Changes to US MD equivalencies - thoughts?

[abcd1288]

53 minutes ago, ChemPetE said:

Had a short update with UME leadership where someone asked a clarifying question. It sounds like LCME accreditation was associated with huge cost burdens (over 7 figures easy) and didn’t allow for programs to continue to improve in direction that CACMS wished to pursue, and so decided to part ways. That was their perspective on the situation fwiw

 

7 figures is a lot! I wonder what those requirements that the LCME needed are. Also, I might contact my UME office to see if they have more insights

[zoxy]

55 minutes ago, abcd1288 said:

7 figures is a lot! I wonder what those requirements that the LCME needed are. Also, I might contact my UME office to see if they have more insights

Knock yourself out:

https://lcme.org/publications/

[ChemPetE]

1 hour ago, zoxy said:

Do you have an idea what those directions might be?

No I do not. Was a brief line item in the overall agenda and the focus of the meeting wasn’t UME but PGME business

[ChemPetE]

1 hour ago, abcd1288 said:

 

7 figures is a lot! I wonder what those requirements that the LCME needed are. Also, I might contact my UME office to see if they have more insights

It sounded like schools in the US just hire consultants now so that they don’t overtax their staff, and it has become a big business. For those that do accreditation in any capacity, it’s a big endeavour, even for internal accrditation.

[UWOFTW]

Sounds like good old Canadian mediocrity and tall poppy syndrome.

[Edict]

1 hour ago, UWOFTW said:

Sounds like good old Canadian mediocrity and tall poppy syndrome.

If this trend continues and this is a bit of a slippery slope argument, but it will give the Canadian government much more power to crack down on physician pay. The only thing really keeping Canadian physician pay American style not European style is the fact that Canadian physicians can work in the US relatively easily. The brain drain of the 90s and early 00s was a testament to that, physician pay in Canada was significantly lower than the US and Canadian MDs did US residencies in droves back then. Then physician pay rose dramatically in the mid late 00s and has plateaued since about the early-mid 10s. 

This decoupling could be the first step towards a new "Canadian" system that pays doctors a lot less. Physicians are one of the few major professions where Canadian pay is similar to the US, just in Canadian dollars. In almost all the other professions, US pay is much better than Canada (tech, law, finance). If we don't protect our ability to work in both countries, we could easily join the rest, but the difference would be that Canadian physicians wouldn't be able to simply leave. 

There is an ongoing brain drain in these fields (tech, law, finance) and many young Canadians leave for the US for much higher pay. We need to keep the US door open at all costs in order to prevent a situation where we are forced to accept lower pay and poor contracts. 

[UWOFTW]

On 2/1/2022 at 8:32 PM, Edict said:

 

Barring being physically located in the US, there isn't really any significant advantage to doing residency in the US from a financial or experiential point of view. 

 

Difficult to believe that there is no experiential difference between training at NOSM and MGH, or Manitoba and Hopkins, etc.

[rmorelan]

52 minutes ago, UWOFTW said:

Difficult to believe that there is no experiential difference between training at NOSM and MGH, or Manitoba and Hopkins, etc.

Perhaps not a perfect analogy as you picked two top US schools vs Canadian schools you are grading I suspect as of lower quality than other Canadian ones. 

Exceeding few people relatively speaking are getting training at MGH or Hopkins. How would the average American resident fair against the average Canadian one? I truly don't have any real objective evidence on that either way - if I had to guess probably fairly close

I will say having personally trained medical students a several Canadian schools, vs Harvard there is really no difference I could find in quality. I found that kind of surprising initially but when you look at the admissions data the required GPA and MCAT scores at least it makes sense. We just truly have very high admission requirements.  

[Edict]

1 hour ago, UWOFTW said:

Difficult to believe that there is no experiential difference between training at NOSM and MGH, or Manitoba and Hopkins, etc.

People who are choosing to go to NOSM or Manitoba aren't the ones who are choosing to go to MGH or Hopkins. You will get a difference in experiences within the same country, what I'm saying is there is little that you could get in the US that you couldn't get in Canada. Within medicine, if you want the full academic circuit with all the bells and whistles, UofT offers you that. 

And you'll be surprised, Canadians have an unhealthy obsession with elite US schools and i've worked with residents who went there, they are normal people, their training is sometimes slightly different, but no better. 

