Specialties

[holiday1001]

Getting into a competitive residency is definitely harder than getting into medical school. Most of the terrible people have been weeded out, and you're now competing against people who have been preparing themselves from very early on.

so getting into ROAD specialty is harder than med then. he said 'getting into A residency' is harder than med school.

[Med0123]

I agree with Medhopefuls2016 when he says our colleagues south of the border are more aware of residency entry constraints.

 

Getting in a competitive residency is way more stressful and difficult then getting in medicine, there is no doubt about that. I was myself lucky to "only" like a moderately competitive discipline, but when you are competing with people with almost identical stats as those you have and it took you 4 years to build up your CV, well let's say the pressure can be off the chart during the CaRMS process.

 

Talking about charts, take a look at this one (data from CaRMS 2011 1st iteration if I recall well): http://www.premed101.com/forums/showthread.php?t=60888

 

Let's take ophto for example. It is almost certain that every single of these 62 applicants are similar with research in the field, top electives and top grades. But there are only 36 spots available leading to 26 rejections and that's called live with reality.

 

Of course you'll say : blablabla, ROAD specialty, blablabla

But take a look at peds. Or gen surg. Or uro. I mean, yea there's like a 80% chance of successful match if you consider that 1st choice will fill all the quota (which is false btw), but 20% who, with very similar grades/research experience, will fail to reach their goal and it may be dramatic when you spent your last 2 years working with mentors in the field you want. Unfortunately, luck and PR may be determinant sometimes...

 

So to all of you who got accepted into medschool, congratulations!, but I have 2 important advices:

1- Try to shadow as many different specialists (I include FM) as possible and as soon as you can to "discover" yourself and which field suits you the most early in the process.

2- Try to be open-minded about a primary care specialty career because there is a non-negligible probability that you may pursue your life in this field. I am not saying that pejoratively, I would have been myself satisfied with FM and found ways to do surgical/EM-related things. But too often I heard med students saying how they hated primary care, acting condescendingly and finally being refused in the specialty they wanted... Don't be one of them! If you like primary care, good for you, if you don't, at least don't hate it.

[inspiring-curmudgeon]

so getting into ROAD specialty is harder than med then. he said 'getting into A residency' is harder than med school.

 

I completely agree. However, a LOT of people want a particular program location due to family, significant others, etc, and that definitely ramps up the degree of difficulty, unless it is in an undesirable (to the general applicant pool) location.

[omz222]

Is the job market still good for general internal medicine at hospitals (hospitalists, etc.?) I am open towards primary care but I've heard stressful things about family doctors running their own clinics and so forth and at this stage being employed sounds more appealing.

[BigM]

Is the job market still good for general internal medicine at hospitals (hospitalists, etc.?) I am open towards primary care but I've heard stressful things about family doctors running their own clinics and so forth and at this stage being employed sounds more appealing.

 

There's a huge shortage in GENERAL internal medicine at a lot of hospitals. Definitely more demand than most medicine sub-specialties. It will be interesting to see how this changes when general internal becomes a 5 year residency.

[Starhivest]

Incoming med student here.

 

Why is primary care often looked upon by med students and physicians? Is it the low pay? Or does it have more to do with the job itself (ie referring patients to specialists whenever there's an "interesting" case)?

[inspiring-curmudgeon]

Incoming med student here.

 

Why is primary care often looked upon by med students and physicians? Is it the low pay? Or does it have more to do with the job itself (ie referring patients to specialists whenever there's an "interesting" case)?

 

Probably a combination of all the above. What each person values varies, and one of those aforementioned reasons may resonate more with them. I don't really see much looking down on family medicine in my program, and I don't see why there would be any. Primary care is the most important aspect of healthcare, the hours are (relatively) awesome, and the job is incredibly flexible and portable.

[holiday1001]

There's a huge shortage in GENERAL internal medicine at a lot of hospitals. Definitely more demand than most medicine sub-specialties. It will be interesting to see how this changes when general internal becomes a 5 year residency.

not to doubt you but do you have a source/data to support that?

[medhopefuls2016]

Incoming med student here.

 

Why is primary care often looked upon by med students and physicians? Is it the low pay? Or does it have more to do with the job itself (ie referring patients to specialists whenever there's an "interesting" case)?

 

There is no doubt that primary care is important. If you go into primary care, the job market is always open. Further, there is a significant degree of mobility with regards to primary care which is awesome!

