What happens if I don't get that fellowship?

[justletmein]

Honestly if you like EM you should consider the FM + EM R3 route.

 

He is all about the money... so not likely

[ploughboy]

Going to Ireland is not going to make it easy to get a residency in Canada...You won't get FRCP EM.

 

Statistically speaking, probably correct because there are so many IMGs and so few spots. But on the other hand, several of the IMGs in my program are from Irish schools.

[cheech10]

He is all about the money... so not likely

 

???

The money will be the same (same billing codes) plus you get 2 extra years of earnings due to a 3 year vs 5 year residency. The FM+EM route makes more sense financially (assuming they can get identical jobs, which shouldn't be a problem outside of major academic centres).

[ploughboy]

Ya but that's kind of like cheating myself haha. Its more FM than EM...

 

For better or worse (and that's a whole 'nother topic for whole 'nother time) ccfp-em and frcpc-em docs are more-or-less equivalent in Canada at the moment. With the expansion in frcpc-em residency positions over the last few years that may change, and it will be harder for ccfp-em docs to get jobs in big centres. However, wherever you're hired the remuneration and responsibilities are the same (at least where I've worked).

[Handsome88]

AFAIK, only about 2/3 of FM residents that apply for the +1 EM get it. That leaves a good portion without it who have to find something else to do. So its kind of a gamble. Don't depend on it.

 

Going to Ireland is not going to make it easy to get a residency in Canada. You'll probably need to take an FM spot. You may get an IM spot in one of the lesser desirable areas to live, like SK or MB, but don't count on that. You won't get FRCP EM.

 

Don't let it stop you though. If you get an FM spot, transfer out as soon as you can. I've seen many foreign grads get into other specialties from FM with a lot of networking.

 

I've heard so many good stories about Irish grads though.

 

Plus I'll accept whatever IM program at whatever place. I've lived in SK for a year I think I can survive there...as long as it gets me certified to work anywhere Canada.

 

Does that mean its better to do IM electives at SK or MB?

[Guest copacetic]

I have heard from many residents and attendings that once you match as an R1, people no longer care where you went to med school.

 

When applying for fellowship, you will be a resident trained at X canadian university....

 

I think your biggest hurdle will be matching into IM in canada. Dont want to discourage you, but I think the numbers are deceiving.... you should probably apply to FM as well.

 

this is correct

[Guest copacetic]

I've heard so many good stories about Irish grads though.

 

Plus I'll accept whatever IM program at whatever place. I've lived in SK for a year I think I can survive there...as long as it gets me certified to work anywhere Canada.

 

Does that mean its better to do IM electives at SK or MB?

 

manitoba has historically been more friendly to IMGs. key work being 'historically'

[ploughboy]

AFAIK, only about 2/3 of FM residents that apply for the +1 EM get it. That leaves a good portion without it who have to find something else to do. So its kind of a gamble. Don't depend on it.

 

A bunch of my friends/former classmates are entering the match this year, and I'm a little bit nervous for them. Per the CaRMS website, 18% of applicants didn't match last year, 30% didn't match in '08 and 32% didn't in '07. So it's definitely not a given that the OP will match to +1 EM.

 

http://carms.ca/pdfs/2009R3_MatchResults/R3 - Applicant Match Results by Location_en.pdf

http://carms.ca/pdfs/2008R3_MatchResults/Applicant Match Results by Location_en.pdft

http://carms.ca/pdfs/2007R3_MatchResults/Applicant Match Results by Location_en.pdf

 

 

Another backup plan would be for the OP to find an EM job in a smaller community, work for a few years and then challenge the CCFP-EM exam as a "practice eligible" candidate.

 

http://www.cfpc.ca/English/cfpc/education/examinations/emergency medicine/default.asp?s=1#practice

[nosuperman]

A bunch of my friends/former classmates are entering the match this year, and I'm a little bit nervous for them. Per the CaRMS website, 18% of applicants didn't match last year, 30% didn't match in '08 and 32% didn't in '07. So it's definitely not a given that the OP will match to +1 EM.

 

http://carms.ca/pdfs/2009R3_MatchResults/R3 - Applicant Match Results by Location_en.pdf

http://carms.ca/pdfs/2008R3_MatchResults/Applicant Match Results by Location_en.pdft

http://carms.ca/pdfs/2007R3_MatchResults/Applicant Match Results by Location_en.pdf

 

 

Another backup plan would be for the OP to find an EM job in a smaller community, work for a few years and then challenge the CCFP-EM exam as a "practice eligible" candidate.

 

http://www.cfpc.ca/English/cfpc/education/examinations/emergency medicine/default.asp?s=1#practice

 

But aren't there only 6 IMG spots for EM in all of Canada? It seems that statistically he'd have a way better shot at 2+1, even with a third of those R3's not matching.

[leviathan]

But aren't there only 6 IMG spots for EM in all of Canada? It seems that statistically he'd have a way better shot at 2+1, even with a third of those R3's not matching.

Depends on your background. If you have a really strong app for EM I wonder if you might have a better shot at matching if you apply to the FRCPC EM and rank it highly, rather than applying for family med, or ranking family med high.

 

An example of a strong app might be if you have really good LORs from well known program directors (especially Canadian) in EM, if you have emerg-based research, or maybe if you have a background as an ER nurse or a paramedic etc. An alumnus from my school got one of the IMG EM spots last year. He used to be an ER nurse so I think that was probably a huge help.

 

That looks confusing but I hope that makes sense.

