US Residency from US medical school (Canadian Citizen)

[h9i9j9]

Hi,

 

I was lucky enough to be accepted into a US med school (Jefferson) as a Canadian Citizen. I have heard through older medical students that as a Canadian citizen, its really hard to get an american residency (even if you graduated from an American Medical school). They say that you have VISA issues and the hospital is not always willing to sponsor you for a green card because there is so much paperwork.

I was wondering how true this is? Does anyone have stat on the subject? I am not a bad student, but I don't want to have to kill step 1 to get a mediocre residency.

 

Thanks!

[Mashmetoo]

Hi,

 

I was lucky enough to be accepted into a US med school (Jefferson) as a Canadian Citizen. I have heard through older medical students that as a Canadian citizen, its really hard to get an american residency (even if you graduated from an American Medical school). They say that you have VISA issues and the hospital is not always willing to sponsor you for a green card because there is so much paperwork.

I was wondering how true this is? Does anyone have stat on the subject? I am not a bad student, but I don't want to have to kill step 1 to get a mediocre residency.

 

Thanks!

 

Depends on what you want. If FM, IM, primary care, it shouldn't be too hard. IMGs needing visas fill these spots all the time. If you want the ROAD specialties, then you might run into problems as a Canadian.

[h9i9j9]

ahh ic, so how much harder are we talking about here? I don't know what I'm interested in yet, but I don't want to rule out semi competitive specialties. (So say ophthalmologist or ER)

[nychila]

First of all, congrats on the acceptance. I'm curious about this issue too, but from what I hear, for the most part, all US MD graduates are treated the same for residency applications, regardless of your nationality. A few hospitals may not accept us, but I think most of the university hospitals in large cities will.

 

If anyone has more information on this, please share your insights as to whether Canadians studying at US MD schools are disadvantaged in the US residency application process, and if we are, how disadvantaged we might be.

[demerp]

Curious about this as well! I've read about the Visa situation here and there on premed101 and seems like it does give Canadians a bit of a disadvantage especially for competitive specialties; for a US vs. Can applicant, with all else equal, it would make sense for programs to favour the US candidate simply because of less paperwork. Greatly appreciate any current 4th year Canadians who just went through the match to shed some light

 

Also, anyone know of approx figures for %Canadian grads that cmoe back to Canada vs staying in the states?

[Flame219]

The chances for a Canadian US MD grad getting residencies even for competitive programs is actually just marginally (but noticeably) harder than American counterparts. Better than our chances at Carms. Our graduating class at Wayne every year has Canadian grads going to awesome places, these two years alone we have Canadian grads going to Harvard anesthesiology and other top programs, radiology, derm etc.

[nychila]

The chances for a Canadian US MD grad getting residencies even for competitive programs is actually just marginally (but noticeably) harder than American counterparts. Better than our chances at Carms. Our graduating class at Wayne every year has Canadian grads going to awesome places, these two years alone we have Canadian grads going to Harvard anesthesiology and other top programs, radiology, derm etc.

 

Thanks - that's terrific to hear!

[ISaidPlease]

The chances for a Canadian US MD grad getting residencies even for competitive programs is actually just marginally (but noticeably) harder than American counterparts. Better than our chances at Carms. Our graduating class at Wayne every year has Canadian grads going to awesome places, these two years alone we have Canadian grads going to Harvard anesthesiology and other top programs, radiology, derm etc.

 

Why is the Carms match more difficult? We get first iteration right?

[Flame219]

Yes, we do. According to the books we should be equally competitive to Canadian grads matching to 1st iteration programs. However, and this applies more to competitive programs, there is a degree of bias against Canadian US MDs to the point that it effectively makes us non-competitive when we're trying to split hairs with Canadian grads to get into competitive spots. For the same two years at our school, our grads have tried to apply to anesthesiology programs in Ontario and didn't get in, but ended up in ivy league anesthesiology programs, that says something.

Having said that, we have some stellar grads who beat all odds and got into top programs like those in radiology in Canada.

