Medical School In Canada To Residency In States

[daftypatty]

Hi guys, I live in Kitchener right now and my dream has always been to move to the states, specifically New York City. I'm going to apply for Ontario medical schools, but I was wondering how likely it is for a Canadian med student to do their residency in the States for a competitive specialty? I'm talking about derma, ophta, plastic, etc. 

 

What factors would affect getting admission into US residencies? Does the med school reputation matter? How about research/volunteering/etc.? I already have a feeling it is going to be competitive, but I just want to weigh in everyones' opinions and see what I have to do to make it happen. As I said, it's always been a dream so I want to make it come true.

 

Thanks guys

[JohnGrisham]

Destroy the USMLE board exams, and you're already the majority of the way there. Then the rest of the same standard stuff would likely apply as if you wanted to apply to the same specialties in Canada. And as well do an away rotation in the US, and get some US LORS through it.

[Edict]

Hi guys, I live in Kitchener right now and my dream has always been to move to the states, specifically New York City. I'm going to apply for Ontario medical schools, but I was wondering how likely it is for a Canadian med student to do their residency in the States for a competitive specialty? I'm talking about derma, ophta, plastic, etc. 

 

What factors would affect getting admission into US residencies? Does the med school reputation matter? How about research/volunteering/etc.? I already have a feeling it is going to be competitive, but I just want to weigh in everyones' opinions and see what I have to do to make it happen. As I said, it's always been a dream so I want to make it come true.

 

Thanks guys

 

USMLE scores, research and LORs from US electives are key.

 

Medical school reputation doesn't play a role, don't believe people who tell you otherwise. It is important though to look at your school's curriculum, I don't particularly recommend Mac for those wanting to pursue a US residency because the 3 year program leaves you tight on time to write the USMLE.

 

However if you are planning on pursuing a US fellowship that is different as you just need to pass your USMLEs and research, LORs, residency reputation play a bigger role.

 

Just to let you know very few Canadian MDs go down to the US for residency because of the awkward matching system. If you match in Canada you are automatically withdrawn from matching in the US, so essentially in order to match in the US you can't try to match in Canada.

 

For example, if you applied to both Canada and the US, if you matched to any program in Canada, even if you were wanted by Hopkins you would not be allowed to go and you would never know if you would have gotten in. The Canadian match runs before the US match and the match is like a contract, once you get the Canadian match result, you are automatically withdrawn from the US match.

[thatonekid]

 so essentially in order to match in the US you can't try to match in Canada.

 

For example, if you applied to both Canada and the US, if you matched to any program in Canada, even if you were wanted by Hopkins you would not be allowed to go and you would never know if you would have gotten in. The Canadian match runs before the US match and the match is like a contract, once you get the Canadian match result, you are automatically withdrawn from the US match.

 

While for the most part this is true, there are some very specific programs where the US match occurs first.

[daftypatty]

USMLE scores, research and LORs from US electives are key.

 

Medical school reputation doesn't play a role, don't believe people who tell you otherwise. It is important though to look at your school's curriculum, I don't particularly recommend Mac for those wanting to pursue a US residency because the 3 year program leaves you tight on time to write the USMLE.

 

However if you are planning on pursuing a US fellowship that is different as you just need to pass your USMLEs and research, LORs, residency reputation play a bigger role.

 

Just to let you know very few Canadian MDs go down to the US for residency because of the awkward matching system. If you match in Canada you are automatically withdrawn from matching in the US, so essentially in order to match in the US you can't try to match in Canada.

 

For example, if you applied to both Canada and the US, if you matched to any program in Canada, even if you were wanted by Hopkins you would not be allowed to go and you would never know if you would have gotten in. The Canadian match runs before the US match and the match is like a contract, once you get the Canadian match result, you are automatically withdrawn from the US match.

 

Hi thanks for the response to both of you. I have a question about each of the things you guys just listed.

 

USMLE - does it matter when we take the USMLE for applying to competitive residencies?

 

Research - does the research you do have to be relevant to the field that you are interested in? Or could it be something you continue from undergrad. I really have no idea how research for med students work - is it the same type of deal as undergrad where you can apply to research programs or cold call a professor to ask to help out in their lab?

