BMI - further medical tests?

[andrewjsl]

I have been lurking for a while, and this is my first post. I'm a physician, hoping to start a position in New Zealand. I'm going in for my medical examination soon. I'm in good health overall, apart from a BMI of 36. I've read almost all the posts, going back years, about elevated BMI's.

My options are to apply for a work-to-residence visa (accredited employer), for which I understand the medical requirements are more strict, or an Essential Skills visa. Once my health examination is completed, I'm expecting my case will be deferred to a Medical Assessor. I'm wondering whether anyone may have insight into what further tests the MA might ask for?

Would it be better for me to apply for an Essential Skills visa? What about the possibility of a Medical Waiver?

Any feedback would be immensely helpful! Thank you in advance.

[JandM]

Hello and welcome.

I haven't seen any posts on the threads about a raised BMI for a long time, so it's hard to say what the present attitude among MAs is likely to be. However, in general terms, what they normally did was to require the applicant to send a report from their own doctor on their general state of health - heart, lungs, liver, kidneys, muscle-tone etc., I suppose deciding exactly what, depending on what the original medical showed. An elevated BMI is seemingly taken as a warning that there MIGHT be health problems just around the corner, so if the GP reports favourably on the applicant, and the BMI isn't *very* high, the MA can declare ASH (acceptable state of health). In other cases, MAs have required the applicant to bring their BMI down before they would pass them (and the CO can't recommend approval of the visa application without the declaration of ASH).

If you are hoping for a long-term career in NZ, with the current state of chaos at INZ, and changes in government policy suddenly appearing, in your place, if you now meet the requirements for the Talent Accredited Employer visa which will take you to Residence in two years, I would get the application in without delay. Mostly, once you're in the system, any further changes in regulations won't apply to you, and you'll be dealt with under the rules in force at the time you applied. The drawback about the Essential Skills Visa is that there is no direct route from it to Residence - the holder would have to apply for residence under SMC, and you will have seen here on the forum the painful delay and uncertainty that is happening to those currently waiting for that visa. Also, it has been known for INZ to require the residence-standard of medical for a temporary work visa, in cases where they say there is a reasonable expectation that the applicant will be wanting to move on to a residence visa later (regardless of what the applicant has or hasn't said about their plans).

When you have your medical, the examining doctor will send the eMedical to INZ, which will be scanned by computer upon arrival, and those with any reading outside the pre-set norms will be automatically referred to be looked at by human beings. The first look will eliminate those where there is, for instance, 0.001 outside the norm on some test, which the computer can't distinguish as not mattering, and send on the rest to be seen by an MA. The MA's job is to understand the applicant's state of health, to check whether s/he is likely to cost the NZ Health Service too much money for treatment and care (particularly in the next five years). The MA has the power to require further tests, or reports from stated specialists, or a wait until a certain course of treatment, or a regime, has been tried, to see the outcome, before s/he is sure s/he understands what is going on. (You may have seen this long thread, which eventually had a good outcome. https://www.enz.org/forum/showthread.php?t=26174)

Here https://www.immigration.govt.nz/opsmanual/#45636.htm is the official word about Medical Waivers. If you are told that you need to apply for one (which would only be after the MA has come to a conclusion about you), you would probably have a good chance at getting one, as you have a needed skill.

Here https://www.immigration.govt.nz/docu...ry/inz1216.pdf is the official guidance to doctors about carrying out the medical.

[andrewjsl]

Thank you JandM for your reply!

Ideally, I'd want to migrate to New Zealand. However, at the same time, I'd want to start working as soon as possible. The fact that an Essential Skills visa might be evaluated at the same standard as a work-to-residence visa, makes me think that applying for the work-to-residence visa right of the bat might be the best choice.

For me, the issue is that I'm Canada. Whilst our universal healthcare system is good, there is a very, very long wait list for seeing a specialist (without any option to pay privately). Therefore, if the panel physician is directed to order additional tests and/or a specialist opinion, this would likely take months. As a recent medical graduate, I've been all over, and don't have a general practitioner, who has known me for more than a few months. I'm sure that she would be able to write a a letter, stating that I'm in good health, but I'm not sure how much weight this would have.

I do have an immigration attorney, who has advised me that any Medical Waiver is left to the discretion of the INZ agent handling my case. I was told that it's not possible to apply for a Waiver outright.

Again, thank you so, so much for your input. I'm so ready to start a new career in NZ, but the ASH requirement is really confusing me!

[JandM]

I do have an immigration attorney, who has advised me that any Medical Waiver is left to the discretion of the INZ agent handling my case. I was told that it's not possible to apply for a Waiver outright.

Well, waivers decisions are overseen by senior COs, if your particular CO doesn't have long experience, I believe. That's correct about not being able to initiate the waiver procedure oneself.

In your shoes, I think I would go and see your GP and say you want to bring your BMI down, and agree a regime to follow - probably that would be change of diet, and exercise. Then do it, seriously. That way, when your medical is referred, there will be a benchmark to start from when your GP is asked by the MA to comment, and she will be able to say what you have been doing, and that so far x has been the change in your weight, and y in your waist measurement (and any other tests she decides to apply as a measure of health).

Really, there's nothing confusing in the ASH requirement. It's just that they really mean it - you've got to be reasonably fit to get in, and BMI is regarded as something that you have some control over yourself.

If several weeks/months pass while you're waiting for your case to be assigned to a CO, and there's already been some measurable change in your BMI and readings, it's possible to pre-empt (you hope) the MA's requirements by sending a doctor's letter with the results to INZ, quoting the eMedical number and all your personal details and details of your application, then that letter will catch up with your medical wherever it is waiting in the MA's queue for attention. This might mean the MA would have no further questions, or, at least, that s/he could see you were moving in the right direction.

[andrewjsl]

Thanks again JandM, that is very good advice! I'll see my GP right away, to establish a baseline. Then, as you say, once I lower my BMI, I will forward a letter to INZ with the positive change.