, paid moving expenses and so on.
So that is my experience, I don't know if it helps. Feel free to ask questions.
PS. Forgot to add: I need to be board-certified in Forensic path as well in either country (Canada has its on forensic path boards) -I have 2 years for that. Took FP in Tampa this Sep., will take Canadian one next Sep. (missed the registration dead-line)
PPS. I have an academic appointment as well, which I never wanted but all forensic pathologists in Ontario have one. Big boss from Toronto did his training in the UK and for some reason adopted a Scottish model for the entire province: forensic path = academic appointment. It is not a huge part of the job but I definitely could live w/t it🙂.

 

[Patho2009]

KNOW THE FOLLOWING:

- You have to be American board certified. With the American board certification, you can work directly on a provisional specialist license. Later on and while on job, you can sit for the Royal College certification exam (Canadian board). The Medical Council of Canada exams (the equivalent to the USMLE) are not essential if you pass the Canadian board. You will need them for a general license but your specialist license should suffice. Know that the Canadian board is very differentfrom the American counterpart but it is passable with learning its way and question styles. As a US-boarded graduate, you are automatically eligible to sit for the Royal College Exam provided that you have a fellowship (in order to have FIVE years of training and be equivalent to the Canadian 5-year residency programs).

- The practice in Canada is similar to the one in the States but different in terms of:

* payment: salaries in Canada are now better than in the States. You can start with 300K and above. Know that the Canadian dollar now is same as the American or sometimes higher!

* Less regulations and more flexibility unless your lab is CAP-accredited.

- Easy to get a position in a community based hospital with your American Board certification. It is even easier with both the American and Canadian boards. It is also relatively easier in some provinces than others (Saskatchewan, Manitoba and Newfoundland are the easiest while British Columbia and Ontario are the hardest). Academic positions are limited (because of the limited number of the Canadian universities/medical schools) and therefore more difficult to get in but who cares if you can secure yourself in a decent community based practice with a salary of 300K or higher.

- Currently there is influx of US graduates to Canada, mainly those on
J-1 visas and those who were laid off due to the recession. This makes the competition a little bit higher than before.

- In order to register with the Provinicial College (equivalent to State Medical Board) to get your license, you have to have your credentials source-verified by http://www.pcrc.org/en/
It is a lengthy process and takes time. If you think to come to Canada, you have to start this process as early as you can. Once done, you can apply to the College and have your registration (license) to work as a specialist.

- Once you secure a position, the hospital usually submits your paper to the Canaidan immigration to issue your permanent residence (if you are a foreigner/alien)

- Canadian jobs are posted on many web sites such as www.pathologyoutlines.com and www.careerMD.com


If you need more info, just ask and will answer it.

 

[Gorlum]

Know that the Canadian board is very differentfrom the American counterpart but it is passable with learning its way and question styles.


- In order to register with the Provinicial College (equivalent to State Medical Board) to get your license, you have to have your credentials source-verified by http://www.pcrc.org/en/
It is a lengthy process and takes time. If you think to come to Canada, you have to start this process as early as you can. Once done, you can apply to the College and have your registration (license) to work as a specialist.

Boards are different but not difficult - I didn't have time to prepare and certainly never read what Canadian grads do or went to their review course or had a mock exam - still passed with confidence.
Thanks for reminding about credentials verification! I did it a year in advance (diploma and transcript). Remember, that some provinces will ask for additional verification through their local source - BC is the worst in this respect. And, as far as I remember, only Ontario allows alternative verification (AKA your medschool). The rest require PCRC.

 

[Luis sardina]

😀

 

[mlw03]

There are a few of us on here who practice in Canada, none in Québec that I know of. I have no clue how pathology works in Québec. If you are interested in working there, I would suggest contacting someone in their provincial pathology association and trying to get some information there. The French fluency is good, because they do not allow non-Canadians to immigrate there unless they can prove French language fluency.

Bonne chance à vous.

 

[Luis sardina]

Dear Doctors

this forum is awesome



Regards. Happy 2014

 

[danli77]

Hello all,
Since Canadian Pathology residencies are 5 years long and have one year of "clinica"/ transitional year-type work ... how does this effect licensure? From what I understand, doing a fellowship after 4 years of AP/CP residency in the US is somehow equivalent...(?)
Did anyone here ever persue two fellowships?

Thanks!