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Hi all,

PGY1 who matched into desired CARMS 5 year specialty. Did not do USMLEs during medical school. 

What are some of the reasons to consider when deciding whether to pursue the USMLEs or not during PGY1? Advantages, disadvantages?

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6 hours ago, jondoe said:

Hi all,

PGY1 who matched into desired CARMS 5 year specialty. Did not do USMLEs during medical school. 

What are some of the reasons to consider when deciding whether to pursue the USMLEs or not during PGY1? Advantages, disadvantages?

Advantages: passing makes you eligible for US fellowships that require USLME pass, depending on your residency you may do better with general med knowledge now vs later.

Disadvantages: You may not want to do a US fellowship, your US fellowship may not require it, the time spent studying may affect your residency performance and a US fellowship may not want you anyway, it costs money, it sucks, etc.

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- some states accept LMCC1 in lieu of USMLE, but not every state does that. USMLE is good for life, so having it on hand is handy.

- having a US license can come handy, say if you want to do international work or consulting work etc. Usually it just costs bit of money to renew every few years, that's all.

- now that Step 1 is pass/fail, I think it really takes a lot of stress off from studying for it. So if your PGY1 is not too busy, then might be worthwhile.

- If you are not in FM or IM, a lot of the knowledge will escape you later in residency, so might be better to do it sooner than later.

- their price only goes up, so if you are set on doing it, do it sooner. right now exchange rate is not bad, try doing it when it was 65 cents to the dollar lol.

- same rationale as doing the American board when you do your royal college exam. Just handy to have and it costs a bit of money in the short term but once you're board certified you don't have to worry about it.

- if you happen to fail your royal college, some provinces will still grant you license to work if you are American board certified. If you want to work abroad say in middle east or something, then American certification is usually universally recognized.

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17 hours ago, bearded frog said:

Advantages: passing makes you eligible for US fellowships that require USLME pass, depending on your residency you may do better with general med knowledge now vs later.

Disadvantages: You may not want to do a US fellowship, your US fellowship may not require it, the time spent studying may affect your residency performance and a US fellowship may not want you anyway, it costs money, it sucks, etc.

 

11 hours ago, shikimate said:

- some states accept LMCC1 in lieu of USMLE, but not every state does that. USMLE is good for life, so having it on hand is handy.

- having a US license can come handy, say if you want to do international work or consulting work etc. Usually it just costs bit of money to renew every few years, that's all.

- now that Step 1 is pass/fail, I think it really takes a lot of stress off from studying for it. So if your PGY1 is not too busy, then might be worthwhile.

- If you are not in FM or IM, a lot of the knowledge will escape you later in residency, so might be better to do it sooner than later.

- their price only goes up, so if you are set on doing it, do it sooner. right now exchange rate is not bad, try doing it when it was 65 cents to the dollar lol.

- same rationale as doing the American board when you do your royal college exam. Just handy to have and it costs a bit of money in the short term but once you're board certified you don't have to worry about it.

- if you happen to fail your royal college, some provinces will still grant you license to work if you are American board certified. If you want to work abroad say in middle east or something, then American certification is usually universally recognized.

I see! Thank you for the pointers. Trying to get a hand on if it would be better to study USMLE or study my field and get involved, as it is not at all a general med type of field

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If you are doing a surgical residency, practicing in the US may be something that you may want to look at, considering the current job market. There are two main reasons to need to complete the USMLE to practice there: visa reasons and insurance. Most people who practice in the US are on a H1B visa, which require you to complete the USMLE. However, if you are savvy and research-oriented, you can consider applying for a EB2 NIW visa, which doesn't require them. With regards to insurance, most insurance companies that hospitals use require you to take the USMLE; if you don't take them, you may only be allowed to practice in an academic setting (which may not be so bad tbh).

If you are not doing a surgical residency, more likely than not, practicing in Canada would be your end goal. If this is the case, fellowships are likely the only reason to do the USMLE. Where you do your fellowship, are not that important, unless you have an interest in academia. Unless, the fellowships that you are considering are competitive, I would argue against taking the USMLE, as they may just provide some unnecessary stress during your training. Irrespective of whether or not STEP is pass or fail, it still requires around 4+ weeks of hard studying, as the Canadian med school curriculum is vastly different from the one of the United States'.

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For what it's worth, I am a 4th year IM resident who had initially completed the Step 2 CK during medical school and was signed up to write the step 1 in June 2020. Covid struck and the exam got cancelled, but they allowed me to write it any time in 2020 until June 30, 2021. I got busy with RC exam and Carms 2.0 up until now so haven't written it yet. 

Right now I have the option to pay $70 or so to write it sometime between now and the end of September, but ultimately I decided against it. The money I spent towards writing step 2 CK, uworld and step 1 will now go to waste, but whatever. At this point I feel like it's more of a sunk cost and I won't sign up for them again unless I am sure that I will need them. I don't forsee myself doing a fellowship or practicing in the USA. Even though I may practise medicine outside of Canada in the future, right now I don't forsee myself needing it. Some US states also accept the LMCC as equivelant. So if I think about it, I would only need the USMLEs if I decide to go to the US (unlikely) AND it happens to be a state that doesn't accept the LMCC (more unlikely). 

Essentially, the only reason I would consider it is if I were in a surgical specialty or plan on doing a fellowship there. Also in terms of the money, I'll just pick up an extra call shift as a staff to make up for it. 

If in the future, I find that I need to do it, then I'll just sign up then. For now, I would rather use the time to work out, cook yummy healthy meals and just enjoy my weekends :)

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