| How To Do It Work
in the European Union 
Frances Klemperer
Veröffentlicht in: Eysenbach, Gunther (ed.): Medicine and Medical Education
in Europe - The Eurodoctor Stuttgart-New York: Thieme 1998, ISBN 3-13-115221-4 http://www.yi.com/home/EysenbachGunther/medeuro.htm
Bestellung bei
http://www.amazon.de/exec/obidos/ASIN/3131152214/deutscheinternet/028-682461 0-3475601
Continental Europe is now only 20 minutes away by train from mainland Britain, and
moving ever closer politically. Mutual recognition of medical qualifications within the
european Union is well established: working in other parts of Europe is, in principle,
straightforward. Working in different health care systems can offer new perspectives on
British medical practice and the NHS. But the cultural differences and practical
difficulties are not always easy to overcome.
Registration
Working in Europe has never been easier. Mutual recognition of medical qualifications
applies throughout the European Union and its partners in the European Economic Area
(Norway, Iceland, and Liechtenstein). Any doctor who is a citizen of, and who trained in,
a member state is free to wirk as a doctor in the other member states..12
The first step is to register as a medical practitioner in the country where you want
to work. There ist no centralised registration system. You will have to go through the
procedures unique to each member state. This is likely to cost several hundred pounds,
take several months, and require a good deal of determination.
The British Medical Association can provide addresses of sister organisations and
registering bodies equivalent to the General Medical Council. As in the United Kindgom,
registration requires a lage number of documents, both originals and notarised
translations; these can be arranged through any reputable translator - try Yellow Pages.
Allow time to collect them all. They may habe to be sent, or even taken in person, to
myriad different official departments. You may have to relinquish originals of the most
important document for a long period of time. Some countries require documents that do not
exist in the British system - for example, the "national proof of good character or
good repute" (required in Belgium), the "certificate of goot conduct"
issued by the police (required in Germany), or the "testimonial of moriality and
honesty" (required in Greece). An imaginative response, perhaps a letter from your
head of department, will probably be more effective than seeking further advice from
either the country's registering body or its London embassy.
European Community law requires that the registration process be completed by the
authorities of the country concerned within three month of submission of your application.1 There have been reports of suspected illegal discrimination
against incoming doctor23: the European Public health
Alliance, an association of non-governmental organisations in the health sector, is
looking into these problems. Directorate-General XV of the European Commission has
responsibility for this area. The Maastricht Treaty gives a citizen of the European Union
the right to petition the european Parliament if his or her rights under European law are
being infringed (The parliament will, if it sees fit, then forward the complaint to the
commission for further investigation.)
Certificate of specialist training
Once registered as a doctor, you may also be eligible to register (and practise) as a
specialist. Until recently if trained in the United Kingdom you would have needed the
certificate of specialist training, issued by the General medical Council. To get it you
had to have spent three to five years in recognised training posts and have obtained
membership or fellowship of a royal college. It was not necessary to have reached
consultant status, or to be "fully trained" by British standards - that is,
qualified to apply for a consultant post. These arrangements are now changing with the
implementation of the Calman proposals on specialist training. The certificate of
specialist training will be replaced by a certificate of specialist training that will
apply equally to the United Kingdom and the rest of Europe and will replace accreditation.
Each royal college is publishing exact requirements for every specialty, and during the
transitional period the General Medical council can provide detailed information. The
current and future certificates denote entitlement to charge fees on a specialist's scale,
rather than suitability for any particular post or grade.4
Finding work
The BMA can give advice on where job adverts are published. The European Medical
Association has information on international job opportunities, and it gives members
access to its membership database, a potential source of contacts. Your royal college
membership list may also provide a list of colleagues working in your host country.
International conferences can be a source of opportunities, too. You could try writing to
chief clinicians asking for advice. Consider research or drug company posts, which may be
less daunting in terms of language requirements.
