Pathway 3 application experience

[drake19]

I only had one colleague I could talk to who went through this, had zero guidance on premed101 so thought I would share my experience:

 

summary:

if you want to practice in Canada - go to a Canadian medical school/residency

alternatives - in order of preference 1) U.S. medical school M.D. 2) U.S. D.O. 3) Carribean (4) avoid UK/Australia if you plan to come back to Canada/US - more difficult to get U.S. rotations, different curriculum - and IMO have a viable backup for U.S. residency at Carribean schools

my Ontario application (Pathway 3) was very rigorous and much more expensive than my U.S. license application 

  -Ontario application will take about 6 months; (initial app $4000, $500 to fly down for 1 day for supervisor interviews, $2000 in lost wages due to interview, ~$5000 for end of year assessment, 25% cut to supevisor/office) - when all said and done  probably $100,000+ (since 25% billing cut to office/supervisor)

 - US license - took 1 month and $1000 USD. With much higher wages (for urgent care, not sure about other fields), lower tax, malpractice/license covered by my clinic

-take the #$@$ lmcc1, 2 - lmcc1 in 4th year of med school and lmcc2 2nd year of residency - you will be in a different pathway - and save alot of $$$ and hassle

 

background: 

dual citizenship U.S./Canada

graduated from U.S. residency/ US med school grad - application back to Ontario to practice under the pathway 3 application

in order to qualify need to have graduated from U.S. medical school, (LCME accrediated), U.S. medical  license, US ACGME accrediated residency

if you graduated from a non-U.S. medical school (i.e. Carribean) i believe it is pathway 4.

 

in order to be in independent practice under pthway 3 - need 1 year of supervision, and end of year assessment pass 

 

looking back things I would have done differently:

this stuff will only make sense if you are in the applicatoin process, pathway 4 for IMG-grad from U.S. residency is similar:

-since i didn't take LMCC2 - I need supervision for 1 year - this was a big expensive mistake 

-i took LMCC1 4th year of medical school - I highly recommend taking it in 4th year- approximatelys USMLE step 2 and 3

-no taking the LMCC2 is  a big expensive mistake, LMCC2 only offered a few times a year - need to apply early and plan -best to take in 2nd year of residency - can only take after 1 year of residency

-to apply for LMCC1/2 there is a big application process especially for LMCC2 - I had started the application for LMCC2 wihch requires residency verification - this step took 5-6 months. I ended up not applying for LMCC2.

- if you pass  the LMCC exams you can apply through a different pathway and don't need supervision for 1 year (have to arrange a supervisor approved by college, very expensive, they take a cut, and assessment at end of 1 year is also very expensive)

-arranging a supervisor (if you have not taken LMCC) was very time consuming, expensive. You have to find someone not related, etc. that meets College standards. Had to find one on the website they provide you - complete stranger, flew back, lost wages, fortunately first person I interviewed agreed.

-Ontario license application was very rigorous compared to U.S. and 5-6 times more expensive about $4000 in the end.

-my state U.S. license took 1 month to process - the Ontario one will be about 6 months

-for the ontario application they have only a few meeting dates a year and in order to get your application assessed by the registration committee you need to have a completed application at certain deadlines. Unfortuntaely some documents can only be completed by July 1st (after you graduate from residency). advice is to start going over the application before July 1st and start sending things immediately after July 1st. 

-they need 3 letters of recommendations - i would get these confirmed before you leave for residency.

-they need a letter of standing from the state licensing board - this took the longest as my state licensing board was not efficient - took 2-3 months

-before I sent in my initial application - they told me I could start sending in credentialing documents. I would wait until application is received before sending in USMLE transcripts - I sent these in before they received my applicaiton. This is a time sensitive document that expires and for whatever reason they opened it but didn't save the file, long story short had to resend it again - another $70 USD wasted

-the college basically wanted to know everything from 1st year of medical school on - fortunately no hiccups for me but any hiccup such as year off, criminal record - need a lot of pages of explanation 

-criminal background check (Ontario) - you can actually do this not in person - way to apply online and have relative pick up for you - check the judicial and criminal matters option for criminal back ground check - this took several weeks 

 

Pros: can be with my family and going back to Ontario. This is only the reason i'm coming back

Cons:

lower wages in Ontario for primary care - i have to share 25% with the outpatient clinic when i return - i share 0% with the office in the US and they cover my malpractice. I basically get a wage and bill for the office.

 I work in a North-eastern state in urgent care - i get approximtaely $1500-2000 gross a shift USD, net is probably $900-$1000 and work about 4-7 shifts a week. I would get paid less than half in Ontario.

I intervewed a several primary care sites/urgent care sites - i never heard of sharing a cut of billing with the office - when I applied to Ontario - offices take a cut anywhere from 25% to 35%. You are already getting killed with Canadian taxes - take home pay in Ontario probably 30% of gross.

 

let me know if you hvae questions

[drexler]

discard

[Mashmetoo]

On 8/11/2019 at 10:39 AM, drake19 said:

Pros: can be with my family and going back to Ontario. This is only the reason i'm coming back

Cons:

lower wages in Ontario for primary care - i have to share 25% with the outpatient clinic when i return - i share 0% with the office in the US and they cover my malpractice. I basically get a wage and bill for the office.

 I work in a North-eastern state in urgent care - i get approximtaely $1500-2000 gross a shift USD, net is probably $900-$1000 and work about 4-7 shifts a week. I would get paid less than half in Ontario.

I intervewed a several primary care sites/urgent care sites - i never heard of sharing a cut of billing with the office - when I applied to Ontario - offices take a cut anywhere from 25% to 35%. You are already getting killed with Canadian taxes - take home pay in Ontario probably 30% of gross.

 

let me know if you hvae questions

 

I'm a bit confused as to how you get paid in the US. If you share 0% overhead with the office in the US, and you gross $1500-2000 a shift USD... how do you end up netting $900-1000 per shift? I thought the overhead was 0%? Is the difference of $600-1000 all for malpractice insurance?

[bearded frog]

32 minutes ago, Mashmetoo said:

 

I'm a bit confused as to how you get paid in the US. If you share 0% overhead with the office in the US, and you gross $1500-2000 a shift USD... how do you end up netting $900-1000 per shift? I thought the overhead was 0%? Is the difference of $600-1000 all for malpractice insurance?

They haven't posted in 6m so dunno if they'll get back to you, but from the way they describe it, with "a wage and bill for the office", it sounds like they do have an overhead but it's a fixed amount per shift as opposed to a revenue sharing percentage overhead model. In terms their numbers they're describing a 40-50% overhead going from 1500 to 900 or 2000 to 1000, so while billings may be totally different I'm not sure why from an overhead perspective they think that 25% overhead is worse than 40-50%?

[HarrryMaguire]

Can you bill during the year of supervised practice?