[nychila]

Yes, we do. According to the books we should be equally competitive to Canadian grads matching to 1st iteration programs. However, and this applies more to competitive programs, there is a degree of bias against Canadian US MDs to the point that it effectively makes us non-competitive when we're trying to split hairs with Canadian grads to get into competitive spots. For the same two years at our school, our grads have tried to apply to anesthesiology programs in Ontario and didn't get in, but ended up in ivy league anesthesiology programs, that says something.

Having said that, we have some stellar grads who beat all odds and got into top programs like those in radiology in Canada.

 

Would US MD students who wish to match back to Canada have to write Canadian licencing exams that are equivalent to the USMLE Step 1/2 before applying?

 

Also, would the reputation of the US MD school matter when you apply to Canadian residencies, all else being equal? Eg. NYU/Cornell vs. Michigan State/Rosalind Franklin.

[Flame219]

For your first question, US MDs only need to write the QE1 exam after matching to Carms, you can register to write it at the same time as Canadian grads.

 

As for your second question. I don't really have a clear answer to that as there's really no data backing me up in terms of match rates of US grads to carms separated by schools etc, even if it did the sample size would be too small anyway. But I'd imagine the factors would be quite similar to the results from the nrmp program director survey:

 

http://www.nrmp.org/data/programresultsbyspecialty2012.pdf

 

So the school factor is like the 23rd most impt criteria to select applicants for programs in the states, and that makes sense because which school the applicant comes from tells little info about the applicant, and there are many more important attributes that could allow PDs to gauge an applicant's strength and personality to work with for the next several years. Having said that the school name does have some impact (the reason why it's on there..) and I'd imagine for the above reasoning that carms program directors would think the same.

[h9i9j9]

The chances for a Canadian US MD grad getting residencies even for competitive programs is actually just marginally (but noticeably) harder than American counterparts. Better than our chances at Carms. Our graduating class at Wayne every year has Canadian grads going to awesome places, these two years alone we have Canadian grads going to Harvard anesthesiology and other top programs, radiology, derm etc.

 

Thank you so much for the info!! Do you know where we could obtain any quantitative stats on how much harder? Do you feel like most of your canadian classmates get the specialty they want?

[ItsME]

For your first question, US MDs only need to write the QE1 exam after matching to Carms, you can register to write it at the same time as Canadian grads.

 

As for your second question. I don't really have a clear answer to that as there's really no data backing me up in terms of match rates of US grads to carms separated by schools etc, even if it did the sample size would be too small anyway. But I'd imagine the factors would be quite similar to the results from the nrmp program director survey:

 

http://www.nrmp.org/data/programresultsbyspecialty2012.pdf

 

So the school factor is like the 23rd most impt criteria to select applicants for programs in the states, and that makes sense because which school the applicant comes from tells little info about the applicant, and there are many more important attributes that could allow PDs to gauge an applicant's strength and personality to work with for the next several years. Having said that the school name does have some impact (the reason why it's on there..) and I'd imagine for the above reasoning that carms program directors would think the same.

 

I wouldn't put much weight on this survey. You have competitive fields with VERY high avg. USMLE's with low responses for test scores and the opposite for some fields notorious for very low step scores. There is absolutely NO question that in the US your med school rank is a factor. Spend anytime in the US and you will quickly learn EVERYTHING is about rank.

[Flame219]

Thank you so much for the info!! Do you know where we could obtain any quantitative stats on how much harder? Do you feel like most of your canadian classmates get the specialty they want?

 

Unfortunately there really isn't any quantitative stats broken down into specialties other than anecdotal evidence from recent Canadian US MD grads because the sample size is too small. In our year there's only about 110 Canadians studying in the States in total. However, there this:

 

http://www.carms.ca/pdfs/2012R1_MatchResults/9_Match%20Results%20by%20First%20and%20Lower%20Ranked%20Program%20Choices_en.pdf

 

so from the numbers, about half of us decided to apply to CaRMS last year. The first choice match rate isn't too bad (better than Queen's! jk). Do keep in mind though, that a lot of the "unmatched" stats applied to applicants who were just applying to 1-2 reach programs like e.g. derm/anes/rads in Toronto with the general idea of matching in the States. In my graduating class, just about less than half decided to apply to CaRMS, and most people got their TOP choice. The ones that didn't get their top 1-2 choices (and is therefore unmatched from the reason above) matched into the same specialty in competitive programs in the States and of course are also very happy about it.

