AMA - Canadian Citizen in a US GIM residency

[usatocanada]

Got a few inboxes from med students who are considering a US residency, so I thought I'd host an AMA.

Answers to most common questions I got :

Undergrad - In Ontario
GPA - 3.70
MCAT - 512
Research in Undergrad - 1 year in a research lab without any publications (I got played by the professor who made me do all the work and fired me as we approached publication).

Med school - Caribbean Big 4 (AUC/SGA/SABA/Ross - don't go anywhere else because they are NOT fully accredited and will ruin your odds of matching)
Residency - GIM
How many attempts to get residency - First try
Visa status - J1 in USA, Canadian citizen, no other passports
USMLE Step1/2 CK/3 - 242/245/251
Research in medschool - 4 case reports published,  (surprisingly, they also get read!)
Current year - PGY2
Future plans - Likely will not do fellowship, considering practicing in Canada vs USA at this time

[mohammad]

How do you feel about the stigma that IMGs face of being trained in Caribbean, Australia, Ireland? Do you find the stigma varies depending on which country?

[usatocanada]

43 minutes ago, mohammad said:

How do you feel about the stigma that IMGs face of being trained in Caribbean, Australia, Ireland? Do you find the stigma varies depending on which country?

In practice, I have not once felt any stigma. 

From the patient's standpoint, they see M.D. and that's it. There have been a few instances where I noticed D.O physicians be questioned on if they're a physician or a NP, but that's about it. No one ever asks where my medical school was.

From ancillary staff/mid level perspective, they don't know the difference. The 20+ year experienced ICU nurse only notices whether a doctor is a good one or a bad one.

From a physician colleague perspective, there is some stigma in academia. The big hotshot academic physicians at Harvard, MassGen, MD Anderson, and etc. may bat an eye to the medical school, but either 2 things happen - they respect you because you are a highly competent physician or they don't because you are average joe-schmoe. We had one IMG general surgeon who matched at MD Anderson for colorectal surgery fellowship.

In private practice/employed practice, nobody cares. You may have that one neurosurgeon who thinks he's God's God, but that's not exclusive to IMGs, that's just them in general. Hence why they're paying alimony to 3 wives (true example from a trauma surgeon who was very proud that he was divorced 3 times and drank expensive daily).

From a resident-to-resident perspective, we have a mix of US AMGs, US IMGs, and non-US IMGs. We don't usually butt heads regarding this, because in the US, your intelligence as a doctor is deemed by "what was your step1 score" (not step 2CK, and definitely not step3). USMLE Step 1 was the gauge to determine how competent you are, and that exam has NOTHING to do with medical school and all to do with the individual and their training.

The only stigma we do face is actually related to the match process during residency and fellowship.
Many programs will dump your application seeing it is IMG or non-US Citizen IMG. 
Others will accept, but it will be a subpar program, however, as the motto goes "to match somewhere is better than to match nowhere".

USA has more opportunities to match, so many IMGs will accept subpar programs in IM/FM. However, USA does hold it's meritocracy and step scores can really make or break your case. I was fortunate to have good scores and matched into a university program. What made it difficult for me was my visa status. That actually mattered more than my medical school. 
My friend with a 197 on step1 (passing is 196) matched into a decent university program in Arizona with 23 other interviews (he's a US citizen), and I only had 10 with a step1 of 242. Many programs I called that were outside the North East (think states close to Canada's proximity), such as Texas/Florida, flat-out said "NO NON-US CITIZENS".

As for Fellowship, it revolves around your residency training program and visa status. If your program has a fellowship, you will likely match into it. If it doesn't and you have to match out, they will take into consideration in the following order: 1) Location of residency training (university vs community hospital), 2) visa status, 3) research, 4) USMLE Step scores (particularly step1), and MAYBE 5) medical school location.

 

[cardio_enjoyer]

Just out of curiosity (purely hypothetical question - thank you for hosting this btw), is it possible to do 3 years of core IM in Canada then match to US for a subspecialty fellowship? Would that still require writing the step exams?

