Confused about Canadians doing residency in US

[HerbalPlz]

Hi there,

 

In August 2012, I will hopefully be starting a SMP at an American university. I will apply broadly and early to US med schools before the SMP though.

 

My concerns are post medical school. My plan is to apply through CaRMS to come back to Canada as I've read a Canadian finishing a US MD program goes through the 1st round of the match with all the other Canadian medical grads.

 

However, I would still like to go to US residencies. Now I understand that J1 and H1B are the only options for a US residency. After extensive searching, I am still really confused. All I know is that H1B is a lot better than J1 because you can't count on the 'Spend 2 years in your home country' requirement of the J1 to be waived.

 

So this leaves H1B residencies...and from what I'm reading there are significantly reduced numbers of H1B residencies available and that it's really hard to find them...and on top of that, there's the whole mess of you have to do Step 3 before you can apply for H1B, yet most medical school students finish their Step 3 during PGY1? How is it possible to apply for H1B to do the residency then? Really confused here...

 

Does this mean it would be easier for a Canadian to get matched through CaRMS than it would for a Canadian (who went through a US medical school) to be matched at a US residency? Maybe I'm just reading it wrong, but it seems really, really hard for a Canadian, from a US med school, to get residency in the US.

 

Where do most Canadians who graduate from US med programs end up?

[moo]

Depends on where you are willing to go and what specialty you are applying for. If you don't care where you go, and you want to apply to a non-competitive specialty in the US (FP, IM, psych, peds) you will probably get into a program, and probably get an H1b visa to boot.

 

If you want to go to a good program in a competitive specialty, be prepared to do well on Step I and have awesome references, and good 3rd year grades (getting honors in a few rotations can help).

 

It's not hard to match into most specialties in Canada from a US school. I know many US grads who have gotten into pretty competitive programs in Canada.

[HerbalPlz]

It's not hard to match into most specialties in Canada from a US school. I know many US grads who have gotten into pretty competitive programs in Canada.

 

This is amazing to hear. Do any of the US grads you know use premed101 or SDN forums? I'd like to ask further questions on their process through US med schools and coming back to Canada.

 

I've been reading a lot and it seems getting good grades in 3rd during rotations is very hit or miss. You could ace your first 2 years, but then in 3rd year you can easily get bombed just because of the staff/supervisor where you will be doing the rotations.

 

What score would you say is considered good on Step 1? Trying to gauge how much better than most applicants I would have to be.

 

This is probably a naive question (sorry) but what do you mean by awesome references? Right now I'm lining up my LORs for medical school and most of my professors and referrers let me write my own letter and they just edit it. In medical school, I'm not sure if this would be possible or not, but if the referrer writes their own letter, is it not correct to assume they would write you a good letter? i.e. won't all letters, from a professor or whoever the referrer is, be awesome?

 

Your news about US grads to Canada is amazing to hear, though. Anything you could provide that might help me down the line?

[glucose]

Hey Herbal, just a question question and sorry for going off-topic but what is SMP?

[HerbalPlz]

http://forums.studentdoctor.net/showthread.php?t=346106

 

There you go! That Postbacc subforum on SDN has pretty good resources.

[Slashsev]

Honestly..after doing rez in the USA u probably will decide not to leave....

 

as 90% of my friends have said they would come back..but decided to stay...

 

im sure the better pay, oppertunities , # of patients, weather, etc etc will keep u in america

[moo]

The US health care system is in a state of flux right now. Depending on speciality, it may be better in the US, or it may be better in Canada.

 

One plus is that cost of living is generally way lower in MOST US cities. However, in the most desirable cities, cost of living is generally as high or higher than the most desirable cities in Canada.

 

I left mostly because of salary. You have the potential of making more money in Canada as a primary care doctor.

[Slashsev]

more money???

 

if that before taxes?

[moo]

Before and after taxes. You just have more freedom in Canada. In the US, malpractice insurance is through the roof (40K in some states for family medicine), not to mention ridiculous overhead because you have to hire more people to do your billings. All this disappears if you're salaried, but your after tax salary is still going to be less than my after tax income in Canada. For example, my pediatrician friend makes about 80-90 K pre-tax in So Cal working for Kaiser. I make that in about 4 months working PART-TIME (25 hours a week or less). If you include my residency salary, I make that in 3 months. Not to mention corporate taxes are actually much lower in Canada than they are in the US (14% versus something like 21%), which as an incorporated physician, works out well for me.

[Mashmetoo]

Before and after taxes. You just have more freedom in Canada. In the US, malpractice insurance is through the roof (40K in some states for family medicine), not to mention ridiculous overhead because you have to hire more people to do your billings. All this disappears if you're salaried, but your after tax salary is still going to be less than my after tax income in Canada. For example, my pediatrician friend makes about 80-90 K pre-tax in So Cal working for Kaiser. I make that in about 4 months working PART-TIME (25 hours a week or less). If you include my residency salary, I make that in 3 months. Not to mention corporate taxes are actually much lower in Canada than they are in the US (14% versus something like 21%), which as an incorporated physician, works out well for me.

