RadCdn

New York is definitely IMG friendly. I can speak from experience and I matched at one of the best programs in NYC. The residency is hard though. I think residency is hard at most places on the East Coast though. This was my impression. I do not think it's just New York. I interviewed all over the US for IM. However, I had very high scores on Step 1 and Step 2 CK (I did Step 3 in residency so it was not taken into consideration). The USMLE's are not hard to pass, but difficult to do very well on. The pass mark is really not that high. A failed attempt can be a very difficult thing to overcome. But it's not impossible.

This makes things difficult as most programs have a Step 1 screen. But I do know people who failed and they matched. My advice is to network, network, network. Matching IM will be quite a bit more difficult than matching FM. With networking, I've seen people match to very competitive specialties, and they didn't have amazing Step scores at all. It can work.

Pathway 4 is a good way to get licensed in Ontario. If you find a supervisor (not that hard if you know where to look), you will be on a "Restricted Licence". That just means that you will have to work at the same location as your supervisor and have monthly meetings. The supervision is very light.

GIM here. My lifestyle is amazing. I pick when and how much I want to work. Right now, during this COVID pandemic I'm doing mostly video and phone calls for work. I'm not dependent on an OR which is sweet. Having said that, surgery requires a certain personality type. Me and surgery are like oil and water. It would be a total mismatch. IM fits like a glove for me.

Did you fail a USMLE step? FM is not a hard match at all if you pass all of your step exams. I have IMG friends who failed a step and still managed to match FM. IM on the other hand is more competitive.

I have friends that work in some of the most competitive specialties, many of them in the US. My best piece of advice to those considering competitive specialties, consider writing the USMLE's and opening up your options to the US. High step scores, plus publications will give you a very good shot.

I have many colleagues that trained in Israel and then continued to do residency in Canada. Keep in mind very few Canadians study in Israel. I studied in Israel and I interviewed in Canada for residency. I ended up not ranking any Canadian program and preferred the US match as I interviewed at about 16 programs in the US and I preferred my options down there. I did notice that I got a lot of love from some of the best hospitals in the New York area. Keep in mind, studying in Israel can be a fraction of the cost compared to many other destinations.

FM residency is way more humane, but pay in GIM will be significantly higher. If you are one of those people who can work well with little sleep, then you'll do fine in an IM residency. Lifestyle of GIM can be better than FM. In GIM you don't have to see such a high volume of patients for a good income.

I practiced with two others who did their residency in the US, we all passed. There is also an IM Review Course done in Toronto annually and it's definitely worth doing that course. If you do that course, plus have the Canadian study materials, you will be on the same playing field as the Canadian residents. There is nothing in residency training that helps for the exam, it's the study materials that are needed. That's because about 25% of the questions on the written exam are EXACT copies from year to year. Those questions are so ridiculously detailed that they're impossible to get correct if you have not researched the answers beforehand. I will say that it is probably impossible to pass without the study materials.

ABIM is MUCH easier. It's an 8 hour written exam, no oral component. It's also a much better designed exam. After writing all the US and Canadian exams, I found the US exams were far better designed. I know people that have done residency in Canada and then moved to the US due to more job opportunities in the US. However, these are in fields outside of IM. In IM, you'll find work easily. At most places it's been "what can we do to convince you to work for us?" type of thing. You're in the driver's seat. You can work in the US as long as you're "board eligible". Which means eligible to write the boards. But you can work without having passed the test for quite some time. Writing your USMLE's is never a bad idea. It opens so many doors. In my experience, in the US your talent and skill will go far and it will be recognized. In Canada, there are all sorts of obstacles at every level.

There are no restrictions on patient load. You just have to work at the same clinic as your supervisor. This is not difficult as some clinics are groups practices. The main criteria is that you must meet with your supervisor one time per month. The separate pathway is quite simple. Pass the ABIM, then 2 years of supervision, then pass an in-person evaluation (which I've heard is easy).

Having gone through the US route, I know many Canadians that did their residency in the US. Most stay in the US due to the abundant job opportunities and many of them marry Americans. They are certainly not stuck there. From the IM perspective, it is not hard to come back to Canada. The question is, who would want to? The US is an amazing country in so many ways. I came back because I had nothing holding me there in terms of my private life or job. My family is still in Canada so I came back.

Passing the Royal College exams after doing a residency in the US is completely doable, certainly for Internal Medicine. I did my residency in NYC, then passed the Royal College exams. You are correct that without the Canadian study materials it is almost impossible to pass that test. However, one does not need to do their residency in Canada to get these materials. One can get these materials if you know people doing residency in Canada. I studied with two other international grads doing their residencies in the US. We all shared the Canadian study materials with one another. All of us passed the test.

Just to add some details with regards to Ontario. In IM for example, if you have done a 3 year ACGME accredited IM residency in the US and passed your ABIM, then you can practice under a restricted licence right away in Ontario. All you would need is a supervisor. The supervision is very minimal. Generally meeting with your supervisor one time per month to look over a few cases. After supervision for 2 years, you can get your practice evaluated and then have your independent licence. I know people who have done this pathway and it was quite seamless, allows you to start making money quickly without having to wait to pass exams. With the above pathway, you do not need to write any Canadian exams.

I did 3 years IM in the US, did a 1 year fellowship afterwards as well. Then I was eligible to write the Royal College exams which I passed. I know IM doctors in Canada who just did the 3 year IM in the US, then went through a separate pathway to get qualified in Ontario. No need to do the Royal College exams this way. The Royal College exam is a big headache, and very poorly designed. Personally if I did it again, I'd do the 3 year pathway and start practicing sooner. And yes, you can practice in Ontario right away with a 3 year IM residency from the US as long as you have written the ABIM (which is a much easier exam than the Royal College). You would initially be on the restricted licence and then after two years can have your practice evaluated over a weekend and then you'll have your independent licence.