Changes to US MD equivalencies - thoughts?

[DrOtter]

I just saw this post on the other premed forum by someone who reportedly contacted the AFMC regarding the matter.

If true, it seems that US MD will be considered IMGs for Canada and vice versa, Canadian grad will be considered IMGs for US residencies, starting in 2026.

Personally I'm not affected by this but interested to hear everyone's thoughts on how this huge (if true) change will affect both countries - given a not insignificant number of med students who go in either direction for residency training, as well Canadians attending US MD schools ://.

[abcd1288]

It's true sadly. Here's the official statement: https://afmc.ca/en/media-releases/june-9-2021

It seems that applying to US for medical school is not as viable as before. If someone does go the US pathway, they will have to go through the US residency and then come back to Canada to practice. Fortunately, for the most part, reciprocal agreements in residency training between the US and Canada are still upheld, which opens the door for Canadians to return from US training/fellowship or for Canadians to move to the US to practice. At least in the field that I am interested in, the chair of the board cerification said that the recent changes by the LCME and AFMC do not affect the reciprocal agreement and there are no changes anticipated in the future that might change this agreement.

[shikimate]

Not unexpected. The global geopolitical trend has been the ending of the "global village". Expect more trade barriers, not just movement of goods, but also services. It serves good political purposes at the price of economics.

On a practical level, the process in US is much more friendly to IMGs than in Canada. Although ECFMG certificate is a pain (so I heard), it's just a bureaucratic hurdle. I'd expect elite Canadian students who study at US medical schools to stay in USA without significantly more problems (think of the Canadian who gets admitted to Yale, Harvard, Stanford). 

On the other hand, I believe this will be an invisible form of "brain drain" for Canada. If you are an elite graduate of UCSF, would you be interested in applying as an IMG to Canada and hope for some leftover FM, pathology or psych spots in rural Saskatchewan or newfoundland? Or would you rather apply as an "IMG" to top programs in US? If your medical degree says UCSF I doubt a mere bureaucratic designation of IMG will deter a top tier program in USA from accepting you.

I wonder what percentage of people who do residency in USA and has the option to stay there actually come back (aka they can gain PR or already have PR or already have citizenship). My anecdotal stories from people I know is that they find compensation is higher in USA, cost of living is lower in USA, taxes are lower in USA, they have much variety of living options (aka if you wanna avoid winter work in LA or Tampa). It seems these limited number of people found very few reasons to come back.

 

 

[indefatigable]

Agree.  There will be more matching/staying in the US for those that do med school there as they won't be able to apply to the CMG first round streams.  It may also create more competition for some IMG high-profile spots which sometimes go to UK/Australia or even Carrib grads (e.g. derm/ophtho/plastics..).

There's been fewer and fewer CMGs that apply to the NRMP so that direction shouldn't make much of a difference.  In any case, I don't think it would change that much for anyone that wanted to apply to the US for residency (it wouldn't change visa requirements, they would still need to write MLEs, etc).  CMGs were probably considered to be lesser than USMGs anyways.  Historically, McGill used to send the most grads to the US - but I imagine grads would still get some brand recognition there.  

 I suspect this may have also been a  way to try to keep the unmatched rate Canada manageable, without increasing the number of residency spots, since the matching ratios are so tight by this effectively eliminates the 15-30 USMGs from matching into the CMG stream each year. 

[shikimate]

8 minutes ago, indefatigable said:

 I suspect this may have also been a  way to try to keep the unmatched rate Canada manageable, without increasing the number of residency spots, since the matching ratios are so tight by this effectively eliminates the 15-30 USMGs from matching into the CMG stream each year. 

This is a good argument and something I didn't think of. The by-product of this might be some funny future newspaper headline that reads "Canadian graduate of Harvard Medical School rejected for residency in small town Manitoba" lol. 

[zoxy]

Does anyone know if the American or Canadian schools initiated this? How could this happen? All Canadian schools are still LCME accredited. Will they be changing accreditation moving forward?

My god, I hope we don't lose reciprocal training equivalency for residency. The government will have us over a barrel if that happens.

