IM residency in the U.S. and then return to Canada?

[blueskyguy]

Hi all,

I am a Canadian student currently at a U.S. med school with an interest in primary care. I have read about how General Internal Medicine in Canada is 4 years long, but I have also come across people saying that it is increasing to 5 years long. Can someone explain this to me? Is there a transition happening to 5 year programs now?

Also, if I ended up doing a 3 year IM residency in the U.S. (say, on a J1 visa, which would force me back to Canada after residency), and I had to come back to Canada to live and work, how would this process work? Would I have to do extra year(s) of training somehow? Would I have to do 1 extra year or 2 extra years? (Considering the 4 year and 5 year GIM stuff)

Any clarification on these topics would be much appreciated! Thanks for the help.

[shogun91]

Currently, you could a chief year which would make your training 4 years and then be eligible to write the Canadian board exams. You could also do a 1 year fellowship in ID or something like that after the initial 3 years. 

[shimshim]

Did this route but did GI and hep fellowship so 6 years plus motility and getting certified in advance procedures. 

You have to do the Canadian Boards if you only have 4 years (3 years IM + 1 year chief or ID, Sleep, geriatric). 

My recommendation is to do 5 years of IM, do the boards in US and Canada, way much easier to find jobs, get licensed and start your own clinic

[The Ace of Spades]

On 7/13/2019 at 5:00 PM, shimshim said:

Did this route but did GI and hep fellowship so 6 years plus motility and getting certified in advance procedures. 

Wait... you've done/are doing a hepatology fellowship, motility fellowship, and advanced endoscopy fellowship?! Might as well add IBD and nutrition!

[RadCdn]

On 5/11/2019 at 6:09 PM, blueskyguy said:

Hi all,

I am a Canadian student currently at a U.S. med school with an interest in primary care. I have read about how General Internal Medicine in Canada is 4 years long, but I have also come across people saying that it is increasing to 5 years long. Can someone explain this to me? Is there a transition happening to 5 year programs now?

Also, if I ended up doing a 3 year IM residency in the U.S. (say, on a J1 visa, which would force me back to Canada after residency), and I had to come back to Canada to live and work, how would this process work? Would I have to do extra year(s) of training somehow? Would I have to do 1 extra year or 2 extra years? (Considering the 4 year and 5 year GIM stuff)

Any clarification on these topics would be much appreciated! Thanks for the help.

I did 3 years IM in the US, did a 1 year fellowship afterwards as well. Then I was eligible to write the Royal College exams which I passed.

I know IM doctors in Canada who just did the 3 year IM in the US, then went through a separate pathway to get qualified in Ontario. No need to do the Royal College exams this way. The Royal College exam is a big headache, and very poorly designed. Personally if I did it again, I'd do the 3 year pathway and start practicing sooner. And yes, you can practice in Ontario right away with a 3 year IM residency from the US as long as you have written the ABIM (which is a much easier exam than the Royal College). You would initially be on the restricted licence and then after two years can have your practice evaluated over a weekend and then you'll have your independent licence. 

[Bluberblubo]

5 hours ago, RadCdn said:

ABIM (which is a much easier exam than the Royal College)

Wow, I was always under the impression that the ABIM was more difficult than the royal college (purely based on the fact that the steps are more difficult than the USMLE). Are any of you aware of people finishing residency in Canada and then moving to the states? Would you have to do the ABIM in that case? My understanding is that the USMLEs would be optional depending on which state you want to practice in if you have the LMCC, but please correct me if I'm wrong

[Internalmed1234]

11 hours ago, RadCdn said:

I did 3 years IM in the US, did a 1 year fellowship afterwards as well. Then I was eligible to write the Royal College exams which I passed.

I know IM doctors in Canada who just did the 3 year IM in the US, then went through a separate pathway to get qualified in Ontario. No need to do the Royal College exams this way. The Royal College exam is a big headache, and very poorly designed. Personally if I did it again, I'd do the 3 year pathway and start practicing sooner. And yes, you can practice in Ontario right away with a 3 year IM residency from the US as long as you have written the ABIM (which is a much easier exam than the Royal College). You would initially be on the restricted licence and then after two years can have your practice evaluated over a weekend and then you'll have your independent licence. 

What does the restricted license entail? You'd have to have supervision/reduced billings/reduced patient load? What is the separate pathway to get qualified in Ontario after 3 years of IM in the states? 

[RadCdn]

13 hours ago, Internalmed1234 said:

What does the restricted license entail? You'd have to have supervision/reduced billings/reduced patient load? What is the separate pathway to get qualified in Ontario after 3 years of IM in the states? 

There are no restrictions on patient load. You just have to work at the same clinic as your supervisor. This is not difficult as some clinics are groups practices. The main criteria is that you must meet with your supervisor one time per month.

The separate pathway is quite simple. Pass the ABIM, then 2 years of supervision, then pass an in-person evaluation (which I've heard is easy). 

[RadCdn]

18 hours ago, skyuppercutt said:

Wow, I was always under the impression that the ABIM was more difficult than the royal college (purely based on the fact that the steps are more difficult than the USMLE). Are any of you aware of people finishing residency in Canada and then moving to the states? Would you have to do the ABIM in that case? My understanding is that the USMLEs would be optional depending on which state you want to practice in if you have the LMCC, but please correct me if I'm wrong

ABIM is MUCH easier. It's an 8 hour written exam, no oral component. It's also a much better designed exam. After writing all the US and Canadian exams, I found the US exams were far better designed. 

I know people that have done residency in Canada and then moved to the US due to more job opportunities in the US. However, these are in fields outside of IM. In IM, you'll find work easily. At most places it's been "what can we do to convince you to work for us?" type of thing. You're in the driver's seat. 

You can work in the US as long as you're "board eligible". Which means eligible to write the boards. But you can work without having passed the test for quite some time. 

Writing your USMLE's is never a bad idea. It opens so many doors. In my experience, in the US your talent and skill will go far and it will be recognized. In Canada, there are all sorts of obstacles at every level. 

[metacarpal]

On 8/17/2019 at 12:28 PM, RadCdn said:

I did 3 years IM in the US, did a 1 year fellowship afterwards as well. Then I was eligible to write the Royal College exams which I passed.

I know IM doctors in Canada who just did the 3 year IM in the US, then went through a separate pathway to get qualified in Ontario. No need to do the Royal College exams this way. The Royal College exam is a big headache, and very poorly designed. Personally if I did it again, I'd do the 3 year pathway and start practicing sooner. And yes, you can practice in Ontario right away with a 3 year IM residency from the US as long as you have written the ABIM (which is a much easier exam than the Royal College). You would initially be on the restricted licence and then after two years can have your practice evaluated over a weekend and then you'll have your independent licence. 

How hard was it to pass the Royal College exams after a US residency? People on this forum always post that it's "almost impossible" to pass if you didn't do your residency in Canada because of the way the exam is designed(?)

[RadCdn]

7 hours ago, metacarpal said:

How hard was it to pass the Royal College exams after a US residency? People on this forum always post that it's "almost impossible" to pass if you didn't do your residency in Canada because of the way the exam is designed(?)

I practiced with two others who did their residency in the US, we all passed. There is also an IM Review Course done in Toronto annually and it's definitely worth doing that course. If you do that course, plus have the Canadian study materials, you will be on the same playing field as the Canadian residents. 

There is nothing in residency training that helps for the exam, it's the study materials that are needed. That's because about 25% of the questions on the written exam are EXACT copies from year to year. Those questions are so ridiculously detailed that they're impossible to get correct if you have not researched the answers beforehand. I will say that it is probably impossible to pass without the study materials.