 

However, the reason that primary care is often looked down upon is because of a couple reasons (based on my experiences interviewing in Canada and the States)

 

1. Fam med (along with psych) has the lowest average USMLE Step 1 (below a 220...). The average for Rad/onc, ENT, plastics, derm, and all others are easily 240 or even 250+

 

2. There is no research component to fam med (i.e you can't really do academic medicine with family medicine unless you do some clinical-based research, which are generally of lower quality than basic science work), and research means everything (hate to say it, but true) in most top 20 schools (like Toronto and McGill). Universities get their funding/endowment/ money/reputation for research. These things don't come from primary care.

 

-

Please do not get me wrong. Family medicine is important. The healthcare system would collapse without the important contributions made by our GPs. In particular, GPs provide the necessary longitudinal care for patient, and they are the true practitioner (at least in my opinion) of individualized medicine (because you get to KNOW the patient as a person). Finally, flexibility of it is amazing (esp. if you want a family life) !

 

Where is the premed 101 GOD Dr. Ian Wong when we need him?

[BigM]

not to doubt you but do you have a source/data to support that?

 

Nothing off hand, just what I heard repeatedly about the teaching center in my city and most smaller communities nearby. That said, I believe the OMA predictions that were released a while ago showed an excess in internal medicine by 2016.

[aryastark]

Argh, I've been so stressed lately thinking about which specialty I might want to pursue (in addition to all the admin stuff, police check, immunization, housing, etc - holy crap there's a lot). Does anyone know when the detailed Royal College report is scheduled to be released??

 

Also, any advice for a new med student about which specialties to set up electives for ASAP (i.e. can get the most out of with minimal clinical knowledge)? I ask this because at Mac we get the chance to set up "horizontal electives" (think observerships but with more action) from the get go and being a 3-year program, I want to know sooner rather than later if I fall in love with a ROAD specialty or some ridiculously-competitive thing like that.

 

You took the words right out of my mouth! Would there be an disadvantages to schedule your top choice speciality first, considering that we'll barely have started med school, and have zero clinical skills? Or would it show an eagerness to learn?

[holiday1001]

excellent it seems like IM is a pretty safe residency to go into, that way I don't have to decide a speciality until later on, or just stay an internist

[cheech10]

The safest specialties are those with outpatient practice opportunities. No need to join a group/department, no dependence on hospital/shared resources, just open an office and advertise for referrals. Family practice, psych, endocrinology, outpatient IM, etc will always be more resistant to job market changes, as there is no one (government or entrenched older physicians) to limit your access to cath labs, endo suites, dialysis machines, ORs, or ICU beds.

[inspiring-curmudgeon]

You took the words right out of my mouth! Would there be an disadvantages to schedule your top choice speciality first, considering that we'll barely have started med school, and have zero clinical skills? Or would it show an eagerness to learn?

 

Nobody expects anything from you in a horizontal elective. Do you really think they expect you to know anything? You just started. Anything you actually contribute is a plus.

 

If you are planning on doing horizontal electives in the first few foundations, it's basically to see the day to day happenings of the specialty, and so you can ask yourself "can I see myself doing this?".

 

Calm down.

[cardiomegaly]

2- Try to be open-minded about a primary care specialty career because there is a non-negligible probability that you may pursue your life in this field. I am not saying that pejoratively, I would have been myself satisfied with FM and found ways to do surgical/EM-related things. But too often I heard med students saying how they hated primary care, acting condescendingly and finally being refused in the specialty they wanted... Don't be one of them! If you like primary care, good for you, if you don't, at least don't hate it.

 

THANK YOU!!!!!!!!!

 

For a while now I have been sickened by the attitude of "you're gunning for ROAD or you're garbage" on this forum. It's a real breath of fresh air to hear this from an incoming resident and recently matched grad.

 

At the end of the day, the majority of medical students should be able to find a way to tailor a primary care practice into something they can enjoy -be it cosmetics, office procedures like biopsies, joint injections and vasectomies, hospitalist work, low risk obstetrics, sports medicine, EM, surgical assisting, anaesthesia, or even doing operations like C-sections/appies/choles (granted in rural areas).

[A-Stark]

You took the words right out of my mouth! Would there be an disadvantages to schedule your top choice speciality first, considering that we'll barely have started med school, and have zero clinical skills? Or would it show an eagerness to learn?

