Switching from "No match" or PGY-1 in FM to the US (for a competitive residency)

[Flower]

Hello, 

Even if I am a positive person and optimistic about what the future holds for me. (My CV is much better this year, ++research,  ++implications for the speciality I am applying to), I was wondering if I don't get in the speciality I want this year, would it be better to go unmatched a second time (unmatched in 2022, cause only applied to the speciality I wanted - and I discovered it pretty late in my clinical rotations) and try for a third time in Canada and US, or would it be better to get in FM this year and then apply to the US (or in another country, I wouldn't mind) the year after. I don't have a lot of experience with US applications and if if would be easier for me to get in since they have more schools that offers it. 

Keep in mind, I am really looking at the worst possible scenario here, I do think my chances are better getting in this year, but having been unmatched once, I want to get prepared. 

I am passionate about this speciality and I know this is my dream.

Thank you so much

 

[bearded frog]

It would be helpful to know what you're gunning for to give you better advice on competitiveness in Canada vs US, but basically you NEED to back up this year. If you don't get into your preferred specialty this year it's not going to happen next year or ever, in the US OR Canada. Year of graduation is a huge red flag. You can overcome one unmatched year if you were borderline the first time around and improve your app like you say you did, it's possible to get it in, but you should be also applying FM or something else less compeditive with a solid effort because your options severely dwindle on the third attempt. And US schools don't look at it any better. And for the US you have to write the USMLEs if you haven't already, and with two unmatched years you would be looking at whatever you can get in the US - likely FM too, so no point. And there isn't any other country you can do residency in and practice directly in the US/Canada.

You can always try and transfer one you match FM, although if you didn't get in the first 2 times it's unlikely they would take you after. Alternatively you can keep applying for 2nd round CaRMS spots but if it's a compeditive specialty it's unlikely there will be many spots, if any, and you'd be competing against a wide field.

Long story short: Apply to your preferred specialty but also to a back-up less compeditive specialty like FM. Hopefully you have actually done some FM electives/references so you're not just obviously backing up and have a chance at matching. I am hopeful that you match to your preferred specialty, but if not, honestly that's the end of the road for that, and you have to take what you can get. You can certainly look for alternative pathways in after that, but you NEED to match somewhere, and realistically your chances of then transferring, 2nd rounding carms, or being accepted to the US once already in residency with YOG 2 years back, is slim to none.

[blah1234]

Without a completed residency the value of your medical training is limited and your future prospects will be limited in many ways. A completed residency allows you to buy time to repay educational debt, work in the clinical world, open doors into medical adjacent fields (e.g., admin, government), as well as access residency re-entry programs. Even if you don't end up practising in your specialty of choice down the line it is not the end of the world. Although it may be hard to accept at times given how much you have sacrificed for medicine thus far, there is a lot in the process that is out of your control and down to luck. My candid advice is to ensure you finish some sort of training so you have the ability to practice medicine of some sort. Even if don't end up practising medicine long-term you'll have more doors opened for other opportunities. I know of individuals that instead pursued alternative paths outside of medicine but those paths are more uncertain and less straightforward. Matching to something is the clear priority this time around in my opinion.

[Flower]

Hello thank you for the advice. Just to be more precise, I have been unmatched x1 (not x2, so I graduated in 2022) because I didn't apply to FM, only in the speciality that I wanted. I know people who went unmatched 2 years before getting in the field I am applying to.. I did back up with FM this year, however I heard that you could apply to the US after doing one year of residency in FM for example. 

[bearded frog]

22 hours ago, Flower said:

Hello thank you for the advice. Just to be more precise, I have been unmatched x1 (not x2, so I graduated in 2022) because I didn't apply to FM, only in the speciality that I wanted.

I understood this, my advice is based on one unmatched year.

22 hours ago, Flower said:

I know people who went unmatched 2 years before getting in the field I am applying to.

It happens but it's extremely rare and is certainly the exception and not the rule.

22 hours ago, Flower said:

I did back up with FM this year, however I heard that you could apply to the US after doing one year of residency in FM for example. 

I'm glad you are backing up. You can apply to the US at any time but applying after starting residency in Canada and delayed YOG is a huge red flag, and you're going to have to spend a bunch of time writing the USMLEs and you're going to run into whatever problems you had applying the firs time around. So you could potentially match to non-competitive US programs like FM, but competitive ones are unlikely.

It's great you've worked on your app and are applying again... but if its a no x2 attempts it's not going to be a no on the 3rd attempt. I'm sorry. Specialties that are compeditive in Canada are usually also in the US. To apply to the US you're going to have to do all the USMLEs and with a YOG of 2022 applying in 2024 they're going to wonder why you didn't match the first time around, so you're not going to get more love there. And there is not usually 2nd round Carms spots for most compeditive specialties.

If you were a good applicant before and just were unlikely that you were just under the match cut offs and now you're a great applicant, then you'll probably have good success this year, so don't sweat it. You are correct that lots of people get into compeditive specialties on their second go-around. However, if you still don't match even after doing a masters and research, then nothing's going to change that equation unfortunately. Hence the recommendation to also apply to a less compeditive specialty, like FM.