[mohammad]

reposted with reply

[mohammad]

18 hours ago, usatocanada said:

In practice, I have not once felt any stigma. 

From the patient's standpoint, they see M.D. and that's it. There have been a few instances where I noticed D.O physicians be questioned on if they're a physician or a NP, but that's about it. No one ever asks where my medical school was.

From ancillary staff/mid level perspective, they don't know the difference. The 20+ year experienced ICU nurse only notices whether a doctor is a good one or a bad one.

From a physician colleague perspective, there is some stigma in academia. The big hotshot academic physicians at Harvard, MassGen, MD Anderson, and etc. may bat an eye to the medical school, but either 2 things happen - they respect you because you are a highly competent physician or they don't because you are average joe-schmoe. We had one IMG general surgeon who matched at MD Anderson for colorectal surgery fellowship.

In private practice/employed practice, nobody cares. You may have that one neurosurgeon who thinks he's God's God, but that's not exclusive to IMGs, that's just them in general. Hence why they're paying alimony to 3 wives (true example from a trauma surgeon who was very proud that he was divorced 3 times and drank expensive daily).

From a resident-to-resident perspective, we have a mix of US AMGs, US IMGs, and non-US IMGs. We don't usually butt heads regarding this, because in the US, your intelligence as a doctor is deemed by "what was your step1 score" (not step 2CK, and definitely not step3). USMLE Step 1 was the gauge to determine how competent you are, and that exam has NOTHING to do with medical school and all to do with the individual and their training.

The only stigma we do face is actually related to the match process during residency and fellowship.
Many programs will dump your application seeing it is IMG or non-US Citizen IMG. 
Others will accept, but it will be a subpar program, however, as the motto goes "to match somewhere is better than to match nowhere".

USA has more opportunities to match, so many IMGs will accept subpar programs in IM/FM. However, USA does hold it's meritocracy and step scores can really make or break your case. I was fortunate to have good scores and matched into a university program. What made it difficult for me was my visa status. That actually mattered more than my medical school. 
My friend with a 197 on step1 (passing is 196) matched into a decent university program in Arizona with 23 other interviews (he's a US citizen), and I only had 10 with a step1 of 242. Many programs I called that were outside the North East (think states close to Canada's proximity), such as Texas/Florida, flat-out said "NO NON-US CITIZENS".

As for Fellowship, it revolves around your residency training program and visa status. If your program has a fellowship, you will likely match into it. If it doesn't and you have to match out, they will take into consideration in the following order: 1) Location of residency training (university vs community hospital), 2) visa status, 3) research, 4) USMLE Step scores (particularly step1), and MAYBE 5) medical school location.

 

I've found many Canadians studying abroad to avoid talking about where they went to medical school to the point where it gets suspicious. They will talk about where they did their training but always hide where they went to medical school. That's why I thought there may be stigma because I have never heard an IMG honestly tell anyone they studied in Caribbean, Australia, Ireland.

[usatocanada]

On 4/4/2023 at 9:03 PM, cardio_enjoyer said:

Just out of curiosity (purely hypothetical question - thank you for hosting this btw), is it possible to do 3 years of core IM in Canada then match to US for a subspecialty fellowship? Would that still require writing the step exams?

So I've not seen this happen regularly, but USA and Canada do have reciprocity of training. I know of a cardiologist in my hometown who did his residency in USA but fellowship in Canada. Likewise, similar exists in the US, however, you have to make sure its okay with the Royal College. Check out the below link.

Reciprocity of Training | Career Planning in Medicine - McGill University

[usatocanada]

On 4/5/2023 at 7:40 AM, mohammad said:

I've found many Canadians studying abroad to avoid talking about where they went to medical school to the point where it gets suspicious. They will talk about where they did their training but always hide where they went to medical school. That's why I thought there may be stigma because I have never heard an IMG honestly tell anyone they studied in Caribbean, Australia, Ireland.

Really? I could see that. In Canada, there was massive stigma against Caribbean/UK/Australia/Ireland amongst the Undergraduate Premed pool. There's a lot of downtalk and viewing these physicians negatively.

