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macstjo

Surgery for IMG?

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Hello

 

I am a Canadian citizen, just finished my first year at University College Cork, Ireland, (I KNOW.. DON'T LEAVE YET!) and now I'm doing a clinical research at St. Michael's Hospital, Toronto, on internal medicine related stuff. Graduated from UofT B.Sc. and McMaster M.Sc.

 

As far as I am concerned, connections with doctors are really important and as such I am trying to show my face around as much as possible (kind of observership), mostly internists, while doing research at the same time. But, more I think about it, more I feel like I want to do surgery, more hands-on, technical works than "primary care" works, like internal medicine.

 

Given the fact that only a handful of IMGs, if any, are accepted every year for each specialty, I want to make probably one of the most right, and the most important, decisions in my life: should I still pursue surgery? Before it is too late, by making the right choice, I want to either 1. stay in the internal med stream and keep myself connected with those internists, or 2. focusing more on surgery specialties and start making connections with those surgeons. Simply put: take the risk of not matching back but pursue something I am more interested in OR take the safe road but do something I am less interested in.

 

I am not asking for a direct answer, as I understand there is none atm. All I am asking is perhaps a few suggestions, or maybe even some questions about myself that will guide myself to more appropriate questions.

 

I also understand that it will be a very tough, bumpy road for any IMG but any suggestions would be tremendously appreciated. (no trolling please) Now, I still have so many questions to ask, but I'll keep the thread short for now and save them for later.

 

Thank you!

 

(just to give you a little bit of stats on match last year from my school: 6 FM, 1 IM, 1 EM, 1 Ortho in Canada and 2 FM, 1 IM, 1 Peds, 1 GS, 1 Plastics and 1 Path in US)

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Would you be willing to go to Manitoba for residency?

 

Every person that I know who went to Ireland for medicine* (they are from Toronto and Vancouver themselves) had to spend time in Manitoba. As soon as they were done they moved to their home cities for fellowships, etc.

 

*They did their residency in family medicine and pediatrics.

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You can essentially write off highly competative subspecialties (ex plastics, ENT, Uro). There are very few, if any first round imG spots. The spots also tend to be not filled if they exist (politics mostly). The chances of second round spot in a non French program is basically zero. Stick to the less competitive surgical stuff, but even then, it's long odds.

 

I would focus of stuff you have the best chance at (family, psych). Unfortunately, in your situation, the odds are against you and if it was me I'd much prefer ANY residency position vs. a 300k debt and no way to pay it off.

 

Plus once you are in the system, you could always try to switch. A lot depends on how willing you are to risk never working as a doc.

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The match is brutal, especially if you want to aim for surgery. If you don't mind going unmatched and going down the scary road of re-applying, then don't take this advice. If you just want to make sure you have a job, then do the following.

 

1. In Canada: Apply for surgery, backup with internal med+/-family med.

 

2. In the US: Do the same thing, but also look at the prelim surgery spots, as they are much easier to get. The people I know who matched in surgery this year were matched into prelim spots except for one categorical, but the prelim spots were at Yale and Mt. Sinai school of medicine in NYC, which I believe are good programs. At least with prelim you have a job, and coming from a good school you can probably transition into surgery or at the very least a family med position in the middle of nowhere. At least you have a job and can be a practicing physician.

 

Also it goes without saying, but apply broadly.

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Surgery will be a very hard go, though it's not impossible. You can certainly apply, but ideally you would not spread your elective choices too thin.

 

In any case, there are usually second iteration spots open in Sask (and Quebec if you're French-speaking) in IM, but the pickings are slim elsewhere. MUN has taken IMGs in the past but not in the past two years. Manitoba is possible, but it's important to realize how ridiculously competitive these handfuls of spots end up being. Psych would be a better prospect, but even there not a guarantee.

 

As an aside, internal medicine is not anything like "primary care" in Canada.

 

Is there some reason you can't leave Ireland and apply to Canadian med schools? The IMG route is NOT a good prospect and is getting worse.

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That person who scored plastics clearly had some sort of connection of nepotism, carnality or patronage, since it is essentially unheard of for non-oilstan FMGs to land any spots in any competitive fields.

 

I agree that this is highly likely there were connections.

 

Your best (and probably only) bet for plastics: Marry the kid of a plastics program director.

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You're not getting into surgery. The safe road is your only road, and even then it is no guarantee. I'd more or less just call it the road.

