Process for dual citizen studying in Canada to get a residency in US with 2026 changes

[madara_uchiha]

Basically what the title is describing. I'm a dual US-Canada citizen but have lived in Canada for most of my life. With that being said, there was always a thought to go back to the states in the future to practice (for a few reasons: family, opportunities, etc.). The "plan" initially was to try and get into a Canadian medical school (vastly cheaper, familiarity with resources, etc.) and then 1.) try to get either a US residency upon graduation or 2.) get Canadian residency then work in the states since I knew US accepted Canadian accreditation with not too much obstacles and vice versa.

That was the "plan" until this came out: https://www.afmc.ca/us-and-canada-remain-committed-to-ensuring-medical-education-quality/

It seems that for residency positions, Canadian students will be considered IMGs in the US's eyes and vice versa starting 2026 - which would definitely cripple the realistic-ness of the plan. However, when I tried understanding the process behind studying in Canada and then working in the states, it would either a.) explain it from the POV of someone that isn't a dual-citizen or b.) not be updated to what will happen in 2026 since right now US-Canada med students won't be considered IMGs.

What I'm basically asking is what are my options? Let's say I graduate a Canadian medical school (would graduate after 2026), would I be able to apply to US residencies through CaRMS (getting an ERAS token). Would I be put in the same boat as people who studied in the Caribbean or abroad? Would there be any advantages that I'd be graduating from a Canadian school or that I'm a US citizen?

In the second hypothetical, let's say I complete a Canadian medical school and a Canadian residency. What would be the process for me to be able to practice in the States? Would I need to do another residency in the states? Would there be any advantages if I came from a high-ranking school like UofT or if I'm a US citizen?

Would appreciate any help or guidance on this if there are any other people familiar with this cross-country process. Part of the reason why I'm having a tough time making my decision to just go to a US medical school despite the increased costs (if it saves a ton of headache) is that I'm in my 3rd year undergrad right now and I've been fortunate enough to get a couple Canadian medical school interviews. There's no guarantee I get an offer but based on post-interview acceptance rates it's definitely a possibility I get an offer and I just want to figure out what I would do if I was to get one. Do I accept it, save a year, get a chance to start learning what I've dreamed about sooner - but potentially hamper my options in the future. Or do I have to make an unfathomable decision and reject it to try and get in US med schools, and have another year of tough school, ECs, and application writing.

(Just want to add I know how privileged my "problem" sounds. I don't want to come across as ungrateful, I'm really thankful for the opportunities I've been provided and realize my post could be seen as a tad neurotic, but would appreciate any help from people experienced/knowledgeable in this topic)

[bearded frog]

1 hour ago, madara_uchiha said:

What I'm basically asking is what are my options? Let's say I graduate a Canadian medical school (would graduate after 2026), would I be able to apply to US residencies through CaRMS (getting an ERAS token). Would I be put in the same boat as people who studied in the Caribbean or abroad? Would there be any advantages that I'd be graduating from a Canadian school or that I'm a US citizen?

Citizenship does not change the med school or residency math much, other than as a Canadian, you don't have to pay exorbitant prices for Canadian medical school, and you can do residency in Canada if you want, as an American, you may possibly be "in state" at some American schools depending on the methodology they use to assess this, and you have more options for residency in the US (not all programs are accommodating to those requiring VISAs). To specifically answer the above question, you can apply to both CaRMS and the NRMP (if you meet the criteria, ie doing the USMLEs) regardless if you do medical school in Canada and the US. As you say, with the new rules, you will be considered an "IMG" for the country you don't do medical school in. Technically, this is the same category as those who did medical school in the Caribbean, Ireland, Australia, India, etc. For CaRMS, it means that in the first round you will be restricted to applying to spots designated for IMGs, which are fewer in number with limited specialty and location options. Realistically, you may have an advantage having attended a reputable US school compared to overseas schools, all else being equal. Conversely, for the NRMP, you still have an IMG designation, however how this affects your application vs USMD will vary depending on each program in the NRMP, and there isn't a blanket restriction (each program can decide if or how many IMGs they consider). I think an American citizen who attended a Canadian MD, especially with connections to the US program you are applying to, would be thought of relatively similar to a USMD applicant (this scenario is extremely rare as it is, as dual citizens will generally attend a USMD as it is (generally) easier to be accepted in the US vs Canada).

2 hours ago, madara_uchiha said:

In the second hypothetical, let's say I complete a Canadian medical school and a Canadian residency. What would be the process for me to be able to practice in the States? Would I need to do another residency in the states? Would there be any advantages if I came from a high-ranking school like UofT or if I'm a US citizen?

This would be specialty and state-specific. It certainly is simpler since you are a citizen, but Canadian schools are all essentially equal in quality and so ranking doesn't really matter. (perhaps the name recognition of a McGill or U of T might be helpful?) All Canadian schools would be top 100 (majority top 50 probably) if ranked with US schools (at least on medical education). If the training is equivalent, which it is for most residencies, you shouldn't need to do additional training to work in the US, but you might have to write the equivalent US board exam along with the Royal College exam. If you have a specific state and discipline in mind, start with that state's medical licensing board to see what the requirements are for Canadian trained physicians to get licensed in that state.

