Eras

[kjys]

Hey guys,

 

I'm still in undergrad and I know it's early to be thinking about this but I'm curious to learn more about ERAS and I thought it would be most appropriate to post this here.

 

I know nothing about ERAS except for the fact that it's completing your residency in the states. Is it more/less competitive than CaRMS for Canadian med students (in terms of being matched up with a residency program of your choice)?

 

Please share any info you have about ERAS... like its pros/cons? percentage of med school grads that go to the US for residency...etc. anything!

 

Thanks in advance!

[Lactic Folly]

I'd suggest checking out SDN as well if you haven't already...

[DrKovac]

Hey i'm doing the CaRMS and ERAS thing.

Not sure what you are going into, but regardless there are many many more spots in the US. The only big catch is if you don't have a green card or permanent resident status in the US, its tough to get into competitive specialties like derm, plastics, ortho etc. Also ERAS starts on Sept 1, interviews ran from mid-Nov to the end of Jan...match day comes out 2 weeks after CaRMS.

Not sure if you have any other more specific questions but let me know.

[kjys]

Hey i'm doing the CaRMS and ERAS thing.

Not sure what you are going into, but regardless there are many many more spots in the US. The only big catch is if you don't have a green card or permanent resident status in the US, its tough to get into competitive specialties like derm, plastics, ortho etc. Also ERAS starts on Sept 1, interviews ran from mid-Nov to the end of Jan...match day comes out 2 weeks after CaRMS.

Not sure if you have any other more specific questions but let me know.

 

Thanks DrKovac

 

would you say it's more difficult to get into a competitive specialty like derm/plastics/etc. in the US than it is to get into one in Canada?

 

also... is there any way for us canadian students to get a 'green card' without living in the US for... however many years?

 

I don't know when the CaRMS/ERAS matches are released but I wish you the best!!!!!!!

[Ian Wong]

I'm finishing my radiology residency here in the US, after having graduated from UBC.

 

It's really difficult to say which is more difficult. Both situations (getting a competitive Canadian residency spot vs getting a competitive US residency spot) are difficult, but for different reasons.

 

1) Canadian residency spot: This is tough because of the small number of available residency positions. For the really competitive specialties (ie. Derm, Plastics, Ophtho, ENT, etc), most programs have very few spots each year.

 

2) US residency spot. This is tough because of visa issues, as well as geographic issues. Unlike Canada, there are a lot more residency spots for each specialty.

 

However, you cannot train in a US program (unless you have US citizenship or a green card) without a visa, and most competitive specialties in the US would rather take a US citizen so they don't have to deal with the visa paperwork.

 

Most of these programs similarly have many more applicants than spots, and therefore you need to be significantly better than their average applicant in order for them to even consider going the extra mile to take you, and your accompanying visa obligations. That can be very difficult, since a lot of these programs use the USMLE Step 1 scores to weed out applicants, and Canadian schools in general do not teach to this test, like they do in many US med schools. If you do poorly on the USMLE Step 1, you've markedly handicapped your chances for any competitive US residency.

 

As well, US programs tend to be quite geographically biased. They know the relative caliber of their surrounding US med schools, and know what general caliber of med students are at coming from those programs. You are an unknown quantity coming from a Canadian med school (most programs have heard of McGill and U of T, but few of the other ones), and therefore programs in competitive specialties are once again hesitant to take you on.

 

 

What applying to the US does is give you an alternate track of getting into a residency program. It isn't necessarily easier, but having it available as another option means that now you've got two difficult pathways to get your residency, rather than just one.

 

Still, the vast majority of Canadian med students will still get their residency through CaRMS (and therefore do a Canadian residency). There are definitely some big advantages to training in the US, including a lot more access to new technology and medications, a chance to see and experience an alternate model of healthcare delivery, and getting pretty much guaranteed licensure if you desire to work in the US after residency. Many Canadian folks end up staying in the US to practise after they complete their training; I've met several.

 

Ian

[kjys]

Thanks Ian!!!!

 

Is there a way for us to get a Visa PRIOR to applying for residency programs in the US so that US schools don't have to worry about the paperwork..etc?

 

Also, other than the USMLE Step 1 test, are there other tests you need to take in order to be able to apply to residency programs in the US?

[Ian Wong]

Unfortunately, you cannot apply for the visa until after you have matched into the program; the visa is specific to that training program and specialty. This pertains to a non-US citizen training in a Canadian med school.

 

If you were training in a US med school, and were not a US citizen, you'd already be on something called an F-1 visa, and can use something called your OPT year for your PGY-1 (so you wouldn't need to apply for either a J-1 visa or H1B visa until you were starting your PGY-2 year).

 

To match into a US residency program requires only USMLE Step 1. You will need to have passed USMLE Step 2 before starting your PGY-1 year, and if you are trying to get an H1B visa, will also need to have passed USMLE Step 3.

