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(Neurosurg) Realistic advice about job prospects


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On 2/15/2021 at 10:30 AM, Jack Marcos said:

Unfortunately, no. Any individuals who completed training after 1997 in Canada can no longer become certified in the United States, doesn’t matter how many fellowships you do. http://www.neurosurgeryschools.com/faqs/index.htm
 

You can still practice in the United States though.

Is there a list of residencies which are not eligible for board certification in the US? I know neurosurg, ENT and FM are it, but are there any other ones?

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On 2/17/2021 at 2:52 PM, MasterDoc said:

Is there a list of residencies which are not eligible for board certification in the US? I know neurosurg, ENT and FM are it, but are there any other ones?

I've also never seen a list and found out mostly through word of mouth. I feel like this is almost intentional as you don't want to inform students what their options are so they stick around in Canada in high-need fields.

Could be an interesting initiative for CFMS as you just need a couple of students to do some phone calls and website research to compile a spreadsheet for medical students to get informed about future cross-border employment issues.

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2 hours ago, blah1234 said:

I feel like this is almost intentional as you don't want to inform students what their options are so they stick around in Canada in high-need fields.

Most docs that jump the border I always assumed it was because of the lack of employment opportunities of specialists in Canada. So, the argument of needing to keep doctors here because they are "needed" makes no sense if the government can't provide a job for them.

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57 minutes ago, MasterDoc said:

Most docs that jump the border I always assumed it was because of the lack of employment opportunities of specialists in Canada. So, the argument of needing to keep doctors here because they are "needed" makes no sense if the government can't provide a job for them.

The government doesn't care if there aren't jobs available they just care if there is a supply which can only help them deliver patient care. My neurosurgery colleague told me that a big reason why the curriculum doesn't match up was because there was an effort to prevent a brain drain to the US a while back. I don't know if this is true as this is just their hearsay.

While there may not be a full staff position there are usually random locums that people can secure which still provides the end goal of patient care which the government cares about without any consideration for the needs of new graduates.
 

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8 hours ago, blah1234 said:

The government doesn't care if there aren't jobs available they just care if there is a supply which can only help them deliver patient care. My neurosurgery colleague told me that a big reason why the curriculum doesn't match up was because there was an effort to prevent a brain drain to the US a while back. I don't know if this is true as this is just their hearsay.

While there may not be a full staff position there are usually random locums that people can secure which still provides the end goal of patient care which the government cares about without any consideration for the needs of new graduates.
 

Seems a little egotistical on the Canadian side.  The decision is ultimately up to the American Boards to allow or not allow Canadian applicants. The Americans set and revise their criteria for acceptable training all the time without consulting Canadians.  If anything, I think the restrictions are a protectionist pressure from the American side to prevent possible flooding of their market (if they think about Canadians at all).

There's other evidence of this in the NAFTA agreement (or whatever it's called now).  Most Canadian professionals, including lawyers, nurses, and RTs can just show up at the boarder with a job offer and get a TN visa on the spot. There's a specific carve out that prevents Canadian medical doctors from accessing TNs so they have to get the far more restricted and onerous H1bs or J1s. Thank the AMA for that one. 

The more interesting question is why do any of the American Boards allow Canadians to sit their exams? 

https://travel.state.gov/content/travel/en/us-visas/employment/visas-canadian-mexican-nafta-professional-workers.html

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15 minutes ago, jnuts said:

Seems a little egotistical on the Canadian side.  The decision is ultimately up to the American Boards to allow or not allow Canadian applicants. The Americans set and revise their criteria for acceptable training all the time without consulting Canadians.  If anything, I think the restrictions are a protectionist pressure from the American side to prevent possible flooding of their market (if they think about Canadians at all).

There's other evidence of this in the NAFTA agreement (or whatever it's called now).  Most Canadian professionals, including lawyers, nurses, and RTs can just show up at the boarder with a job offer and get a TN visa on the spot. There's a specific carve out that prevents Canadian medical doctors from accessing TNs so they have to get the far more restricted and onerous H1bs or J1s. Thank the AMA for that one. 

The more interesting question is why do any of the American Boards allow Canadians to sit their exams? 

https://travel.state.gov/content/travel/en/us-visas/employment/visas-canadian-mexican-nafta-professional-workers.html

Perhaps there's US pressure to prevent the influx of Canadians but I honestly find that a little hard to believe as well as the number of specialists we produce is not that large in comparison to their existing training pipeline. I think the job markets for things like family medicine and neurosurgery are pretty good in the US (as neurosurg has more opportunities in the community compared to Canada).

I honestly have no idea what the policy logic is as I'm assuming my colleagues learned their history facts from their professors who were probably in the know. That combined with my pessimism with how the government increasingly wants to manage us as resources is probably why I came to that conclusion.

You might be right that they don't think about us at all. Given that medical research and knowledge are largely focused around US centres (due to funding) I would always assume that our training would parallel theirs given the similarities. It just seems really odd that we wouldn't adapt our curriculum to match unless there was some other pressure involved. But maybe that's just misplaced paranoia.

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You made a good point about the TN visa. You can still go to US on a J1 and try to work in a rural area to get waiver, or try to get institutional H1B sponsorship (usually limited to large academic centers).

Anecdotally I know of ENT people working in US (large cancer center) without US board certification, on an institution sponsored visa (not sure what type). I am not sure if board certification affects billing for these people or not.  

So overall getting medical license in US is easy, but board certification varies by specialty. For example small rural places in US desperate for doctors will accept someone without FM boards (eg. a resident with 1-2 years experience in IM/FM, etc). Again their employment model is very different, so I guess that could open certain doors and close other doors.

 

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2 minutes ago, shikimate said:

You made a good point about the TN visa. You can still go to US on a J1 and try to work in a rural area to get waiver, or try to get institutional H1B sponsorship (usually limited to large academic centers).

Anecdotally I know of ENT people working in US (large cancer center) without US board certification, on an institution sponsored visa (not sure what type). I am not sure if board certification affects billing for these people or not.  

So overall getting medical license in US is easy, but board certification varies by specialty. For example small rural places in US desperate for doctors will accept someone without FM boards (eg. a resident with 1-2 years experience in IM/FM, etc). Again their employment model is very different, so I guess that could open certain doors and close other doors.

 

Yea, there are specific immigration exceptions for MDs made for rural need in the US but those communities seem rough to work in based on my understanding.

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