2 hours ago, madara_uchiha said:

Would appreciate any help or guidance on this if there are any other people familiar with this cross-country process. Part of the reason why I'm having a tough time making my decision to just go to a US medical school despite the increased costs (if it saves a ton of headache) is that I'm in my 3rd year undergrad right now and I've been fortunate enough to get a couple Canadian medical school interviews. There's no guarantee I get an offer but based on post-interview acceptance rates it's definitely a possibility I get an offer and I just want to figure out what I would do if I was to get one. Do I accept it, save a year, get a chance to start learning what I've dreamed about sooner - but potentially hamper my options in the future. Or do I have to make an unfathomable decision and reject it to try and get in US med schools, and have another year of tough school, ECs, and application writing.

In general, unless were talking hundreds of thousands of dollars difference in fees, if you were 100% sure you wanted to work in the US, you should do medical school and residency in the US. Your life would be a lot simpler, and it will be easier to get a more desirable residency and network for eventual job positions. That being said, a bird in hand is better than two in the bush, but in general if you were able to get in in Canada you'd be able to get in in the US, although there is no guarantee, and no knowing where and what quality school with how much tuition. And if you reject a Canadian offer you basically close the door to Canadian medical school permanently if you can't get in in the US.

[madara_uchiha]

4 hours ago, bearded frog said:

In general, unless were talking hundreds of thousands of dollars difference in fees, if you were 100% sure you wanted to work in the US, you should do medical school and residency in the US. Your life would be a lot simpler, and it will be easier to get a more desirable residency and network for eventual job positions. That being said, a bird in hand is better than two in the bush, but in general if you were able to get in in Canada you'd be able to get in in the US, although there is no guarantee, and no knowing where and what quality school with how much tuition. And if you reject a Canadian offer you basically close the door to Canadian medical school permanently if you can't get in in the US.

Based on just tuition (since living costs should be comparable), UofT's MD program will cost roughly 74,216 USD. The average out-of-state/private medical school cost in US is about $60k a year making it be roughly 240,000 USD. It would be technically possible to handle either number (with loans), but we are talking hundreds of thousands of dollars difference in fees (over the 4 years).

4 hours ago, bearded frog said:

I think an American citizen who attended a Canadian MD, especially with connections to the US program you are applying to, would be thought of relatively similar to a USMD applicant (this scenario is extremely rare as it is, as dual citizens will generally attend a USMD as it is (generally) easier to be accepted in the US vs Canada).

How are IMGs (or MGs in general) exactly assessed for residency positions? Obviously, USMD will have an advantage, but I'm curious how substantial. Is it because they are USMDs they have higher chances, or is it because USMDs will be more likely to have competitive connections at US programs that they get picked more. Based on the 2023 NRMP statistics, it's pretty clear that IMG numbers are low across the board (spiking in internal medicine and family med), but I couldn't find information on how many IMG applicants there were for those positions. 

I'm really just trying to see if I can thread the needle and work in the states but save a lot of money on fees and save a year. I know my summers I'd be able to get some experience in Michigan clinics and would definitely have some research work from Canada (maybe some from US schools as well as I've heard of some students in Canadian med schools doing some work for American labs). But I'd appreciate any brutal honesty if it's sounding like I naively want to have my cake and eat it too.

5 hours ago, bearded frog said:

If the training is equivalent, which it is for most residencies, you shouldn't need to do additional training to work in the US, but you might have to write the equivalent US board exam along with the Royal College exam. If you have a specific state and discipline in mind, start with that state's medical licensing board to see what the requirements are for Canadian trained physicians to get licensed in that state.

Would you happen to know where I could find this information? When I was looking for information in Michigan, I couldn't find any specialty specific information (what I was looking at for reference - https://www.michigan.gov/lara/bureau-list/bpl/health/hp-lic-health-prof/medical#Licensing_Applications_&_Forms)

 

 

[bearded frog]

2 hours ago, madara_uchiha said:

Based on just tuition (since living costs should be comparable), UofT's MD program will cost roughly 74,216 USD. The average out-of-state/private medical school cost in US is about $60k a year making it be roughly 240,000 USD. It would be technically possible to handle either number (with loans), but we are talking hundreds of thousands of dollars difference in fees (over the 4 years).

That is a big difference on paper, but there is an opportunity cost regardless, and the difference between being able to have a competitive application to a competitive residency or a job in the field/location you want will also have a difference of earning potential far outweighing this difference... just something to think about.

2 hours ago, madara_uchiha said:

How are IMGs (or MGs in general) exactly assessed for residency positions? Obviously, USMD will have an advantage, but I'm curious how substantial. Is it because they are USMDs they have higher chances, or is it because USMDs will be more likely to have competitive connections at US programs that they get picked more. Based on the 2023 NRMP statistics, it's pretty clear that IMG numbers are low across the board (spiking in internal medicine and family med), but I couldn't find information on how many IMG applicants there were for those positions.

