Applying to US Residency/Fellowship as CMG

[mayerofcanada]

Hi all,

I've got a few questions.

A few months ago I read somewhere that in 2026, CMGs will be considered IMGs for US Residency Applications and vice versa for Canadian Residency Applications. First of all, is this true? And if so, how will this affect Canadians applying? i.e will it make it harder?

My other main question is: is it worth applying to US residencies as a CMG? I know the Step 1 and Step 2 can be a bit of work, so I'm just wondering if it's already difficult and competitive to match in Canada, is it even worth trying to match competitively in the US?

My last question is regarding fellowships: how difficult is it to get a fellowship in the US as a CMG? Is it difficult to get one at a top institution like Columbia or Stanford, etc.?

 

Thanks!

[Laika]

2 hours ago, mayerofcanada said:

My last question is regarding fellowships: how difficult is it to get a fellowship in the US as a CMG? Is it difficult to get one at a top institution like Columbia or Stanford, etc.?

Likely institution and specialty dependent, but definitely possible.

[zoxy]

5 hours ago, mayerofcanada said:

First of all, is this true?

Yes It's true.

5 hours ago, mayerofcanada said:

And if so, how will this affect Canadians applying?

The sample size of Canadians applying to the US is so small that it's hard to even currently speak of the difficulty of matching, let alone predict what happens for the class of 2026 and later. The extra step of getting ECFMG certification won't make the process any easier but it's not a huge dealbreaker. The US doesn't have USMD and IMG streams like in Canada. Everyone is put into the same stream.

5 hours ago, mayerofcanada said:

is it even worth trying to match competitively in the US?

Depends on the specialty. Some specialties are very competitive or moderately competitive in Canada but much less so in the US. Ophtho, EM, Peds, IM, Psych, and Anaesthesia fall into that category. However Ophtho, EM, Peds, IM, Psych have shorter residency lengths in the US and you'll have to jump through some hoops(extra fellowship, arranging an extra year of residency in Canada) to come back to Canada. I think you can't sit the Royal College exams in Anaesthesia even with an extra fellowship or year of residency if you do your residency on the US but I'm not 100 percent sure about this.

Additionally, as a Canadian applying to the US, you will have to go on a J1 visa as you need all three USMLE Steps to be elligible for an H1B visa. Most good programs won't even bother with H1B even if you have all three Steps anyway. A J1 visa however requires a two year return to your home country when you finish your training.

On the other hand, Ortho, NSx, and CVSx are much less competitive in Canada than the US.

5 hours ago, mayerofcanada said:

My last question is regarding fellowships: how difficult is it to get a fellowship in the US as a CMG? Is it difficult to get one at a top institution like Columbia or Stanford, etc.?

Pretty easy if it's a non-ACGME fellowship that provides no official credentialing. An example would be any non-peds NSx fellowship, any Cardiac surgery super-fellowship such as advanced aortic, minimally invasive, or mechanical circulatory support and transplant for CVSx or spine and oncology fellowships for NSx. In those cases, the fellow is providing attending level care and resident like call coverage for 80,000 a year. The US programs would love to have this cheap labor. Accordingly, with the exception of Ortho, almost everyone gets a job after finishing their required training in the US. If you look at the fellowship roster of top tier US schools for CVSx and NSx, they are disproportionately filled by Canadians. Look at Northwestern's advanced cardiac fellowship as an example.

https://www.surgery.northwestern.edu/education/fellowships/advanced-cardiac/index.html

If however you want an ACGME fellowship that provides explicit credentialing, such as Peds Surg, Thoracic Surgery, Surgical Oncology, Electrophysiology, Interventional Cardiology, or Interventional Radiology, it will be much more competitive as you will be competing with US trainees who require those fellowships for the explicit credentialing those fellowships provide and are required to practice in that discipline. 

[HounsfieldUnit]

12 hours ago, mayerofcanada said:

My last question is regarding fellowships: how difficult is it to get a fellowship in the US as a CMG? Is it difficult to get one at a top institution like Columbia or Stanford, etc.?

