Doing FM residency in the U.S. on a visa (questions)

[blueskyguy]

Hi all,

I am a Canadian citizen at a U.S. med school interested in pursuing FM. I have been hearing different things by students at my school regarding this stuff, so I wanted to get some clear answers.

If I were to complete a FM residency in the U.S. on a J1 visa, would I be able to return to Canada to live and work wherever I want right after residency? Or would I have to work in an "underserved area" or something like that, etc.? (What about doing residency in the U.S. on an H1B visa?)

i would like to live and work near my family, so I was hoping to be able to complete a U.S. FM residency (if I don't get into a Canadian residency) and then return to Ontario near my family to live and work.

Any clarification on these points would be much appreciated.

 

[rmorelan]

while I am not really an expect on family medicine residency rules in terms of coming back here (other than you have to write our exam etc and that route should be open) the J1 visa situation is clearer to me - there would be no restrictions.

 

The J1 visa only gives you restrictions on what you can do in the US - they grant the visa and they make their rules. Canada on the other hand has no restrictions at all - it isn't their visa. You don't give up your Canadian freedoms but having another country's visa. 

 

Same with the H1B visa except you would have the option of potentially continuing in the US with coming back to Canada for 2 years first. 

 

 

 

[blueskyguy]

7 minutes ago, rmorelan said:

while I am not really an expect on family medicine residency rules in terms of coming back here (other than you have to write our exam etc and that route should be open) the J1 visa situation is clearer to me - there would be no restrictions.

 

The J1 visa only gives you restrictions on what you can do in the US - they grant the visa and they make their rules. Canada on the other hand has no restrictions at all - it isn't their visa. You don't give up your Canadian freedoms but having another country's visa. 

 

Same with the H1B visa except you would have the option of potentially continuing in the US with coming back to Canada for 2 years first. 

 

 

 

Hi there, thanks for the response!

So, just to confirm, if I complete a 3 year FM residency in the U.S. (on a J1 or H1B) I would be able to return anywhere in Canada and work right away?

Also- I thought that If I successfully complete a 3 year FM residency in the U.S., i wouldn't have to complete the Canadian exam. Is this true?

[rmorelan]

2 hours ago, blueskyguy said:

Hi there, thanks for the response!

So, just to confirm, if I complete a 3 year FM residency in the U.S. (on a J1 or H1B) I would be able to return anywhere in Canada and work right away?

Also- I thought that If I successfully complete a 3 year FM residency in the U.S., i wouldn't have to complete the Canadian exam. Is this true?

Ha I have been carefully avoiding rules about the licensing etc as it is outside of my scope - that being said in my perhaps outdate nodes there was a reference to the college of family medicine which states:

Physicians who obtained certification in family medicine in a jurisdiction acceptable to the College of Family Physicians of Canada (CFPC) through a practice-eligible route are not eligible to apply for Certification in the College of Family Physicians of Canada (CCFP) without examination.

The CCFP designation may be granted without examination by the CFPC to physicians who meet all the following criteria:

1. Graduated successfully from an accredited postgraduate training program in family medicine in a jurisdiction where the standards for accreditation of postgraduate family medicine training and the criteria for certification are judged to be comparable and acceptable to the CFPC

2. Maintained a continuous (throughout their entire career), valid, and unrestricted licence/registration to practise family medicine in that jurisdiction since completing their family medicine training program:

and under acceptable juridictions:

United States: Graduates of family medicine residency training programs that have been accredited by the Accreditation Council for Graduate Medical Education (ACGME) who hold the Diplomate of the American Board of Family Medicine (DABFM) designation

sounds like a good place to start

[drake19]

On 10/11/2019 at 12:32 PM, blueskyguy said:

Hi there, thanks for the response!

So, just to confirm, if I complete a 3 year FM residency in the U.S. (on a J1 or H1B) I would be able to return anywhere in Canada and work right away?

Also- I thought that If I successfully complete a 3 year FM residency in the U.S., i wouldn't have to complete the Canadian exam. Is this true?

I have been practicing for last 2-3 mo in Ontario after us fm residency. 