[zoxy]

1 hour ago, UWOFTW said:

Difficult to believe that there is no experiential difference between training at NOSM and MGH, or Manitoba and Hopkins, etc.

The US isn't just Man's Greatest Hospital and Johns "Osler Residency" Hopkins. Manitoba is probably closer to MGH and Hopkins than it is to an IM program in Joplin Missouri or Mason City Iowa. The average MCAT for UofA and Manitoba is 514, the same as Brown, Dartmouth, Ohio State, and Emory.

There are also plenty of DO grads and Caribbean grads doing residency in the US.

[indefatigable]

1 hour ago, UWOFTW said:

Difficult to believe that there is no experiential difference between training at NOSM and MGH, or Manitoba and Hopkins, etc.

FWIW NOSM had 2 Derm matches last year - probably the highest match rate per class size in Canada. 

And I know of a Canadian SGU alumnus internist on the staff at MGH.  

[bellejolie]

4 hours ago, Edict said:

If this trend continues and this is a bit of a slippery slope argument, but it will give the Canadian government much more power to crack down on physician pay. The only thing really keeping Canadian physician pay American style not European style is the fact that Canadian physicians can work in the US relatively easily. The brain drain of the 90s and early 00s was a testament to that, physician pay in Canada was significantly lower than the US and Canadian MDs did US residencies in droves back then. Then physician pay rose dramatically in the mid late 00s and has plateaued since about the early-mid 10s. 

This decoupling could be the first step towards a new "Canadian" system that pays doctors a lot less. Physicians are one of the few major professions where Canadian pay is similar to the US, just in Canadian dollars. In almost all the other professions, US pay is much better than Canada (tech, law, finance). If we don't protect our ability to work in both countries, we could easily join the rest, but the difference would be that Canadian physicians wouldn't be able to simply leave. 

There is an ongoing brain drain in these fields (tech, law, finance) and many young Canadians leave for the US for much higher pay. We need to keep the US door open at all costs in order to prevent a situation where we are forced to accept lower pay and poor contracts. 

i dont think this is true at all. the qualifications for getting the h1b visa (which you need to work basically) requires the usmle anyway. the j1 you can get away with not having it but that's ONLY an educational visa. the work policies don't change much. literally this policy just makes it so that you have to write the usmle exams. that's it. let's not freak out (says me who temporarily freaked out).

no but for real that's all it changes from what i can see. for residency applications you needed to write the usmle anyway also. if you want to go to the states it can happen, and canadians are well regarded just cuz we literally only have 17 schools for medicine instead of 1700 with mixed tiers. 

[Edict]

3 minutes ago, bellejolie said:

i dont think this is true at all. the qualifications for getting the h1b visa (which you need to work basically) requires the usmle anyway. the j1 you can get away with not having it but that's ONLY an educational visa. the work policies don't change much. literally this policy just makes it so that you have to write the usmle exams. that's it. let's not freak out (says me who temporarily freaked out).

no but for real that's all it changes from what i can see. for residency applications you needed to write the usmle anyway also. if you want to go to the states it can happen, and canadians are well regarded just cuz we literally only have 17 schools for medicine instead of 1700 with mixed tiers. 

You are completely right, i'm just saying it as a hypothetical, a slippery slope argument. You are free to go to the US right now, but if our medical schools aren't accredited by the LCME, can the US begin to say, well.... now you need a US residency to get a job here, we don't recognize Canadian residencies anymore. As you know, many IMGs have to redo residency in the US to get a job. 

Before 2014, the LCME accredited all north american MD schools, then in 2014, Canada demanded to create CACMS to dual accredit their own schools. Now, they take the next step to do away with LCME altogether. Next, they can bring about their own changes to Canadian medical schools. If they continue to make their own changes, we could eventually end up with a system that the US no longer recognizes.   

[rmorelan]

14 minutes ago, indefatigable said:

FWIW NOSM had 2 Derm matches last year - probably the highest match rate per class size in Canada. 

And I know of a Canadian SGU grad internist on the staff at MGH.  

Ha, well done by them!

To add there really is a bit of hero worship in general at time regarding the US top schools - not surprising I suppose as one of the major points of those sorts of schools is to promote their image and hopefully for them create a self-reinforcing pattern - we are amazing so amazing people want to come here. So they do, and thus it is amazing..... Along in the circle the most important point is the "amazing people". There is not insignificant education research showing if the people of the same caliber end up in other places, they still achieve amazing things, and in fact sometimes going to an ivy league school is a bad idea from a career point of view. 