 

LOR - Who does the LORs generally have to be from? I'm guessing the people you had used for your medical school application LORs cannot be used for this since it is a bit "higher" up? Or does it not matter (i.e., I used my high school teacher as one of my med school LOR)

 

Thanks so much

[daftypatty]

USMLE scores, research and LORs from US electives are key.

 

Medical school reputation doesn't play a role, don't believe people who tell you otherwise. It is important though to look at your school's curriculum, I don't particularly recommend Mac for those wanting to pursue a US residency because the 3 year program leaves you tight on time to write the USMLE.

 

However if you are planning on pursuing a US fellowship that is different as you just need to pass your USMLEs and research, LORs, residency reputation play a bigger role.

 

Just to let you know very few Canadian MDs go down to the US for residency because of the awkward matching system. If you match in Canada you are automatically withdrawn from matching in the US, so essentially in order to match in the US you can't try to match in Canada.

 

For example, if you applied to both Canada and the US, if you matched to any program in Canada, even if you were wanted by Hopkins you would not be allowed to go and you would never know if you would have gotten in. The Canadian match runs before the US match and the match is like a contract, once you get the Canadian match result, you are automatically withdrawn from the US match.

 

Hm... so to your last point, basically if you want to apply for US residency, you are completely sacrificing your chance at obtaining residency in Canada? Is this seen as very risky and that's why most people don't do it?... That is pretty discouraging 

[JohnGrisham]

Well if you're applying to something super competitive in Canada, the US in that sense would be a good back up to have in the event you don't match in Canada. If you aren't applying to something competitive, then it gets a bit tricky. Deciding to only rank "desirable" sites in Canada, and all the top ones, to you, in the US, etc and all that kinda stuff. It gets tricky and is very unique to your situation.

[Edict]

Hm... so to your last point, basically if you want to apply for US residency, you are completely sacrificing your chance at obtaining residency in Canada? Is this seen as very risky and that's why most people don't do it?... That is pretty discouraging 

 

You can still apply to both Canada and the US, do your interviews and then decide not to rank Canadian schools. For example lets say you interviewed at UCSF, Hopkins and UCSF and you feel like you have a good shot at matching at one of these locations, and you prefer these locations to all your Canadian schools. Then you can just not rank Canadian schools and then hope for a US match.

 

So its not completely blind in the sense that you have to apply to the US from day one without applying to Canada, its just that when it comes time to ranking after the interview, all your Canadian choices must be preferred to your US choices. 

 

Lets say your rank list is as follows

 

1. UofT

2. UBC

3. Hopkins

4. Duke

5. Harvard 

6. Alberta

7. McMaster

 

If lets say after interviews you have good feelings from Duke, Hopkins, Harvard (i.e. you think you'll match there) rank UofT and UBC in the Canadian match and then rank all your US matches. 

 

If lets say you aren't very sure about Hopkins, Duke and Harvard then you have to take the risk of ranking choices lower on your list in Canada, like Alberta and Mac. If you get into these schools you are automatically withdrawn from the US match and you'll never know if Hopkins, Duke or Harvard would have taken you. But at the same time if those 3 didn't take you, and you didn't match at UT or UBC and you didn't rank Alberta and Mac, you'll probably match at a lower preference US program. 

 

This isn't the only deterrence, the biggest is the fact that you have to write the USMLE which is already very difficult and you have to do that on top of your coursework. There is just a lot more work to do and US residencies are not much better. Only a select few big name programs are actually better than Canadian programs. More Canadians go abroad for fellowship though, you'll notice that a lot of Canadian academic physicians have done a fellowship in the US but rarely residency. 

[Edict]

Hi thanks for the response to both of you. I have a question about each of the things you guys just listed.

 

USMLE - does it matter when we take the USMLE for applying to competitive residencies?

 

Research - does the research you do have to be relevant to the field that you are interested in? Or could it be something you continue from undergrad. I really have no idea how research for med students work - is it the same type of deal as undergrad where you can apply to research programs or cold call a professor to ask to help out in their lab?

 

LOR - Who does the LORs generally have to be from? I'm guessing the people you had used for your medical school application LORs cannot be used for this since it is a bit "higher" up? Or does it not matter (i.e., I used my high school teacher as one of my med school LOR)

 

Thanks so much

USMLE - it doesn't, only your score, but obviously there are better times to write it because you have more free time and your information is fresh in your mind. Writing your USMLE step 1 as an attending will be rough

Research - Ideally but not really. If you are interested in ophtho for example you should do clinical research with an ophthalmologist. This is specialty dependent, some specialties want research in their specialty while others don't care as much. 