 

I wonder why you jumped the gun to go to an overseas school rather than taking more stabs at applying to Canada? The result is that you have limited your options. I'd reapply to Canadian schools.

 

 

That person who scored plastics clearly had some sort of connection of nepotism, carnality or patronage, since it is essentially unheard of for non-oilstan FMGs to land any spots in any competitive fields.

 

NLengr is right about the forced IMG spots in the match. The competitive programs are notorious for not filling them, because frankly why would they fill their programs with potentially inferior products? Who can blame them?

 

You might get family, internal, psych, or path in Winnipeg, Sask, or NFLD. GS is a very long shot. Surg subspec is an impossibility.

 

wrong, but thanks for trying

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wrong, but thanks for trying

 

You do realize that Gen Surg is now as or more competitive than anesthesia, and that programs that actually have IMG positions will happily take a good CMG candidate who was unlucky in the first iteration over you?

 

Because they will and do and have.

 

There were applicants this year - CMGs - who ended up with only 3-4 interviews despite applying broadly. One I know is now in Saskatoon. Do you like the Prairies? UofT programs are the most competitive in th country. Doing an elective there in either IM or Gen Surg is not a sufficient condition for an interview invite for a CMG let alone a student from Ireland.

 

So, yeah. Brooks is only trying to help you avoid making a huge mistake.

 

With CaRMS as an IMG, it's all well and good to hope for the best, but experience shows you should expect the worst. On the other hand, St John's is a nice smaller city, but the psych program is not (from what I hear) that great. Nor is Dal's for whatever reason. (???). I only mention those programs as they are more likely outcomes of failing to match to IM let alone any surgery program.

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I am trying to show my face around as much as possible (kind of observership), mostly internists, while doing research at the same time. But, more I think about it, more I feel like I want to do surgery, more hands-on, technical works than "primary care" works, like internal medicine.

 

Given the fact that only a handful of IMGs, if any, are accepted every year for each specialty, I want to make probably one of the most right, and the most important, decisions in my life: should I still pursue surgery? Before it is too late, by making the right choice, I want to either 1. stay in the internal med stream and keep myself connected with those internists, or 2. focusing more on surgery specialties and start making connections with those surgeons. Simply put: take the risk of not matching back but pursue something I am more interested in OR take the safe road but do something I am less interested in.

 

....

 

(just to give you a little bit of stats on match last year from my school: 6 FM, 1 IM, 1 EM, 1 Ortho in Canada and 2 FM, 1 IM, 1 Peds, 1 GS, 1 Plastics and 1 Path in US)

 

Just out of curiosity are you planning to write the USMLE? My friend is an IMG and scored 98% percentile in the USMLE step1 and 95th in step2 and he's basically good to go for any residency he applied to (radiology in a Tier 1 school, etc etc).

 

This might help you if you are interested in the US as a backup. I know another IMG who scored very high in Step 1, did a 6 week internship in the US (Cornell), and is now a surgeon there.

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Programs do choose to leave IMG-only spots unfilled, because the quality of IMGs varies from excellent to shameful, and even if you're from Canada and go to a plum UK school, people will still ask why you didn't get in in Canada(the obvious luck of the draw notwithstanding).

 

The fact is, as an IMG, you're going to have an uphill battle to get any residency in Canada. In the US, the residencies you will probably be able to get are IMG(I'm talking ESL-to-the-max) heavy midwestern scut-factories that border on racist slavery. If you don't believe me, go down to SDN and see what they think of your predicament.

 

That plastics dude certainly had an uncouth ace up the sleeve, and if they deny it, they're lying, plain and simple.

 

Personally I'd reapply to Canadian schools.

 

I do not see how I am wrong about any of this.

 

No offense but you are wrong about almost all of that.

 

There are rarely any IMG spots leftover in the second round of CaRMS, including the highly competitive specialties. Last year there were 259 IMG positions, of which 249 were filled. The majority of the 10 unfilled spots were actually in Family (5/127 unfilled). The rest were IM (2/33), Gen surg (1/6), OB (1/5), and Psych (1/17). All other competitive fields were filled 100% for IMGs including anesthesia, derm, ortho, uro, ophtho, rads, etc.

Source: https://www.carms.ca/pdfs/2012R1_MatchResults/8_Discipline%20Choices%20of%20IMG%20Applicants_en.pdf

 

As for plastics there was an alumnus from my school who matched into it a few years ago, and I didn't meet him personally but he's supposed to be a very bright and capable guy, no connections etc. I find it a little insulting and ignorant for someone to presume he must have connections because he's an IMG and got a competitive spot. I think the elitism of some Canadian medical students/grads can be a little bit nauseating at times, especially as it's often undeserved. Calling him a liar with absolute conviction like that makes me think you have that same attitude, but I hope I'm wrong about that / maybe I'm misinterpreting what your intent was by saying that.

