As we draw closer to finishing cardiology training and moving into independent practice, we must decide where we wish to lay down roots and practice our craft. Throughout medical training, most young cardiologists lead a nomad life, traveling from one center of excellence to the next. Practice in multiple centers is encouraged to cultivate a diverse medical foundation by learning from different mentors and frameworks for practice. We learn to be flexible and relocate without much thought, pursuant of the best opportunities such as top education and lifestyle. Resultant from this medical migration is a cardiology community which is a vibrant cultural melting pot.

Following this model, physicians across the globe thrive through diversity and a desire to collaborate and grow their practice. New developments in communication technology and quick global transportation facilitate this collaboration. The language of cardiology is universal and effortlessly understood worldwide by specialists in major medical centers. At the latest ACC Annual Scientific Sessions, I engaged in stimulating debates with practicing physicians from the Netherlands, Italy and Japan. To my surprise, my level of training and distance from their practice did not deter an invitation for collaboration in research. Instead, it made me wonder: knowing that job opportunities are vast both in the U.S. and abroad, should we limit our reach for the perfect lifestyle by geographical boundaries?

In 2018, the Medscape Physician Lifestyle and Happiness Report surveyed more than 15,000 physicians from 29 specialties, 4 percent belonging to cardiology. Cardiologists were ranked at the bottom of the list as least happy outside their work. Daily stress can be accounted for by the challenges and acuity of care we manage in our practice. In addition to patient care, we add bureaucratic hurdles, insurance claims and the practice of defensive medicine triggered by the rising cost of malpractice insurance premiums. As Fellows in Training (FITs) we are shielded from this bureaucracy. Once we surface out of training as independent practitioners, we must all face these challenges. To give ourselves the best chance at a fulfilling career and lifestyle, we have to take advantage of the growing demand for specialized practitioners and study the global job market. Medical migration may be a wise step for those that feel comfortable leaving the U.S. in search for the perfect job. This leap can be difficult though, and it is not without challenges. Below is a brief outline of the steps required to qualify for cardiology practice in some attractive locations around the globe:

Canada: U.S. specialists looking to migrate north can request a provisional or full medical license depending on how long they wish to remain in the country. Canadian medical licensure is granted by the medical regulatory authority of one of the 13 Canadian provinces and territories where the physician wishes to practice. For a provisional medical license, the U.S. trainee must pass the U.S. Cardiovascular Disease Specialty Board and then practice with a mentor or supervisor in Canada for one year minimum. Following that, some provinces may require the completion of a competency based post-practice assessment and also the Medical Council of Canada's Qualifying Examination Part II. Specialist must also apply for a certificate of registration with the Royal College of Physicians and Surgeons of Canada to be fully licensed.

Australia: Board certified cardiologists can move to Australia using a General Skilled Migration Visa. Under the Specialist Pathway, physicians undergo an assessment of comparability to an Australian trained specialist and do not require additional examination to start practice.

United Arab Emirates (UAE): The UAE has several health licensing authorities depending on where you wish to practice, but getting a medical license is not challenging. Given the need for skilled practitioners, U.S. trained physicians are encouraged to apply for jobs. Obtaining a work visa is not hard. Salaries are comparable to the U.S. and as an incentive, there is no income tax. Jobs are available at institutions like the American Hospital in Dubai. This hospital is in the Mayo Clinic Care Network and provides American standard health care in the region. Likewise, the Cleveland Clinic Abu Dhabi opened its doors in 2015. It is a state of the art 364 bed facility which pursues the American model of health care.

United Kingdom (U.K.): In order to register for a General Skilled Migration Visa to work in the U.K. cardiologists must be registered and licensed to practice with the General Medical Council. Full registration for unsupervised employment and specialist registration must be obtained. To register, a professional and linguistic assessment board may also be required unless otherwise sponsored by a direct employer.

These are only a few examples of locations around the world where U.S. physicians are welcomed to apply. Making the choice to leave the U.S. is far from simple, requiring a lot of paperwork to obtain a medical license and working visa. However, by erasing geographical constraints we give ourselves the opportunity to branch out into a global job market and perhaps find a better lifestyle and employment opportunity. For the FIT willing to overcome the initial hurdles, a new adventure may be on the other side.

This article was authored by Sergiu Darabant, MD, Fellow in Training (FIT) at the University of Louisville in Louisville, KY.