All Canadian med schools have very high admission requirements, and thus ultimately get high achieving students - as measured and measured constantly by high quality assessments. 

Edited February 5, 2022 by rmorelan

[indefatigable]

1 hour ago, Edict said:

You are completely right, i'm just saying it as a hypothetical, a slippery slope argument. You are free to go to the US right now, but if our medical schools aren't accredited by the LCME, can the US begin to say, well.... now you need a US residency to get a job here, we don't recognize Canadian residencies anymore. As you know, many IMGs have to redo residency in the US to get a job. 

Before 2014, the LCME accredited all north american MD schools, then in 2014, Canada demanded to create CACMS to dual accredit their own schools. Now, they take the next step to do away with LCME altogether. Next, they can bring about their own changes to Canadian medical schools. If they continue to make their own changes, we could eventually end up with a system that the US no longer recognizes.   

From what I can understand, H1B depends on state licensing which at the moment is still "Canadian friendly" - so US MLEs would be sufficient to work in the US as it stands today (providing one had a job offer).

https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/img/licensure-comparison-imgs-usmgs_1.pdf

When this rule goes into effect, any state legislature could potentially revisit the licensing issue - and now with the upcoming non-equivalence of Canadian & US UME could decide to revoke the "Canadian exemption" to IMG licensing rules meaning Canadian physicians would have to complete residency in the US to work there.  For now though, Canadian residencies I think are mostly ACGME equivalent? so not sure if that would happen easily.  

 Given how slowly things move, it could be well-over a decade, and some states would likely act earlier/later, but eventually it could be harder and harder to Canadian physicians to work in the US with only Canadian post-graduate training.  Fellowships would likely still be allowed under J-1.

[zoxy]

11 minutes ago, indefatigable said:

From what I can understand, H1B depends on state licensing which at the moment is still "Canadian friendly" - so US MLEs would be sufficient to work in the US as it stands today (providing one had a job offer).

https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/img/licensure-comparison-imgs-usmgs_1.pdf

When this rule goes into effect, any state legislature could potentially revisit the licensing issue - and now with the upcoming non-equivalence of Canadian & US UME could decide to revoke the "Canadian exemption" to IMG licensing rules meaning Canadian physicians would have to complete residency in the US to work there.   

It used to be like that in many states. Even though Canadian schools were LCME accredited and individual US specialty boards would accept Canadian training, some state boards would still deny a license because the state board itself didn't recognize Canadian training.

It's not hard to reason how an individual state's medical boards could use the lack of LCME accreditation as an excuse to not accept Canadian training. State boards are at their core protectionist institutions.

https://www.cmaj.ca/content/cmaj/158/8/1061.full.pdf

[UWOFTW]

12 hours ago, rmorelan said:

Perhaps not a perfect analogy as you picked two top US schools vs Canadian schools you are grading I suspect as of lower quality than other Canadian ones. 

Exceeding few people relatively speaking are getting training at MGH or Hopkins. How would the average American resident fair against the average Canadian one? I truly don't have any real objective evidence on that either way - if I had to guess probably fairly close

I will say having personally trained medical students a several Canadian schools, vs Harvard there is really no difference I could find in quality. I found that kind of surprising initially but when you look at the admissions data the required GPA and MCAT scores at least it makes sense. We just truly have very high admission requirements.  

True, my analogy might be a stretch but it is to highlight that a resident will experience different exposures depending on where he/she trained.

Also, medical student training does not equal resident training. 

[UWOFTW]

13 hours ago, zoxy said:

The US isn't just Man's Greatest Hospital and Johns "Osler Residency" Hopkins. Manitoba is probably closer to MGH and Hopkins than it is to an IM program in Joplin Missouri or Mason City Iowa. The average MCAT for UofA and Manitoba is 514, the same as Brown, Dartmouth, Ohio State, and Emory.

There are also plenty of DO grads and Caribbean grads doing residency in the US.

Yes, the range of quality in the USA is wider than in Canada for training - but this also means the highs are higher.

[UWOFTW]

13 hours ago, indefatigable said:

FWIW NOSM had 2 Derm matches last year - probably the highest match rate per class size in Canada. 

