Internal Med Training in USA versus Ontario

[HarrryMaguire]

I'm an IMG hoping to practice GIM in/near the GTA: Primarily outpatient but some locum ER consult shifts too. I was considering the pros/cons of training in an ACGME Internal Medicine program versus an Ontario Internal Medicine program.

USA training:

• 3 years of GIM training (can get equivalency to a 4-year Ontario program through CPSO's Pathway A)
• No return of service  
• 12-18 months of (light) supervision by CPSO-approved physician – might be hard to find one (?)

 

Ontario training:

• 4 years of GIM training 
• 5-year return of service outside of GTA (severely limits job opportunities per HFO-Jobs website) 

 

Is my understanding correct? Would it not be easier and faster to find work after training in the States versus training in Ontario?

[bearded frog]

Your millage will vary with US residencies. There are good ones and there are bad ones. That being said if you are compeditive for Ontario IMG spots you likely would match to a good program in the US, as long as they don't reject all visa applicants.

I can't speak to GIM specifically, but consider as well the potential limitations of the US pathway/degree depending on where you want to work. Canada has the 5 year GIM program which is already causing a bit of divide between the 4/5 year programs, and an even shorter US pathway may look less appealing for compeditive jobs, without X number of practice years. However if you are not interested in academic medicine at the primary U of T affiliated tertiary care centres than this might not matter.

The other advantage of doing Canadian training is networking. Even doing training in a different province puts you at a disadvantage for compeditive jobs vs those who trained in that province, just based on if the people know you or not. Now the supervision requirement means you would have to do some networking however a supervised position is likely not going to be compeditive. Again I will leave it up to people more familiar with GIM in Ontario to talk how easy it would be to find a supervised position in the GTA.

[Edict]

I thought even places near Ottawa and hospitals like Richmond Hill were considered "return of service", not sure if that has changed. I also thought the other loophole was that if an academic site wanted you, they could justify taking you by saying you can't do this kind of work outside of RoS sites. 

 

http://www.healthforceontario.ca/UserFiles/file/PracticeOntario/ROS Exclusions in Ontario Map 2017_En.pdf

[HarrryMaguire]

Thank you both for your inputs! 

[HarrryMaguire]

Not sure if anybody would know this but...

If I end up in an US-ACGME Internal Medicine residency: Can I sit the Royal College exams and obtain an independent, unrestricted license after the CPSO's required 12-18 months of supervised practice (as outlined in CPSO's Pathway A)?

 

[ACHQ]

On 1/13/2023 at 2:06 PM, HarrryMaguire said:

Not sure if anybody would know this but...

If I end up in an US-ACGME Internal Medicine residency: Can I sit the Royal College exams and obtain an independent, unrestricted license after the CPSO's required 12-18 months of supervised practice (as outlined in CPSO's Pathway A)?

 

You have to meet the Royal college training requirements to sit and write the exam. If you do they shouldn't be anything to hold you back.

[futureGP]

Finding a supervisor may be challenging unless you have connections.

 

I would probably do 4 year GIM in Ontario. You could run a ‘RoS contract’ in places close to but outside of Toronto (RHill, Newmarket, Barrie, Milton etc). Could probably still live in the city and commute while you do that contract and most likely also locum at closer hospitals (as there is no limit to locuming) with plan to switch if you want.

 

the intensity of US IM training also does not compare with IM training in Canada as US IM is mostly primary care whereas canada IM is primarily consultative/hospital work.

 

you need to realize that most GIMs in the GTA do not practise pure outpatient in a private clinic.
Most GIM practice is hospitalist work + ED/IP consults and hospital-based urgent medicine clinic.