 

Does he work part time or something? 80-90k seems excessively low...

[moo]

Does he work part time or something? 80-90k seems excessively low...

 

Nope, full-time salaried. You do get benefits and vacation and health insurance, but still, that's not a lot of money.

[Mashmetoo]

Nope, full-time salaried. You do get benefits and vacation and health insurance, but still, that's not a lot of money.

 

that is pretty sad to put it bluntly... a physician assistant can make more than that.. Nurse practioners.. pharmacist.. etc etc etc..

[blizzah]

Nope, full-time salaried. You do get benefits and vacation and health insurance, but still, that's not a lot of money.

 

Doesn't Kaiser and other HMO offer fairly aggressive income increases, pensions, etc.?

 

SDN indicates that IM and EM working for Kaiser on a 40 hour week start at 130-200k but then again, that is IM and EM compared to peds.

[moo]

Yes, you're talking about peds.

 

In general though, in primary care you have the potential to make more in Canada. Averages only tell half the story. If you want to work hard in Canada you can. In the US, private practice is hell (due to insurance, malpractice, etc.) and you are really limited by working in an HMO like Kaiser.

 

For procedural based specialities you make more in the US in general, but Canadian surgeons, radiologists, etc. aren't exactly starving either. In the end, you will make enough to survive and for me, coming back to Canada was a no-brainer.

[fluztom18]

Honestly..after doing rez in the USA u probably will decide not to leave....

 

as 90% of my friends have said they would come back..but decided to stay...

 

im sure the better pay, oppertunities , # of patients, weather, etc etc will keep u in america

 

but what if you are a masochist that wants to pursue neurosurgery? or a hardcore jock that wants orthopedic surgery? that is, what if you end up realizing that your dream career lies in a really competitive specialty, in which case most good programs would opt to choose a US citizen/permanent resident over a H1b applicant that requires a crapload of paperwork?

 

My initial plan was to in fact stay in the U.S., but I'm having second thoughts. I feel like the H1b situation in the U.S. could really limit my choice of specialty...

 

also, I don't meant to offend anyone with the stereotypes - just wanted to get my point across

[moo]

You're right. The H1b really limited my choice of staying versus leaving. I applied to a competitive speciality (anesthesia) but the only place that would give me an H1b that was a good program was my alma mater (Northwestern). I had interviews at several other decent places (USC, and several other Cali schools) but they did not offer the H1b so I didn't even go to the interviews. Other schools that offered the H1b were of decent quality but I didn't want to live in those towns (Wayne State and Buffalo). I had no doubt that I would've matched at Northwestern, but the issue also after of how to return to Canada was difficult, as training in the US is one year shorter. In Canada, I interviewed at several places in anesthesia (UT and McGill and also got invited for several other interviews at smaller schools) but in the end, for various reasons (including shorter length of training, more flexible hours, and geographical flexibility) I chose family med and public health and preventive medicine (called community med at the time).

 

That said, I've found out the only places that really offer the H1b are the really crappy places where no one wants to go, or the uber excellent places where you need killer step 1 scores and recommendations, and grades like Mass Gen, Northwestern, etc.

 

If you want to go to excellent state programs like U of Washington or UCSF or UCLA, forget it. They have enough solid applicants who are US citizens or PRs and will not go to bat for you.

[Mashmetoo]

You're right. The H1b really limited my choice of staying versus leaving. I applied to a competitive speciality (anesthesia) but the only place that would give me an H1b that was a good program was my alma mater (Northwestern). I had interviews at several other decent places (USC, and several other Cali schools) but they did not offer the H1b so I didn't even go to the interviews. Other schools that offered the H1b were of decent quality but I didn't want to live in those towns (Wayne State and Buffalo). I had no doubt that I would've matched at Northwestern, but the issue also after of how to return to Canada was difficult, as training in the US is one year shorter. In Canada, I interviewed at several places in anesthesia (UT and McGill and also got invited for several other interviews at smaller schools) but in the end, for various reasons (including shorter length of training, more flexible hours, and geographical flexibility) I chose family med and public health and preventive medicine (called community med at the time).

 

That said, I've found out the only places that really offer the H1b are the really crappy places where no one wants to go, or the uber excellent places where you need killer step 1 scores and recommendations, and grades like Mass Gen, Northwestern, etc.

 

If you want to go to excellent state programs like U of Washington or UCSF or UCLA, forget it. They have enough solid applicants who are US citizens or PRs and will not go to bat for you.