I cant answer if you can just practice anywhere but you can practice in Ontario.

in Ontario you don’t need the lmcc 1,2 but you will be at a severe disadvantage. You will be on restricted license, end up needing a very expensive assessment over several days from the college. You will still need to have passed abfm, obtained a USA state license in order to qualify for that exception. - I was us and Canadian citizen so didn’t have issues with that. 

be prepared for 2-3 mo possible gap to wait the Ontario license, I was a us citizen so was able to find work while waiting, for you are on visa may not be able to work

oversll working in the u.s. as a primary care/ urgent care I made more money with less bureracy, less work, less overhead, less taxes compare to Ontario. Was making alot more per shift without needing to pay all these fees. In Ontario you have to split with the office, pay insurance, license is expensive. I also spend a lot more time doing lab Followup  etc in Ontario. 

I came mainly for family reasons 

 

it will fewer ever years and more straight forward if you plan to practice in Canada to just go to a Canadian residency. USMLE is expensive and fm residency is 3 years in USA. 

[blueskyguy]

28 minutes ago, drake19 said:

I have been practicing for last 2-3 mo in Ontario after us fm residency. 

I cant answer if you can just practice anywhere but you can practice in Ontario.

in Ontario you don’t need the lmcc 1,2 but you will be at a severe disadvantage. You will be on restricted license, end up needing a very expensive assessment over several days from the college. You will still need to have passed abfm, obtained a USA state license in order to qualify for that exception. - I was us and Canadian citizen so didn’t have issues with that. 

be prepared for 2-3 mo possible gap to wait the Ontario license, I was a us citizen so was able to find work while waiting, for you are on visa may not be able to work

oversll working in the u.s. as a primary care/ urgent care I made more money with less bureracy, less work, less overhead, less taxes compare to Ontario. Was making alot more per shift without needing to pay all these fees. In Ontario you have to split with the office, pay insurance, license is expensive. I also spend a lot more time doing lab Followup  etc in Ontario. 

I came mainly for family reasons 

 

it will fewer ever years and more straight forward if you plan to practice in Canada to just go to a Canadian residency. USMLE is expensive and fm residency is 3 years in USA. 

Hi there! Thanks for the response. A few follow-up questions for you.

What do you mean that I will be at a "severe disadvantage" if I do a U.S. FM residency and want to come back to Ontario? Do you mean that I will just have to go through a few more "hoops" to get Ontario license?

So, to confirm, if I do a U.S. FM residency, would the path to an Ontario FM license be like this? : 

Finish U.S. FM residency with U.S. license --> Finish "assessment" over several days by Canadian college --> Wait 2-3 months for Ontario license

Thanks for the clarification.

[drake19]

4 hours ago, blueskyguy said:

Hi there! Thanks for the response. A few follow-up questions for you.

What do you mean that I will be at a "severe disadvantage" if I do a U.S. FM residency and want to come back to Ontario? Do you mean that I will just have to go through a few more "hoops" to get Ontario license?

So, to confirm, if I do a U.S. FM residency, would the path to an Ontario FM license be like this? : 

Finish U.S. FM residency with U.S. license --> Finish "assessment" over several days by Canadian college --> Wait 2-3 months for Ontario license

Thanks for the clarification.

severe disadvantage

-so you will be in a pathway 3 application if you graduated from U.S .residency without lmcc examinations - you need a supervisor for 1-2 years, you will pay a chunk to the supervsior, restricted license, etc - ontario license application was about 2,000. The end of year assessment from college i heard is 8,000-10,000? Don't quote me on that price.

---------------

so to clarify the steps.

1) pathway 3 application for Ontario license - only if you graduated from LCME (US/Canadian) medical school, have a U.S. state license, completed residency, ABFM-exam passed

-will take 2-3 months assuming no hiccups - they have specific dates where they review application if you miss that deadline then you wait till next cycle - i almost missed deadline because my state-license confirmation letter took 2 months to mail to the college. 

-ontario licesne application was very time consuming - alot of things out of your control - i.e. my USMLE scores cost ~$100 to submit and the college "lost them" the first time - had to resubmit this, i had to find a supervisor (college has strict requirements - cannot know the person, etc.) and meet/interview before submitting application (difficult to arrange if you live in the U.S.)

