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 A Message for IMGs and Canadian Physicians

NewPhysician understands that Canadian-trained physicians and international medical graduates (IMGs) in particular require information about the business of medical practice in the U.S., and we welcome all IMGs and Canadians to this site.

The types of things IMGs need to know about contracts, compensation and other issues are similar to the things U.S.-trained physicians need to know, and you will find them throughout NewPhysician. You will also find information on immigration, which U.S.-trained physicians generally do not need to know about. Please visit the links below if you would like more information on this subject. Because many IMGs and Canadian physicians must find U.S.-based employment in order to immigrate here, you may also wish to review our practice opportunities section.

We have worked with many Canadian physicians and IMGs and can speak in general about what makes U.S. medical practice different or unique.

Here are several points to consider if you are unfamiliar with life or practice in the U.S.

*It is a mistake to generalize. The United States is a big country. Styles of practice and life differ considerably from region to region. Where you practice and live will make a difference. In general, the U.S. can accommodate a lot of different tastes and cultures.

*Medical practice is, in general, more entrepreneurial than it is in other countries. Again, this is a generalization which we just warned against. However, if you practice in a group or as a solo physician, you will at some point be responsible for your own patient base, which will affect your income. Though demand for physicians is great, unless you are heavily tied into managed care, you will be tasked with seeing that patients come in the door. This means that a favorable bedside manner can be important. It also means that you need to be savvy about marketing issues and the business side of running a practice.

*Third-party payers and the government will challenge you. Medicine in the U.S. is highly regulated by U.S. standards, which many physicians here find frustrating. The level of regulation is apparently less than in some other countries, but it is still a major factor. In particular, it can be frustrating to obtain payment from the various insurers, including government (Medicare/Medicaid) and private insurance companies/managed care. In addition, malpractice rates have increased in the last year and can be a burden on certain specialists involved in high-risk care.

*Resources are abundant. In comparison to most systems, you will find access to resources easy and the resources abundant. Medical imaging is pervasive—most towns of any size have CT, MRI and other modalities. Tests and access to specialists are generally available in most areas. Managed care may limit your ability to provide for your patients in some areas. In other areas, restrictions on how you treat patients will be few.

*Patients are respectful. Though not on a pedestal like they used to be, physicians are still highly respected in the U.S. The downside today, however, is that continuity of care is diminishing. Employers often switch insurance plans seeking better deals, and patients are obliged financially to see physicians who are on their plans.

*It's a hodgepodge. The key to understanding medical practice in the U.S. is to realize that the U.S. system has not figured out what it wants to be yet. Patients in certain categories (like the elderly) are insured by the government, though they may supplement their insurance with private plans. Others have no insurance and may use the emergency department as their main point of entry to the system. Still others are part of Health Maintenance Organizations (HMOs) which may seek to control how physicians practice, while still others have old-style indemnity plans that pretty much cover everything. It is not a uniform system, so it requires flexibility and innovation.

In short, practicing in the U.S. is not for everyone. Those who enjoy it best will be flexible, willing to adjust, patient and highly energetic.

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