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jnuts

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jnuts last won the day on December 30 2015

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  1. The QE1 is scored. Yes, you will need to submit your score if you've completed prior to CaRMS.
  2. jnuts

    Orthopedic Surgery

    Ok. Lots of wrong information here. The below applies specifically to ortho. I'm a Canadian trained Ortho staff in the US. I'm a permanent resident in the US by marriage. This refers to setting up an independent practice in the US, not fellowship. The job market for general ortho is very good in the US right now. It is also easy to find a job for most subspecialties but expect to do some general to get started. But you have to be qualified to work here. In general, all of my peers who have immigration rights in the US left Canada after residency. Those who do not are still in Canada with a few exceptions who are often struggling with visa issues. In short, there are reasons that the backlog of underemployed orthopaedic surgeons in Canada just don't all leave for the USA. The biggest barrier is immigration. You cannot work outside of academic centers with a J-1 or H1b (or any visa). If you have US citizenship or a green card, expect to have many more options. Very very broadly and with exceptions, the US job market is very different from Canada. Starting academic jobs are more work, lower remuneration, higher obligation. They tend to be in places where the pay:cost of living ratio is less desirable. Most people who end up in them are research keeners trying to get to a senior position, IMGs, or just can't live without teaching. The vast majority of new grads down here avoid academic jobs. The only consistent positive to academic positions is that they tend to be more prevalent in geographically desirable areas. The next two barriers I'll mention are softer and likely more variable. I'm sure there exceptions and workarounds that are possible but I'm going to discuss them with the assumption that the person considering a move down to the US would like to maintain the widest array of options and minimize future administrative snags. You must (most likely) write the USMLEs. Some border States might give you a license for a fellowship with just the MCC or some such but the US regulatory structure is multilayered and the State license is not a big barrier to practice. At some point for the hospital to credential you, or to enroll to bill one of the insurance plans, or to get malpractice insurance, or to get a visa, you will need to have the USMLEs. Even if there are examples of people getting around this requirement, why would you shoot yourself in the foot and limit your options? My advice to anyone considering the US route to practice is to get all the Steps done during or as close to medical school as possible. As a motivating cautionary tale, I know people who would prefer to be under-employed in Canada than to face these exams in their early career -- so again, get them done early. Similarly, one of the layers of barriers to independent practice outlined above will (most likely) require that you complete the ABOS (orthopaedic board) exams. You can do them after the RCPSC exams but there is a year lag before you can take the first step (usually during fellowship). The ABOS exam is divided into two Steps. For the first ABOS Step, the written exam, the material is not the same as the RC material but review questions are much easier to access--it's on orthobullets. The first step of the board exam itself is just MCQs at a prometric center. In that sense, it's easier than the RC exam. Expect to spend some time studying during your fellowship. After completing the first step you become Board Eligible (BE), which is the same status American graduates have for their first few years of practice -- in other words, you're in the normal stream after the first Step of the ABOS from the American perspective. The second ABOS Step exam comes after a couple of years of being in practice and involves collecting your own cases over your first year of practice and sitting an oral exam where a selection of your own cases that you must defend form the basis of the exam material. The ABOS Step 2 is the same whether you're Canadian or American and isn't relevant to relocating other than to say that, to stay employed, some hospitals will require you to complete it within a certain number of years from finishing residency as part of their by-laws. After you complete the second ABOS Step you're Board Certified (BC) in the US. Of note, I was able to work as a locum tenens with just my RC board certification. However, the visa problem with working outside academic centers above would still apply if you're not a permanent resident.
  3. I think this list is broadly accurate. I'm currently Ortho staff in the US after a Canadian residency and a one year US fellowship. I think there are a few points to add to 'easy to work in the US'. No question that it's a viable exit strategy compared to unemployment but there are a few things to consider. The job market in the US is better without question. However, unless you have immigration rights for another reason (you're a US citizen or married to one) you will be limited to academic jobs due to visa restrictions at this time. This restriction has been stable for several decades and I would not plan on seeing a change even if you're currently a medical student. All of my peers who have a green card or citizenship in the US have left to set up practice in the USA and have not looked back. Those who do not have access to immigration status--with a few exceptions--have not and it's not just because they enjoy additional fellowships or casual employment. If you are married to an American and are considering this route, expect it to take up to two years to get your green card. The US is a little inverted from Canada. Unless you're very senior, academic jobs-- very broadly--are not desirable. An academic job generally has lower remuneration, more obligations, and worse working hours than a community job. The remuneration to cost-of-living ratio for most academic centers is much worse than in the community. Most young American surgeons accept jobs in academic programs to only build their resume and maintain a clear exit strategy; unless they are stuck there due to the visa problem I mentioned above. Or they can't live without teaching--in which case god bless. There are some other less firm barriers to consider: You must pass the USMLEs. Though it is technically possible to work in some states with your MCC, at some point the credentialing hospital or one of the many insurance companies will require you to be fully certified and past all 3 Steps. Negotiated workarounds are always possible, I guess, but why shoot yourself in the foot. Get these done as soon as possible while the knowledge is fresh in your brain. As hard as it is to imagine, there are surgeons locuming, or worse, in Canada because they can't face the USMLEs. You must repeat your Board certification with an accredited US specialty board. In Orthopaedics this is a headache but not the end of the world. It hasn't been the end of the world but there may be more or fewer problems for other specialties. Strongly consider a US fellowship. Canadians are IMGs in American's brains. A US fellowship takes the edge off of that stigma. A US fellowship will also give you insight and experience within the US system. I'd be drowning without that experience. In orthopaedics, this is a match process (SFmatch) that requires some planning starting in R2.