I completed medical school and residency in Canada and aimed to enter a US fellowship.  I applied to four and received offers from three, including Stanford.  The application process is no different for CMGs relative to US, but the visa application process can be slow and the credentialing processes at each of the hospital groups can be onerous (especially if you're at one of the largest US medical teaching centres, like I was, with three different hospital groups).  That being said, I'm very happy I completed the US  fellowship, and for many reasons.

[alliteal]

11 hours ago, HounsfieldUnit said:

I completed medical school and residency in Canada and aimed to enter a US fellowship.  I applied to four and received offers from three, including Stanford.  The application process is no different for CMGs relative to US, but the visa application process can be slow and the credentialing processes at each of the hospital groups can be onerous (especially if you're at one of the largest US medical teaching centres, like I was, with three different hospital groups).  That being said, I'm very happy I completed the US  fellowship, and for many reasons.

Do you have to take any additional exams in order to apply for US fellowships as a CMG who has done residency in Canada?

[zoxy]

On 6/24/2022 at 3:06 PM, alliteal said:

Do you have to take any additional exams in order to apply for US fellowships as a CMG who has done residency in Canada?

It varies. It's state dependent, institution dependent, and visa dependent. O1 and J1 visas don't require USMLE whereas an H1B does. The majority of states will accept Canadian exams for getting a medical license but some require the USMLEs, the link with each state's requirements is attached. A J1 visa is relatively straightforward for the institution to sponsor but has a two year home return requirement,  making it the least desirable visa from the perspective of the fellow. Some institutions might not want to sponsor anything other than the straightforward J1 as an H1B or O1 will require lawyers, especially the O1.

 

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

[mayerofcanada]

21 hours ago, zoxy said:

Yes It's true.

The sample size of Canadians applying to the US is so small that it's hard to even currently speak of the difficulty of matching, let alone predict what happens for the class of 2026 and later. The extra step of getting ECFMG certification won't make the process any easier but it's not a huge dealbreaker. The US doesn't have USMD and IMG streams like in Canada. Everyone is put into the same stream.

Depends on the specialty. Some specialties are very competitive or moderately competitive in Canada but much less so in the US. Ophtho, EM, Peds, IM, Psych, and Anaesthesia fall into that category. However Ophtho, EM, Peds, IM, Psych have shorter residency lengths in the US and you'll have to jump through some hoops(extra fellowship, arranging an extra year of residency in Canada) to come back to Canada. I think you can't sit the Royal College exams in Anaesthesia even with an extra fellowship or year of residency if you do your residency on the US but I'm not 100 percent sure about this.

Additionally, as a Canadian applying to the US, you will have to go on a J1 visa as you need all three USMLE Steps to be elligible for an H1B visa. Most good programs won't even bother with H1B even if you have all three Steps anyway. A J1 visa however requires a two year return to your home country when you finish your training.

On the other hand, Ortho, NSx, and CVSx are much less competitive in Canada than the US.

Pretty easy if it's a non-ACGME fellowship that provides no official credentialing. An example would be any non-peds NSx fellowship, any Cardiac surgery super-fellowship such as advanced aortic, minimally invasive, or mechanical circulatory support and transplant for CVSx or spine and oncology fellowships for NSx. In those cases, the fellow is providing attending level care and resident like call coverage for 80,000 a year. The US programs would love to have this cheap labor. Accordingly, with the exception of Ortho, almost everyone gets a job after finishing their required training in the US. If you look at the fellowship roster of top tier US schools for CVSx and NSx, they are disproportionately filled by Canadians. Look at Northwestern's advanced cardiac fellowship as an example.

https://www.surgery.northwestern.edu/education/fellowships/advanced-cardiac/index.html

If however you want an ACGME fellowship that provides explicit credentialing, such as Peds Surg, Thoracic Surgery, Surgical Oncology, Electrophysiology, Interventional Cardiology, or Interventional Radiology, it will be much more competitive as you will be competing with US trainees who require those fellowships for the explicit credentialing those fellowships provide and are required to practice in that discipline. 

Thanks for the reply, this is super helpful.

Do you know if there's data out there that show match statistics for Canadian MD students matching into US residencies?

