Voyage to Aotearoa

Practicing medicine in New Zealand: Tackling 3 misconceptions about working abroad

Sydney LeFay, DO, debunks some common misconceptions about practicing abroad as a DO. Dr. LeFay also shares the story of her unforgettable experience of working in the Land of the Long White Cloud.

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My dream of practicing medicine abroad was first ignited at the 2013 American Psychiatric Association conference in San Francisco. As a medical student, I was dazzled by the many fascinating talks and stalls in the exhibit hall. I found myself especially drawn to the stall that proclaimed, “Practice in New Zealand!”

I grew up in a small town, and I’d never traveled to another country before. I was enticed by the literature at the table on work-life balance, the opportunity to see another health system and exposure to new cultural experiences, all while being paid for the privilege.

I was hesitant, however. I didn’t even have a passport back then, let alone any experience obtaining a visa. The idea of working abroad was as intimidating as it was exciting.

The man working the New Zealand stall unfortunately didn’t know the answers to my many questions, so I tabled the idea. I wouldn’t be able to act on it for many years anyway.

Keeping the dream alive

New Zealand stuck in the back of my mind all the way through residency and fellowship. I met a mentor in residency who had practiced there himself, and he encouraged me to keep the dream alive. In 2019, the year I would finish fellowship, I talked with my partner (now my spouse) about where we should go next. I half-jokingly said, “Maybe we should move to New Zealand.”

“When can we leave?” was their unflinching response.

It was almost one year between that conversation and our first day in New Zealand. I could write a tome about all the intricacies involved in the process of our journey to Aotearoa (the Māori name for New Zealand) in mid-March 2020, but, for now, let’s start with the three basic misconceptions I had to clarify for myself before I made contact with my recruiter.

The picturesque view from the top of the Wellington Botanic Garden, near Dr. LeFay's New Zealand home.

Misconception #1: DOs are limited in their practice rights overseas

Although DOs have historically been classified as strictly “osteopaths” (only licensed to practice osteopathic manipulation) in some countries, the AOA has worked diligently for years to educate licensing organizations on the realities of osteopathic training in the United States. In fact, it was just announced last month that the association representing the medical regulatory boards of 47 countries passed a resolution supporting recognition of U.S.-trained DOs as equal to U.S.-trained MDs.

As time has gone on, DOs have seen their rights to practice overseas increase. This map has more info about DOs’ practice rights in various countries, and the AOA’s International Licensure page has more details about practicing abroad today.

When I applied to work in New Zealand, there was absolutely no problem with my degree and no difference in how I was treated by my employer. All physicians seeking to practice medicine in New Zealand must register with the Medical Council of New Zealand, which provides this helpful self-assessment tool for internationally trained physicians to use to see if they qualify for licensure and determine their licensure pathway.

As a psychiatrist, I qualified under the Specialist registration pathway, but other DOs may qualify under the Comparable Health System pathway. The first time I was asked about the letters after my name was several months into my work, when a social worker observed that he’d never seen “DO” before. He was simply curious to learn about my training, and that was the end of it.

Misconception #2: You’ll have to retake your boards or redo your residency

While in New Zealand, Dr. LeFay worked at Te Whare o Matairangi, an in-patient facility for those experiencing mental illiness, at Wellington Hospital, pictured here.

The short answer here? Not always. Based on my personal experience, psychiatrists in New Zealand have six months of child and adolescent psychiatry rotations, compared to the three months that I completed. Psychiatry residencies in the U.S. vary significantly in their child exposure, so it is not unusual for an American psychiatrist to be considered “deficient” in this area.

As a result, when I was applying for a permanent New Zealand license, I was required to complete three additional child psychiatry months under supervision. I functioned as an attending on an inpatient child unit and was paid accordingly during this period.

I did not have to retake any board exams in New Zealand; however, some countries may require some or all exams to be retaken. For example, some provinces in Canada require taking the Canadian-equivalent specialty boards and/or the Canadian licensing exam, the Medical Council of Canada Qualifying Examination, but some may not. These requirements have changed in some Canadian provinces as recently as this year, and the AOA, the National Board of Osteopathic Medical Examiners and the Canadian Osteopathic Association continue to partner to educate provincial regulatory authorities and help ease the barriers to practice for well-trained U.S. DOs.

These rules differ between countries and even between regions within countries, so if you know where you want to go, it is worthwhile to look up the current local requirements.

Misconception #3: Getting a visa for myself will be hard, and I probably won’t be able to take my family

The bureaucratic component of immigration can be overwhelming! However, there may be agencies that can help. I received advice and assistance with the paperwork through a New Zealand immigration specialist recommended by my recruiter. Locum companies may have their own avenues to help with the immigration process.

For people with complex situations, such as health problems requiring a special waiver or unique legal circumstances, immigration attorneys may be helpful. I did not require an attorney in my situation; however, my stress over the visa process eased with the knowledge that there are professionals out there to help with most situations. Countries tend to be eager to support physicians in obtaining a visa.

Knowing that physicians need to be comfortable in their new environment if their work is going to be sustainable, many countries have provisions to support the immigration of the physician’s immediate family. My non-physician spouse was able to accompany me under a visa that allowed them to work anywhere they would like, or to stay at home if they preferred. Because my income was considered adequate to support us both, they were not required to maintain any specific employment. I had several colleagues in New Zealand who immigrated with children as well.

For those with pets, there may be options for you, too! My contract negotiations included moving expenses, which I was able to use towards all my household goods, including the transportation of my beloved cats. Countries may vary in the types of pets they allow and the regulations around their transport. At the time of my move, my cats had to spend a couple of weeks in a quarantine facility to ensure they were free of communicable diseases before they were turned over to my care. I spent time searching for a reputable pet exporting agency to assist with the vet visits, paperwork and flights.

Taking next steps

Working abroad can seem daunting or impossible, but there are structures in place to make the dream a reality if you’re ready to put in the work. There are options for every desire and length of stay, including permanent, locums or humanitarian work with an organization like Doctors Without Borders or DOCARE International.

The most important element of the process is careful planning and research. Whether you’re considering a moving company, pet exporter, recruiter or immigration adviser, always double- and triple-check to ensure the companies and professionals you use are reputable, licensed and well-established.

The breathtaking views Dr. LeFay saw while kayaking in Milford Sound/Piopiotahi.

After signing my contract, I asked to speak to some Americans at my new job while I was planning the move and solicited their advice. Networking early, even before you make the move, can greatly improve your transition. Aside from the advice prior to arrival, it was great to sit down for tea with people I already “knew” when I arrived in New Zealand.

I remained in New Zealand for 16 months on a permanent contract, with the possibly of making it my home. My time there was complicated because I arrived at the beginning of the pandemic. Ultimately, it became clear to my partner and I that our greatest opportunities for personal and professional growth were back in Oregon, where we started. I learned tremendous lessons from my friends, colleagues and patients in Aotearoa, and I returned home with a stronger sense of what I value in life.

You might be wondering: After putting in all the work to go around the world and back, would I do it all again? Well, I probably will someday. Adventure awaits.

Related reading:

What we can learn from international osteopaths

Osteopathic physicians and international osteopaths find common ground in Finland

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