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US Residencies and CaRMS

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Hi!

I've been wondering about matching to US residencies. From what I understand, it comes with two risks: 1) if you match to a Canadian residency, you'll automatically be required to go there and 2) if you take an American residency, you might be at a disadvantage in terms of practicing in Canada? Are both of those presumptions true?

How does the ERAS match fit in with CaRMS? Would picking a US specialty as a top choice make me more likely to go unmatched (assuming the US residency is competitive, and I've reduced my chances at Canadian residencies due to my gamble at US residencies).

Am I correct at all? I'm an incoming M1, I really have no idea how most of these things work unfortunately.

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The problem is the CaRMS match happens first, so if you match to a Canadian residency program you will be automatically withdrawn from the American match. You don't get to match to a program in Canada, subsequently match to something in the US, then get to pick between the two. Basically, you have to not submit a rank-order list to CaRMS at all if you seriously want to match to the US; however, you then risk not matching in either country at all. It's a very risky move. In most cases, it's not feasible to apply to programs in both countries as you only have so much elective time in fourth year and have to focus on one match. And it goes without saying that CaRMS is becoming tighter every year. 

One thing you can do to get a sense of how strong an applicant you might be in the US is to take the USMLE step 1. If you score > 250, you can be reasonably sure of matching in the US as long as you're not applying to rads/ophthal/anesthesia/derm/plastics. 

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Reasons why Canadian medical students don't do residency in US:

1) You have to write the USMLE at some point during medical school, and it will be more difficult compared to the average US medical student because a) you don't have dedicated time to study and b) the premedical curriculum at US school teaches to the test, and you'd have to do a lot of stuff on your own at most Canadian schools.

2) Canadians who want to do residency in the states generally don't want to go to any program, they have specific programs in mind, and unless it's purely for location regions, they are generally prestigious, competitive programs, which will require a lot of time and energy to be competitive with your US counterparts, and again you're doing it on your own time.

3) You would have to do electives at your desired program(s) the US, which are more difficult to arrange, more expensive, and would take away from possible Canadian electives if you don't match to the US.

4) Unless you are a dual citizen, you will need a visa which is not necessarily easy to get.

5) The above mentioned system where the Canadian match is first, so you essentially have to give up the chance at matching in Canada in the first round to match to the US.

6) If you want to work in Canada, some residencies are different enough to their Canadian counterparts that you would require additional fellowship time to be able to be board certified in Canada.

7) You can do your residency in Canada and then take the USMLEs at your leisure and then usually you can work in both Canada and the US at that point.

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Take it from me, who has done a residency and currently doing a competitive fellowship in the USA, and I use Caps so I make my point across. 

 

DO NOT DO RESIDENCY IN USA if YOU WANT TO END UP BACK IN CANADA. 

 

Reasons:

1) Duration of Residency in the USA is not acceptable for RCPSC (Most Residencies)

2) The route back is so hard that you will end up being jobless for at least 6 months if you do end up coming back 

3) USMLE Steps are no joke and getting electives at places (Harvard, Yale, Hopkins, and UCLA) is very hard. 

 

Advice: 

1) Do the residency here in Canada, along with USMLE steps and/or Boards and apply for fellowship or job. 

For saturated specialties like Gastroenterology or Int. Cardio / Radio you can find many jobs in the USA after being board certified, but again for some fields like FM or Peds is not even worth it.

If you doing Ortho, Gastro, Int-Cardio, NeuroSurgery or Plastic Surgery (subs) the USA is the place with base salaries of 500 to 1 million potential. for anything else do not even waste your time. 

Although I will make tons of money after finishing my fellowship, own my own Ambulatory Surgical center (Partnership) with full benefits, I dream of coming back to Canada, and Guess what, being in contact with RCPSC and CPSO it seems I still need to find a mentor, work under supervision and there is no jobs. 

 

I say it again, do the residency in Canada and be happy. 

 

 

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On 8/5/2018 at 1:52 PM, shimshim said:

Take it from me, who has done a residency and currently doing a competitive fellowship in the USA, and I use Caps so I make my point across. 

 

DO NOT DO RESIDENCY IN USA if YOU WANT TO END UP BACK IN CANADA. 

 

Reasons:

1) Duration of Residency in the USA is not acceptable for RCPSC (Most Residencies)

2) The route back is so hard that you will end up being jobless for at least 6 months if you do end up coming back 

3) USMLE Steps are no joke and getting electives at places (Harvard, Yale, Hopkins, and UCLA) is very hard. 

 

Advice: 

1) Do the residency here in Canada, along with USMLE steps and/or Boards and apply for fellowship or job. 

For saturated specialties like Gastroenterology or Int. Cardio / Radio you can find many jobs in the USA after being board certified, but again for some fields like FM or Peds is not even worth it.

If you doing Ortho, Gastro, Int-Cardio, NeuroSurgery or Plastic Surgery (subs) the USA is the place with base salaries of 500 to 1 million potential. for anything else do not even waste your time. 