Find out the local style for both a curriculum vitae and a covering letter. Some place
will expect to see your handwriting, which might even be analysed by a graphologist;
others will expect a typewritten letter. When going to a job interview, consider taking
open references with you: use of references and referees does not always follow practice
in the United Kingdom.
Attend seminars in your chosen country. The medical registration body may be able to
provide information or addresses: continuing medical education may be compulsory for
continued registration. You may find local contacts through doctors who work for the
english speaking community, particularly if you hav an introduction from one of their
patients. Ask the United Kingdom consulate or embassy, whose addresses can be obtained
from the foreign Office in London, if they can let you have a list of English speaking
doctors. Follow up letters with a phone call and then a thank you note. Small gifts for
helpful secretaries may also be a worthwhile investment. Check on what is local practice.
If you are in a training scheme in the United Kingdom discuss with the scheme organiser
the possibility of arranging an exchange with a doctor of the same grade. The United
Kingdom is a popular destination for foreign trainees; this may be a way to find a job
without entering the open market. Bear in mind that postgraduate training may not be
structured; some countries have no postgraduate exams. If you want to gain accreditation
for your post abroad agree this well in advance with your royal college.
Finding patients
What if there is no suitable job available? (Medical unemployment continues to be high
in many European countries.5) What if you still want more
work?
Then look for patients: in most of Europe it is less common than it is in the United
Kingdom for specialists to be in full time salaried posts. Many conduct a largely or
exclusively, outpatient practice from their own premises. A common, cheap, and convenient
option in many countries is to use part of your home as an office. Remember that you will
need to allow space for a waiting room, too, and that there may be tax implications. For
general practitioners and psychiatrists this is a natural choice. Expatriates of all
nationalities will be clients. Most, for whom English, rather than the local language, is
their first or second tongue, may prefer a doctor who is a native English speaker and from
the same or similar cultural background. Make yourself known to the expatriate community:
visit their doctors; make contacts with English speaking embassies; write articles in
their newsletters; give talks at the international clubs, schools, and churches; become
associated with helplines and voluntary organisations. Make sure your office address is
convenient for the expatriate community - for example, near an international school - and
don't go anywhere without your business card. But be wary of advertising: many European
countries are less liberal than Britain about advertising or even providing information
for patients.
Language
The 1993 council directive 93/16 (article 20) states: "Member States shall see to
it, that, where appropriate, the persons concerned acquire, in their interest and in that
of their patients, the linguistic knowledge necessary to the exercise of their profession
in the host country."1 This is interpreted, and
implemented, in different ways: only a few countries impose language requirements other
than the informal hurdle posed by the need to negotiate the bureaucracy. Even if you
choose to practise medicine only with expatriate patients, however, you need to be able to
liaise with colleagues, hospitals, and pharmacies, not to mention patients' insurance
companies. To learn the language, consider an intensive residential course: this is
expensive, but a good investment to facilitate administrative tasks and social and
professional integration. Everyday colloquial language is often harder to learn than
technical medical language.6 For continuing studies,
government sponsored courses, which are equivalent to those run in English by the British
Council, may be cheaper and better regulated than private enterprises. Find conversation
partners native to your new country. The ability to speak native English is greatly in
demand throughout the world. Others will be keen to improve your colloquial language and
teach you their culture in exchange for the opportunity to practise English with you. Try
advertising for a "conversation exchange" through a local shop or library or a
British Council language school.
Health care in the European Union
There are significant cross cultural differences in health care across the European
Union. About half of the countries in the union finance health through insurance schemes,
usually controlled by the government. Patients often have completely free choice of
doctor, with direct access to specialists.7+9 Working as
a hospital employee necessitates adaptation to local facilities and therapeutic practices;
working independently requires a thorough knowledge of local social security and health
insurance schemes. The European Council has suggested that countries set up
"information centres" to provide migrating doctors with information on the
health and social security laws and the professional ethics of the host country.1 At the moment these are not widely available - gather information
in advance.