I can't say, because unlike in Canada where across the board IMGs are relegated to specific spots, each US program has their own system for assessing applicants, and how they compare USMD vs international applicants. You are correct that we cannot tell if the low IMG applicants is due to bias or less impressive applications and less networking, etc. Unfortunately, when it comes to generalizations, assuming you were an average medical student, you will probably be able to match as a Canadian MD to a US residency in something like FM, peds, etc. without much issue. You might have a tough uphill battle if you want a competitive surgical subspecialty or something however, although who knows if it would be more competitive than how ultra-competitive it is for Canadian residency spots in these fields.

2 hours ago, madara_uchiha said:

Would you happen to know where I could find this information? When I was looking for information in Michigan, I couldn't find any specialty specific information (what I was looking at for reference - https://www.michigan.gov/lara/bureau-list/bpl/health/hp-lic-health-prof/medical#Licensing_Applications_&_Forms)

It looks like https://www.michigan.gov/lara/-/media/Project/Websites/lara/bpl/Medicine/Licensing-Info-and-Forms/Certification-of-Medical-Education-of-Medical-Schools-in-US.pdf?rev=7425ec9ac1854d11b391f36038bc414f&hash=878D565EDA522B274C25F59CD4953C60 says that you need the USMLEs regardless, if that changes your math. I can't seem to see if the licensing by exam requires the American exam or Canadian exam, but it looks like Michigan at least accepts Canadian medical school/post-grad.

[Edict]

On 4/9/2023 at 1:47 PM, madara_uchiha said:

Basically what the title is describing. I'm a dual US-Canada citizen but have lived in Canada for most of my life. With that being said, there was always a thought to go back to the states in the future to practice (for a few reasons: family, opportunities, etc.). The "plan" initially was to try and get into a Canadian medical school (vastly cheaper, familiarity with resources, etc.) and then 1.) try to get either a US residency upon graduation or 2.) get Canadian residency then work in the states since I knew US accepted Canadian accreditation with not too much obstacles and vice versa.

That was the "plan" until this came out: https://www.afmc.ca/us-and-canada-remain-committed-to-ensuring-medical-education-quality/

It seems that for residency positions, Canadian students will be considered IMGs in the US's eyes and vice versa starting 2026 - which would definitely cripple the realistic-ness of the plan. However, when I tried understanding the process behind studying in Canada and then working in the states, it would either a.) explain it from the POV of someone that isn't a dual-citizen or b.) not be updated to what will happen in 2026 since right now US-Canada med students won't be considered IMGs.

What I'm basically asking is what are my options? Let's say I graduate a Canadian medical school (would graduate after 2026), would I be able to apply to US residencies through CaRMS (getting an ERAS token). Would I be put in the same boat as people who studied in the Caribbean or abroad? Would there be any advantages that I'd be graduating from a Canadian school or that I'm a US citizen?

In the second hypothetical, let's say I complete a Canadian medical school and a Canadian residency. What would be the process for me to be able to practice in the States? Would I need to do another residency in the states? Would there be any advantages if I came from a high-ranking school like UofT or if I'm a US citizen?

Would appreciate any help or guidance on this if there are any other people familiar with this cross-country process. Part of the reason why I'm having a tough time making my decision to just go to a US medical school despite the increased costs (if it saves a ton of headache) is that I'm in my 3rd year undergrad right now and I've been fortunate enough to get a couple Canadian medical school interviews. There's no guarantee I get an offer but based on post-interview acceptance rates it's definitely a possibility I get an offer and I just want to figure out what I would do if I was to get one. Do I accept it, save a year, get a chance to start learning what I've dreamed about sooner - but potentially hamper my options in the future. Or do I have to make an unfathomable decision and reject it to try and get in US med schools, and have another year of tough school, ECs, and application writing.

(Just want to add I know how privileged my "problem" sounds. I don't want to come across as ungrateful, I'm really thankful for the opportunities I've been provided and realize my post could be seen as a tad neurotic, but would appreciate any help from people experienced/knowledgeable in this topic)

I think its safe to say that if you get into medical school in Canada you should just go here, not only will you save a year and the pain of reapplying, but you would have the option to stay in Canada or work in the US down the line.

Although right now it says Canadians will be considered IMGs, I don't believe anything will change. The US is an open door, they just classify people differently and they may require you to write your Step 2 as well and get ECFMG certified, but everything in the US will work the same. Americans definitely view Canadians favourably and you won't be treated worse because of this designation change when it comes to residency or fellowship or otherwise.

You won't ever have to redo your residency in the US to get a job, even if you don't obtain US board certification, places will hire you based on your Canadian boards. Having US board certification if it is doable will probably also help. 

From my experience, where you go to medical school has never really come up or mattered when in the US. Most people don't think of UofT as any different from other medical schools and in the US, people work as physicians from all kinds of academic backgrounds, such that people care more about whether you can do the job not where you went to school.