In the US, this is definitely not the case and you will not be able to tell which physician trained where unless you asked or did an extensive Google Search. 

Myself, personally, am not ashamed of going to a Caribbean school. Rather than get run ragged by the Canadian system by doing a Masters and then a PhD and then !!!!MAYBE!!!! match into a med school, I saved 1-4 years of attending pay being lost. Multiple colleagues of mine were Canadian graduates who failed to get in after doing a Masters (despite good scores/MCAT). One of our most stellar med students (top 5 in the class) was a Masters graduate with a 3.9 in Canada, but failed to match despite advanced training.

Do I wish I went to a Canadian school? Sometimes.
Would I reconsider going to a Caribbean school if I had to do it all over again? No. If I did not match into a US or Canadian MD program, I would have gone to a Caribbean school (never DO though).

[NutritionRunner]

On 4/5/2023 at 1:40 PM, mohammad said:

I've found many Canadians studying abroad to avoid talking about where they went to medical school to the point where it gets suspicious. They will talk about where they did their training but always hide where they went to medical school. That's why I thought there may be stigma because I have never heard an IMG honestly tell anyone they studied in Caribbean, Australia, Ireland.

Interesting. I’m a patient at an academic FHT (in addition to being a health care professional at a separate centre) and in the lobby they have photos of all the attendings and residents, and where they studied for their medical degree, and for the attendings, where they did their residency. That’s why I know two of the three residents I’ve seen did their degrees in Ireland, whereas the third did theirs at Queen’s. Some places don’t hide their residents’ or attendings’ backgrounds, but most won’t understand the differences, unless they also work in healthcare, as I do. 

[GH0ST]

7 hours ago, usatocanada said:

Really? I could see that. In Canada, there was massive stigma against Caribbean/UK/Australia/Ireland amongst the Undergraduate Premed pool. There's a lot of downtalk and viewing these physicians negatively.

In the US, this is definitely not the case and you will not be able to tell which physician trained where unless you asked or did an extensive Google Search. 

Myself, personally, am not ashamed of going to a Caribbean school. Rather than get run ragged by the Canadian system by doing a Masters and then a PhD and then !!!!MAYBE!!!! match into a med school, I saved 1-4 years of attending pay being lost. Multiple colleagues of mine were Canadian graduates who failed to get in after doing a Masters (despite good scores/MCAT). One of our most stellar med students (top 5 in the class) was a Masters graduate with a 3.9 in Canada, but failed to match despite advanced training.

Do I wish I went to a Canadian school? Sometimes.
Would I reconsider going to a Caribbean school if I had to do it all over again? No. If I did not match into a US or Canadian MD program, I would have gone to a Caribbean school (never DO though).

Appreciate your perspective and I can see the benefit of not waiting, though I think you have been fortunately to experience less stigma. 

I hear from staff regularly throughout my training that, especially for PGY1, they consider IMGs to be medical student level and expect them to not do well. As they continue on in the same system eventually they fail out or they maintain the same quality as everyone else according to them. 

I've also sat on appeals panels before and unfortunately there's a lot of IMGs that struggle in residency (I won't elaborate further). 

Not to impune on your experience and I do think that from the pt perspective, they probably don't care as long as you're providing good medical care, but the stigma is more prevalent than you let on in my opinion. 

- G 

[trying1997]

14 hours ago, GH0ST said:

Appreciate your perspective and I can see the benefit of not waiting, though I think you have been fortunately to experience less stigma. 

I hear from staff regularly throughout my training that, especially for PGY1, they consider IMGs to be medical student level and expect them to not do well. As they continue on in the same system eventually they fail out or they maintain the same quality as everyone else according to them. 

I've also sat on appeals panels before and unfortunately there's a lot of IMGs that struggle in residency (I won't elaborate further). 

Not to impune on your experience and I do think that from the pt perspective, they probably don't care as long as you're providing good medical care, but the stigma is more prevalent than you let on in my opinion. 

