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USMD applying CARMs - Orthopaedic surgery


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USMD in 2022 applying for CARMs 2022 R-1 CMG in Ortho.

1 month elective in Ortho in 3rd year, 3 months of Ortho elective in 4th year. No ortho elective in Canada due to COVID

I took a year research fellowship in Ortho in between 3rd and 4th year of med due to how competitive US ortho is. Currently have 6 pubs with 12 submitted for peer-review. 5 Ortho surgeons who have written me letters for US residency.

What are my chances? Will being USMD put me at significant disadvantage over Canadian grads?

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Ortho isn’t very competitive in Canada outside of Quebec.  There have been spots left over into the second round recently.

 So I think you’d have a good chance with the caveat that you would not have any local contact which could help get your foot in the door.  I think if you applied broadly though you’d get interviews

usually CaRMS happens first, but I believe currently NRMP occurs first - which means that you would have to not match in the US to have a chance to match in Canada.  

Interviews would probably help get a sense what your ranking strategy should be.

obviously there are significant practice differences between both countries including job prospects and remuneration.

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15 minutes ago, indefatigable said:

usually CaRMS happens first, but I believe currently NRMP occurs first - which means that you would have to not match in the US to have a chance to match in Canada.  

For 2021 and 2022 this is indeed the case. Do you think CaRMS will revert to running earlier than NRMP for 2023 and beyond?

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20 hours ago, indefatigable said:

Ortho isn’t very competitive in Canada outside of Quebec.  There have been spots left over into the second round recently.

 So I think you’d have a good chance with the caveat that you would not have any local contact which could help get your foot in the door.  I think if you applied broadly though you’d get interviews

usually CaRMS happens first, but I believe currently NRMP occurs first - which means that you would have to not match in the US to have a chance to match in Canada.  

Interviews would probably help get a sense what your ranking strategy should be.

obviously there are significant practice differences between both countries including job prospects and remuneration.

Yeah, it's ridiculously competitive here but outside Quebec, you probably have a decent shot on paper. The x-factor is how admission committees will feel about taking a US applicant and nobody can answer that, unfortunately.

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  • 2 weeks later...

Ortho here, relocated to the US after residency in Canada.  I think it's tough going right now.  Canadians have some pretty deep biases and knowledge gaps when it comes to American applicants (e.g. they won't understand the research year at all).  Another issue would be if you're a DO.  That would put you into the IMG stream in a lot of provinces.  

Happy to discuss more in private. 

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On 10/28/2021 at 9:21 PM, jnuts said:

Ortho here, relocated to the US after residency in Canada.  I think it's tough going right now.  Canadians have some pretty deep biases and knowledge gaps when it comes to American applicants (e.g. they won't understand the research year at all).  Another issue would be if you're a DO.  That would put you into the IMG stream in a lot of provinces.  

Happy to discuss more in private. 

Just out of curiosity, were you able to write the US ortho boards after Canadian residency? I was under the impression that some surgical residencies in US have changed structure such that Canadian residents cannot become board certified down there now.

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On 11/1/2021 at 8:59 AM, shikimate said:

Just out of curiosity, were you able to write the US ortho boards after Canadian residency? I was under the impression that some surgical residencies in US have changed structure such that Canadian residents cannot become board certified down there now.

Don't think you can, but they usually accept Canadian boards there and you can still be called board certified, you just can't say ur American board certified. 

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  • 1 month later...
On 11/1/2021 at 8:59 AM, shikimate said:

Just out of curiosity, were you able to write the US ortho boards after Canadian residency? I was under the impression that some surgical residencies in US have changed structure such that Canadian residents cannot become board certified down there now.

Yes you can, there's reciprocal recognition of the residency with the ABOS (but you need to sit the multi-step boards).  In some circumstances people practice without doing the ABOS but opportunities would be limited (usually to underserved border states).  I know people without the ABOS practicing in Maine.

 

https://www.abos.org/certification/

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22 hours ago, jnuts said:

Yes you can, there's reciprocal recognition of the residency with the ABOS (but you need to sit the multi-step boards).  In some circumstances people practice without doing the ABOS but opportunities would be limited (usually to underserved border states).  I know people without the ABOS practicing in Maine.

 

https://www.abos.org/certification/

Do most Orthos in the US complete two fellowships before getting their first job? This seems to be the norm for new hires in Canada.

Edited by ArchEnemy
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2 hours ago, ArchEnemy said:

  

Do most Orthos in the US complete two fellowships before getting their first job? This seems to be the norm for new hires in Canada.

No, it's extremely rare to do multiple fellowships and a fair number (though trending down) don't do a fellowship at all. 

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  • 8 months later...
19 hours ago, StaleCoffee said:

Pretty much in the same boat but a year later, how did the match season go and any advice for a US MD applying to CARMs?

Why do you want to come back to Canada? You realize that we have orthopods doing 2 years of fellowship +/- going down the the U.S. to find work right?

I'm not in orthopaedics but I have seen strong USMDs join surgical and nonsurgical programs. Traditionally USMDs have been a part of the CMG (Canadian medical graduate) stream, which has been to their benefit. Orthopaedics is not usually highly competitive here, though there are some occasional rough years, so you will probably find interviews if you are a decent applicant.