  4. The system is quite sophisticated now. Start with the list of Canadian medical schools https://en.wikipedia.org/wiki/List_of_medical_schools_in_Canada. Go to each of the Canadian medical school websites in Canada (there are only 15 or so). Most of them will have a section on electives. For example: https://md.utoronto.ca/electives Follow the application rules and guidelines religiously and get everything in the day the application opens including all supporting documents (which means having everything ready in advance including vaccinations etc). Some schools use a lottery so there is some luck involved.
  5. There's a box for it on the application as far as I remember--you'd have to ask the CaRMS people if that implies an obligation to report. Even if you do, don't worry about it Canadians won't know how to interpret the score, much less use it in a rank algorithm.
  6. 3) Canadian medical students write MCCQE 1 after interviews/matching at the end of 4th yr, however since I will be taking QE 1 btw 3rd and 4th yr, if I happen to fail the exam am I required to report it since I rather not and plan to take it again before or after the match process. Yes, you will be required to report it.
  7. If you quit, you may not be eligible for funding for the second position. I've seen instances where residents who want to transfer are kept in their originally specialty until the service line demands allow for their release. If you decide that you want to transfer in July, your program may keep you for an extra year until they can get a replacement through CARMS. It's really ugly but it happens. Pagers need to be answered.
  8. I have one additional concern to add to this list. When you complete a residency in the USA you must pass the Royal College (RCPSC) exams in your specialty in order to practice in Canada. I believe that passing these exams would be almost impossible if you did not complete your training in Canada. The final years of Canadian residencies are filled with intensive preparation for these exams. The review materials used are not publically available and the ciricumlum is a largely an oral tradition. I dont know of anyone in my specialty (orthopaedic surgery) who has passed these exams without training in Canada. There may be exceptions in more populous specialties but I'd imagine the 'USA return to Canada' route would be one of the most difficult paths to pull off. There are a few exceptions to the problem above. If you finish an ACGME family medicine residenicy (or a family medicine training scheme in the UK, Ireland, or Australia) you do not need to write the College of Family Physicians of Canada (CFPC) examinations as there is reciprocal recognition. Depending on provincial rules, you will likely need to pass the MCC exams but I think those are much more reasonable than the RCPSC exams with widely publicized prepation material and a relatively standard curriculum in general medicine. Someone will have to comment about US DO family medicine programs -- I have no idea what the state of training in the USA is in terms of harmonizing ACGME and DO family med programs. I think they are still separate, but dont quote me. Some provinces also have an additional exception that will grant academic physicians a licence without passing the RCPSC exams under certain circumstances. The most common are highly positioned academic faculty who are granted exceptions on a case-by-case basis. I wouldn't count on taking that path as a CSA (or anyone else). There may also be programs for under-serviced areas but I havent seen or heard of those types of programs being active for years.
  9. LoL I guess so. I'll have to bring that to the next pub night. I'm sure their retorte will be something about that being the average across all 13 years of training and that the juniors get worked and abused more or something like that (which is also true in NA). They might also talk about biases in self reporting. It's the same thing with ACGME work hour restrictions. We all say we're meeting them that isn't usually the truth "Nearly two thirds (61%) of the approximately 3000 respondents to the census said that the quality of training had become worse or much worse since the implementation of the [working hours]directive, up from 57% in 2010. A similar proportion (63%) thought that the quality of care had worsened under the directive". If you're going to claim the above it probably makes sense to claim that you're complying with the rules. The end of that article also refers to the pervasive job stresses I mentioned. I made some edits to expand on my original post to explain a bit more carefully where I'm coming from. But point taken.
  10. I have no idea if that's objectively true. It should be noted that there are also cushy and stressful residencies in North America. I don't think anyone is describing PMR as running a race. My primary experience is in North America so I may well be mistaken but here's the background/biases and you can judge. I'm basing my opinion on stories of woe over pints with my European medschool classmates so it's hard to tell objectively. In terms of daily hours, they claimed that they were spending similar amounts of time in house as a typical resident in NA. There may be some exaggeration and chest puffing involved. I've never seen a side-by-side objective comparison. My friend's chief gripe that really resonated with me was that they had to do all sorts of extra courses and academic activities (paid out-of-pocket) to pad their resumes for the next stage (a next stage that never arrived for some of them). I thought that pressure sounded terrible and wasn't anything I could relate to at the time. They also seemed much more stressed than I was--which I attributed to the uncertainty in their career paths compared to mine. My career path was pretty solid until my final Staff level job. Their uncertainty sounded awful and much more emotionally draining than my life. Then again, I may be just biased to support my life choices and self-medicated myself into reinforcing my impression that my residency wasn't that bad