[Flame219]

I wouldn't put much weight on this survey. You have competitive fields with VERY high avg. USMLE's with low responses for test scores and the opposite for some fields notorious for very low step scores. There is absolutely NO question that in the US your med school rank is a factor. Spend anytime in the US and you will quickly learn EVERYTHING is about rank.

 

Err...not everything is about the med school rank.

 

And I don't want to base this on anecdotal evidence, so here is the real evidence: Your school probably gave this out to their students in every 3rd year advising info-session or at least in interest groups for competitive specialties.

http://www.ncbi.nlm.nih.gov/pubmed/19240447

it lists the relative importance of selection criteria broken down by specialties, including the most competitive programs in the States (Plastics, ENT, Ophtho, Rads, Rad onc, neurosurg) in order of importance: EVERYTHING includes your 3rd year clerkship grades, then comes rec letters, then step 1 scores, then grades in senior elective in specialty, then number of honours, then step 2 scores, then class rank, then step 2 CS, then AOA status, and THEN it's med school reputation...the only things less important are your awards/research/preclinical grades/MSPE which is useless anyway. I would even put research above the school factor for competitive programs.

Here's an older one illustrating the same thing:

http://www.ncbi.nlm.nih.gov/pubmed/9934296

in order of importance: grades in required clerkships>number of honours>grades in senior electives in specialty>class rank>AOA status>step 2 score>awards>step 1 score>med school reputation>grades in electives>research>preclinical grades

A third one...for emergency: http://www.ncbi.nlm.nih.gov/pubmed/10894243

EM grade> interview> clerkship grades> rec letters>> elective done at institution> step2> interest in program> step1> awards>>> AOA> med school reputation> extracurrics> preclinical grades> research

 

so yeah...like I said earlier, the school factor is a factor but it's like the 23rd factor. The NRMP link I sent earlier never charted anything about the average step scores needed to match. It only charted the minimum step scores required for interview and the minimum step scores to guarantee an interview. They don't need to include the average step scores because that is readily available here: http://www.nrmp.org/data/chartingoutcomes2011.pdf

I don't think this survey should be taken like the gospel, but at the same time don't be too quick to dismiss it after all it is generally consistent with the other publications.

 

The real importance your school plays a factor is the local factor: most programs and especially programs from competitive specialties tend to give a leg up to their own students when selecting applicants. Therefore if you are gauging on a competitive specialty, you're most likely going to end up in YOUR OWN school's residency program.

[demerp]

Great informative post, thanks!

 

This will definitely help when I decide on which US school to attend.

Err...not everything is about the med school rank.

 

And I don't want to base this on anecdotal evidence, so here is the real evidence: Your school probably gave this out to their students in every 3rd year advising info-session or at least in interest groups for competitive specialties.

http://www.ncbi.nlm.nih.gov/pubmed/19240447

it lists the relative importance of selection criteria broken down by specialties, including the most competitive programs in the States (Plastics, ENT, Ophtho, Rads, Rad onc, neurosurg) in order of importance: EVERYTHING includes your 3rd year clerkship grades, then comes rec letters, then step 1 scores, then grades in senior elective in specialty, then number of honours, then step 2 scores, then class rank, then step 2 CS, then AOA status, and THEN it's med school reputation...the only things less important are your awards/research/preclinical grades/MSPE which is useless anyway. I would even put research above the school factor for competitive programs.

Here's an older one illustrating the same thing:

http://www.ncbi.nlm.nih.gov/pubmed/9934296

in order of importance: grades in required clerkships>number of honours>grades in senior electives in specialty>class rank>AOA status>step 2 score>awards>step 1 score>med school reputation>grades in electives>research>preclinical grades

A third one...for emergency: http://www.ncbi.nlm.nih.gov/pubmed/10894243

EM grade> interview> clerkship grades> rec letters>> elective done at institution> step2> interest in program> step1> awards>>> AOA> med school reputation> extracurrics> preclinical grades> research

 

so yeah...like I said earlier, the school factor is a factor but it's like the 23rd factor. The NRMP link I sent earlier never charted anything about the average step scores needed to match. It only charted the minimum step scores required for interview and the minimum step scores to guarantee an interview. They don't need to include the average step scores because that is readily available here: http://www.nrmp.org/data/chartingoutcomes2011.pdf

I don't think this survey should be taken like the gospel, but at the same time don't be too quick to dismiss it after all it is generally consistent with the other publications.

