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Shall I Work Towards This? Or Am I A Zero Chance?


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You are correct in that most of the EM residents in the 2016 Match were US residents.  Cost is not the issue, US Immigration policy is the issue.  In 1991, Section 303(a)(5), the law was modified to allow Canadians to practice in the U.S. to "pursue graduate medical training."  That is done via the H-1B visa that must be employer-sponsored.  However, the kicker here is that the Canadian student must have passed all 3 steps of the USMLE and few Canadians even take the test (they take the LMCC).  That is significant obstacle number one.  Number 2 obstacle is that U.S. programs prefer US students because our residency programs are federally funded and program directors seem to prefer US citizens.  I agree that may not be fair, but that is what is happening in this competitive market.  PreMed is the most grueling, demanding major and the end-goal of graduate medical training becomes even more so.  Some Canadians have also tried using the temporary TradeNAFTA (TN) work status - but that too does not work for the practice of medicine.  Therefore, it seems like the best option is to take the USMLE tests if that is your goal to enter a US emergency med program and then compete on a more level playing field with all IMG graduates.  Again, tough road, but not impossible.

I might also ask - why do you want to practice in the USA anyway?  Is the grass that much greener?  

Ronald Kapp, MD, PhD 

Well then. We're lucky "premed" isn't an actual major! 

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Well then. We're lucky "premed" isn't an actual major! 

You have hit the proverbial nail on the head - so many students and campus gurus do treat PreMed as "THE MAJOR."  It is my personal opinion that there is nothing more useless than a failed PreMed Major  (correct, no such ugly beast) as little can be done with such.  I call the premedical world THE PREMED TOURNAMENT because that is how it really is to so many.  Either win or lose!  There is no middle ground.  Some might continue year after year (not a bad strategy if you have the time and money), some recommend the PostBac route (not the worst), but most just give up on their dreams.  I hate to see dreams go unrealized.  Thus, an early strategy is critical for eventual success.  I was initially one of the Tournament Losers (long ago), but my dream kept me going.  I'm not saying others should do what I did, unless they too have that dream, drive and determination.  

So the question today becomes - how vivid is your dream?  How serious are you about medicine?  And why?

Ronald Kapp, MD, PhD  

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Question: Then why and how did nearly 100 IMGs graduates from 3 different, and well recognized, Caribbean Med Schools place in the 2016 MATCH for US emergency medicine programs? While you are correct that said programs are "not IMG friendly," that does not preclude acceptance. 3 years versus 4 years should not matter an iota for a passionate student, just as "tuition cost" should not hinder reaching one's potential. I also see nothing wrong with Family Practice, Internal Medicine, General Surgery as other options if one really has the drive and passion to practice emergency medicine. There are many paths to the bountiful and exciting practice of ER Medicine, if one simply thinks outside the box. It should be noted however that I practice only in the USA. In fact, reality in the "good ole USA" says that many docs do not have to even be board-certified to work in various ER departments, although I do not recommend that option. The IMG route remains a viable option for a passionate and studious PreMed. Just do the proper research and consider your options.

Ronald Kapp, MD, PhD

I personally know an IMG who matched EM for a 3 year program.

 

That is not my point.

 

Canadian citizens, unlike other IMGs are HEAVILY RESTRICTED on what residencies they can and can not do for the US NRMP match on a J1 visa. Canada will NOT allow you to do a 3 year US EM residency on a j1 visa anymore. The majority of EM positions are 3 year, thus a canadian IMG has very little chance of matching to IM as 4 year programs are very competitive. Not impossible but highly improbable for an IMG. A Canadian MD might have a slightly better shot than a Canadian IMG(carrib, Aussie, Irish etc) at a 4 year program but still only a small benefit.

 

A j1 is much more plentiful than an h1b, only for very competitive applicants or undesirable areas are h1bs generally considered, due to cost. Why would I waste thousands of dollars on an h1b when I have the pick of the litter in a big metropolitan area? Only if that student is outstanding and top of my rank list.

 

I am very well aware of the intricacies involved, you're preaching to the choir

 

Please read up on health Canada's statment of need website, before attempting to pseduo-educate me.

 

So no. Youre advice is currently irrelevant and incorrect - as you are not up to date on the current situation and nuances of the post graduate residency matching system from a Canadian citizen perspective. Youre making false assumptions and parrellels without stratifying the nuances involved with citizenship, country of medical education etc

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I personally know an IMG who matched EM for a 3 year program.

 

That is not my point.

 

Canadian citizens, unlike other IMGs are HEAVILY RESTRICTED on what residencies they can and can not do for the US NRMP match on a J1 visa.

 

I am very well aware of the intricacies, you're preaching to the choir

 

Please read up on health Canada's statment of need website, before attempting to pseduo-educate me.

 

So no. Youre advice is currently irrelevant and incorrect - as you are not up to date on the current situation and nuances of the post graduate residency matching system from a Canadian citizen perspective.

I am saddened that you are not getting what you seemingly want, when others are. 

Obviously there are methods-to-this-madness, i.e., you also confirm you know other(s) who have so done the nearly impossible.

Perhaps there is something else precluding your success in accomplishing your goal?

As we both know, this is a political issue far beyond our control.  We can only function within the rules set before us..... which have been inhibiting PreMed dreams for years on both sides of the border.  While the U.S. system is unlikely to change for the better in the near future, from my vantage point of getting undergrads on the path to success, the IMG route remains a viable option; sadly, still a competitive option.  Even more sadly, it is my personal opinion that that too will soon tighten even more based on numbers alone as PGY1 caps remain in place.

Ronald Kapp, MD, PhD 

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I am saddened that you are not getting what you seemingly want, when others are.

Obviously there are methods-to-this-madness, i.e., you also confirm you know other(s) who have so done the nearly impossible.

Perhaps there is something else precluding your success in accomplishing your goal?

As we both know, this is a political issue far beyond our control. We can only function within the rules set before us..... which have been inhibiting PreMed dreams for years on both sides of the border. While the U.S. system is unlikely to change for the better in the near future, from my vantage point of getting undergrads on the path to success, the IMG route remains a viable option; sadly, still a competitive option. Even more sadly, it is my personal opinion that that too will soon tighten even more based on numbers alone as PGY1 caps remain in place.

Ronald Kapp, MD, PhD

Again you are missing the point completely, while at the same time stating confusingly contradictory statments within the same breath. Odd.

 

The IMG I know that matched 3 year EM was from the UK. Not a Canadian.

 

Canadian citizens are NOT eligible for 3 year EM programs on the j1 visa anymore. What part of that dont you understand? Rules change, and they have.

 

Anyways, I've made my point.

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Thus, we are done with this topic.  The take-home point remains that "anyone" considering a career as a doctor, who decides to 'major' in PreMed had better take the long-term, holistic perspective on what needs to be done over a 10 to 12 to 14 year time frame in order to reach their potential and accomplish their dreams.  The road is long, complicated and competitive.  To simply jump in and rush head-strong into this campus major is fraught with potential difficulties.  The reality is that the "premed degree" is virtually worthless, unless eventually accepted into medical school, since there is no such beast in the first place.  As seen this week in this forum, failure along the way leads to heartaches, anger and resentment.  I believe that is a tragedy that should not continue.  Unfortunately, the system as currently devised naturally leads to such.  Sabela has asked an important question, albeit perhaps a few years late.  Now it is up to each individual to decide what path to pursue in the future - yes PreMed 101 is a competitive dream.

Ronald Kapp, MD, PhD

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