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At any rate, I still agree with Brooks and others that it's virtually impossible to match into something like gen surg as an IMG. That said, those ~6 spots have to go to somebody every year, and the number of truly competitive applicants who are gunning for and apply to surgery every year isn't necessarily that high.

 

Bottom line, apply for it and hope for the best, but back up broadly with other programs and be pleasantly surprised if you do get a match in surg, let alone anywhere.

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There are rarely any IMG spots leftover in the second round of CaRMS, including the highly competitive specialties. Last year there were 259 IMG positions, of which 249 were filled. The 10 unfilled spots were in Family (5/127), IM (2/33), Gen surg (1/6), OB (1/5), and Psych (1/17). All other competitive fields were filled 100% for IMGs including anesthesia, derm, ortho, uro, ophtho, rads, etc.

Source: https://www.carms.ca/pdfs/2012R1_MatchResults/8_Discipline%20Choices%20of%20IMG%20Applicants_en.pdf

 

There's one thing that analysis won't capture, and I don't know if there's any way to account for it.

 

A residency program that I am very familiar with has left at least one of its IMG spots unfilled for the past several years, and the funding for that spot has somehow been reallocated within the university for the second round in such a way that the "unmatched" first round spot does not show up in the CaRMS statistics you cited.

 

I don't claim to understand the politics behind it, but I have it on pretty good authority that this has happened repeatedly.

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There's one thing that analysis won't capture, and I don't know if there's any way to account for it.

 

A residency program that I am very familiar with has left at least one of its IMG spots unfilled for the past several years, and the funding for that spot has somehow been reallocated within the university for the second round in such a way that the "unmatched" first round spot does not show up in the CaRMS statistics you cited.

 

I don't claim to understand the politics behind it, but I have it on pretty good authority that this has happened repeatedly.

 

Actually if you look at the plastics spot in that link, it shows people applying for it but it has a quota of 0 spots??? So you're right, something is definitely up there. That said, what Brooks is trying to imply is that every program does this, yet you can see that all the other programs have lots of IMGs matching every year. In fact the % match rate for ortho was slightly better than gen surg.

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It's more likely than not that someone who makes a long shot and hits the target had some help doing so. I'm skeptical towards anyone who manages to do the essentially impossible and then claims it was all on their own merit. You can call it elitist if you like; I call it suspicious, and I think its justified. My point for the OP was that unless one has a really good ace up their sleeve, going for something crazy like plastics is more or less impossible.

 

Think about it this way: when the applicant pool is quite good(I'll give the benefit of the doubt to anyone trying to get something like plastics), it is impossible to differentiate them based on merit. Therefore, other factors come into play like nepotism etc. It's the way of the world.

 

I think those are the 2012 stats. In 2013, there were a few good IMG spots that were left unfilled. Again, not something one should bet on getting.

 

Yeah, I couldn't find the stats for 2013 yet. I don't imagine they're too different for this year. You're almost certainly right that sometimes there is probably a hidden connection that gets someone a spot. More often than not there isn't.

 

I know in the case of plastic surgery there probably wasn't, but I don't know him personally so you could technically be right. I also have many classmates who matched into pretty competitive spots in Canada last year and this year, with no connections. I matched in Canada with no connections either, although it was into IM which is slightly less competitive (13% match rate in 2012 vs 10% for gen surg). One of my friends got a pretty competitive spot over another friend, despite being a much less competitive applicant (at least on paper/scores etc) and not even doing a rotation at this university. The other friend had done 16 weeks there. We have no idea why he got ranked higher. The one who didn't match is really outgoing, charismatic guy with stellar scores, also, so it's not like they met him in the interview and would have had some reason to decide to rank him lower.

 

The match process can be pretty random.

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OP is NOT getting into surgery. There are simply far too many highly qualified CMGs for any competitive program like surgery to take an FMG.

 

Let's face it. You're going to be a FMG because you sucked too much to get into a Canadian school. You didn't work hard enough so your GPA and MCAT scores were too low. You got rejected too many times, said "**** it," and threw in the towel. Canadian FMGs are incompetent. Everybody knows this, including PDs.