 

The real importance your school plays a factor is the local factor: most programs and especially programs from competitive specialties tend to give a leg up to their own students when selecting applicants. Therefore if you are gauging on a competitive specialty, you're most likely going to end up in YOUR OWN school's residency program.

[nychila]

Great information Flame!

 

I have done quite a bit of research on SDN, and the consensus seem to be that the relative importance for residency application is roughly:

 

step 1 > clinical grades >> AOA award > research > reference letters > step 2 > school reputation >> pre-clinical grades > extra-curricular activities

 

This, of course, depends on the program that one applies to, ie. family medicine in rural Montana will not care about research. The above does seem to be the accepted consensus for competitive programs, however. There is also a lot more to the rather simplistic algorithm above:

 

- most competitive programs have a cut-off for step 1, for which grades lower will render interview invitation impossible

- an unsatisfactory clinical grade (which could mean anything other than honors) in the field in which one is applying will be a significant setback

- for competitive specialties, almost every applicant has 6-10 publications, which makes sufficient research almost an unwritten requirement

- top programs seem to mostly accept applicants from top or at least very reputable schools, for whatever it's worth

- surveys likely (relatively) down-play the importance of school reputation, since no residency director wants to claim that the top selection criteria for their program is school reputation, which just looks awful on their part

- by the same token, residency directors don't tend to say that they place utmost priority on standardized testing, because that looks bad

- connections will help, including application to school within region of medical school or hometown and reference letters from famous faculty

- a poor interview will obviously kill one's application

 

Anyone who knows more, please feel free to comment.

[omz222]

If all OP wants is to get into some community program or low end academic program, than any school will suffice. For good academic programs, med school reputation and rank nowadays ABSOLUTELY matters, partly because competitiveness for a number of fields in the US has been increasing over the last few years and they get more than a handful of applicants all with top scores and stats and extracurriculars and research etc. - these programs will even use cutoffs based on school reputation/rank (this coming straight out of the mouth of three program directors at >moderately competitive programs). If you don't go to one of those Top 25 US schools you will have trouble getting interview invites to those places.

 

But then again, if all OP wants is some community or Wayne State-tier programs, med school reputation won't matter one bit.

[ItsME]

If all OP wants is to get into some community program or low end academic program, than any school will suffice. For good academic programs, med school reputation and rank nowadays ABSOLUTELY matters, partly because competitiveness for a number of fields in the US has been increasing over the last few years and they get more than a handful of applicants all with top scores and stats and extracurriculars and research etc. - these programs will even use cutoffs based on school reputation/rank (this coming straight out of the mouth of three program directors at >moderately competitive programs). If you don't go to one of those Top 25 US schools you will have trouble getting interview invites to those places.

 

But then again, if all OP wants is some community or Wayne State-tier programs, med school reputation won't matter one bit.

 

Agreed 100%. Also agree with post above this one as well. If you truly believe that med school rank is the 20 something most important criteria on PD's selection criteria, google a competitive program at a an academic center. Have a look how many residents you will find from lower tier med schools. Here's the first one I just did that for - the link is for Harvard NeuroSx. Is it a coincidence that every single resident is from a top tier med school? Granted, this is one example. Dig around for yourself and you will find this is certainly not the exception.

 

http://residents.neurosurgery.mgh.harvard.edu/CurrentResidents.html

[Flame219]

If all OP wants is to get into some community program or low end academic program, than any school will suffice. For good academic programs, med school reputation and rank nowadays ABSOLUTELY matters, partly because competitiveness for a number of fields in the US has been increasing over the last few years and they get more than a handful of applicants all with top scores and stats and extracurriculars and research etc. - these programs will even use cutoffs based on school reputation/rank (this coming straight out of the mouth of three program directors at >moderately competitive programs). If you don't go to one of those Top 25 US schools you will have trouble getting interview invites to those places.

