US MD/PhD student - how hard will it be to match back/any tips?

[convolutions_]

I will have a very competitive publication record and have won a CIHR doctoral award as well as other Canadian awards in high school (US undergrad as well). My main motivation for coming back is that I want to take care of my family and also work on a start up. I generally miss Canada as well. 

Specialties that I am interested in include IM, derm, radiology, psychiatry (most of my work is in this area). Would appreciate any advice on how to improve odds of matching etc. I still have roughly 2 years on my PhD and my clinical years left.

Thank you!

[zoxy]

USMDS will be categorized as IMGs from the 2026 match so that means you'll only have access to IMG spots in CaRMS. In the 2023 Carms there were 2 Derm IMG spots and Rads had 4 IMG spots. Of the 2 IMG spots for Derm, 1 was left empty in the first round and went to a CMG resident in the second round. I don't know specifically about the Rads IMG match but it's probably very competitive with similar slim odds. Also, Canadian programs put a premium on electives at their institution and if you're unfortunate enough not to secure an away elective at the schools with IMG spots, then it's going to be tough regardless of how good you are on paper. IM and Psych should be more doable though by virtue of having many more IMG spots.

You can't really count on such few IMG spots for Derm and Rads even if you're the best candidate on paper. Competitive programs with few spots are oftentimes filled by IMGs with the most connected daddie rather than necessarily the best IMG candidate (cough cough Toronto Neurosurgery cough chough). You might be the best candidate on merit but how well-connected are you? Can you get first-author publications with your dad who happens to be the the head of the department you want to match to? Nepotism and cronyism are the reality of Candian postgraduate training, especially when you are restricted to less than a handful of spots because of being an IMG.

Additionally, if you apply to both the NRMP match and CaRMS, whichever match runs first will be given priority. For example, in 2024 the US match is on March 15th, whereas the Canadian match is on March 19th. So if you dual apply and match to any program in the US, you'll automatically be taken out of the Canadian match automatically. So the only way to ensure a Canadian match is to not rank a single American program.

All in all, if you're a US MD/PhD, just do a residency down there. Becoming competitive for Rads and Derm as an IMG in Canada will be much more difficult than matching to any program in the US. I know that I didn't answer your question about improving your odds, but I just wanted to let you know about the barriers you would have to overcome to match to Derm or Rads as an IMG.