LOR - It definitely should not be anyone who is not a doctor, basically all your LORs for med school apps shouldn't be used. They ideally for the US are US doctors you worked with on electives or research supervisors, and for Canada they are ideally Canadian doctors you work with on electives or who supervised you  in some capacity be it research, core rotations/electives or both. Not all doctors are the same as well. If you manage to impress a big name who usually doesn't write that great references it is more powerful. 

[shikimate]

Ideally you would write USMLE Step 1 after 2nd year, having spent 1st and 2nd year preparing for it given its difficulty (remember you are graded on a curve with many other med students). Then write Step 2 CK after 3rd year and get a top score as well (many US programs now seem to encourage people to write Step 2 CK and have a score ready, I remember reading this in the First Aid book for CK, you may want to double check this). If you are curious about factors in NRMP match look at the first chapter of First Aid for Step 1 book; usually the rank of importance is Step 1 score > Research/LOR > Step 2 score > misc factors.

 

On an aside some US programs do match early, for example one person in Ontario this year matched to Stanford Ophtho early and didn't bother with CaRMS.

[Maruo]

This is an interesting topic. I had some questions as well:

 

In terms of USMLE content; is it much different from the curriculum (year 1+2) taught here in Canada?

 

I'm guessing that having LOR's, elective experience and research in the US would hold much more weight over having the same experiences, but in Canada? I don't mind going down to the states for the first 2, but research in the states (over summer I guess?) would be a real pain.

[shikimate]

I am not sure about UBC curriculum, but the USMLE Steps has a very perculiar material and style of question. Some areas which are covered frequently on USMLE (for example tuberculosis and hepatitis) may not be emphasized in Canada. LMCC 1 was very different in material, lots of social science type of questions with 1 step answers.

 

Step 1 is difficult in that the basic science it covers is very broad, and unfortunately mostly not very useful in clinical practice. There are plenty of free sample questions on the internet for your leisure. High yield areas are path, micro, biochem. Not a lot of anatomy but maybe a bit of histo and embryo.

 

USMLE is mostly 2 step questions. For example

 

A 60 y.o. male is hospitalized with unsteadiness when walking leading to 2 falls, forgetfulness/memory loss and loss of urine continence, which he attributes to unsanitary well water on his farm. His vitals are BP 144/85 HR 67 stand, 140/80 HR 70 supine. T= 37.3C. His past medical history is remarkable for diabetes mellitus, type 2 for the past 12 years, hypertension, left knee replacement 2 years ago. He was hospitalized 11 months ago for severe bloody diarrhea which his farm well water was tested positive for E.coli. His family history is positive for TIA in his mother, who died of a MI at age 67. A chest X-ray from 1 year ago was not remarkable. A focal neurological exam today revealed no focal weakness or sensory defects. His mental status exam score was 22/30 with loss of points for 5 minute recall. Which of the following is the most likely finding on his lumbar puncture?

 

Answer: normal opening pressure, normal WBC, normal glucose, normal protein.

(notice how you have to diagnose first, then make the second step of correlating with lab work. Also notice how you can tell he has NPH just from the first sentence and there's a lot of useless red herring in a typical question)

 

It's not hard to pass USMLE, after all you just have to be better than the bottom few percent, but the flip side is to excel you have to beat out many many other very good students.

[medhoping]

While for the most part this is true, there are some very specific programs where the US match occurs first.

Which programs are these?

[JohnGrisham]

I think the optho and some other speciality run through a special match called the San Francisco match

[lost__in__space]

 

 

Medical school reputation doesn't play a role, don't believe people who tell you otherwise. It is important though to look at your school's curriculum, I don't particularly recommend Mac for those wanting to pursue a US residency because the 3 year program leaves you tight on time to write the USMLE.

 

 

I disagree with this in regards to surgical residencies at top US schools. The program director at Johns Hopkins for an extremely competitive surgical specialty specifically noted to me that she knew UofT's reputation for surgery was excellent and that it was one of the big reasons she would interview students from UofT but not other Canadian schools. 