 

But then again, if all OP wants is some community or Wayne State-tier programs, med school reputation won't matter one bit.

 

Oh please, before you start bashing my school and start a flame war, real stats or gtfo. First of all, I agree with the post before yours from nychila but the way how you could present the same information in a misleading way is pretty bushly. Sure, med school reputation is a factor, we have established that already, and I appreciate your point that it should not be overlooked. From your post though, it is misleading to suggest that the competitive programs exclusively accept students from top tier medical schools. Top tier med schools yield many of the country's top candidates, it spells confounding factors all over the place. Also, to the post below, Harvard neurosurgery one of the top programs in the country right? Tulane and Loyola are unranked schools, not even top 60, your argument of exclusivity completely fails at that. Anecdotal evidence to anecdotal evidence my friend. I do agree that people should search more residency programs for comparison though, you'll always see residents that come from non top 20 schools.

Second, exclusivity of some top 20 programs to top 20 schools certainly does not mean that candidates from a non-top 20 school cannot get into a top 20 academic program. Just this year we have grads just off the top of my head going to Harvard, Yale, Hopkins, UCSF, UPenn, WashU, Pritzker, UofM, UWashington, Cornell, USLA, UCSD, mayo etc etc. Community programs or low end academic programs? Pshh give me a break.

Third, if my so-called Wayne State-tier school is as lowly as you think, check out our match list, you'd be surprised. Oh, check out our CaRMS match list too while you're at it, surprise x2!

[ItsME]

My friend... I am not saying that it is IMPOSSIBLE to match to a competitive program if you are not from a top ranked program. When I said rank is everything what I am saying is that Americans LOVE to rank things. This does not only apply to med school but every academic program, residency, fellowship, hospital, etc... You will find a few graduates of lower ranked schools in most programs. You might even find an IMG or DO thrown in there too. I am saying that med school rank is absolutely a factor in residency selection and a MUCH bigger one than this survey would make you believe. My point about USMLE scores and this survey is do you REALLY believe that only 70% percent of dermatology PD's consider USMLE as a factor in selecting residents? A specialty with a 250+ avg. Step 1 score? Rrrright. It would be great if PD's answered this survey truthfully, but as nychilla said it nobody wants to look bad. Pick a what you would consider a top ranked academic centre and a competitive specialty, put those two things in Google and flip through the

residents. The VAST majority will be from top tanked med schools time and time again. I'm not saying this to discourage anybody from applying to a lower ranked med school or applying to competitive programs coming from one of these schools. You will have to work harder to beat out applicants from higher ranked med schools though. Best thing to do is pick a specialty EARLY. If its competitive start working on things that will boost your application immediately! And do the best you can on step 1. This goes for everybody regardless of rank.

[omz222]

Oh please, before you start bashing my school and start a flame war, real stats or gtfo. First of all, I agree with the post before yours from nychila but the way how you could present the same information in a misleading way is pretty bushly. Sure, med school reputation is a factor, we have established that already, and I appreciate your point that it should not be overlooked. From your post though, it is misleading to suggest that the competitive programs exclusively accept students from top tier medical schools. Top tier med schools yield many of the country's top candidates, it spells confounding factors all over the place. Also, to the post below, Harvard neurosurgery one of the top programs in the country right? Tulane and Loyola are unranked schools, not even top 60, your argument of exclusivity completely fails at that. Anecdotal evidence to anecdotal evidence my friend. I do agree that people should search more residency programs for comparison though, you'll always see residents that come from non top 20 schools.

Second, exclusivity of some top 20 programs to top 20 schools certainly does not mean that candidates from a non-top 20 school cannot get into a top 20 academic program. Just this year we have grads just off the top of my head going to Harvard, Yale, Hopkins, UCSF, UPenn, WashU, Pritzker, UofM, UWashington, Cornell, USLA, UCSD, mayo etc etc. Community programs or low end academic programs? Pshh give me a break.