 

No disadvantage, gain exposure to as much as you can as early as you can.

 

Like the name btw...

 

(My name does refer to *those* Starks...)

[SharkLvr]

Soup, yes there is a huge VISA issue. I was admitted to Cornell and UToronto this year, and the major reason I didn't end up going South of the border was because of Visa. The Premed 101 God Ian Wong (UBC med then radiology res in the States summarizes it up very nicely.

 

"Originally Posted by Ian Wong

I did med school at UBC, and am currently doing my radiology residency in the US. I am in my PGY-5 year, which is my last year in residency.

 

It is possible to do residency in the US, but not easily. In my UBC class, only one other person went to the US for residency. She did anesthesiology, and went to the US primarily because her fiance was American.

 

One major hurdle is the visa issue. If you don't have US citizenship or a green card, you will need a visa to do residency in the US. For numerous reasons, most US program directors want nothing to do with visas. It's an additional headache for them. It's more paperwork, and if that person ever loses their visa during residency, they will be unable to enter/stay in the US, which is obviously a nightmare for a program director.

 

There are two potential types of visas.

 

1) H1B visa. This is the harder visa to get from US immigration. It allows you to stay in the US after your training, and puts you on the path to getting a green card, which can eventually lead to the option of getting US citizenship. Unfortunately, this visa costs the program money to obtain. Additionally, you cannot apply for this visa unless you have taken and passed USMLE Step 3. You cannot for Step 3 until after you graduate medical school. You then need to take and pass this exam, and get the results before you can start applying for the H1B visa. That means that it's nearly impossible to graduate from medical school and start internship/residency on time on July 1.

 

Most competitive specialties will not offer an H1B visa, because they have more than enough applications from qualified US applicants, and the few foreign applicants that they get would be more than happy to settle for a J-1 visa.

 

Non-competitive specialties in the US like Family Medicine, Pediatrics, Psych, Internal Medicine etc, often offer H1B visas to their foreign applicants as an incentive in order to fill their programs and avoid going unfilled.

 

2) J-1 visa. This is the more likely visa that you will end up with if you are applying to a competitive specialty, such as Derm, Plastics, Ophtho, ENT, Urology, Radiology, etc. This visa is easier to obtain from your residency program. A catch is that you need Health Canada to issue you a "Statement of Need", which is a letter stating that Canada needs more physicians in your specialty. If you can't get this letter, you can't get a J-1 visa.

 

I didn't have any problems getting this letter, but I've heard that that can be an issue sometimes, depending on what province you are coming from. For example, let's say you are from Manitoba, and want a "Statement of Need" letter to do Orthopedic Surgery in the US. If Manitoba gives you that letter, there's no guarantee that you will come back to Manitoba to practise. On the other hand, if they refuse you that letter, and you don't match into Ortho in CaRMS, chances are good that you'll pick up an unfilled Manitoba residency spot in Family Medicine or something in the second round.

 

I should note that while I've heard anecdotally of this sort of thing happening, I didn't experience it myself, and therefore can't verify its prevalence.

 

The other issue with the J-1 visa is that you need to come back to Canada for 2 years once your training is complete. If you don't want to do that, you can apply for a J-1 waiver in the US, which means that you will work in a VA (Veteran's Administration) hospital in the US for 3 years, or an underserved area of the US for 3 years. Both of these options can be distasteful for a number of reasons.

 

 

In order to match in the US in a competitive specialty, you need to dominate the USMLE Step 1, which is the single most important factor in getting the interview invites you need in order to match successfully. This exam is usually done in the summer after your Med 2 year. It is heavily weighted in the basic sciences. An average score on Step 1 (such as a 220), combined with your Canadian background, is probably enough to sink your application to a competitive specialty in the US.

 

US schools also care extensively about your clinical grades, and your letters of recommendations. Still, since most every residency program uses USMLE Step 1 scores with cutoffs, if you don't make the numerical cut-off, you will instantly be rejected, no matter what your medical school grades are.

 

Also, unfortunately, most US programs know very little about Canadian programs (they all seem to think McGill is the best school in Canada (NO it's not....by 2/3 global rankings UT is better), some have heard of UBC and U of T, and pretty much all the other Canadian schools are entirely unknown to them). This makes it tough to establish any amount of "street credibility", because medical school reputation definitely counts in getting interviews for residency.

