Writing the USMLEs if I go unmatched?

[penicillin]

Applied to CaRMS this year to a very competitive specialty. Did not back up with anything else. 

Due to the competitive nature of CaRMS, I am just preparing myself in case I do not match. My plan would be to write the Step 1 and 2 before September so I can meet the ERAS deadline. Then I would apply to both the US and Canada for my preferred specialty + backup.

Does this seem like a reasonable plan? Anyone else planning on this approach? Or should I just find something in the 2nd round?

[Bluberblubo]

In theory it's a good approach but in practice is doesn't always work out. You can write the USMLE and apply to Canada and the USA but if you do decide that you also agree that if you match in one country that you will be removed from the match in the other. I might be wrong but I believe the USA equivalent of carms has their match earlier than Canada. If that's true then you have to decide, would you rather go unmatched again or potentially match to the USA when you might've matched in Canada that cycle.

 

Whatever you decide, good luck! 

[indefatigable]

This is a relatively common question and has discussed multiple times on the forum which you can easily find by searching.

However, I think the question is really whether to reapply to CaRMS next year in the first round if you are unmatched this year.       

Even if you spent months prepping the MLEs, I don't think it's feasible to have a competitive application to the US and that time on the MLEs wouldn't help your Canadian competitiveness for another application round at all.  Most disciplines are even more competitive in the US (although there are some notable exceptions like EM).

Making the decision to reapply to the first round comes down to how close you were (i.e. multiple interviews?), whether there is something you can do to "beef up" your application (e.g. research or MSc..), your risk tolerance, the discipline, your acceptability of other disciplines...  You can search the threads for other opinions.

If you're not driven to improve your application and don't think you have a good chance, then it's probably better to take your chances in the second round.    

[bearded frog]

11 minutes ago, indefatigable said:

This is a relatively common question and has discussed multiple times on the forum which you can easily find by searching.

However, I think the question is really whether to reapply to CaRMS next year in the first round if you are unmatched this year.       

Even if you spent months prepping the MLEs, I don't think it's feasible to have a competitive application to the US and that time on the MLEs wouldn't help your Canadian competitiveness for another application round at all.  Most disciplines are even more competitive in the US (although there are some notable exceptions like EM).

Making the decision to reapply to the first round comes down to how close you were (i.e. multiple interviews?), whether there is something you can do to "beef up" your application (e.g. research or MSc..), your risk tolerance, the discipline, your acceptability of other disciplines...  You can search the threads for other opinions.

If you're not driven to improve your application and don't think you have a good chance, then it's probably better to take your chances in the second round.    

This. Also specialty dependant, there are some that are relatively less compeditive in US vs Canada.

[Findanus]

regardless of what anyone does it is always a good idea to have the USMLE exams

[shikimate]

If your specialty is equally competitive in the US (Eg. plastic, derm, ophtho), then unless you have an amazing score, probably wouldn't be any easier matching there. And if your score is average or below, then you can forget about matching to competitive things in US. If you are backing up with FM/IM/path/peds and stuff like that in the US, then it's a totally different story.

[bearded frog]

On 3/5/2023 at 11:00 AM, Findanus said:

regardless of what anyone does it is always a good idea to have the USMLE exams

Disagree. Although scores for step 1 have gone by the wayside, it is a non-negligible investment of time and money to pass the exam and achieve a compeditive step 2 score, and IMHO is only helpful in limited scenarios, as suggested above.

[canada747]

On 3/5/2023 at 1:11 PM, indefatigable said:

This is a relatively common question and has discussed multiple times on the forum which you can easily find by searching.

However, I think the question is really whether to reapply to CaRMS next year in the first round if you are unmatched this year.       

Even if you spent months prepping the MLEs, I don't think it's feasible to have a competitive application to the US and that time on the MLEs wouldn't help your Canadian competitiveness for another application round at all.  Most disciplines are even more competitive in the US (although there are some notable exceptions like EM).

Making the decision to reapply to the first round comes down to how close you were (i.e. multiple interviews?), whether there is something you can do to "beef up" your application (e.g. research or MSc..), your risk tolerance, the discipline, your acceptability of other disciplines...  You can search the threads for other opinions.

If you're not driven to improve your application and don't think you have a good chance, then it's probably better to take your chances in the second round.    

These are the real questions. Also recognize whether the US match comes before the CaRMS match - if so, then the US match will not be a backup. Not all specialties use ERAS. Ophtho (a notoriously difficult program to match to in the past few years) also uses a different match called SFMatch, making the timelines different and important to know.

[Findanus]

5 hours ago, bearded frog said:

Disagree. Although scores for step 1 have gone by the wayside, it is a non-negligible investment of time and money to pass the exam and achieve a compeditive step 2 score, and IMHO is only helpful in limited scenarios, as suggested above.

I think the upside of learning the medical concepts of the USMLEs is reason enough to take them.

It's a lot harder to take the exams in residency or afterwards, and you never know when or if you might need them, so its best to get them done during medical school.

Sure it's non negligible but what worth doing isn't?

The fact is that having more options in your pocket is always advantageous, and by having the ability to jump borders if things go sour here, and that's not just for the match but for independent practice as well, your bargaining power is strengthened.

[bearded frog]

17 hours ago, Findanus said:

I think the upside of learning the medical concepts of the USMLEs is reason enough to take them.