And I know of a Canadian SGU alumnus internist on the staff at MGH.  

Guess they had to leave NOSM as no dermatology program. 

Also, isn't the mantra at Canadian schools that all matches are equivalent? This anecdote would suggest otherwise.

[carmsregrets]

41 minutes ago, UWOFTW said:

Guess they had to leave NOSM as no dermatology program. 

Also, isn't the mantra at Canadian schools that all matches are equivalent? This anecdote would suggest otherwise.

lol

[Edict]

5 hours ago, UWOFTW said:

Guess they had to leave NOSM as no dermatology program. 

Also, isn't the mantra at Canadian schools that all matches are equivalent? This anecdote would suggest otherwise.

They are all equivalent in the sense that you will get a solid training, but to say they are the same is incorrect. Each school has different pros and cons. 

[Artier]

If you graduated from a Canadian medical school prior to 2026, do you still have to go through ECFMG certification? i.e. as a current resident, will I need to write the USMLEs to do a fellowship in the US in 2026 on a J1 visa?

[bellejolie]

5 hours ago, Artier said:

If you graduated from a Canadian medical school prior to 2026, do you still have to go through ECFMG certification? i.e. as a current resident, will I need to write the USMLEs to do a fellowship in the US in 2026 on a J1 visa?

I would think yes possibly as that’s when the rules will change and the previous certification wont be valid. 

[zoxy]

On 2/5/2022 at 3:44 PM, Artier said:

If you graduated from a Canadian medical school prior to 2026, do you still have to go through ECFMG certification? i.e. as a current resident, will I need to write the USMLEs to do a fellowship in the US in 2026 on a J1 visa?

I disagree with the above poster and I think the answer will be no. An ECFMG certification will not be required in all likelihood for those who graduate before June 30th of 2025. Since Canadian schools are LMCE accredited up to 2025, it would make zero sense to make a 2025 or earlier graduate do an ECFMG certification. How would current accreditation standards be relevant to someone who already graduated? Their medical school was accredited when they were students so I don't see how a change in its current curriculum would impact them. Certification boards are certifying someone's training not the current state of the residency program or school where they were a student or resident.

That's how it works for surgery boards anyway. Older Canadian trained Neurosurgeons and Cardiac Surgeons are board eligible for US boards, even though recent graduates aren't accepted and their training was eons ago. For example, you can see in the 2020 bylaws of the American Board of Neurosurgery that those who started training in Canada before July 16th 1997 are still board eligible in the US. You can find a list of Canadian neurosurgeons who are board certified by the American Board of NSx below but practice in Canada. Many still maintain active certification even though they currently practice in Canada.

https://abns.org/wp-content/uploads/2020/06/Bylaws-Rules-and-Regulations-Code-5_2020-v36.pdf

https://abns.org/find-a-neurosurgeon/

[bellejolie]

18 hours ago, zoxy said:

I disagree with the above poster and I think the answer will be no. An ECFMG certification will not be required in all likelihood for those who graduate before June 30th of 2025. Since Canadian schools are LMCE accredited up to 2025, it would make zero sense to make a 2025 or earlier graduate do an ECFMG certification. How would current accreditation standards be relevant to someone who already graduated? Their medical school was accredited when they were students so I don't see how a change in its current curriculum would impact them. Certification boards are certifying someone's training not the current state of the residency program or school where they were a student or resident.

That's how it works for surgery boards anyway. Older Canadian trained Neurosurgeons and Cardiac Surgeons are board certified by US boards, even though recent graduates aren't accepted. For example, you can see in the 2020 bylaws of the American Board of Neurosurgery that those who started training in Canada before July 16th 1997 are still board eligible in the US. You can find a list of Canadian neurosurgeons who are board certified by the American Board of NSx below but practice in Canada. Many still maintain active certification even though they don't practice in the US.

https://abns.org/wp-content/uploads/2020/06/Bylaws-Rules-and-Regulations-Code-5_2020-v36.pdf

https://abns.org/find-a-neurosurgeon/

your point is well taken, but to be safe, i would still write the usmle's over the next 5 years. whether it will be required or not at the time none of us actually know, and even if theres a 5% chance they will be, I would write. it's unclear how any of this is going to function down the road, and what they'll require and the biggest change that impacts canadians is the examinations so if you have the next 5 years, and aren't sure and it's not clear what you'll need, why wouldn't you write?