[Scholastica]

Before you worry about applying & matching to a fellowship, make sure you match to IM first. Like many posters have already pointed out, job available is a BIG issue for cardio, GI, and CC. Are you ready to do 3 years of cardio fellowship followed by another 2 years of sub-fellowship in ECHO/interventional or something else plus 1 or 2 years of research so that you could be an academic cardiologist in a big city with a "high" income?

 

My impression is that most physicians do very well in Canada, and you won't have much difficulty paying off your debt eventually.

 

Another option is to consider a career in GIM. There's lots of flexibility, diversity of cases, and I hear that their remuneration is improving. In rare cases, I've heard of some GIM specialists working in busy centres pulling off, gulp!, $1 mil.

 

If not, you could always train as a plastic surgeon or dermatologist.

[nosuperman]

Depends on your background. If you have a really strong app for EM I wonder if you might have a better shot at matching if you apply to the FRCPC EM and rank it highly, rather than applying for family med, or ranking family med high.

 

An example of a strong app might be if you have really good LORs from well known program directors (especially Canadian) in EM, if you have emerg-based research, or maybe if you have a background as an ER nurse or a paramedic etc. An alumnus from my school got one of the IMG EM spots last year. He used to be an ER nurse so I think that was probably a huge help.

 

That looks confusing but I hope that makes sense.

 

Nope, makes perfect sense! Though I'd be cautious about catering an application to just those EM spots only because of the vast number of FM spots relative to EM. I did meet a couple IMG's who matched to EM and one who matched Derm and they were exactly as you've described; Canadians with strong references, research and experience in the field. I always wonder though how many of their similarly-equipped colleagues don't match. Since I'm not in med school, let alone an international one, I don't know how many well-qualified students aren't able to match just because there aren't enough spots to house every competitive individual.

 

I think it'd be reasonable to say that someone who was at least competitive for an EM spot should be more or less guaranteed an FM spot, and that the limiting factor in their case would be the R3 match, whereas it'd be the R1 match if they tried to go FRCPC. Just looking at it like this there'd be more of a limit on the FRCPC R1 then the CFPC 2+1, numbers-wise at least.

 

I believe we both have backgrounds in EMS and so we've been more or less padding an EM application for years (extra training, networking with docs in high places, going to conferences, research etc) and this case is probably relatively unique, this also goes for your colleague who had a background in nursing. For the OP or any general IMG who'd be looking at the R1 mid-way through med school, it might just come down to numbers.

[Handsome88]

Before you worry about applying & matching to a fellowship, make sure you match to IM first. Like many posters have already pointed out, job available is a BIG issue for cardio, GI, and CC. Are you ready to do 3 years of cardio fellowship followed by another 2 years of sub-fellowship in ECHO/interventional or something else plus 1 or 2 years of research so that you could be an academic cardiologist in a big city with a "high" income?

 

My impression is that most physicians do very well in Canada, and you won't have much difficulty paying off your debt eventually.

 

Another option is to consider a career in GIM. There's lots of flexibility, diversity of cases, and I hear that their remuneration is improving. In rare cases, I've heard of some GIM specialists working in busy centres pulling off, gulp!, $1 mil.

 

If not, you could always train as a plastic surgeon or dermatologist.

 

Thanks for the info.

Plastic surgeon or derm? That's near impossible as I'm international...

[sfinch]

You should be very careful with your optimism that they'll open more spots for applicants in the next 5 years

I say this because the Canadian med schools have faced various stages of expansion recently. Take U of A for example - the 2010 class had ~120 students, 2011 has ~135, 2012 has 155 and 2013 has 189. Calgary is similar. The alberta province grew 62 spots alone in one year. The Ontario schools have increased by smaller amounts but still 10-20 spaces.

The number of residency spots will have to increase to cover CMGs, and they will be very very hard pressed to do so. There's going to be a disproportionate jump in FM spots and IMGs are going to see a really big crunch in available spots pretty soon. Not saying it's fair, just that it's reality.

 

In the last 8 years, Ontario has gone from 540 spots to around 970 spots. And the specialists graduating the last 2-3 years, when therere were almost only 500 spots in Ontario, have having a super hard time getting jobs.

 

I really cannot see how there will be more spots for IMGs in the near future. It makes no sense - we have a shortage of GPs because most young canadian minorities do not want to work in small homogenous towns where the shortage is - and for that matter, neither do young white canadian med school grads who often end up marrying other professionals who cannot do jobs in small towns.

 

Increasing the number of docs is going to create a doctor surplus - and for the first time - underemployed if not unemployed specialists. Not sure how the government can justify all these new residency spots for IMGs.

[moo]

In the last 8 years, Ontario has gone from 540 spots to around 970 spots. And the specialists graduating the last 2-3 years, when therere were almost only 500 spots in Ontario, have having a super hard time getting jobs.

 

I really cannot see how there will be more spots for IMGs in the near future. It makes no sense - we have a shortage of GPs because most young canadian minorities do not want to work in small homogenous towns where the shortage is - and for that matter, neither do young white canadian med school grads who often end up marrying other professionals who cannot do jobs in small towns.

 

Increasing the number of docs is going to create a doctor surplus - and for the first time - underemployed if not unemployed specialists. Not sure how the government can justify all these new residency spots for IMGs.

 

I agree with you. Specialists, especially subspecialists are having a hard time finding jobs. I know a few subspecialists in peds for example are extending training by doing CIP or Masters degrees just to delay finding a job. That's why I caution med school grads today to really think about job prospects for the future. Even for me, I know that the ideal job for me in public health may not be available in the city of my choice, so that's why I am keeping my skills up in family practice. There will always be a need for GPs. For specialists, the population here just may not support it.