Really? The USMLE medical concepts are notoriously unhelpful for the practice of medicine. American medical school teaches to the USMLE exams for the first two years, then you start learning the actual practice of medicine. Canadian medical schools are much more practical in this regard, as their pre-clerkship can be much more clinical-relevant and not have to worry about teaching the esoteric pathology that is tested on the USMLE (at least step 1).

17 hours ago, Findanus said:

The fact is that having more options in your pocket is always advantageous, and by having the ability to jump borders if things go sour here, and that's not just for the match but for independent practice as well, your bargaining power is strengthened.

I guarantee that unless you are in academic research with the power to get grants, no health authority or hospital system in Canada is going to care if you have the opportunity to go to the US. And realistically, if you were in a position where you could be headhunted by the US, they would find a way around you not having the USMLEs.

[Findanus]

32 minutes ago, bearded frog said:

Really? The USMLE medical concepts are notoriously unhelpful for the practice of medicine. American medical school teaches to the USMLE exams for the first two years, then you start learning the actual practice of medicine. Canadian medical schools are much more practical in this regard, as their pre-clerkship can be much more clinical-relevant and not have to worry about teaching the esoteric pathology that is tested on the USMLE (at least step 1).

I guarantee that unless you are in academic research with the power to get grants, no health authority or hospital system in Canada is going to care if you have the opportunity to go to the US. And realistically, if you were in a position where you could be headhunted by the US, they would find a way around you not having the USMLEs.

I disagree regarding the USMLEs. I found them profoundly useful in solidifying concepts. The theoretical is the foundation for the practical.

Your arguments are not compelling as to why one should not have the USMLEs completed. If more Canadian students/doctors have the USMLEs, the ease of crossing borders into any state increases their options and thereby their collective power. It is not about whether a health authority wants to keep you there or not, it's about the freedom to walk away from a bad deal into a better one. On an individual basis, again, it gives practitioners freedom to practice in any state, regardless of whether one is 'headhunted'. For students, it provides another chance at matching if one is applying to a competitive field, and a leg up in finding a fellowship later on if desired.

I cannot see any reason why any Canadian physician or potential one should not have the USMLEs in their back pocket. It's not that expensive, it's difficult but like I said anything worth having is difficult to get, and the time invested in it is in the grand scheme very minimal, particularly now that step1 has regrettably become P/F.

[IMislove]

2 hours ago, Findanus said:

It's not that expensive

Lol tells me all I need to know. 

[shikimate]

the price of licensing exams only go up over time, so the sooner you pass it you could save a few bucks.

[IMislove]

45 minutes ago, shikimate said:

the price of licensing exams only go up over time, so the sooner you pass it you could save a few bucks.

Cool, doesn’t change the original point. 

[ChemPetE]

18 hours ago, Findanus said:

I disagree regarding the USMLEs. I found them profoundly useful in solidifying concepts. The theoretical is the foundation for the practical.

Your arguments are not compelling as to why one should not have the USMLEs completed. If more Canadian students/doctors have the USMLEs, the ease of crossing borders into any state increases their options and thereby their collective power. It is not about whether a health authority wants to keep you there or not, it's about the freedom to walk away from a bad deal into a better one. On an individual basis, again, it gives practitioners freedom to practice in any state, regardless of whether one is 'headhunted'. For students, it provides another chance at matching if one is applying to a competitive field, and a leg up in finding a fellowship later on if desired.

I cannot see any reason why any Canadian physician or potential one should not have the USMLEs in their back pocket. It's not that expensive, it's difficult but like I said anything worth having is difficult to get, and the time invested in it is in the grand scheme very minimal, particularly now that step1 has regrettably become P/F.

I agree with much of this. With the exception that for Canadian students who don’t explicitly study/cover as much Step 1 material as our US colleagues, pass/fail probably is in our favor. Step 2 is much more in keeping with our training.

Speculation: in a few years, when Canadian med student grads will no longer be LCME accredited, in addition to societal economic and demographic factors, we will see more downward pressure on Canadian physician workplace environment and salaries (if not in frank private practice). That USMLE is going to be looking good then, and will be out of reach for the future generation sadly.

I already have one colleague in practice only a few years, got their most-coveted specialist job in their choice location. They’re unhappy with our current group practice, and only now looking for US certification before their board eligibility expires. They’ve since resigned from practice in Canada. Even if you never intend to practice in the US, it really does open up options. You never know how things might turn out. An escape hatch is invaluable, even if you never have to use it.

[mdapp]

Canadian who has taken the USMLE (and did well enough) here.

I think it's generally a good idea as a medical student to take them if you have the time/money, especially with how limited opportunities are in Canada and its unpredictability.

USMLE is challenging but don't be discouraged. Many US schools do not even tailor their curriculum to USMLE content, not to mention IMGs at International schools certainly do not benefit from exam-related curriculum. Canadian med students are smart and hardworking (at least as pre-meds), and can certainly do well if they put in the same sacrifices (i.e. take a summer off to study instead of traveling, spend 1-2 hrs a day after microbio lectures to watch sketchy micro) during the pre-clerkship years. Of course, this is a general observation, I'm sure a good number of students also occupy themselves with equally productive commitments during pre-clerkship years such as researching in opthal labs or networking with derm, and do not actually have the luxury of time.

Taking the exam as a resident is a different story tho and I can make a good argument for taking and not taking them... but goal is to take them while you're a student like how most USMD/DO/IMGs do in the first place anyway