However there has been a major change recently: for the graduating class of 2026, USMDs will be considered IMGs. The number of IMG spots is much more limited. I believe it will be challenging to find a residency position if you are from the graduating class of 2026.

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32 minutes ago, 1D7 said:

Why do you want to come back to Canada? You realize that we have orthopods doing 2 years of fellowship +/- going down the the U.S. to find work right?

I'm not in orthopaedics but I have seen strong USMDs join surgical and nonsurgical programs. Traditionally USMDs have been a part of the CMG (Canadian medical graduate) stream, which has been to their benefit. Orthopaedics is not usually highly competitive here, though there are some occasional rough years, so you will probably find interviews if you are a decent applicant.

However there has been a major change recently: for the graduating class of 2026, USMDs will be considered IMGs. The number of IMG spots is much more limited. I believe it will be challenging to find a residency position if you are from the graduating class of 2026.

They might want to come back home, or see themselves practicing here. Regardless of the job situation if you want to practice in Canada, doing residency here is probably the only way you'll even have a shot. Also, since ortho is quite competitive in the US, some may want to have an alternative if things don't work out in the US match. 

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3 hours ago, 1D7 said:

Why do you want to come back to Canada?

Because it's an easier match to Ortho in Canada and matching here doesn't preclude you from going to the US for work. Mean Step1 for Ortho is a 248, which is about the 80th percentile for US grads, and many take a research gap year in medical school to make themselves competitive. You definitely don't need to be impressive academically to match Ortho in Canada.

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On 9/5/2022 at 1:37 PM, 1D7 said:

Why do you want to come back to Canada? You realize that we have orthopods doing 2 years of fellowship +/- going down the the U.S. to find work right?

I would like to come back to Canada to be closer to family, eventually practice in Canada, and the ortho match in the USA is getting a little terrifying: 40% unmatched rate, many people taking prophylactic research years, and a lot of programs automatically screening out anyone who would need a visa for residency. 

I am trying to get a sense how competitive the Canadian ortho match is (graduating 2023 so would be a CMG) and being a little out of the system it can be hard to guage competitiveness. 

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  • 2 weeks later...
On 9/13/2022 at 6:40 AM, StaleCoffee said:

I would like to come back to Canada to be closer to family, eventually practice in Canada, and the ortho match in the USA is getting a little terrifying: 40% unmatched rate, many people taking prophylactic research years, and a lot of programs automatically screening out anyone who would need a visa for residency. 

I am trying to get a sense how competitive the Canadian ortho match is (graduating 2023 so would be a CMG) and being a little out of the system it can be hard to guage competitiveness. 

Having worked both sides I think that's totally reasonable! US Ortho is insane right now and being a visa applicant is brutal. Don't count on most Canadians being aware of that though. Most Canadians just see the number of US spots in total and figure if you can't get one of those that you're red flagged in some way they can't see. It sucks but that's the bias.  

The CaRMS process for Ortho really comes down to personal contacts.  As I've posted before, scores and grades really don't matter as Canadians don't have them and don't know how to read them. Only LORs from people they know will really be considered. Almost all residents picked will be known to the program in some way.  I cannot emphasize enough how different the selection criteria are in Canada versus the US. There's really no answer to your 'how competitive' question due to the complete lack of objective measures.  The closest you get is the CaRMS data on successful first choice matches, which doesn't tell someone in your situation much.

What you're fighting against is the fact that you've taken a relatively different path than the students you're competing with (and different from the faculty themselves).  Something ridiculous like 50% of Canadian docs do a straight shot at a single school from UG through end of residency.  I hope things are better now, but just that unfamiliarity--and nothing strongly against the candidate--got a few USMDs knocked down or out of rankings in favour of a 'known quantity' CMG when I was involved.

School reputation might help if you're at a top ten otherwise don't count on it--in fact I've seen that assumed hidden red-flag assumption work against very qualified applicants.

Also, you may be robbing Peter to pay Paul with your overall goals. As one of the posts above mentioned, at the end of it all, many Canadian Ortho grads have to leave Canada to find work in the US.  Make sure you're very comfortable with the 3-5 years of post grad 'work' it may take you to find a job after residency if your plan is to stay in Canada or alternatively going back to the US with whatever immigration restrictions that may affect you personally.  That said, there is a world where you ride the least competitive part of both systems to reach your long-term career goal. That's what I did (wether or not I fully planned it that way).

Practical advice: I would highly encourage you to target a few programs to reach out to.  Write program directors or other influential faculty so they know your story (why you're in the US).  Ask to shadow or other informal ways of getting face-time so you're not an unknown. Exploit any research connections between your home school and your target schools to get introduced. Exploit any alumni connections, and ex-fellows or current local Ortho connections? Even friend-of-a-friend associations. Dig deep to find these connections and use them. 

What's your plan for navigating backing up in the US?  There haven't been a ton of open second round spots in recent years for Ortho in Canada but they do come up (and that tends to be when Canadian programs loosen up and start thinking outside the box to get their warm bodies).  I think that would be a good chance.  But I think it does mean you risk going unmatched otherwise you'll get bound into your US match before the second round or scramble run. 

 

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