Practicing in Canada

[Ironspy]

I have some logistics questions I’d love to discuss with a Canadian physician. I am a board certified adult psychiatrist in practice in the USA >5 years. I am not fluent in French. I’m looking at the Ca licensing website and would appreciate clarification.
1. Which provinces require supervision and/or exams?
2. Some states in the US issue licenses much faster than others. Is that the case in Canada? If so, which provinces have reputations for being faster
3. Anything else I should know?

Happy to take the conversation offline as well.
Thank you!!

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[Stagg737]

Not a Canadian physician, but curious about this as what I was told by Canadian friends that I did med school and residency with was "Lol, if you're not a Canadian citizen not gonna happen."

 

[vanfanal]

I have some logistics questions I’d love to discuss with a Canadian physician. I am a board certified adult psychiatrist in practice in the USA >5 years. I am not fluent in French. I’m looking at the Ca licensing website and would appreciate clarification.
1. Which provinces require supervision and/or exams?
2. Some states in the US issue licenses much faster than others. Is that the case in Canada? If so, which provinces have reputations for being faster
3. Anything else I should know?

Happy to take the conversation offline as well.
Thank you!!

1. Ontario has removed their requirement for supervision if you have board certification. Canadian exams are not necessary. CPSO website would be a good place to start for Ontario.
2. took me about 3 months
3. Malpractice costs almost nothing. CMA and CPSO annual fees are expensive though. Documentation is fast and easy. Having a professional corporation is sweet. Fee for service and reimbursement amounts really push volume over time spent with each pt. No scope to charge rates outside of government insurance for extended psychotherapy sessions. System is very siloed can difficult to move people across the continuum of care - opt therapy, DBT, SUD beds all very difficult to find or refer to.

 

[Stagg737]

1. Ontario has removed their requirement for supervision if you have board certification. Canadian exams are not necessary. CPSO website would be a good place to start for Ontario.
2. took me about 3 months
3. Malpractice costs almost nothing. CMA and CPSO annual fees are expensive though. Documentation is fast and easy. Having a professional corporation is sweet. Fee for service and reimbursement amounts really push volume over time spent with each pt. No scope to charge rates outside of government insurance for extended psychotherapy sessions. System is very siloed can difficult to move people across the continuum of care - opt therapy, DBT, SUD beds all very difficult to find or refer to.

I know I'm not OP, but follow up question to point #2. Are you a citizen who did training in Canada? If someone is not a Canadian citizen and trained outside the country, how much does that affect licensing or ability to get licensed at all?

 

[vanfanal]

I know I'm not OP, but follow up question to point #2. Are you a citizen who did training in Canada? If someone is not a Canadian citizen and trained outside the country, how much does that affect licensing or ability to get licensed at all?

Correct, took me 3 months as a citizen and I did all my training outside of Canada. One would need a form of work authorisation before being able to apply for a license, like citizenship, work visa sponsored by an interested party or permanent residency through a spouse.

 

[trophyhusband]

We moved to Canada in Nov of 2022 in anticipation of the current events. Wife is a C&A Psychiatrist and the kids and I followed along.

1. You'd have to look at each province but I think Ontario, Nova Scotia and a couple of the other east coast ones changed their rules so US docs could practice reciprocally. We're in Alberta and she had to do 6 months of supervision or something like that. She still got to bill for her time and it wasn't all that painful but that probably depends on your supervisor. British Columbia supposedly has a more painful supervision process but we didn't look into it.

2. Unless you can skip the credentialing process through Medical Council of Canada it doesn't really matter. This may be where Ontario and others made it easier if they don't require you to get the Education Credential Assessment. If you do still need it you'll need to get some of your documents source verified through the ECFMG which will take a few months. Just be sure you get whatever the province's college of physician's require source verified at the same time or you'll need to wait 2 months more like we did accidentally.

3. If you're not a citizen you'll need to find a job that will sponsor you for a work permit. There is a Facebook group called Hippocratic Adventures or something where there's a lot of info on moving to Canada and sometimes the docs there know of local places looking for new physicians. That's where my wife connected with a local doc here who started the process.

4. Malpractice is done through one company called CMPA and costs like $3k a year. They seem like they fight for the docs way more than American carries do. If you're a US citizen you probably won't be able to take advantage of the medical corp tax benefit because the US doesn't recognize those as legitimate corporations. I think there are some docs who are trying to use a loophole in the tax code that as a CPA myself I am not comfortable that it would fly if the IRS ever really cared to look at it.

5. Canada is cutting back on immigration which probably won't affect docs who want to come or their kids (kids get visitor permits so they can go to school and get healthcare) but I don't know if it will be as easy for spouses to get an open work permit based on their spouse's position any longer. We're now Permanent Residents and it took about a year and a half to get that. If you're above a certain age cut off (40 something) you'll probably need to apply for a Provincial Nomination to get Permanent Residency.