 

Edit:

LMAO, to answer my own question we're no longer LCME accredited after June of 2025. Does anyone know what that will mean for our residency training programs going forward? Why on earth would they allow this to happen?

https://cacms-cafmc.ca/about-cacms

https://www.afmc.ca/en/media-releases/june-9-2021

Edited February 1, 2022 by zoxy

[zoxy]

17 minutes ago, indefatigable said:

I suspect this may have also been a  way to try to keep the unmatched rate Canada manageable, without increasing the number of residency spots, since the matching ratios are so tight by this effectively eliminates the 15-30 USMGs from matching into the CMG stream each year. 

It's got nothing to do with that, we're losing LCME accreditation from June 30th of 2025 onward.

[abcd1288]

9 minutes ago, zoxy said:

Does anyone know if the American or Canadian schools initiated this? How could this happen? All Canadian schools are still LCME accredited. Will they be changing accreditation moving forward?

My god, I hope we don't lose reciprocal training equivalency for residency. The government will have us over a barrel if that happens.

 

Edit:

LMAO, to answer my own question we're no longer LCME accredited after June of 2025. Does anyone know what that will mean for our residency training programs going forward? Why on earth would they allow this to happen?

https://cacms-cafmc.ca/about-cacms

 

Probably initiated by Canadian schools tbh given that the LCME accredits both US and Canadian schools while CACMS only accredits Canadian schools. Plus, the press release states that with CACMS being the sole accreditating agency, medical schools in Canada can focus on Canadian values and context during medical training. Regarding the reciprocity in training equivalency for residency, I think it depends on the specialty. The specialty I'm interested in said they will keep the reciprocity because the agreement is based on the training and criteria by the ACGME and RCPSC rather than the status of a medical school. So maybe reach out to the board/certifying organization in your specialty of interest? I too hope that they won't change the reciprocal agreement. If anything at least, it provides an option for Canadian-trained docs to find employment in the US for fields that are extremely hard to find jobs in Canada (e.g. ortho)

[indefatigable]

1 hour ago, zoxy said:

It's got nothing to do with that, we're losing LCME accreditation from June 30th of 2025 onward.

How do you know?  The unmatched problem/matching ratio is a long-standing issue - it's not as if we're adding seats.  I think this could have been an "opportunity" for the decision-makers when looking at the issues "globally".  Again, the official reason cited is "social accountability", but I wouldn't be surprised if this issue were in the back of their mind or part of their perspective on "accountability"

In the recommendations for decreasing the number of unmatched grads, released a few years ago, one of them specifically trageted USMGs.  Even it happens in 2025, that's irrelevant - the point is it's way to target the issue.  The other things that's happened recently is reducing the IMG streams - that's why there's less unmatched than there was a few years ago.

The disparity between in/out-flow from the US has only increased.

http://www.afmc.ca/sites/default/files/pdf/AFMC_reportreducingunmatchedcdnmg_EN.pdf

"Because of a US/Canada reciprocity agreement, Canadian citizens or permanent residents who have graduated from an accredited U.S. medical school have equivalent rights and opportunities as current year CMGs during the matching process. Since the CaRMS match occurs prior to the US match each year, CMGs and USMGs will already have their Canadian matching decision before the US match takes place. This is an advantage for USMGs and a disadvantage for CMGs.
More USMGs match to Canadian residency positions each year than CMGs match to US residency programs. Over the past 8 years, an average of approximately 25 US medical graduates without prior training match to Canadian residency positions each year. An average of approximately 12 CMGs without prior training match to US residency programs. Discussion is required with a view to creating equity between the number of USMGs matching in Canada and the number of CMGs matching in the US."

Now US/Canada reciprocity is gone..

[indefatigable]

54 minutes ago, shikimate said:

This is a good argument and something I didn't think of. The by-product of this might be some funny future newspaper headline that reads "Canadian graduate of Harvard Medical School rejected for residency in small town Manitoba" lol. 

