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Irish Medical School - US residency. What are the challenges for CSA?

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Hi,

A lot of Irish schools have a quite high rates for matching in the US, even for competitive specialities. Are there any challenges that Canadian students may encounter when matching into the US system?

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35 minutes ago, MMI 2017 said:

Hi,

A lot of Irish schools have a quite high rates for matching in the US, even for competitive specialities. Are there any challenges that Canadian students may encounter when matching into the US system?

I don't know about competitive specialties, from what I know, match rates from Ireland to the US are good but very few do amazingly well. Generally speaking they match to the less competitive specialties in moderate locations or some moderately competitive specialties in less desirable to medium desirable locations. 

The main challenge you encounter as a Canadian is that you need a visa, which makes you less desirable since programs have to spend money and time getting you that visa. Other than that you are usually fine. Truthfully, it isn't a big deal, because if you are truly really good, it shows eventually and people who might match to an average residency due to being an IMG can subsequently get great fellowships if they perform well in residency.

 

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It ultimately depends on your end goals and your financial resources. 

1. J1-VISA - As a Canadian completing medical school in Ireland, you are considered an international medical graduate when applying for residency in the USA. You can only apply to residency programs that are willing to sponsor your J1-VISA. 

2. STATEMENT OF NEED - Once you secure a residency, you need to obtain a statement of need ASAP. Each year, Canada releases a list of how many SONS they are willing to give out for each speciality and if they anticipate that to decrease or increase. If you want a competitive specialty (IM, Peds, Surgery, Radiology) then your in big trouble as Canada is decreasing the SONS for those specialties. You can match into a residency and have to turn it down because you didn't get the SON. 

3. J1-VISA WAIVER - Once you complete your residency you need to return to Canada for 2 years. This is unless you apply for a J1-VISA Waiver which is offered in very underserved areas such as North Dakota. 

4. FELLOWSHIP - You can no longer apply for a fellowship that is greater than 1 year in length. Lets say you want to do a Cardiology fellowship in the USA. That is no longer an option. 

5. Some programs require "X" month of US experience which may be impossible to meet because of the Irish curriculum. 

6. RETURNING TO CANADA FROM THE US - Internal Medicine is 3 years in the USA and 4 in Canada, so you need to make up the extra year. You may need to do extra elective time in certain rotations if you want to meet the requirement to return back to Canada in your speciality. 

7. USMLE - Fail a board exam and chances are you will never match and be carrying 400-500 K debt. There are only a set number of Irish Internship spots based on your final grades for non-Irish students. 
 

Do not go unless your flexible or want family medicine.

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On 5/30/2018 at 9:34 AM, Serenpidity said:

It ultimately depends on your end goals and your financial resources. 

1. J1-VISA - As a Canadian completing medical school in Ireland, you are considered an international medical graduate when applying for residency in the USA. You can only apply to residency programs that are willing to sponsor your J1-VISA. 

2. STATEMENT OF NEED - Once you secure a residency, you need to obtain a statement of need ASAP. Each year, Canada releases a list of how many SONS they are willing to give out for each speciality and if they anticipate that to decrease or increase. If you want a competitive specialty (IM, Peds, Surgery, Radiology) then your in big trouble as Canada is decreasing the SONS for those specialties. You can match into a residency and have to turn it down because you didn't get the SON. 

3. J1-VISA WAIVER - Once you complete your residency you need to return to Canada for 2 years. This is unless you apply for a J1-VISA Waiver which is offered in very underserved areas such as North Dakota. 

4. FELLOWSHIP - You can no longer apply for a fellowship that is greater than 1 year in length. Lets say you want to do a Cardiology fellowship in the USA. That is no longer an option. 

5. Some programs require "X" month of US experience which may be impossible to meet because of the Irish curriculum. 

6. RETURNING TO CANADA FROM THE US - Internal Medicine is 3 years in the USA and 4 in Canada, so you need to make up the extra year. You may need to do extra elective time in certain rotations if you want to meet the requirement to return back to Canada in your speciality. 

7. USMLE - Fail a board exam and chances are you will never match and be carrying 400-500 K debt. There are only a set number of Irish Internship spots based on your final grades for non-Irish students. 
 

Do not go unless your flexible or want family medicine.

I have one additional concern to add to this list.  When you complete a residency in the USA you must pass the Royal College (RCPSC) exams in your specialty in order to practice in Canada. 

I believe that passing these exams would be almost impossible if you did not complete your training in Canada. The final years of Canadian residencies are filled with intensive preparation for these exams.  The review materials used are not publically available and the ciricumlum is a largely an oral tradition.  I dont know of anyone in my specialty (orthopaedic surgery) who has taken these exams without training in Canada. There may be exceptions in more populous specialties but I'd imagine the 'USA return to Canada' route would be one of the most difficult paths to pull off.

There are a few exceptions to the problem above.  If you finish an ACGME family medicine residenicy (or a family medicine training scheme in the UK, Ireland, or Australia) you do not need to write the College of Family Physicians of Canada (CFPC) examinations as there is reciprocal recognition.  Depending on provincial rules,  you will likely need to pass the MCC exams but I think those are much more reasonable than the RCPSC exams with widely publicized prepation material and a relatively standard curriculum in general medicine.  Someone will have to comment about US DO family medicine programs -- I have no idea what the state of training in the USA is in terms of harmonizing ACGME and DO family med programs.  I think they are still separate, but dont quote me.

Some provinces also have an additional exception that will grant academic physicians a licence without passing the RCPSC exams under certain circumstances.  The most common are highly positioned academic faculty who are granted exceptions on a case-by-case basis.  I wouldn't count on taking that path as a CSA (or anyone else).  There may also be programs for under services areas but I havent seen or heard of those types of programs being active for years. 

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