Deciding to return to North America and re-emigrating to Canada in late 1975 presented no problems of licensing, since I had taken the LMCC 17 years earlier and had received FRCP(C) as a late sequel to passing the certification examination in anaesthesia. Then, of course, the LMCC format was of essay type questions, and included orals and clinicals. When I fell into the chairman's position a few months after arriving here, there was a department to restaff, a residency programme to develop, a daily commitment to the operating room, some participation in the intensive care unit, and a little spare time to settle into a new environment. Gradually, with some encouragement from friends there, I moved to a point of decision: to get licensed in the States. I had known for years about the Educational Commission for Foreign Medical Graduates (ECFMG; required of all graduates of medical schools outside the US and Canada), and the Federation Licensing Examination (FLEX; the uniform state licensing exam), which would have to be taken. However, by late 1977, US laws on medical immigration had been tightened, and the first Visa Qualifying Examination (VQE) had been "offered" to some 4611 foreign physicians who did not have a state licence and were not practising "on the day" (10 January 1977).