The international section of the BMA has a wide range of health care information on the
European Union. The Permanent Working Group of European Junior Hospital Doctors produces
booklets giving information on training an health care systems, also available from the
BMA. The European Medical Association provides a service for doctors in the union,
particularly those practising outside of their home country, with access to information on
all aspects of helth care, including structure and regulations, doctor's associations,
specialist medical centres, and medical education. The King's Fund library is also an
excellent source of information on international health. Although there is a single market
in medicines in practice this does not seem to be the case. Drug companies have different
marketing strategies and are subject to different controls in different countries. Whether
a drug can be sold in a supermarket, over the counter in a pharmacy, or on prescription
only varies widely. Drugs that are unknown in the United Kingdom may be in common use just
across the Channel; conversely, those that are routinely used in the United Kingdom may be
unavailable or may be prescribed at different doses under different names. The European
Medical Association can provide information on drugs available across the union and the
different proprietary names under which they are available.
Living in Europe
Medical registration is only the start of the bureaucratic slog. Everything takes twice
as long if you cannot speak the language well, and 10 times as long if you are unfamiliar
with the system. You will probably need to do the following:
- Find accommodation (and schools/childcare for your familiy)
- Acquire an identity card
- Set up a bank account
- Register with the local social security/health insurance system
- Subscribe to medical indemnity
- Organise local and central government taxes.
Consider, early on, hiring an accountant who is familiar with handling doctor's
affairs. If you need a car, seek advice from a United Kingdom company specialising in
export and find out what the second hand car market is like in your destination country
before buying in Britain. Your car should be registered and insured in the country in
which you are resident.
Consider your own and your family's health care.The E111 form, available from the Post
Office, will give you access to temporary emergency care at the same level as that
provided for citizens of the host country. If you forget the form, you will have to pay
and seek reimbursement later. Register with the local health insurance or social security
system or ensure that your employer has made the arrangement for you. In view of
prescribing differences across Europe take supplies of regular medicines. It is also worth
discovering the telephone number of the emergency services and the location of the nearest
English speaking general practitioner and assident and emergency department before you, or
yous children, need them.
Consider communications and access to library services. Depending on your destination,
you may want to arrange for your home medical library to help with acquiring articles, or
use the library facilities of your royal college. The BMA library also provides an
excellent service to its members. With a modem and computer you can directly access remote
databases. The BMA library Medline is available for the price of the (international)
telephone call; other health databases are also available on line.
Culture shock
When the initial honeymoon period of excitement and novelty subsides, anticipate
culture shock.10 Homesickness is a slightly different
problem. Try assuaging it with the widespread availability of the BBC on cable television.
The difficulties caused by culture shock are rarely acknowledged in the success
oriented worlds of expatriate medical and business staff. It can be all the more
disconcerting when the new culture is geographically close and superficially similar to
the one you have left behind. If you are the main breadwinner remember that culture shock
is usually worse for a spouse who has not got a job and for children (with a new school!
Culture and educational system to negotiate), because the loss of social networks and the
environmental change are greater.
Familiarising yourself with the new culture and language and making social contacts
within the host country will help to reduce culture shock.11
Handbooks on expatriate living will complement tourist guides: thera are now increasing
numbers of books on living and working on the continent as the European markets have
become more accessible.8+15 If you can, and particularly
if you are taking your family, visit your destination for a weekend reconnaissance trip
before you move. Take a camera with you.
Coming home
Before you leave, think about coming home again. Appointments to posts are rarely made
a long time in advance, but you may be able to take leave of absence for a specified
period of time. This offers job security for the future and continuing pension rights. It
may allow you time abroad to learn the language before starting work in a job exchange or
provide a safety net if your job abroad does not work out. Being on leave of absence can
also give extra credibility to your curriculum vitae.
On your return, prepare for reverse culture shock. Coming back is notoriously harder
than the move away from home - and harder than most people anticipate. The shock will be
grater if you have not had access to British media: some aspekts of life back home will
have been forgotten, others will have changed.