  11. I totally agree with you, if you're talking about medical school hours. I thought the thread had moved to post-graduate training hours; but I may be mistaken. My last post refers to post-grad. Even then, I hear what you are saying. But the pressures to get to the next phase of your training are much worse in the UK and that eats a lot of the time difference. Briefly, what I was trying to express was that yes the daily work hours in the UK may be lower but your overall time spent working and advancing your career--at best--balances out the work time difference between the UK and North America. Advancing to the next level also stresses post-graduates out a lot more in Europe which I think explains the mixed opinions populating this forum. Regarding ward time in medical school, though it's not quite optional at most medical schools, you're certainly more of a tag-along in the UK/Ireland and not actively part of the care team. There is no question that medical school is much less of daily commitment and is, in general, much less stressful. It would have been noted if I consistently skipped morning rounds. It was rare that I was asked to stick around after morning rounds. I had no patient assignments or such unless it was part of a tutorial or other organized academic activity. There were more organized tutorials and clinical skills labs than North Americans would be used to. There was usually one or two organized activities per day as opposed to one per week. Mock charting and case reports were handed in and graded by a clinical lecturer as opposed to reviewed by a resident and added to the chart. We had group projects and assignments. You can definitely take liberties with ward time in the UK and Ireland, but the assumption is that you're off somewhere studying. We were encouraged to take self-structured time on the wards and to return to talk to and review the charts of interesting patients that we saw on AM rounds. We were often told that spending more auto-tutorial time on the wards would improve our performance on the final exams (in fact, I got sick of hearing that). To compare, medical students in the UK/Ireland aren't allowed to write in the chart or contribute to the official patient record in the UK/Ireland -- co-signing a medical student's clerking or orders doesn't exist as far as I know. In North America, being an active part of the care team is integral to senior medical student training. In the UK and Ireland there is no obligatory call and if you do stay on call it's unlikely you would do very much actively or carry a pager--again in contrast to North America where call is standard on most rotations. I have mixed views on which strategy is better; there are advantages to each of them. There were rare exceptions in Europe where someone with North American exposure would treat me like a North American medical student--my family practice rotation stands out as being good at that and there were a few others. There's a core educational philosophical difference. In the UK/Ireland, you learn your patient management skills later in your training post-medical school. UK and Irish medical schools seem to focus on general medical knowledge to a much greater extent early on (in my subjective opinion). Early medical education in the UK/Ireland fills the time with a lot of medical knowledge that North Americans learn in residency. You get to the same place at the end of all your training I think, but the educational roadmap is different It's worth noting that a major contributor to the lack of Uk and Irish medical student stress is that you're not gunning for a residency. After medical school you either do a rotating internship (Ireland), or enter the Foundation Years 2 year program(UK). It's only after you finish these first couple post-graduate years that you start applying to your specialty--and even that may not be a direct educational path from finishing your prelim years to becoming independently qualified as a specialist. Getting through that pathway from prelim to Consultancy is where the stress comes. Getting through that part of your "training" can constitute most--if not all of--your medical career.
  12. You're trying to compare apples and oranges. The training schemes are very different. Think of the UK less as a harmonized linear training scheme, like North American residency, and more like a job where you're fighting with your peers for a rare promotion 3 or 4 times before you gain any independent practice qualification. Under such a system, the hours aren't necessarily better because you're struggling to stand out to get the next SHO/SPR/NCHD/Consultant job that comes up ahead of everyone around you. The training is slower--not because of work hours--but because the whole philosophy of medical training is different. You're not a Resident (in educational parlance something like a post-graduate student in a taught course with an accepted timeline for completion), you're an employed physician with a limited skill set. Further education is the junior doctor's independent responsibility to a much greater extent than in North America. As a UK trainee, you're not exposed to nearly as much career furthering work in your early training and are instead employed by your hospital to do daily work that most residents in North America would consider scutt that has no benefit to your education. And your employer is relatively happy to keep you employed at that level more-or-less indefinitely. It's not as though there is a sufficient number of Consultant jobs waiting at the end of the game for everyone to get one anyway. There's no set number of years in the UK to become an independent specialist; there are just averages. The UK system is complex with many more stalled careers post-medical school graduation. The advantage is that the time as a junior doctor is considered a real job and not a training program like North American residency. As a consequence, the pay is (very subjectively) better/liveable and, most of the time, you get paid for your actual working over time (but not your educational time). However, NCHD compensation has been a big issue in the UK recently. This is a very long topic to explain and not useful for most readers of this forum (given its Canadian bent). Just make sure you fully investigate this route before considering getting started in the UK. FYI-other European countries function very differently and possibly more like North America but I don't know enough about other places to provide any details.
  13. jnuts

    Tips For A Canadian Img

    I'd emphatically second this post. Passing the RCPSC is completely independent of expertise in your field. The concept that Canadian residents are "taught to the test" would be a laughable understatement if the situation were at all funny. That said, most fully trained IMG specialists moving to Canada don't write this exam. They just get an academic license. (http://www.cpso.on.ca/Policies-Publications/Policy/Academic-Registration)
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