[Edict]

I disagree with this in regards to surgical residencies at top US schools. The program director at Johns Hopkins for an extremely competitive surgical specialty specifically noted to me that she knew UofT's reputation for surgery was excellent and that it was one of the big reasons she would interview students from UofT but not other Canadian schools. 

 

Unfortunately your evidence is only anecdotal. But it is not logical to do that if you truly want the best candidates. Going to UT's UG MD program does not make you a better surgical resident than other schools even if it had a surgical program with great attendings since you are learning the basics of medicine in medical school. Even upon graduating medicine as a surgical residency gunner you have learned very little about surgery.

 

 

Your point might be slightly more valid regarding a Toronto surgical residency program as you actually work with those surgeons during your residency. 

[birthoggdube]

Unfortunately your evidence is only anecdotal. But it is not logical to do that if you truly want the best candidates. Going to UT's UG MD program does not make you a better surgical resident than other schools even if it had a surgical program with great attendings since you are learning the basics of medicine in medical school. Even upon graduating medicine as a surgical residency gunner you have learned very little about surgery.

 

 

Your point might be slightly more valid regarding a Toronto surgical residency program as you actually work with those surgeons during your residency. 

Sorry to break it to you, but I've been through the American system that lost_in_space was alluding to and (s)he is right on the mark.  That's how the American system judges medical graduates.  The University of Toronto has a very strong reputation in the US and a very distinct advantage that lost_in_space was referring to.

[lost__in__space]

Sorry to break it to you, but I've been through the American system that lost_in_space was alluding to and (s)he is right on the mark.  That's how the American system judges medical graduates.  The University of Toronto has a very strong reputation in the US and a very distinct advantage that lost_in_space was referring to.

 

[JohnGrisham]

Sure, one PD at some program may have that view. But if the person has a poor USMLE score then its a moot point. 

Step 1 score will mean a whole lot more than what Canadian med school you went to. 

Given the small amount of Canadians that even apply to the US for residency, odds are unlikely that you will end up having 2 candidates with the exact same research acumen, step scores and then it comes down to the school they went to applying to a given program. Even then, they may not even have the same preference for a given program in a given specialty etc. Not to mention there are so many quality programs in a given specialty that it wouldn't even matter if 1 PD was "OMG TORONTO< MUST HAVE TORONTO"...and its rarely just 1 PD making the decisions anyways. Add on the fact that you would also have to actually be a good interviewer too and fit with the program.

 

No point arguing over hypotheticals and anecdotals. 


 

[Edict]

Sorry to break it to you, but I've been through the American system that lost_in_space was alluding to and (s)he is right on the mark.  That's how the American system judges medical graduates.  The University of Toronto has a very strong reputation in the US and a very distinct advantage that lost_in_space was referring to.

 

What is your background then?

[Edict]

Sure, one PD at some program may have that view. But if the person has a poor USMLE score then its a moot point. 

Step 1 score will mean a whole lot more than what Canadian med school you went to. 

 

Given the small amount of Canadians that even apply to the US for residency, odds are unlikely that you will end up having 2 candidates with the exact same research acumen, step scores and then it comes down to the school they went to applying to a given program. Even then, they may not even have the same preference for a given program in a given specialty etc. Not to mention there are so many quality programs in a given specialty that it wouldn't even matter if 1 PD was "OMG TORONTO< MUST HAVE TORONTO"...and its rarely just 1 PD making the decisions anyways. Add on the fact that you would also have to actually be a good interviewer too and fit with the program.

 

No point arguing over hypotheticals and anecdotals. 

 

 

 

 

I have to 100% agree, no two candidates are the same and I feel like the whole reputation discussion is the domain of naive premeds and inexperienced medical students, the further on you go in your training the more you realize there is that differentiates you from your competition. There are a million other factors to a candidate and where you went to undergraduate medicine is very low down on the pole.  

[birthoggdube]

What is your background then?

Why would I give away my identity on a public forum?

 

 

Unfortunately as far as elite American residency admissions is concerned, school reputation does matter hugely.  Program directors get way too many applications and it saves them a lot of time to use ERAS filters to lighten the load of applications they have to look at.  This is very different from the way that Canadian residencies or 'less-desirable' American residencies do admissions.  I'm not saying what they do is right - some of the brightest medical students I had the privilege of working with weren't from U of T but were from schools like Calgary and UBC... But that's the way things are.  And I speak from a position of experience and expertise.

