"I Lost My Identity in England as a Doctor" - Dr. Afra Rafique on Leaving the NHS for Canada

Dr. Afra Rafique spent over a decade working in the NHS — training as a neurosurgeon, pivoting into general practice, and taking on shifts across urgent treatment centres, A&E and salaried GP roles in cities including London, Ipswich and Oxford. By 2024, she was working ten to twelve hours a day, six days a week, as the sole breadwinner in her household. Something had to change. Within three months of first looking into the possibility, she had packed up her life and moved to Winnipeg, Manitoba. Here, she reflects on what drove her to leave, what surprised her when she arrived, and what she would tell any UK doctor now standing at the same crossroads.

Can you give me a bit of background about who you are, your job title, and where you were working in the UK?

I graduated — I did my medicine in Dubai, in the UAE in Ajman — and then I moved to England in 2011 for neurosurgical training. That was sort of what I wanted to do initially. And then going through the hoops, I did lots of neurosurgical jobs, but I worked in London most of my neurosurgical training time. And then I met my husband and he said that we need to sort of have time for family — why don't you do some GP work? Whilst doing this sort of neurosurgical stuff in London, I was also doing some A&E shifts, mainly focused on a lot of GP urgent treatment centre work. So that's when I realised I had this knack of short appointments and I could do very well in the GP world because of the way I performed in A&E UTCs. So then I retrained to become a GP — I trained in Colchester and Ipswich. Then I worked in Ipswich for a little while. Then I got a job in Oxford for a year, found out about Canada, and then we decided to move here. From the decision to the move was about three months.

What made you decide you wanted to move?

From 2011 to 2024, I constantly worked for the NHS — I loved the NHS and I still do. And I worked and worked and worked, but I struggled. I was the only breadwinner in my family and we were struggling to sort of have a lifestyle which was concordant with what we did and how we were. So somebody told us that actually Canada has more opportunity. So we then looked into it and it seemed like whatever work I did in England, I would get compensated for that in Canada better. In England I was working ten to twelve hour days, six days a week. I used to take one day off — I was doing this to be able to survive for both of us. And it was proving challenging.

How does clinical practice in Canada compare to clinical practice in the NHS?

The clinical practice is more or less very similar. The same pathology here, same pathology in England. Same sort of patients here, same in England. If you've been working and practising as a medic, as a doctor in the UK, you can just step right into a role in Canada. Yeah, it was literally — landed here, three days later went to work and I was seeing coughs and snotty noses as I would in England.

In terms of patient expectations, appointment length and documentation — does that differ or is it the same?

Patient expectation is becoming challenging everywhere around the world. Because of the advent of AI, it has become even more challenging. The patient expectation is obviously everywhere that we spend as much time with the patients as possible. But the thing is that that's not always a reasonable expectation or an expectation that is needed. I can auscultate and make a decision based on my findings within seven or ten minutes. It's very similar to what we did in England — in England as well we're allotted ten minute slots per patient. I think the expectation in England perhaps is that because everybody does this ten minute appointment thing and everybody's aware of it, I think the patients tolerate that slightly better. Whereas here, they sometimes want super long appointments which are not paid. So it becomes then challenging for the doctor and the patient.

Do you feel that you have more autonomy in your role in Canada than you did in the UK?

Oh my God, that is the one thing that I love being here. I have total autonomy over what I do. In England I was a salaried GP, which means that I had a rota. My expectation was that when I became an independent I would have more autonomy over my rota, that I would be able to do whatever I want. That was not the case. If you had a clinic and you couldn't do that clinic for some reason, you had to find someone to cover that clinic and all that sort of thing. And I understand why — it's patient safety at the end of the day. However, it is a great tool to me as a person because I also suffer from a disability. So sometimes some days are harder for me, or if I have a little bit more tiredness or stress — I couldn't move my rota around even though I was nearly forty years old and working for the NHS for such a long time. Now in Canada, if one day the snow is falling too much and I don't want to drive to work, I can change the appointments to a virtual one and I can work from home. I can move days around and patients are very understanding and they are happy to move things around. So you have full autonomy over what you do and how you design your day.

It sounds like you feel that you're a little more respected?

Blimey. You have no idea. Respect is something that I lost. I lost my identity in England as a doctor. Nobody respected you — even the people you worked with. It's like, you're a doctor, so big deal. Here I went to the bank. There is a physician account with a special physician delegate that handles your bank account. When I went to buy a car, they did a special discount as a physician. Like everywhere I go — it's a small city so everybody gets to know you — once I went to buy something in a store and first time I went to that store and they're like, oh hi, Dr. Rafique. And I was like, is it on my face? And then it's like, oh, I'm your patient. So it's like every way you see your patients and they always are helpful and they respect you so much. As a physician, if you say somewhere that you are a physician, you get so much respect. It's actually something we lost in England.