-be prepared to have no income in 2-3 months+ if you can't find a job while awaiting ontario license - since I could only apply after graduating from residency

-i moonlighted at our hospital's urgent care system and just continued this while awaiting ontario licnese - if you are not a U.S. citizen or on a visa i don't think you will be able to work

-also lose 1 year of your life and 1 year of attending salary - since U.S. FM residency = 3 years

2) restricted license for 1 year under supervision - you will need to find a supervsior - you will split costs with office and supervisor

-i had to specifically fly back to meet with supervisor/job interview - loss 1 day of wages and flight so that was like 2000-3000 USD

3) pass end of year assessment from college - expensive

4) you wil always have a restricted Ontario license despite passing assessment - don't know how this affects your transferability from province to province

---------

i was lazy and didn't think ahead - i passed lmcc1 and will be taking lmcc2 then reapply for independent license after i pass the exam

------

i highly recommend just completing a Canadian residency - makes things alot easier - especially if you have no U.S. citizenship

guidelines, billing are different - i did spend 1-2 months reviewing all guidelines/studying (CHEP, canadian DM, billing, etc.) and met with other family physicians to become acquainted with the EHR they use in Ontario/billing as well before starting - so that took some time and lost income as well

[drake19]

actually i just read that you go to a U.S. medical school - 

I guess you may not have a choice where you go to residency - will probably be the USA

i was at a severe disadvantage when apply to carms - because i was from the USA - you  are in the same pool with Canadian graduates so you are competing against canadians  - i think that was  a disadvantage. Don't know if this is still the case. To alot of the interviewers they weren't familiar with the USA curriculum and were puzzled why i was even at the interview and not in the IMG pool interviews despite me doing 12 weeks of FM rotations in Canada. I remember when i applied odds percentage wise are not good overall for US graduates like 50-60% during my year.

but at the end of the day i would try to get to a canadian FM residency if your final destination is to be in Canada. if you plan to live in states then go to a U.S. residency

[blueskyguy]

18 hours ago, drake19 said:

severe disadvantage

-so you will be in a pathway 3 application if you graduated from U.S .residency without lmcc examinations - you need a supervisor for 1-2 years, you will pay a chunk to the supervsior, restricted license, etc - ontario license application was about 2,000. The end of year assessment from college i heard is 8,000-10,000? Don't quote me on that price.

---------------

so to clarify the steps.

1) pathway 3 application for Ontario license - only if you graduated from LCME (US/Canadian) medical school, have a U.S. state license, completed residency, ABFM-exam passed

-will take 2-3 months assuming no hiccups - they have specific dates where they review application if you miss that deadline then you wait till next cycle - i almost missed deadline because my state-license confirmation letter took 2 months to mail to the college. 

-ontario licesne application was very time consuming - alot of things out of your control - i.e. my USMLE scores cost ~$100 to submit and the college "lost them" the first time - had to resubmit this, i had to find a supervisor (college has strict requirements - cannot know the person, etc.) and meet/interview before submitting application (difficult to arrange if you live in the U.S.)

-be prepared to have no income in 2-3 months+ if you can't find a job while awaiting ontario license - since I could only apply after graduating from residency

-i moonlighted at our hospital's urgent care system and just continued this while awaiting ontario licnese - if you are not a U.S. citizen or on a visa i don't think you will be able to work

-also lose 1 year of your life and 1 year of attending salary - since U.S. FM residency = 3 years

2) restricted license for 1 year under supervision - you will need to find a supervsior - you will split costs with office and supervisor

-i had to specifically fly back to meet with supervisor/job interview - loss 1 day of wages and flight so that was like 2000-3000 USD

3) pass end of year assessment from college - expensive

4) you wil always have a restricted Ontario license despite passing assessment - don't know how this affects your transferability from province to province

---------

i was lazy and didn't think ahead - i passed lmcc1 and will be taking lmcc2 then reapply for independent license after i pass the exam

------

i highly recommend just completing a Canadian residency - makes things alot easier - especially if you have no U.S. citizenship

guidelines, billing are different - i did spend 1-2 months reviewing all guidelines/studying (CHEP, canadian DM, billing, etc.) and met with other family physicians to become acquainted with the EHR they use in Ontario/billing as well before starting - so that took some time and lost income as well

Hello drake19,

Thanks for the response. I have a few more questions for you!