Also is it true that if you do end up applying to the US for residency that it can dilute your chances for both CaRMs and ERAS if you plan on applying and being competitive for both?

[zoxy]

59 minutes ago, mayerofcanada said:

Do you know if there's data out there that show match statistics for Canadian MD students matching into US residencies?

Yeah, from the NRMP data itself, knock yourself out. Canadians are listed in the "Other" category for the NRMP match data along with "Fifth Pathway" grads. Since the fifth pathways has been been disbanded for over a decade, all the applicants and matches in the "Other" category are Canadians. Here are the links for the 2022 data. You can find older match lists if you want and in older data tables Canadians are actually listed as Canadians. Two Canadians matched to Derm in 2018, and one matched to Derm in 2020. 

https://www.nrmp.org/wp-content/uploads/2022/06/2022-Match-Results-by-State-Specialty-and-Applicant-Type-1.pdf

https://www.nrmp.org/wp-content/uploads/2022/05/2022-Main-Match-Results-and-Data_Final.pdf

59 minutes ago, mayerofcanada said:

Also is it true that if you do end up applying to the US for residency that it can dilute your chances for both CaRMs and ERAS if you plan on applying and being competitive for both?

I doubt it. But again, the sample size is so small that it's hard to say. My understanding is that Canadian programs won't know that you applied to the US unless you're dumb enough to tell them. CaRMS, your school, and your references will know but not sure how that much that could hurt you. But remember that if you participate in both CaRMS and NRMP or the SF Match, whichever matching service runs first will be the binding one and you'll be withdrawn from the second match if you match to a program in the earlier match. Details in the link below.

https://www.carms.ca/the-match/application-to-the-us-eras/

[Edict]

On 6/23/2022 at 4:38 PM, mayerofcanada said:

Hi all,

I've got a few questions.

A few months ago I read somewhere that in 2026, CMGs will be considered IMGs for US Residency Applications and vice versa for Canadian Residency Applications. First of all, is this true? And if so, how will this affect Canadians applying? i.e will it make it harder?

My other main question is: is it worth applying to US residencies as a CMG? I know the Step 1 and Step 2 can be a bit of work, so I'm just wondering if it's already difficult and competitive to match in Canada, is it even worth trying to match competitively in the US?

My last question is regarding fellowships: how difficult is it to get a fellowship in the US as a CMG? Is it difficult to get one at a top institution like Columbia or Stanford, etc.?

 

Thanks!

People do match to the US from Canada as long as the Canadian match happens after, which allows you to back up. Is it worth it? That's up to you, do residency where you want to practice full stop. If you want to work as a physician in the US, do residency there. 

Fellowship's vary, some fellowship's are competitive, others are not. It really depends and top institutions aren't necessarily that much more competitive. Remember that for most of us Canadian medical students, we are well trained and can often go toe to toe with the best and brightest in the US. So, these fellowships are a way to get extra training, a foot in the door for US jobs and a prestige boost for those looking towards Canadian jobs. 

Don't forget that other than a J-1 and H1-B, there is also an O-1 visa, which you can get if you are well published/above the average for your field. The O-1 visa also allows you to stay in the US like the H1-B. 

 

 

[HounsfieldUnit]

9 hours ago, alliteal said:

Do you have to take any additional exams in order to apply for US fellowships as a CMG who has done residency in Canada?

I applied to fellowships in California, Tennessee and Massachusetts and none of those states/programs required any additional exams, i.e., they all accepted Canadian credentials.  (BTW, word within many US programs is that the Canadian board exams are far more difficult than the US, which may be part of the reason.)  My fellowship only offered the J-1 visa, which was ideal as my spouse came with me, so they were also offered the equivalent visa so they could work in the US if they wished.  (This is not the case  with the H1-B.)

[alliteal]

15 hours ago, HounsfieldUnit said:

I applied to fellowships in California, Tennessee and Massachusetts and none of those states/programs required any additional exams, i.e., they all accepted Canadian credentials.  (BTW, word within many US programs is that the Canadian board exams are far more difficult than the US, which may be part of the reason.)  My fellowship only offered the J-1 visa, which was ideal as my spouse came with me, so they were also offered the equivalent visa so they could work in the US if they wished.  (This is not the case  with the H1-B.)