 

An applicant coming from a "name school" in the US (like UCSF, Mayo, WashU, Harvard, or Hopkins) is going to get many more interview invites compared to an applicant with identical grades coming out of a no name US med school. Coming out of a Canadian med school is even worse, unless it happens to be McGill.:"

 

Question on the American Visa issue: I've heard many conflicting reports on exactly what the situation is for Canadian grads who try to land a US residency. Of course Ian Wong's post above paints one picture (and this is generally the situation that Canadian med students who try to apply to residency in the states face).

 

But what about for Canadian citizens (like medhopefuls2016, I assume) who might do their medical school at a top 10 US school (like Cornell, Hopkins, Harvard, etc). Would these students still have the same issue landing a "competitive" US residency? I would assume they still have the same visa issues, but I do know of Canadian students at these top tier US schools, and from what I hear they do not seem worried at all about landing a top US residency as a Canadian...

[NLengr]

specialties listed above reflect a lack of positions in CANADA, not only in GTA

 

Yes there is a lack of positions vs. grads, but it doesn't mean there are NO positions. In my own specialty I know of multiple jobs, but none of them are in Toronto/Vancouver/Montreal.

 

My point is that it's easier to survive the job shortage if you are willing to move anywhere. There are many grads who aren't, and they will have a harder time finding a position.

[medhopefuls2016]

NLengr, could you give some advices for us incoming medical students on how to survive the job crisis besides being flexible with where we see ourselves working in the future?

[NLengr]

NLengr, could you give some advices for us incoming medical students on how to survive the job crisis besides being flexible with where we see ourselves working in the future?

 

Work hard and be well liked.

 

It's hard to say do this specialty or that since you are ten years from being fully finished. However the more generalized you are, the more job opportunities will be available. But don't let that dictate your life.

[AtomSmasherXVIII]

Getting into a competitive residency is definitely harder than getting into medical school. Most of the terrible people have been weeded out, and you're now competing against people who have been preparing themselves from very early on.

 

I don't think so. When you're applying to med, there's like 10 people applying per spot. Half of them are shitheads that only occaisonally make it through, so it's actually like 5 applicants per spot. Even if you're applying to something good like derm, it's still only like 2 applicants per spot. And as long as you took all your electives in it and published research, you're pretty much on equal footing with everybody else, in terms of your paper application... after which it's just luck.

 

I'd say it's a lot less stressful. But I haven't gotten there yet so maybe not.

[A-Stark]

I don't think so. When you're applying to med, there's like 10 people applying per spot. Half of them are shitheads that only occaisonally make it through, so it's actually like 5 applicants per spot. Even if you're applying to something good like derm, it's still only like 2 applicants per spot. And as long as you took all your electives in it and published research, you're pretty much on equal footing with everybody else, in terms of your paper application... after which it's just luck.

 

I'd say it's a lot less stressful. But I haven't gotten there yet so maybe not.

 

I think that's a good point, but the match is much more of a one-shot at a time of life where it may be more difficult to consider moving or facing large upheavals. Having said that, if you're flexible about moving, and don't apply overly narrowly, it works out. When it doesn't, it's usually because someone applied to only a few programs or decided late on something competitive without preparing a strong application (sometimes impossible). But most people do fine - it's just that it's easier to imagine alternate careers when you're not yet in medicine as opposed to making a semi-lasting decision for your life.

[aryastark]

No disadvantage, gain exposure to as much as you can as early as you can.

 

Like the name btw...

 

(My name does refer to *those* Starks...)

 

Thanks! Sorry if the questions are a bit naive, but I want as much info as possible to avoid undergrad-like mistakes.

 

P.S. Thanks I was curious whether thats what yours referred to!

[liszt]

However the more generalized you are, the more job opportunities will be available.

 

At the moment, this is true outside of academic centres. The abundance of residents going on to do fellowships has resulted in lots of highly specialized physicians who are filling fairly "general" positions. Even many of the general surgeons and internists I've met have done fellowships.

 

I guess for people to survive this situation, it's important that, when planning your time/life/budget, to consider for the fact that postgraduate med education (for non-family med) is often not 5 years long anymore. An extra 1-2+ years will very possibly be necessary before you can settling into attendinghood. Since you know from the beginning, the decisions and plans you make can atleast be a bit more informed.