 

For logistical reasons, it's very, very hard for people to get the H1B visa for a competitive specialty, as well as start internship on time on July 1. The reason being that you need to have graduated med school before you can apply to take Step 3. Then, you need to take it, pass it, and get the marks back before you can even start applying for the H1B. Then, that visa needs to get approved and back to you in order to start on July 1 (or perhaps at least a week or two earlier, since most programs have a week of orientation before officially starting on July 1). As well, most competitive specialties don't offer H1B visas.

 

This is why most Canadian med school grads doing a competitive residency in the US are on J-1 visas.

 

Ian

[kjys]

Thanks again Ian!

I had to read your post twice to understand what you were saying, but I get it now

 

 

More questions for ya,

 

When's the best time to write the USMLE Step 1 AND USMLE Step 2 (if this is required prior to PGY-1 year)???

 

And... what's the format of USMLE Step 1 like? What are they trying to test you on?

[lostintime]

This may sound sort of obvious, but if you're single, marrying an American is always an option lol. Who knows, it may happen, and that would probably be way faster than any other route. Now to meet a "marriable" American haha....

[Lactic Folly]

Thanks again Ian!

I had to read your post twice to understand what you were saying, but I get it now

 

 

More questions for ya,

 

When's the best time to write the USMLE Step 1 AND USMLE Step 2 (if this is required prior to PGY-1 year)???

 

And... what's the format of USMLE Step 1 like? What are they trying to test you on?

 

Step 1 is typically written after the first two years of medical school. It is a full-day multiple choice examination that tests basic science knowledge learned in the preclinical curriculum - for more information visit http://www.usmle.org

 

Step 2 CK and CS are typically written during/after fourth year of medical school.

[legal78]

Guys, anyone can tell me how can you get matched to most of US residencies which require post-graduate med experience. Do u have to match to preliminary/transitional year first? Or u have to choose only the programs not requiring the 1st year?

Or it is better to match in can residency and transfer after the 1st year to the US?

[Ian Wong]

What you are probably referring to is that many of the US residencies start at the PGY-2 level, such as Radiology, Dermatology, Psychiatry, Anesthesiology, Physiatry, etc. However, you need to complete a PGY-1 year before you can enter these residencies.

 

What this means is that during your ERAS application, you need to apply for, interview for, and match into both a PGY-1 (which can be a Transitional Year, a prelim Medicine year, or a prelim Surgery year), as well as your PGY-2+ years of residency.

 

This is unlike in Canada, where matching into Radiology (or any other specialty) guarantees you the PGY-1 along with it.

 

As you can see, in the US, this means that you might do your med school at one place, match into a different city for your PGY-1 year, and match into an entirely different city for the remainder of your residency. Luckily, there is a feature in ERAS, where you make a sub-list for your PGY-1 years which goes along with the ranklist for your actual residency.

 

For US students, this typically means that they interview at all the PGY-1 programs in their home city, as well as perhaps some of the PGY-1 programs in the cities where they'd like to do their residency, and usually, this means that you only need to move once. For Canadian students, since you don't have a home PGY-1 program that you can try to get into, odds are better that you'll need to move twice.

 

Also, Canadian programs won't want to take you for one year. The CaRMS and ERAS matches communicate with each other. Whichever country has their match date first will take priority over the other. So, if Canada matches you first, you will be entirely withdrawn from the US match, and vice versa.

 

Ian

[ED527]

So is it possible to match into a PGY-2 position and not for a PGY-1 position (transitional, prelim) in the US match?

 

Or is a PGY-1 position a prereq for a PGY-2 match?

[legal78]

Thanx Ian, that's perfectly clear for me now

[Ian Wong]

So is it possible to match into a PGY-2 position and not for a PGY-1 position (transitional, prelim) in the US match?

Yes. If that happens after the match, then you will need to find a PGY-1 spot in the scramble. You cannot go on to your PGY2+ program, until after you have completed the PGY-1 year.

 

The good thing is that usually there will be PGY-1 spots in the scramble. However, they will usually be either prelim medicine or surgery years, which are usually significantly more difficult (harder rotations) than a transitional year.

 

Ian

[legal78]

Also, Canadian programs won't want to take you for one year. The CaRMS and ERAS matches communicate with each other. Whichever country has their match date first will take priority over the other. So, if Canada matches you first, you will be entirely withdrawn from the US match, and vice versa.

 

Ian

 

What if I try to match next year (after being matched in Canada) for US residency? Do u think I will be withdrawn from the program?

[Ian Wong]

Who knows? You are asking a theoretical question that is so rare as to not have any generalizable rules.

 

What I can say, is that if you are already in a residency training program, you would need to list that on your CV when you reapplied (regardless of which country you are currently in, or which country you are applying to).

 

You would also probably need to produce a letter of reference, or some other document stating that you are in good standing at your current program. It's unlikely you'd get very far without your program director's help.

 

Ian