You can actually earn more doing what you do in Canada than you can in the UK — can you tell us about that?

You still have to put the legwork in. So if people think that they're going to come to Canada and just sit here and get paid, it's not true. If you don't see a patient, you don't get paid. But if you see a patient, you get properly reimbursed and it comes to you as a doctor. What happens is that the government pays the doctor directly for their services and you then pay a part to the clinic. This is opposite to England — in England, the practice gets paid and you get a salary. Here, every doctor gets reimbursed for every single thing they do. In England I used to see thirty, forty patients a day. Here I probably see, in a ten or twelve hour day, sixty also.

When you first moved to Canada, what surprised you about the place and what did you find hardest?

When we were in England and we tried to Google about Canada, nothing came up. I was trying to look at physician incomes and all that sort of thing — they had told me what I may or may not earn but I didn't believe it and I said, okay, let me just do my own research. But the research didn't happen because the same websites don't come up in England because of the VPNs or whatever. So it was very difficult to sort of research about Canada. I took a leap of blind faith, really — just like, okay, I'm going to just do this. But then the things that surprised me — A, how easy it is to set up life in Canada as a physician. There's a lot of opportunity in terms of people giving you a car lease easily. But it was the ease with which everybody respects you, even at the airport, getting the visa, getting here. It was just all quick, quick. They still are very welcoming. They still thank me for coming. It's humbling. And then the other thing that surprised me was how much people need you. There are patients who haven't seen a doctor for ten years and they have multiple medications. They've been relying on virtual doctors or a walk-in service. It's sort of like you're actually changing something and making somebody better and making a change in their life. How many people I picked up with cancer in the last stages because they haven't seen their doctor in so many years. Patients get shocked when I say I'll come to your house — they're like, we're not used to this. It's not a sense of entitlement that they need you to come. It's like, thank you, you're coming.

How big a support and help were Canada Medical Careers in your move?

I couldn't have done it without them. The amount of help needed — I mean, I didn't do an exam, I just converted my training here. So they had to approve every single thing, which they rightly have to. And navigating through all of that — that's one part, so that you can get recognised as a doctor in Canada and the training translates. The other thing was the visa business. It was so complicated in terms of the medicals and how to get it, and I was forever scared because you kind of get the visa on the border, so you never get a pre-sent visa. So you land in Canada on your British passport and you say to them, I'm a doctor, can I have a visa please? And that scared me because I was like, gosh, that's too much uncertainty. But my gosh, within fifteen minutes — the Canada Medical Careers obviously referred us to a solicitor who helped us prepare a package. Then we went there and the package was ready to submit to the border agency, and they gave us a visa in fifteen to twenty minutes. And then when I came here they supported me in how to get my full registration, because you don't get your full registration until you have your visa. So that was a slightly complicated step. We managed to get here, we got the visa, we sent the visa stuff, and then they gave me my full registration to practise.

I think they did an extra handholding for me because I hate these little things and because of my disability I struggle with forms and how to do things. What they did is they spent — they would sit down and spend even an hour, two hours doing forms with me and applications. And every single day they'd be like, Dr. Rafique, click here, or Dr. Rafique, do this. They'd keep me updated on every step because sometimes things take time and they'd say, don't worry, it'll be fine. They have quite a big team and they all were wonderful with me. I wouldn't have done it without them really.

I found out about Canada Medical Careers because I Googled Canada things online and John was the only Canadian number. So I said, he must know something. So I sent him a text from work — all about how do I move to Canada. That's all I sent him. And he said, can we have a chat in an hour? So I finished work and I had a phone call with him and he's like, can I just ask how old you are for visa purposes? And I said so and so, and he's like, yeah, this is what we do. He then said, would you like to do an exam? I didn't know anything about Canada. I didn't know the cities, where to practise, where to start. And John is like, would you like to give an exam and what would you like to do and what's your home situation? And then he recommended Winnipeg to me. And he said, would you like to go for an interview with the owner? He spoke to the owner of the clinic. I said to him, I'll do an interview like a week later on my day off. And he's like, no, no, we need to do it in two days. And then I had a phone interview and, gosh, the rest is history. The contracts were sent and it was all signed and we came to Canada three months later. Canada Medical Careers, John and his team really helped me go through every single step.

What would you say to your old self — thinking about whether you should or shouldn't move to Canada?

Gosh. I think I should have done it earlier. Because I'm in my forties now and then there's all complications of when you want permanent residency here with your age and there are points. So the younger you do it, I think it's probably better — I'm not sure. But I feel like I should have done it much, much earlier. It's been good for my mental health. It's challenging sometimes, but when I hear about the troubles back home, I feel like I made a good decision in good time.