Third, if my so-called Wayne State-tier school is as lowly as you think, check out our match list, you'd be surprised. Oh, check out our CaRMS match list too while you're at it, surprise x2!

 

I've never said that it's 'impossible' for a Wayne State grad to get into a top-tier program. A Wayne State grad with the same raw stats (Steps 1 and 2, clinical grades, AOA) as someone from the Top 25 would have to jump through a lot more hoops than that person from Top 25 (e.g. special LORs from national-level big-wigs - which Wayne State doesn't really have, randomness of interviewer or interview invite selection, extracurriculars, research & pubs). Wayne State is a HUGE school and of course there'd be people from Wayne State who has these amazing stats and have jumped through ALL the loops to get to those top academic programs.

 

Because let's face it, i) Wayne State is a badly ranked school, and i) theres a TON of stellar applicants stats-wise, so when program directors have to try to distinguish between all these top-stats applicants in some way, of course they are going to discriminate against the people from lower ranked schools. Of course they'll still get invited, but their probability of being invited of course is significantly lower than if they are in the Top 25.

 

If anyone doesn't believe me just go to for example (obviously I can't tell you which program directors I heard it from cuz I need to be anonymous), SDN's Internal Medicine forum where all the IM matches post their stats etc. Real eye-opener.

[Flame219]

Sure. What I'm trying to say is that our chances is not as bad as you put it to be. More hoops, but not that many more. You can always find national big-wigs around the Detroit area (e.g. trauma surgery, perinatology etc) not just for letters but also research, and the extracurriculars you can do around here with the underserved and socioeconomically disadvantaged population is very significant and amazing. Our chances are definitely not impossible, but also not improbable. Take UofM for example, a lot of our graduates end up in UofM vs other top 25s because it also reflects the fact that not everyone views going to Harvard as their top priority. A lot of our grads are from the local area and they just want to stay local and stable and start a family maybe, and UofM is just less than an hour drive here. It also is reflected on the interview invites, they have them but chose not to go. If UofM disproportionately accepted other top 25s I would think our chances would be about the same as those at other top 25s. Our huge class has a higher match rate than the national average, AND both our first choice and our top 3 choices match rate is also higher than the national average. In choosing residency at the end of 4 years, getting your top 3 choices is all that matters.

 

Anyway, as a side perk for Canadians, for those thinking of applying to CaRMS our school is in a wonderful position in that there is enough critical mass of Canadians in our program to share valuable insight to make ourselves good applicants. Things like doing research in UofT as a 1st/2nd year at Wayne, establishing connections with the Canadian programs, and even living in Canada (Windsor) for the whole 4 years is easier for us.

[ISaidPlease]

Yes, we do. According to the books we should be equally competitive to Canadian grads matching to 1st iteration programs. However, and this applies more to competitive programs, there is a degree of bias against Canadian US MDs to the point that it effectively makes us non-competitive when we're trying to split hairs with Canadian grads to get into competitive spots. For the same two years at our school, our grads have tried to apply to anesthesiology programs in Ontario and didn't get in, but ended up in ivy league anesthesiology programs, that says something.

Having said that, we have some stellar grads who beat all odds and got into top programs like those in radiology in Canada.

 

But lets say that we want an H1B visa while attending US residency, do you still think that a Canadian US MD applying to Carms will be at a greater disadvantage match wise compared to a Canadian US MD applying to US residency with hopes of obtaining a H1B?

[omz222]

But lets say that we want an H1B visa while attending US residency, do you still think that a Canadian US MD applying to Carms will be at a greater disadvantage match wise compared to a Canadian US MD applying to US residency with hopes of obtaining a H1B?

 

Depends on the program. Some like Harvard are really good about sponsoring H1bs, others may be reluctant/somewhat unwilling to sponsor a H1b but may do it depending on the circumstances.

 

 

Also, as a side note 'ivy league' residency doesn't mean anything. Programs at schools like Dartmouth and Brown are not competitive programs because those Ivies do not have top-of-the-line medical schools or medical centers. Similarly there's also some Ivies where programs in certain specialties are weak and not exceedingly competitive.