Who is a physician?

In the UK, the word ‘physician’ typically denotes a doctor who is specialised in general internal medicine or its subspecialties, distinguishing it from other specialists, such as surgeons, general practitioners and psychiatrists. The General Medical Council uses the term ‘medical practitioners’ to denote all doctors. In recent times, there have been controversies about professional designation, including a legal challenge to the term ‘medical professional’ (British Medical Association 2024). In Canada, all doctors are referred to as ‘physicians’.

These terminologies are of anthropological significance. Referring to doctors generally as physicians recognises and dignifies the extensive training and vocation of doctors.

Undergraduate medical education

Medical students in the UK can enter medical school after completing A-levels – the equivalent of grade 12-level education – whereas in Canada an undergraduate degree is a prerequisite for entry into medical school.

Medical students in Canada enter medicine from varying backgrounds, such as health sciences, nursing, kinesiology, theatre arts, law and engineering. In addition, some have master’s degrees in various fields of study, including speech and language therapy, public health and biostatistics, before commencing undergraduate medical education. Consequently, Canadian medical students tend to have diverse skills and interests; they also tend to be more mature in worldview, more experienced in leadership and to possess advanced skills in research and advocacy (Howe Reference Howe2022).

This, in turn, translates to greater respect for the work and mission of doctors within Canadian society. This diversity in medical student backgrounds, knowledge and experiences means that there are non-monolithic voices and diverse perspectives, which can be enriching for learning activities such as small group study and clerkship. Canadian medical students also tend to focus earlier on specialisation pathways. They do not undertake foundation training or an equivalent internship. Instead, they enter specialist training directly from medical school.

In the UK, by contrast, medical school graduates undertake 2 mandatory years of foundation training before specialisation; however, this does not necessarily guarantee more grounded knowledge or application of the basic and foundational principles of clinical medicine (Gnanalingham Reference Gnanalingham, Gnanalingham and Gnanalingham2024).

Postgraduate medical education (residency)

Both the UK and Canadian systems are characterised by structured training pathways and a competency-based approach to progression, the latter only formally introduced in Canada in 2017. In the UK, the application process for residency is centralised through a national electronic recruitment system, which includes competitive interviews, portfolio assessments and standardised examinations. In Canada, medical graduates apply directly to residency programmes via the Canadian Resident Matching Service (CaRMS) in their final year of medical school. The Canadian system places significant emphasis on clinical electives, research experiences, interviews and reference letters, thereby appearing more arbitrary, as these assessment tools have lower validity.

In the UK, psychiatry postgraduate training is 6–7 years in duration and is divided into Core and Advanced training. In Canada, it is structured as a 5-year run-through programme, which includes placements in medicine and neurology, and may be followed by an optional 1–2 years of fellowship (advanced training). Child and adolescent, geriatric and forensic psychiatry are the only recognised subspecialties, although consultation-liaison (or liaison) psychiatry is being developed as an area of focused competence (AFC), following approval by the Royal College of Physicians and Surgeons of Canada in May 2020 (Royal College of Physicians and Surgeons of Canada 2020).

Supervision structures and workplace cultures also differ. In the UK, residents are assigned both clinical and educational supervisors, and training is supported by electronic portfolios, reflective practice and workplace-based assessments. The culture tends to be formal and hierarchical, although recent efforts have aimed to improve inclusivity. Nonetheless, concerns persist regarding workload, rota design and differential attainment (Dave Reference Dave and Dhakras2025).

In Canada, each residency programme is led by a programme director and includes academic half-days and mentorship opportunities. Supervision intensity varies widely, but there is a strong emphasis on progressive responsibility. The culture is generally more collegial, supported by robust resident unions and a growing focus on equity, diversity, inclusion and decolonisation. Resident wellness is prioritised, with dedicated safety and wellness committees embedded within programme governance (Royal College of Physicians and Surgeons of Canada 2020).

With regard to international medical graduates’ (IMG) access and recognition in psychiatry, the UK provides a more flexible route via the Professional and Linguistic Assessments Board (PLAB) and Certificate of Eligibility for Specialist Registration (CESR) pathways, as alternatives to formal UK training. Canada, while supportive of IMGs in principle, has more restrictive entry points and a province-by-province approach to licensing and international specialist recognition. This persists despite documented chronic physician shortages, with one report indicating that 5.7 million Canadian adults did not have a regular healthcare provider in 2024 (Canadian Institute for Health Information 2025).

Post-qualification specialist experience

It was with some surprise that we realised, on arriving in Canada, that the perceived respectability of the MRCPsych qualification was less than we had expected. There is no reciprocity in the recognition of professional certification between the UK’s Royal College of Psychiatrists and its equivalent, the Royal College of Physicians and Surgeons of Canada.

At the time, colleagues who trained in Canada and the USA often questioned why we were ‘members’ when they were ‘fellows’. This differential can accumulate when being considered for promotion and professional opportunities. Anecdotally, from our experience in clinical practice in Canada, patients regularly express appreciation for the emphasis on patient-centred approaches, which is a hallmark of UK psychiatry training.

Although we appreciate the important role that clinical audits and quality improvement activities play in improving patient care, increasing the emphasis on formal clinical research during residency training in the UK would have a positive impact on skills such as grant writing, ethics review and conducting clinical trials in human participants. These are invaluable across the longitudinal career of a psychiatrist and are embedded within the scholarly activities of Canadian psychiatric training. Although the UK offers the Academic Clinical Fellowship (ACF), which has a more intensive focus on research training and development, this differential availability of research learning and experience during residency between the UK and Canada disadvantages UK-trained psychiatrists in ‘academic’ medicine, as it is referred to in North America.

Summary

This reflective piece describes the experiences of two UK-trained psychiatrists now practising as specialists in Canada, who have been significantly involved in academic medicine in the province of Ontario over the past 5 years. It explores salient issues in undergraduate medical education, postgraduate psychiatric education and post-qualification specialist practice. It highlights differences in entry requirements and their impact on leadership and advocacy skills in undergraduate medical education; collegiality, research learning opportunities and experiences in postgraduate psychiatry training; and challenges related to reciprocity of certification and professional recognition in post-qualification specialist practice.

It is hoped that our experiential knowledge of the UK and Canadian systems, highlighted in this piece, draws attention to areas of focus and areas of potential improvement, such that educational leaders, clinical leaders, regulatory and certification bodies, and policy-makers may strengthen their systems. Finally, we acknowledge our UK training and rededicate our skills to ‘improving the lives of people with mental illness’, which is the mission statement of the Royal College of Psychiatrists (UK).