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strawberryjams

Orthopedic Surgery

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Hi,

I go to a Canadian school. If I match to orthopaedic surgery in Canada, can I practice in the US? From my research, I found that jobs are very scarce in Canada, but there are lots of opportunities in the US for orthopaedic surgery. 

Do I need to write STEP1 to be considered? What are some hurdles to practicing in US? Immigration seems to be an issue.

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I don't know anything about the job market for ortho so listen to the orthopods on that one.

Immigration to practice of fellowship in the US is actually fairly easy.  I moved to the US for fellowship.  I did it on a J1 visa because I was returning to Canada after 1 year.  USMLE is not required for a J1 visa.

Licensing depends a bit on which state you're in, but Canadian exams are generally considered on par. 

Work visa is a bit more challenging.  If you are thinking about moving to the US to work permanently, then yes just do all the USMLE.  It will help your visa status because you can get an H1B pretty easy.  Except for the expense and hassle of actually writing the USMLE, there is no downside to having them in your portfolio.  It does increase options for you for fellowship or work in the US.  There are ways to do it all without the USMLE, but it can be a bit more complicated.

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3 hours ago, Histolytica said:

I don't know anything about the job market for ortho so listen to the orthopods on that one.

Immigration to practice of fellowship in the US is actually fairly easy.  I moved to the US for fellowship.  I did it on a J1 visa because I was returning to Canada after 1 year.  USMLE is not required for a J1 visa.

Licensing depends a bit on which state you're in, but Canadian exams are generally considered on par. 

Work visa is a bit more challenging.  If you are thinking about moving to the US to work permanently, then yes just do all the USMLE.  It will help your visa status because you can get an H1B pretty easy.  Except for the expense and hassle of actually writing the USMLE, there is no downside to having them in your portfolio.  It does increase options for you for fellowship or work in the US.  There are ways to do it all without the USMLE, but it can be a bit more complicated.

Could you comment briefly on doing it without the USMLEs, specifically if you just want to setup a simple private practice outpatient clinic?

 

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The job market for orthopedics is getting better now from what i've heard from graduating residents. All of this stuff is cyclical, choosing a specialty is a bit like choosing to buy a house in 10 years. The market could be booming or in a recession. 

 

Regarding your question, it seems as if Canadian FRCSC's can write the US boards. You just need to have finished your Canadian boards before you write the US ones. 

https://www.abos.org/certification-exams/part-i.aspx

It also says below that you are eligible for board certification with Canadian residency training. 

https://www.abpsus.org/orthopedic-surgery-eligibility

 

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22 hours ago, strawberryjams said:

It seems very complicated. I think FM is the safest option in Canada atm. I think getting board certified is great but the issue is visa (H1B) which means we  just need to pass the steps (1,2 and 3). Definitely doable tho

It's a bit complicated but not terrible.  If you want to move to the States it's completely feasible.  Just pick what specialty you want and where you want to practice it. 

 

On 6/21/2018 at 6:23 PM, PhD2MD said:

Could you comment briefly on doing it without the USMLEs, specifically if you just want to setup a simple private practice outpatient clinic?

 

I don't know anything about setting up a private practice clinic.  My experience in US is limited to advanced fellowship training.

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In fact, I don't even think being board certified is a requirement to find jobs in certain situations. Most job listings ask for board certified/board eligible, but that is mainly because they don't necessarily trust foreign training, but they make exceptions for Canadians because of how similar our system is to theirs. In reality they would hire someone who is Canadian board certified with good fellowship and recommendation letters without board certification. I've definitely seen Canadian trained doctors work in top US academic centers and their training clearly would not qualify them to be Board Certified in the US. 

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2 hours ago, Edict said:

In fact, I don't even think being board certified is a requirement to find jobs in certain situations. Most job listings ask for board certified/board eligible, but that is mainly because they don't necessarily trust foreign training, but they make exceptions for Canadians because of how similar our system is to theirs. In reality they would hire someone who is Canadian board certified with good fellowship and recommendation letters without board certification. I've definitely seen Canadian trained doctors work in top US academic centers and their training clearly would not qualify them to be Board Certified in the US. 

The Royal College is way harder than the US boards, at least in my specialty. 

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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. 

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