6. Almost all docs are fee for service which is to say independent contractors (there are some salary jobs but they mostly seem to be for researchers and admin). So there are no benefits. You can get benefits through your medical association but the fees for the medical associations are steep ($2K or something for the Alberta one) and the benefits suck. You can also get them through a spouse's job or just pay out of pocket like we chose to.

 

[magdellan]

We moved to Canada in Nov of 2022 in anticipation of the current events. Wife is a C&A Psychiatrist and the kids and I followed along.

1. You'd have to look at each province but I think Ontario, Nova Scotia and a couple of the other east coast ones changed their rules so US docs could practice reciprocally. We're in Alberta and she had to do 6 months of supervision or something like that. She still got to bill for her time and it wasn't all that painful but that probably depends on your supervisor. British Columbia supposedly has a more painful supervision process but we didn't look into it.

2. Unless you can skip the credentialing process through Medical Council of Canada it doesn't really matter. This may be where Ontario and others made it easier if they don't require you to get the Education Credential Assessment. If you do still need it you'll need to get some of your documents source verified through the ECFMG which will take a few months. Just be sure you get whatever the province's college of physician's require source verified at the same time or you'll need to wait 2 months more like we did accidentally.

3. If you're not a citizen you'll need to find a job that will sponsor you for a work permit. There is a Facebook group called Hippocratic Adventures or something where there's a lot of info on moving to Canada and sometimes the docs there know of local places looking for new physicians. That's where my wife connected with a local doc here who started the process.

4. Malpractice is done through one company called CMPA and costs like $3k a year. They seem like they fight for the docs way more than American carries do. If you're a US citizen you probably won't be able to take advantage of the medical corp tax benefit because the US doesn't recognize those as legitimate corporations. I think there are some docs who are trying to use a loophole in the tax code that as a CPA myself I am not comfortable that it would fly if the IRS ever really cared to look at it.

5. Canada is cutting back on immigration which probably won't affect docs who want to come or their kids (kids get visitor permits so they can go to school and get healthcare) but I don't know if it will be as easy for spouses to get an open work permit based on their spouse's position any longer. We're now Permanent Residents and it took about a year and a half to get that. If you're above a certain age cut off (40 something) you'll probably need to apply for a Provincial Nomination to get Permanent Residency.

6. Almost all docs are fee for service which is to say independent contractors (there are some salary jobs but they mostly seem to be for researchers and admin). So there are no benefits. You can get benefits through your medical association but the fees for the medical associations are steep ($2K or something for the Alberta one) and the benefits suck. You can also get them through a spouse's job or just pay out of pocket like we chose to.

How is the pay for psychiatrists in Canada?

 

[TexasPhysician]

Does Canada still require a 5th training year?

 

[trophyhusband]

How is the pay for psychiatrists in Canada?

Too much variance between provinces and jobs to really say for sure. Each province has its own FFS pay schedule and they pay for things in different ways. Psychiatry is mostly time based but there are add-ons that can have rather large effects on the final amount paid per patient.

I can only speak to Alberta. C&A pays better because you can add on family therapy, where appropriate, for most patients because they generally come in with their family. Adult psychiatrists don't usually have this add-on available.

Adult psychs can make as much or more but they would need to see more patients.

Another big difference is that most Psychiatrists don't provide longitudinal care. A lot only see the patient once or a few times and then send the patient back to their PCP for med management. You make more for initial consults and reconsults than you do for follow-ups... I'm sure these things are in no way related.

My wife's job isn't typical. She works inpatient CL, outpatient CL, and Psych Emerg (she's actually the Medical Director too now of PES). On her full outpatient days she typically sees 3 patients (2 new and 1 follow-up) and makes $2-$2.5k... since she's CL these are typically more difficult so the initial eval is scheduled for 3 hours. On inpatient days she can make $500-$2.5k depending on how many patients their are to see and if she scheduled any OP follow-ups. On PES days she can make $0-$4k depending on how many patients there are to see... busiest day is usually 12 or so. They were taking call once a month but now they're down to once every 2 to 3 months. The get a stipend that's a few hundred for call but on a weekend or holiday she can make $8k depending on how much she wants to work.

She typically aims for around $40k a month minus 6 weeks off... but she has been taking off 6 weeks or more and has made more than budgeted both years.

There are other docs who make as much but they work more like typical American docs. The Canadian docs see less patients and aren't as efficient so they make less. My wife was shocked at how few patients they saw on average.

There's also tons of variation month to month. During the summer it's super slow so we usually take a couple of big vacations but during the school year it's pretty busy.

We've been told that BC pays significantly worse on its FFS schedule. Dunno about the other provinces.

 

[trophyhusband]

Does Canada still require a 5th training year?

Maybe, Canadian residency is 5 years. Specialty certification (as opposed to GP) is 48 months so it took a bunch of effort to explain that the wife's 3 years + 2 years fast tracked at another program actually included 48 months of General Psychiatry training but we got there eventually using the ABPN's certification standards.

She had 5 years total so if that is a requirement it never came up. They authorized her for both General Psychiatry and C&A even though I'm fairly certain she should have only been approved for General. The hospital system didn't care they let Gen Psych only work in C&A anyway.