Thanks for your detailed response! Very helpful info to have.

[Jack Marcos]

On 6/24/2022 at 3:42 AM, HounsfieldUnit said:

I completed medical school and residency in Canada and aimed to enter a US fellowship.  I applied to four and received offers from three, including Stanford.  The application process is no different for CMGs relative to US, but the visa application process can be slow and the credentialing processes at each of the hospital groups can be onerous (especially if you're at one of the largest US medical teaching centres, like I was, with three different hospital groups).  That being said, I'm very happy I completed the US  fellowship, and for many reasons.

Did you write all of your USMLEs/steps?

1) do you need to complete them to do a fellowship in the USA?

2) do you need them to practice in the USA after fellowship? 
 

thanks!

[HounsfieldUnit]

6 hours ago, Jack Marcos said:

Did you write all of your USMLEs/steps?

1) do you need to complete them to do a fellowship in the USA?

2) do you need them to practice in the USA after fellowship? 
 

thanks!

I did not write the USMLEs, so did not require them to complete a US fellowship.  The MCCQEs were all that was required.

The USMLEs are not necessarily required to practice in the US, but it depends on the situation, i.e., if you need a visa to practice, and if so, the type of visa.

[Nogah7]

On 6/27/2022 at 3:29 AM, HounsfieldUnit said:

I did not write the USMLEs, so did not require them to complete a US fellowship.  The MCCQEs were all that was required.

The USMLEs are not necessarily required to practice in the US, but it depends on the situation, i.e., if you need a visa to practice, and if so, the type of visa.

In situation where one is Canadian citizen, fully trained in Canada, obtained a US medical license, not 'renowned' for O visa, and told needs H-1B: it seems here the only option is to do the USMLE according to some old rule established back when the 'FLEX' exam existed. How can one determine which step of USMLE is needed in a case like this? USCIS general line apparently has no human reps able to direct one to the relevant official to clarify. 

[zoxy]

6 hours ago, Nogah7 said:

How can one determine which step of USMLE is needed in a case like this?

By reading things, including my comment in this thread saying you "need all three USMLE Steps to be eligible for an H1B visa", or other sources internet. If you want other sources, I've attached links.

If you're graduating after 2025, you will need Steps 1 and 2 for your ECFMG certificate anyway. You need an ECFMG certificate for a J1 residency and state licensing purposes if your an IMG, essentially making Step1 and Step2 mandatory for doing US fellowships for future Canadian graduates. Canadian graduates who graduate in 2025 or earlier don't need ECFMG certificates for medical licensing or J1 visa, as Canadians were previously seen as USMDs. Accordingly it was possible NOT to take Step 1 and Step 2 and go to the US for a fellowship on a J1.

I honestly don't know how to be any clearer.

H1B requirements from different universities and programs:

https://ap.washington.edu/ahr/visas/admin-resources/h1b/h1b-eligibility/medical-graduates/

https://pathology.uchicago.edu/education/residency-applications

https://residency.dom.pitt.edu/visa-guidelines/

Requirements for a J1 as an IMG from the AMA:

https://www.ama-assn.org/education/international-medical-education/immigration-information-international-medical-graduates

ECFMG requirements which include Step 1 and Step 2.

https://www.ecfmg.org/2022ib/certification-requirements.html

[HounsfieldUnit]

2 hours ago, zoxy said:

9 hours ago, Nogah7 said:

In situation where one is Canadian citizen, fully trained in Canada, obtained a US medical license, not 'renowned' for O visa, and told needs H-1B: it seems here the only option is to do the USMLE according to some old rule established back when the 'FLEX' exam existed. How can one determine which step of USMLE is needed in a case like this? USCIS general line apparently has no human reps able to direct one to the relevant official to clarify. 

If you're graduating after 2025, you will need Steps 1 and 2 for your ECFMG certificate anyway. You need an ECFMG certificate for a J1 residency and state licensing purposes if your an IMG, essentially making Step1 and Step2 mandatory for doing US fellowships for future Canadian graduates. Canadian graduates who graduate in 2025 or earlier don't need ECFMG certificates for medical licensing or J1 visa, as Canadians were previously seen as USMDs. Accordingly it was possible NOT to take Step 1 and Step 2 and go to the US for a fellowship on a J1.