 

Given that something like 1 in 4 FMGs from Irish schools get a residency spot in Canada, you better damn well play it safe unless you want to be $300K in debt and have to pay it back with a McJob. You're going into FM or another CO2 specialty. You will never be a surgeon. Sorry.

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OP is NOT getting into surgery. There are simply far too many highly qualified CMGs for any competitive program like surgery to take an FMG.

 

Let's face it. You're going to be a FMG because you sucked too much to get into a Canadian school. You didn't work hard enough so your GPA and MCAT scores were too low. You got rejected too many times, said "**** it," and threw in the towel. Canadian FMGs are incompetent. Everybody knows this, including PDs.

 

Given that something like 1 in 4 FMGs from Irish schools get a residency spot in Canada, you better damn well play it safe unless you want to be $300K in debt and have to pay it back with a McJob. You're going into FM or another CO2 specialty. You will never be a surgeon. Sorry.

 

 

Six schools in Ireland (matched/applicants) this year:

1. UCC: 15/20

2. RCSI: 33/35

3. TCD: 13/16

4. UCD: 14/21

5. UL: 21/28

6. NUIG: 3/3

 

CaRMS1+2, NRMP, SOAP all combined, but if you take only CaRMS into account, % actually becomes higher.

 

You better damn well say it right.

 

@leviathan

I really appreciate your advice.

 

@brooksbane

Some of the facts you stated were just clearly way off the chart, didn't really bother trying to explain but if you felt offended I apologize.

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I absolutely wholeheartedly disagree with your assertion that, when a long-shot manages to get a spot in something deemed impossible, that it was done on their own merit more often than not.

 

From my experience, and from the numerous PMs I've been receiving outing people who have had connections (and providing pretty good paper trails), I have seen that connections trump all.

 

Unfortunately, all we have to go on are anecdotes, since there can be no studies about this. Who the hell would even admit to having a leg up on their competition because daddy doctor plays golf at the country club with the PD? Heck, look up some of the stories on SDN, particularly for programs like derm and plastics. In one case, an applicant gets in because she is married to one of the staff. Come on!

 

I cannot subscribe to what you said. I cannot recommend that anyone take your mindset, for it does nothing but act as a setup for disappointment. You're free to have that opinion, and I am free to disagree and recommend that others disagree as well.

Are you talking about IMGs or CMG matches? Sounds like we'll have to agree to disagree, and you're entitled to your opinion based on whatever experiences you've had. But while we both only have anecdotes, as an IMG with many classmates and friends to base my experience on, it does start to become more representative than just an n=1 experience.

 

As someone who matched in Canada without connections, and having several close friends who I know well enough to be certain didn't have connections, it paints a very different picture from yours.

 

And I don't think I'm giving anyone false hope here. I already wrote many times, including in this thread, that the chances are still dismal. Just not 0, as you claim. The whole point of this thread was to give the OP some advice on how to proceed. Whereas you seem to think they shouldn't apply, I am advocating applying for surgery, but applying broadly in both the US and Canada, and backing up broadly with FM or something uncompetitive for the more likely outcome of a 2nd specialty choice match.

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OP is NOT getting into surgery. There are simply far too many highly qualified CMGs for any competitive program like surgery to take an FMG.

 

Let's face it. You're going to be a FMG because you sucked too much to get into a Canadian school. You didn't work hard enough so your GPA and MCAT scores were too low. You got rejected too many times, said "**** it," and threw in the towel. Canadian FMGs are incompetent. Everybody knows this, including PDs.

 

Given that something like 1 in 4 FMGs from Irish schools get a residency spot in Canada, you better damn well play it safe unless you want to be $300K in debt and have to pay it back with a McJob. You're going into FM or another CO2 specialty. You will never be a surgeon. Sorry.

 

Lol, I used to enjoy some of your posts but you're not even trying anymore. Terrible trolling attempt, way too obvious.

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As someone who matched in Canada without connections, and having several close friends who I know well enough to be certain didn't have connections, it paints a very different picture from yours.

 

And I don't think I'm giving anyone false hope here. I already wrote many times, including in this thread, that the chances are still dismal. Just not 0, as you claim. The whole point of this thread was to give the OP some advice on how to proceed. Whereas you seem to think they shouldn't apply, I am advocating applying for surgery, but applying broadly in both the US and Canada, and backing up broadly with FM or something uncompetitive for the more likely outcome of a 2nd specialty choice match.

 

It sounds like the best chance at surgery is to reapply to a Canadian medical school. Even if the OP has some personal connections.