I have to 100% agree, no two candidates are the same and I feel like the whole reputation discussion is the domain of naive premeds and inexperienced medical students, the further on you go in your training the more you realize there is that differentiates you from your competition. There are a million other factors to a candidate and where you went to undergraduate medicine is very low down on the pole.  

 

[NLengr]

I disagree with this in regards to surgical residencies at top US schools. The program director at Johns Hopkins for an extremely competitive surgical specialty specifically noted to me that she knew UofT's reputation for surgery was excellent and that it was one of the big reasons she would interview students from UofT but not other Canadian schools.

Just don't mistake US reputation for actual quality. U of T med students are the same run of the mill med students as med students from other schools when we see them on elective in my specialty. They're don't have any special skills or rank any better than any other school when we submit rankings.

 

Basically a similar story with the UofT residency in my specialty. It has strengths and weaknesses same as all the other programs. Their residents are similar to all the other programs in the country and they match to similar fellowships as the rest of the country.

[Edict]

Why would I give away my identity on a public forum?

 

 

Unfortunately as far as elite American residency admissions is concerned, school reputation does matter hugely.  Program directors get way too many applications and it saves them a lot of time to use ERAS filters to lighten the load of applications they have to look at.  This is very different from the way that Canadian residencies or 'less-desirable' American residencies do admissions.  I'm not saying what they do is right - some of the brightest medical students I had the privilege of working with weren't from U of T but were from schools like Calgary and UBC... But that's the way things are.  And I speak from a position of experience and expertise.

 

I wasn't actually asking for your identity, just a bit more background. Your experience you described and anyone's ability to trust it varies tremendously based on what experience you had. 

 

What you are describing sounds on the surface as logical, but if you actually think about it, it is laughable to think PDs would use medical school as their distinguishing factor for admissions to a fellowship or residency. You could argue that the variation in medical school teaching is larger in the states than here, so PDs might use US medical school to distinguish between candidates, but only in the broadest of senses (i.e. not UCLA vs Hopkins) but rather (UCLA vs Podunk medical school) and even then they would look at the candidates experiences. If the candidate from Podunk had more relevant experiences than that from UCLA, the PD would not ignore that candidate, how else do some of the top residents at top medical residencies come from less well known medical schools? 

 

Medical school reputation is so distantly removed from any individual candidates performance on tests that it is almost a joke to use it as a surrogate marker.

 

In a PD survey for residency, only 53% of PDs cared if a grad was from a highly regarded medical school in the states( that in and of itself is subjective , but the difference in reputation in the states is so much greater than it is in Canada, so PDs are even less likely to use that to make any judgements when it comes to Canadians. 

 

Where you went for medical school will become almost completely irrelevant for fellowship since again your most recent experience, residency will become more relevant.   

 

PDs know that your school does not necessarily define you, and what certainly does not define you is your school's size or research presence. A lot of UofT's "reputation" in research is purely due to its size and less due to its quality. What that means is that you will find world leading profs across Canada at all schools, maybe more at UofT because of its size, but it doesn't mean that if you went to Queens for example that they don't have profs that are amazing at what they do, in fact they likely do and if you were interested in research in their specific area, you would be doing research that is field leading. 

[ralk]

The problem is US schools trying to apply their system to the Canadian one, incorrectly. In the US, school reputation matters. It's reflected in where med school applicants apply, in entrance requirements, in clinical opportunities and then in residency options. School reputation has some validity as a marker for quality in the US because everyone at all stages acts as though it does and students compete to get into the more reputable schools.

 

In Canada, that doesn't apply. Medical school quality is pretty consistent and U of T, while a very good school, is by no means uniquely good. Yet, because U of T is a large school, affiliated with the quaternary care centres in Canada, with an established international research presence, it has a reputation for quality in the US. That has very little to do with its undergraduate medical program, but since the US equates reputation with quality in all things, U of T students likely have somewhat of an advantage when applying to the US.

 

That advantage is far from absolute, however, and good applicants from other Canadian schools can be very successful in the US. I know last year a Western grad matched to a highly competitive US program (like, a crazy-competitive program that US students are actively stabbing each other in the back to get into). Canadian schools are all LMCE-accredited, and US programs aren't likely to ignore a stellar applicant from an LMCE-accredited school based on school reputation alone.