I recently completed a US fellowship on a J-1 visa.  Just to be clear, Canadian medical school graduates (who have completed the MCCQEs) are considered akin to US  medical school graduates, and not IMGs.  We still must apply through the ECFMG to obtain the J-1 visa, but in order to do so, other documentation must be obtained including, but not limited to: a state medical license, I-94 form, and a statement of need.  The entire process can take many months.  (I began the entire process over a year before beginning fellowship and my J-1 visa arrived around June 21, i.e., nine days before fellowship commenced.)  I also know someone who had secured a US fellowship, but couldn't end up going as their visa did not emerge in time.  They ended up scrambling, last minute, to find a Canadian fellowship spot.  The extra documentation doesn't end with fellowship, either.  If you're planning to return to practice in Canada, most provincial licensing bodies require multiple documents about your licensing status, etc., in the US, in order to obtain a provincial license.  All to say that, completing a cross-border fellowship (and/or residency) ideally requires the need for a good admin assistant!

[zoxy]

20 hours ago, HounsfieldUnit said:

Just to be clear, Canadian medical school graduates (who have completed the MCCQEs) are considered akin to US  medical school graduates, and not IMGs.  We still must apply through the ECFMG to obtain the J-1 visa, but in order to do so, other documentation must be obtained including, but not limited to: a state medical license, I-94 form, and a statement of need

That's what I meant. Currently Canadian medical graduates are equivalent to USMD and don't need the Steps to get ECFMG status for their J1. The class of 2025 will be the last Canadian grads to count as equivalent to USMDs.

My understanding is that the class of 2026 and onwards will be IMGs for the US, which means that they will require Step1 and Step2 for ECFMG status. Without the ECFMG status, you can't get a J1.

[The John]

On 7/2/2022 at 11:58 PM, zoxy said:

That's what I meant. Currently Canadian medical graduates are equivalent to USMD and don't need the Steps to get ECFMG status for their J1. The class of 2025 will be the last Canadian grads to count as equivalent to USMDs.

My understanding is that the class of 2026 and onwards will be IMGs for the US, which means that they will require Step1 and Step2 for ECFMG status. Without the ECFMG status, you can't get a J1.

Thanks guys for the amazing thread. I’m an IMG doing residency in Canada. As I understand, I need USMLE 1&2 to get the ECFMG certificate. To get into an ACMGE accredited fellowship, do I need to do step 3?

 

[Edict]

On 7/6/2022 at 8:27 AM, The John said:

Thanks guys for the amazing thread. I’m an IMG doing residency in Canada. As I understand, I need USMLE 1&2 to get the ECFMG certificate. To get into an ACMGE accredited fellowship, do I need to do step 3?

 

Don't quote me, but i'd imagine that for a H1B visa you would need step 3 but if you are going on a J1 and if all they require is a ECFMG cert, then you wouldn't need the step 3. However, if you want the US state license you would also have to meet requirements for the state license whatever that may be. All that is to say, if you are going to be doing a fellowship in the US, I would strongly recommend you complete the Step 3 anyways, because it'll likely open up more doors for you even if there is a way to get into a specific US fellowship without it. 

[plantlover33]

Hey - follow up Q:

I am a Canadian medical grad in a surgical subspecialty and I have dual citizenship (Canada and USA). If I don't need a Visa, is there any reason why I need to write the Steps? Or would it be just to get fellowship in certain states (but not California, NY...etc from the list above)?

Thanks!

[bearded frog]

9 hours ago, plantlover33 said:

Hey - follow up Q:

I am a Canadian medical grad in a surgical subspecialty and I have dual citizenship (Canada and USA). If I don't need a Visa, is there any reason why I need to write the Steps? Or would it be just to get fellowship in certain states (but not California, NY...etc from the list above)?

Thanks!

Some programs require you to have passed the step exams. Not sure if you would need them if you ever wanted to be US boarded (maybe the RC is enough?)