 

I know of people who went to Ireland for 1 year and one person who went to Australia for 1 year and then started at a Canadian med school. I guess they really wanted to match back to Canada.

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It sounds like the best chance at surgery is to reapply to a Canadian medical school. Even if the OP has some personal connections.

 

I know of people who went to Ireland for 1 year and one person who went to Australia for 1 year and then started at a Canadian med school. I guess they really wanted to match back to Canada.

 

I agree with you. I know lots of people who also went abroad for 1 year and then finally got into med back in Canada. If that doesn't pan out though, then I wouldn't throw the cards in and give up just because the chances are low.

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Are you talking about IMGs or CMG matches? Sounds like we'll have to agree to disagree, and you're entitled to your opinion based on whatever experiences you've had. But while we both only have anecdotes, as an IMG with many classmates and friends to base my experience on, it does start to become more representative than just an n=1 experience.

 

As someone who matched in Canada without connections, and having several close friends who I know well enough to be certain didn't have connections, it paints a very different picture from yours.

 

And I don't think I'm giving anyone false hope here. I already wrote many times, including in this thread, that the chances are still dismal. Just not 0, as you claim. The whole point of this thread was to give the OP some advice on how to proceed. Whereas you seem to think they shouldn't apply, I am advocating applying for surgery, but applying broadly in both the US and Canada, and backing up broadly with FM or something uncompetitive for the more likely outcome of a 2nd specialty choice match.

 

Did you match into surgery?

 

 

The IMG spots are something like:

Gen surg - 7

Ortho - 7

Plastics - 2

Uro - 2

Cardiac - 1

Neuro - 3

Ophthal - 1

ObGyn - 4

 

Less than 30 surgical spots for IMGs across the country! Connections or not, the odds are never in your favour. More than half are at Ottawa and Toronto which takes lots of IMGs because they get lots of funding. They are also notorious for either not filling the spots or taking a CMG in round 2 (as the spots in round 2 are mixed together).

 

And in all fields of medicine, nepotism is rampant. It's common for residents' parent to be in the field or in the program. It's also common for residents to be married/dating or siblings of older residents. You think junior residents are going to vote against a senior resident's younger brother/sister? Maybe, but the other applicant will have to be superb. To think that all this does not apply to IMGs is foolish; you need every advantage and then some, as an IMG because you're already behind!

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Did you match into surgery?

 

 

The IMG spots are something like:

Gen surg - 7

Ortho - 7

Plastics - 2

Uro - 2

Cardiac - 1

Neuro - 3

Ophthal - 1

ObGyn - 4

 

Less than 30 surgical spots for IMGs across the country! Connections or not, the odds are never in your favour. More than half are at Ottawa and Toronto which takes lots of IMGs because they get lots of funding. They are also notorious for either not filling the spots or taking a CMG in round 2 (as the spots in round 2 are mixed together).

 

And in all fields of medicine, nepotism is rampant. It's common for residents' parent to be in the field or in the program. It's also common for residents to be married/dating or siblings of older residents. You think junior residents are going to vote against a senior resident's younger brother/sister? Maybe, but the other applicant will have to be superb. To think that all this does not apply to IMGs is foolish; you need every advantage and then some, as an IMG because you're already behind!

 

Well said (no sarcasm)

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I don't recall ever saying the 'odds are in your favour'. In fact I said the exact opposite. That doesn't mean you don't apply to surgery at all, if that's what you want to do. They are not notorious for not filling the spots, either. Sure it happens, but the majority get filled.

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I don't recall ever saying the 'odds are in your favour'. In fact I said the exact opposite. That doesn't mean you don't apply to surgery at all, if that's what you want to do. They are not notorious for not filling the spots, either. Sure it happens, but the majority get filled.

 

No, The Hunger Games said that. (...ish)

 

 

You claimed to be "someone who matched to Canada without connections" but never stated what program you matched to. You lead us to believe that your point is reinforced by that fact but never stated that you are actually in surgery.

 

But I agree that the odds are tough. I would specifically disagree with you and say that the odds are in fact DISMAL. Somebody will match to those spots, but if you want plastics as an IMG you have to be the best or second best applicant in the pool. (And yes, there are years that Ottawa and Toronto have interviewed people - IMGs - and then left the spots empty until round 2, and not picked an IMG. This is evident on the CaRMS stat pages - 1 IMG spot left after round 1, then not an IMG filling it in round 2.)

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