We have Canadian trained MD/PhD neurosurgeons doing FM residency in rural Manitoba.. (at +1:00)

https://www.youtube.com/watch?v=sl2lZatlro0&t=79s

 

[lovemedicinesomuch]

So now CMG will have no option to pursue residency in the US starting in 2026?

Yikes - I guess the many people who are poorly matched in Canada ( to specialties they don't desire) - will have limited option to re-train in the US.

[insomnias]

Anyone know how this might affect grads pre-c2025 applying to fellowship/second residency?

[zoxy]

18 minutes ago, indefatigable said:

How do you know?  The unmatched problem/matching ration is a long-standing issue - it's not as if we're adding seats.  I think this could have been an "opportunity" for the decision-makers when looking at the issues "globally".  Again, the official reason cited is "social accountability", but I wouldn't be surprised if this issue were in the back of the mind.

In the recommendations for decreasing the number of unmatched grads, released a few years ago, one of them specifically trageted USMGs.  Even it happens in 2025, that's irrelevant - the point is it's way to target the issue.  The other things that's happened recently is reducing the IMG streams - that's why there's less unmatched than there was a few years ago.

The disparity between in/out-flow from the US has only increased.

http://www.afmc.ca/sites/default/files/pdf/AFMC_reportreducingunmatchedcdnmg_EN.pdf

"Because of a US/Canada reciprocity agreement, Canadian citizens or permanent residents who have graduated from an accredited U.S. medical school have equivalent rights and opportunities as current year CMGs during the matching process. Since the CaRMS match occurs prior to the US match each year, CMGs and USMGs will already have their Canadian matching decision before the US match takes place. This is an advantage for USMGs and a disadvantage for CMGs.
More USMGs match to Canadian residency positions each year than CMGs match to US residency programs. Over the past 8 years, an average of approximately 25 US medical graduates without prior training match to Canadian residency positions each year. An average of approximately 12 CMGs without prior training match to US residency programs. Discussion is required with a view to creating equity between the number of USMGs matching in Canada and the number of CMGs matching in the US."

You're right, I don't actually know that. But it's an incredibly idiotic thing to do if that was their sole motivation. Talk about cutting off one's nose to spite one's face, if that's the main reason. They could have just run  CARMs right after NRMP like they did the past year and how it will be run in 2022. That way Canadian USMGs wouldn't have the advantage they previously did, where they'd only match to the US if they didn't match in Canada. In the document you link, even they mention that one of the reasons Canadian USMGs take up spots in Canada is that CARMs runs earlier.

For comparison there were 9 USMG matches in 2021 compared to 24 in 2020, 21 in 2019, and 24 in 2018. I'm sure 2022 will have a similarly low number of USMG matches. They could have just done that instead of cutting ties with the AAMC and LMCE.

[zoxy]

16 hours ago, lovemedicinesomuch said:

So now CMG will have no option to pursue residency in the US starting in 2026?

Yikes - I guess the many people who are poorly matched in Canada ( to specialties they don't desire) - will have no option to re-train in the US.

Not for the year you're graduating. You need to have finished your degree to be eligible for ECFMG certification. E.g., the class of 2026 will be eligible to apply for the 2027 NRMP match or a later one.

So if you delay graduation to do more electives, you won't be eligible for ECFMG and still won't technically have graduated.

[indefatigable]

5 minutes ago, zoxy said:

You're right, I don't actually know that. But it's an incredibly idiotic thing to do if that was their sole motivation. Talk about cutting off one's nose to spite one's face, if that's the main reason. They could have just run  CARMs right after NRMP like they did the past year and how it will be run in 2022. That way Canadian USMGs wouldn't have the advantage they previously did, where they'll only match to the US if they don't match to Canada.

For comparison there were 9 USMG matches in 2021 compared to 24 in 2020, 21 in 2019, and 24 in 2018. I'm sure 2022 will have a similarly low number of USMG matches. They could have just done that instead of cutting ties with the AAMC and LMCE.

I doubt it was their sole motivation, but I do wonder if it was part of it - "social accountability" can really be broadly defined.  CaRMS after NRMP is all secondary to the pandemic - it could or could not be switched back.   Before the pandemic, the trend was pretty clear.  