Although I will make tons of money after finishing my fellowship, own my own Ambulatory Surgical center (Partnership) with full benefits, I dream of coming back to Canada, and Guess what, being in contact with RCPSC and CPSO it seems I still need to find a mentor, work under supervision and there is no jobs. 

 

I say it again, do the residency in Canada and be happy. 

 

 

What if I am COMPLETELY MISERABLE in my current Canadian residency program and don't have it in me to continue on. And have been unable to switch into my specialty of choice in Canada?

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13 hours ago, neuroscience_nerd said:

What if I am COMPLETELY MISERABLE in my current Canadian residency program and don't have it in me to continue on. And have been unable to switch into my specialty of choice in Canada?

what program

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4 minutes ago, neuroscience_nerd said:

Which USMLE exams would I need to take to apply for residency? Is it both Step 1 and Step 2 CK?

Step 1, Step2 CS, Step2 CK and some people are taking Step 3 to be competitive. some Residency programs prefer applicants to have step 3 completed.

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9 minutes ago, stephenpeters2 said:

Step 1, Step2 CS, Step2 CK and some people are taking Step 3 to be competitive. some Residency programs prefer applicants to have step 3 completed.

Thank you! For clarification, do you write Step2 CS before Step2 CK?

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You can do either one first... Step 2 CS is the easiest, you can knock that out with one week of study time or less if you are in clinical rotation or residency program.

Step 2CK will require 4-6  weeks of study time or if you do not have the time to dedicate to it, you can subscribe to UWorld and practise questions on your smart phone.. uworld is all you need for step2.  The format for uworld is, tutor mode for 2-3 rounds and timed mode

Now, with high confidence, you can deal with step1. This test is the hardest, it will take alot from you like an ex-wife during divorce. First aid and Uworld will come in play. 

Step3 is the easiest (depends on how you feel post-divorce). Being in a residency program helps  because 25% of the exam is simulated patient test and management. 75% is step 2 style questions so residual memory will come into play.

This is my personal opinion.

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6 hours ago, neuroscience_nerd said:

Thank you! For clarification, do you write Step2 CS before Step2 CK?

You need to write Step 1 2 CK and 2CS before writing Step 3. Otherwise you can write them in any order you like. You need to have Step 3 if you want the H1B visa that allows you to stay in the US after residency. Otherwise if you get just the J1 visa, you have to come back to Canada for 2 years before reapplying to go to the states, or you can get a J1 waiver by working in an underserved area for a number of years i don't know how many. 

Just as a word of caution though, you'll probably still match if you do well on the Steps, but you'll probably have to declare that you are a current resident, even for the US applications which may be considered a red flag, but probably won't stop them from taking you since you have a good explanation for it. 

 

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I did them in order. Not sure if i recommend it 

Aim to Ace them. Easier said than done. I had the benefit of good hours. Not sure your situation.

Step 1: ufap w costanzo and goljan for clarification. Six months hard study. >250.

Step 2: two months uworld only. Dont bother with mtb. > 250.

Cs: took it a week after step 2. Read through first aid once. It's bs.

Step 3: two months uworld only. > 250

 

Get all 3 done and you're open to h1b which is a far better visa. The drumpf administration is causing programs to reduce that visa but you might as well open up for it

 

Good luck

 

 

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10 hours ago, GrouchoMarx said:

I did them in order. Not sure if i recommend it 

Aim to Ace them. Easier said than done. I had the benefit of good hours. Not sure your situation.

Step 1: ufap w costanzo and goljan for clarification. Six months hard study. >250.

Step 2: two months uworld only. Dont bother with mtb. > 250.

Cs: took it a week after step 2. Read through first aid once. It's bs.

Step 3: two months uworld only. > 250

 

Get all 3 done and you're open to h1b which is a far better visa. The drumpf administration is causing programs to reduce that visa but you might as well open up for it

 

Good luck

 

 

thanks for that - there is a good chance I will be writing those as well in the next two years. Main advantage I have I guess is other than ego I don't really need to get a good score. 

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6 hours ago, neuroscience_nerd said:

Also, are Canadians considered IMGs when applying to the states?

And what matching service is used?

You aren't, but the US doesn't do IMG quotas like we do here. The reality is you probably sit somewhere below the US but above other IMGs due to a similar med system. I'd honestly only consider the US if you have family reasons etc. The training you get in the US is equivalent to Canada, in fact in many cases Canadian training is better. The issue with applying to the US is you basically have to commit to it because of the aforementioned match timings, and very few people can really commit to US only. 

If you are just a high achiever, (which is often why so many M1s ask this question and then by M4 basically no one applies), you'll find its basically better to stay in Canada for residency and then do your fellowship in the US. At that point its a free for all, you can apply anywhere and receive multiple offers and go wherever you choose. 

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On 8/5/2018 at 12:22 PM, shimshim said:

Advice: 

 

If you doing Ortho, Gastro, Int-Cardio, NeuroSurgery or Plastic Surgery (subs) the USA is the place with base salaries of 500 to 1 million potential. for anything else do not even waste your time. 



 

How about derm?

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