When doing your 1 year with a supervisor in Ontario, are you making a normal FM physician salary (and have to split costs with the supervisor)? You are not making a resident salary, correct?

Also, how many years do you have to spend with the supervisor before you can work on your own? Is it just 1 year? (Because you said 1-2 years)

Also, after your 1 year with the supervisor, and you pass the assessment, does that give you a full Ontario license to go practice on your own? What do you mean that you "will always have a restricted Ontario license despite passing assessment"? How does this "restrict" you? Does it prevent your "earnings" in any way, etc.?

Also, why are you taking LMCC 1 and 2 if you said that you did not need to?

Thanks for the clarification.

[JohnGrisham]

If you do LMCC 1 and LMCC 2, you do not need supervision. 

It is very much to your advantage to just do the exams, and not very difficult to do as you would be doing USMLE 1-3 anyways.  

So get those done, and you avoid all the wasted time, loss of income and needing supervision that Drake19 is talking about.

[blueskyguy]

7 minutes ago, JohnGrisham said:

If you do LMCC 1 and LMCC 2, you do not need supervision. 

It is very much to your advantage to just do the exams, and not very difficult to do as you would be doing USMLE 1-3 anyways.  

So get those done, and you avoid all the wasted time, loss of income and needing supervision that Drake19 is talking about.

Hey JohnGrisham,

When you say LMCC1 and 2, that is the same as saying MCCQE1 and 2, correct?

Also, do you know the timeline on when these exams are typically taken? If I am in the U.S. taking USMLE exams, do you know how they correlate, timeline wise?

[JohnGrisham]

4 hours ago, blueskyguy said:

Hey JohnGrisham,

When you say LMCC1 and 2, that is the same as saying MCCQE1 and 2, correct?

Also, do you know the timeline on when these exams are typically taken? If I am in the U.S. taking USMLE exams, do you know how they correlate, timeline wise?

Yes, they are mccqe1 and 2.

Your second question is something easily searchable. Again, if you're truly a MS3, I would be honestly very concerned with the questions you're asking, and seek out other Canadian ms3s and ms4s at your program.  I'm really not trying to be hard on you, but at the same time, provide a bit of a reality check - you are very uninformed for someone who is already 3/4ths done your medical degree. These are things ideally you should have known before even starting in the US for medicine.

Qe1 correlates with CK and Qe2 correlates a hybrid of CS and step 3. Not directly correlated.   Many Canadian IMGs take QE1 after 3rd year cores, because that is when they have time, and due to requirements for CaRMS. QE2 you take early on in residency. 

[mechy]

Hello everyone,

I have a similar question to the OP

I want to do med school here in Canada, but then complete my residency in the US.

Will I be able to come back to Canada and practice here? I am a Canadian citizen.

Thanks!

[bearded frog]

2 hours ago, mechy said:

Hello everyone,

I have a similar question to the OP

I want to do med school here in Canada, but then complete my residency in the US.

Will I be able to come back to Canada and practice here? I am a Canadian citizen.

Thanks!

It depends on the residency and where you want to work. Generally yes, but it may require doing extra year(s)/fellowships, and writing multiple exams.

[mechy]

20 hours ago, bearded frog said:

It depends on the residency and where you want to work. Generally yes, but it may require doing extra year(s)/fellowships, and writing multiple exams.

Thanks for the answer! Do you know where I can get more information on this?

[bearded frog]

1 hour ago, mechy said:

Thanks for the answer! Do you know where I can get more information on this?

Start with the college of physicians and surgeons of the province you'd like to work in, basically your goal is to be licensed by them to practice, so it's their requirements you have to meet. I know Ontario's site has information for foreign grads on how to get licensed. Generally you need to meet the equivalent requirements of Family med/royal college depending on your specialty. Some residencies in the states are shorter than their Canadian equivalent meaning you will need to do a fellowship or other extra year to qualify, ie pediatrics which is 3 years in the US and 4 years in Canada.