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Canadian student at U.S. med school with important questions!

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Hi all,

This is my first post to premed101! Thanks for any help in advance.

I am currently a second year Canadian medical student at a mid-to-low tier medical school in the U.S. I have some interests in Internal Medicine and Pediatrics, and I have some questions for you all.

Firstly, I was hoping someone could clarify how Carms work exactly, as I am more familiar with the U.S. system. Just to be clear: there are two rounds/iterations in Carms, with the first round consisting of CMGs and US students who graduate from LCME accredited schools who are also Canadian. The second round consists of those who didn't match in the first round, and IMGs. Is this correct? Did I miss anything?

Additionally, after reviewing my school's match results for Canadians of the past several years, it seems that the vast majority of Canadian students at my school interested in pursuing Internal Medicine (Or Peds) ended up matching at a U.S. residency and not a Canadian residency. But, I also reviewed the Carms data, and for 2018 for instance, it says that after the 1st and 2nd iteration of the IM match in Canada there was still 1 spot left unfilled.

I am having trouble understanding why that is. If IM in Canada is considered a "less competitive" field, with 1 spot left vacant just last year, why are most of the Canadian students at my school matching and completing their IM residency in the U.S. (with most of them on a J1 visa that sends them back to Canada afterwards anyways?). Why are these students not just going to Canada for their IM residency?

I may not be understanding how the system works exactly. For instance, if you wanted to match into IM last year, and there was one spot left vacant at the end, doesn't that mean that IF you wanted spot, no matter what, you would get it? Or I am looking at that wrong? 

TLDR: In essence, I'm not understanding why the vast majority of IM (or Peds) people at my school are doing U.S. residencies on J1 visas (which sends them back to Canada after) instead of just doing a Canadian residency. Is it possible many of them did not match? (Even if there are left over spots according to Carms?)

Any advice would be very much appreciated.

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