- G 

Does this include Ireland IMGs or mainly Caribbean? 

[usatocanada]

On 4/7/2023 at 10:38 AM, trying1997 said:

Does this include Ireland IMGs or mainly Caribbean? 

TBH, probably mainly Caribbean. 

There is definitely stigma as Caribbean IMGs being inferior. 

Does my GPA of 3.70, MCAT of 512, med-school GPA of 3.8, and USMLE scores above 240 (average if 225) mean I'm inferior?

What about the Caribbean IMGs that end up doing general surgery, then a CT fellowship? 

Likewise the IM residents that become interventional cardiologists or electrophysiologists?

Stigma is unnecessary. But it is there. As GHOST said, I have been fortunate - perhaps.

[usatocanada]

On 4/6/2023 at 8:31 PM, GH0ST said:

Appreciate your perspective and I can see the benefit of not waiting, though I think you have been fortunately to experience less stigma. 

I hear from staff regularly throughout my training that, especially for PGY1, they consider IMGs to be medical student level and expect them to not do well. As they continue on in the same system eventually they fail out or they maintain the same quality as everyone else according to them. 

I've also sat on appeals panels before and unfortunately there's a lot of IMGs that struggle in residency (I won't elaborate further). 

Not to impune on your experience and I do think that from the pt perspective, they probably don't care as long as you're providing good medical care, but the stigma is more prevalent than you let on in my opinion. 

- G 

When a Canadian school picks from its pool of 8000 applicants which 40 should match, they will almost always pick the top 99th percentile - would I be incorrect to assume that this is the case (MOST, of course not always, the time)?

When the remaining people go to a Caribbean school, Ireland, UK, or Australia, did they go because they were the worst students or because they did not match a seat on their first or second iteration? Probably both.

So statistically speaking, you will have a bunch of good IMGs, and of course, poorly performing IMGs. Those poor performers will end up soiling the entire barrel but I'm sure that we can agree that one bad apple does not mean the whole batch is bad?

[medianhorizon]

How feasible is it for US trained IM doctors to work in Ontario under the new rules? Will a 3 year US IM residency make you eligible to fully practice as a GIM in Ontario? Or do you need to do fellowship to get 4 years equivalency?

[shikimate]

In the end, when you work in Canada the provincial health insurance doesn't care about where you did your residency or med school, you still get paid the same. 

I tell people that your end sight is passing the RC exam, maybe American board. Don't get distracted by anything else on the way.

[Edict]

On 4/4/2023 at 9:03 PM, cardio_enjoyer said:

Just out of curiosity (purely hypothetical question - thank you for hosting this btw), is it possible to do 3 years of core IM in Canada then match to US for a subspecialty fellowship? Would that still require writing the step exams?

Answer here is yes, there are people who do it. Not many because of the extensive effort and risk required (most Canadian IM programs give 2-3 months of elective time). In terms of whether or not its possible, yes, but the only reason I see it being useful is if you want to work in the US afterwards. 

[1D7]

On 4/15/2023 at 5:30 PM, usatocanada said:

TBH, probably mainly Caribbean.

I agree. There's a lot of negative press around Caribbean schools, and not really around UK/Ireland/Australian schools.

Quote

 

What about the Caribbean IMGs that end up doing general surgery, then a CT fellowship? 

Likewise the IM residents that become interventional cardiologists or electrophysiologists?

Stigma is unnecessary. But it is there. As GHOST said, I have been fortunate - perhaps.

 

Well I wouldn't take it personally. Canadian schools have higher standards than the Caribbean, a fairly standardized training environment, and students get used to the system, so on average CMGs will do better at the start of residency. If someone went to the Caribbean purely to save time and were at the 97th percentile of applicants instead of the accepted 99th percentile (or whatever numbers), I doubt there would be issues. But my experience is that students entering Caribbean schools have higher heterogeneity in their academic & clinical performance, as compared to students in Canadian schools.

That said, if someone is a competent physician, I don't think anyone really cares where they went to school (minus some academics).