I also don't think "loosening the ties" to the US would be something provinces/governments would object to since it could effectively remove physician mobility and therefore increase control (as we've discussed before).

[zoxy]

6 hours ago, indefatigable said:

We have Canadian trained MD/PhD neurosurgeons doing FM residency in rural Manitoba.. (at +1:00)

https://www.youtube.com/watch?v=sl2lZatlro0&t=79s

 

There's more to the story. He's doing Rural FM after 6 years of NSx residency and a fellowship as well. MD/PhD NSx with fellowship training doing northern FM is madness. I assume he was only eligible for the second round since he'd already had training and that's why he's stuck in Northern Manitoba. I know of another guy who did FM after 10 years of Cardiac Sx residency and a concurrent PhD but at least he was in Toronto. Crazy how garbage the NSx and CVSx job markets are. And the training is as brutal as it's ever been.

[indefatigable]

1 minute ago, zoxy said:

There's more to the story. He's doing Rural FM after 6 years of NSx residency and a fellowship as well. MD/PhD NSx with fellowship training doing northern FM is madness. I assume he was only eligible for the second round since he'd already had training and that's why he's stuck in.Northern Manitoba I know of another guy who did FM after 10 years of Cardiac Sx residency and a concurrent PhD but at least he was in Toronto. Crazy how garbage the NSx job market is. And the training is as brutal as ever.

Yeah - I saw the fellowship too (part of the "training")... both cross-overs are  just indicative of a system that isn't fully functioning.  

[zoxy]

4 minutes ago, indefatigable said:

I also don't think "loosening the ties" to the US would be something provinces/governments would object to since it could effectively remove physician mobility and therefore increase control (as we've discussed before).

Exactly. But this isn't a decision that is solely made by the province or government. Don't the MDs sitting on those committees realize what Doug Ford or Legault would do to us if we didn't have leverage? The nurses can go to the US because they have a TN and equivalent training. We don't have the option of a TN and soon won't have equivalent training. And that's even without mentioning Ortho, NSx, CVSx, and IC having awful job markets in Canada.

[bellejolie]

42 minutes ago, insomnias said:

Anyone know how this might affect grads pre-c2025 applying to fellowship/second residency?

yeah im curious abotu this too? i emailed a few months ago and my program is ACGME certified ie i don't need USMLEs, am eligible for J1 and will actually be applying for fellowship in like 6 months so i hope this doesn't change anything?? i am super confused tbh. i dont get this LCME accedited thing at all.

edit: i calmed down and read and indeed understand (i was getting LCME and LMCC confused). ok so essentially per my email with ECFMG in Spring 2021, Most Canadian (if not all) medical programs are LMCE certified therefore you don't need ECFMG certification (which would require the extra exams for the J1). So essentially you'd lose the LCME certification and therefore have to go through the same process as anyone else for the visas, basically USMLEs. phew. i will email to ask if anything has changed but i gather not since the change isn't taking place until 2025.

[abcd1288]

1 hour ago, insomnias said:

Anyone know how this might affect grads pre-c2025 applying to fellowship/second residency?

 

Not much since you won't be affected by this decision as your school will still be LCME accredited. For fellowship purposes, I'd reach out to the specialty program and board authority of interest (for example the American Society of Anesthesiologists, American Board of Family Medicine, etc.) but it seems that this decision doesn't affect fellowship eligibility as US fellowships seems to consider eligibility based on residency training rather than med school. Since US and Canada have reciprocal training equivalency, fellowship seems to be a safe option for now.

 

To quote LCME's response "We would recommend that you speak with your medical school dean's office and/or to CACMS for further information. Briefly, students graduating from Canadian medical schools in 2025 would graduate from a medical education program with both CACMS and LCME accreditation and could apply for post-graduate education positions accordingly. Students graduating from Canadian medical schools in 2026 and beyond will graduate from a medical education program accredited by CACMS; if applying for residency positions in the US, they would go through the ECFMG process."