I acknowledge the advice received from Sallie Nicholas, secretary,
European Medical Committee, and from the BMA.
Appendix
Sources of information and useful addresses
European Commission, DGXV/E2, Rue de la Loi 200, 1049 Brussels, Belgium
Tel: +32 2 295 9061
This is the section of the commission concerned with the free movement
of doctors.
European Medical Association, Place de Jamblinne de Meux 12, 1040
Brussels, Belgium Tel: +32 2 734 21 35 Fax:+32 2 734 21 35 Internet: EMA @spl.y-net.be
European Public Health Alliance, 1 Place du Luxembourg, 1040 Brussels,
Belgium Tel.+ 32 2 512 93 60 Fax: +32 2 512 66 73
Gunn E, ed. Vacher's European companion. London: Vacher's Publications,
1995.
Useful for finding institutions in the European Union and your member of
the European parliament.
King's Fund Library, 11-13 Cavendish Square, London WIMOAN Tel: 0171 307
2400
Standing Committee of doctors of the EC (CP), 66 Avenue de Cortenbergh,
Bte 2, 1040 Brussels, Belgium Tel. +32 2 732 7202 Fax: 32 2 732 7344
Coordinates the views of other European medical groupings and represents
the medical profession as a whole to the institutions of the European Union. One of its
aims is to promote the free movement of doctors within the union.
Unit for Social Security for Migrant Workers, DGV, Rue de la Loi 200,
1049 Brussels, Belgium
Publishes a free summary of both social security and health care schemes
of the member states.
European Commission. Your social security rights when moving within
the European Union: a practical guide. Luxembourg: Office for Official Publications of
the European Communities, 1995. (Also available from HMSO Books.)
HMSO Books (Agency Section), HMSO Publications Centre, 51 Nine Elms
Lane, London SW8 5DR Tel: 0171 873 8372
- Council of the European Communities. Council Directive to facilitate
the free movement of doctors and the recognition of their diplomas, certificate and other
evidence of formal qualifications. 93/16/EEC. Official Journal of the European Communities
1993; April 5. (Available from HMSO Books Agency Section).
- Nicholas S. Mobility of doctors in Europe: vision or reality? In:
Ellis N, ed. European Union of general practitioniers reference book 1994/5. London:
UEMO/Kensington Publications, 1994:156-8.
- Blecher JP. Free movement of health professionals. European Public
Health Alliance briefing paper No 6. Brussels: European Public Health Alliance, 1995.
- Brearly S. Specialist medical training and the European Community.
BMJ 1992; 305:661-2.
- Christensen SM. From surplus to deficit: medical manpower in Europe
by the year 2000. Switzerland: Permanent Working Group of European Junior Hospital Doctors
Medical Manpower Study, 1991:8-9.
- Veale D. Living and working abroad. BMJ 1992; 305:482.
- Hindle A, Hindle GA, Worthington DJ. The health care systems in the
European Community: a comparative analysis. Lancaster: Management School Lancaster
University, 1993.
- International Hospital Federation. A guide to health services of the
world. IHF, 1990.
- Mebazan A, ed. Guide to health in Europe. Neuilly-sur-Seine, France:
Impact Medecin, 1992.
- Pascoe R. Culture shock: a parent's guide. London: Kuperard, 1994.
- Bochner A, Furnham S. Culture shock: psychological reactions to
unfamiliar environments. London: Routledge, 1986:157-8.
- Golding J. Working abroad. Plymouth: How To Books, 1993.
- Adamson-Taylor S. Culture shock: France. London: Kuperard, 1994.
- Gozan G. Daily Telegraph guide to working abroad. 17th ed. London:
Kogan Page, 1994.
- Twinn B, Burns P. Expatriate's
handbook. London: Kogan Page, 1993
- Culture Shock! Successful Living Abroad:
Living and Working Abroad Monica Rabe, Taschenbuch (Mai 1997) Graphic Arts Center
Publishing Company; ISBN: 1558683046
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