 

What exactly makes a residency "crappy"? Like their teaching? The environment it's located in? What makes a place excellent? In the end, I'm sure that basically everyone will graduate from their residency, is there really that much of a difference? Is it more of an issue of wanting to live in a nice climate (e.g. Socal) as opposed to somewhere colder like... Michigan, the midwest?

[fluztom18]

You're right. The H1b really limited my choice of staying versus leaving. I applied to a competitive speciality (anesthesia) but the only place that would give me an H1b that was a good program was my alma mater (Northwestern). I had interviews at several other decent places (USC, and several other Cali schools) but they did not offer the H1b so I didn't even go to the interviews. Other schools that offered the H1b were of decent quality but I didn't want to live in those towns (Wayne State and Buffalo). I had no doubt that I would've matched at Northwestern, but the issue also after of how to return to Canada was difficult, as training in the US is one year shorter. In Canada, I interviewed at several places in anesthesia (UT and McGill and also got invited for several other interviews at smaller schools) but in the end, for various reasons (including shorter length of training, more flexible hours, and geographical flexibility) I chose family med and public health and preventive medicine (called community med at the time).

 

Could you elaborate on what you mean by this? I don't understand why it would be difficult to return because a residency program is a year longer in Canada.

[Lactic Folly]

Training won't be recognized - doesn't meet length requirement.

[moo]

Could you elaborate on what you mean by this? I don't understand why it would be difficult to return because a residency program is a year longer in Canada.

 

You will not be eligible to take Royal College exams which is the main route to getting a license in (?almost) all provinces and territories in Canada. Even if you get a fellowship in Canada, if the fellowship is not recognized or accredited by the Royal College, you will not be able to take the exams. My ophthal friend, for instance, did 4 years ophthal in the US, and did a one year retinal fellowship in Canada but had to fight to get this recognized as a legitimate residency year before he could take the RC exams. He was paid officially as a PGY-5 but had to return 40K in salary in the end because the salary for a fellow is a lot lower (if it is not an official accredited fellowship--most internal and pediatric fellowships are accredited and you fall under the residency contract in that province).

[moo]

What exactly makes a residency "crappy"? Like their teaching? The environment it's located in? What makes a place excellent? In the end, I'm sure that basically everyone will graduate from their residency, is there really that much of a difference? Is it more of an issue of wanting to live in a nice climate (e.g. Socal) as opposed to somewhere colder like... Michigan, the midwest?

 

Not true. There are a lot of bad programs in the US. Some programs I wouldn't touch with a ten foot pole. For example, King-Drew, although affiliated with UCLA, was shut down and residents had to scramble for positions elsewhere. http://www.latimes.com/news/local/la-kingdrew-gallery,0,5651209.storygallery

 

I had almost applied to this hospital's anesthesia program when my best friend in med school warned me against it. Boy was I glad I didn't apply.

 

Training is not all equal in the US. Where you train DOES in fact impact on where you may or may not get hired, especially if you are not in private practice. And your training may or may not prepare you for your board exams, in the US and in Canada.

[deathvvv]

Just curious. Does the name of the US school "matter" when you apply for residency in Canada? Since most schools in the US are H/P/F or P/F, I would imagine that your school's reputation would really help you get interviews in Canada.

[moo]

Just curious. Does the name of the US school "matter" when you apply for residency in Canada? Since most schools in the US are H/P/F or P/F, I would imagine that your school's reputation would really help you get interviews in Canada.

 

Depends on the program/school. My general impression is that the big name schools (UT and McGill) tend to care more about school reputation and are more in tune with the nuances of US medical education, e.g., they know that UPenn, Duke, and UCSF are top schools, on par with Yale, Harvard, and Stanford. Smaller schools (Western, Calgary, McMaster, etc.), in general, are more ignorant and will not recognize that UPenn, Duke, UCSF, etc. are in fact excellent medical schools. This, of course, varies considerably from program to program and school to school. My PD here knows that UCSF is a top school, but he does HIV research so he works a lot with the guys down there.

[deathvvv]

Interesting. Judging from the CARMS 2011 stats, it seems that US med school grads are having a tougher time coming home (matriculation rate went from 75% to about 60% in a span of 2 years). I think school rep is becoming more and more important. Thanks for your input moo.

[moo]

Yeah, it's hard to read into those statistics. First, the numbers are so small. Second, many US grads will only rank a couple programs as they may want to stay in the US (since Carms is generally run first, you are essentially ranking all Canadian programs ahead of US programs).

 

But yes, ironically, my general impression is that people from the smaller schools are more elitist than those from UT and McGill (and to a lesser extent, UBC). Again, this is a major generalization but this is what I've experienced. I've had many people give me a "huh? what's that" when I mention I did research at UCSF. Talk about ignorance!