 

[shikimate]

Maybe this will be a boom for dentistry? At least if you wanna do family dentistry you don't have to deal with the residency issue. I imagine a lot of qualified MD applicants can easily make it to dental school as well, not to mention US dental schools have much lower admission requirements.

[zoxy]

45 minutes ago, shikimate said:

Maybe this will be a boom for dentistry? At least if you wanna do family dentistry you don't have to deal with the residency issue. I imagine a lot of qualified MD applicants can easily make it to dental school as well, not to mention US dental schools have much lower admission requirements.

This isn't a complete catastrophe as long as residency reciprocity is maintained. That's far more important than medical school equivalency. The plight of NSx and CVsx illustrates that LCME accreditation doesn't count for much if you can't get board certified. Plus, dentistry is in rough shape with the influx of graduates of Australian, US, and Irish schools.

If residency reciprocity is maintained, there will be three main differences going forward.

1) The need for EFCMG certification for 2026 grads if they want to work or do fellowships in the US. EFCMG is fairly trivial if you have your USMLEs, which you needed for an H1B if you were looking to move down there anyway.

2)But 2026 graduates will be unable to do fellowships on a J1 in the US with their Canadian exams and will require the USMLEs for all fellowships.

3)CMGs will be unable to apply to the US match the year they graduates. Very few CMGs match to the US for residency so that's not an issue.

Wonder if it was considered how Canadian physicians will now require all three USMLEs for even the simplest of fellowships. If you look at the big academic programs, it seems like a solid 30 percent of them have fellowship training in the US.

[Artier]

30 minutes ago, zoxy said:

This isn't a complete catastrophe as long as residency reciprocity is maintained. That's far more important than medical school equivalency. The plight of NSx and CVsx illustrates that LCME accreditation doesn't count for much if you can't get board certified. Plus, dentistry is in rough shape with the influx of graduates of Australian, US, and Irish schools.

If residency reciprocity is maintained, there will be three main differences going forward.

1) The need for EFCMG certification for 2026 grads if they want to work or do fellowships in the US. EFCMG is fairly trivial if you have your USMLEs, which you needed for an H1B if you were looking to move down there anyway.

2)But 2026 graduates will be unable to do fellowships on a J1 in the US with their Canadian exams and will require the USMLEs for all fellowships.

3)CMGs will be unable to apply to the US match the year they graduates. Very few CMGs match to the US for residency so that's not an issue.

Wonder if it was considered how Canadian physicians will now require all three USMLEs for even the simplest of fellowships. If you look at the big academic programs, it seems like a solid 30 percent of them have fellowship training in the US.

Would CMGs who graduated medical school before 2025, but will be applying for fellowship starting 2026 will also need the USMLEs now for the J1?

[bearded frog]

This is huge, but as people are saying in the other forum™️, the actual number of people who did medical school in the US then came to Canada for residency (and vice versa) is very low.

I think if I had to choose I would still think USMD is still the best option if you can't get into Canada, due to a large number of available residency options in the US, and the ability to come back to Canada to work without too much hassle for most specialties. I think the biggest change is that USDO actually moves up in the ranking because USMD no longer has the advantage of not conferring IMG status. (So going from USMD >> USDO > aus/eu/carib to USMD > USDO > etc.)

[Pakoon]

1 hour ago, bearded frog said:

This is huge, but as people are saying in the other forum™️, the actual number of people who did medical school in the US then came to Canada for residency (and vice versa) is very low.

I think if I had to choose I would still think USMD is still the best option if you can't get into Canada, due to a large number of available residency options in the US, and the ability to come back to Canada to work without too much hassle for most specialties. I think the biggest change is that USDO actually moves up in the ranking because USMD no longer has the advantage of not conferring IMG status. (So going from USMD >> USDO > aus/eu/carib to USMD > USDO > etc.)

Do you mind elaborating a bit on this point, I thought this accreditation change only had an effect on CMGs trying to go state side for residency and vise versa? Or is this boost gained by USMDs being considered IMGs when applying to Canada?

 

I'm just confused how this helps boost them in the states where the residency merger and step 1 going P/F, imo was a set back for USDO