What is considered a Foreign Medical Graduate?

[fremulon]

If a Canadian completed a US MD degree and wanted to do residency back in Canada and go through CaRMS, would they be considered a FMG? Does the "prestige" of your school matter in whether you're FMG or not? 

For comparison's sake, how would a PD feel about a HMS/Hopkins/UCSF 4th year v.s. a Schulich 4th year?

[JohnGrisham]

My interpretation:

A FMG is someone who does medical school outside of north america, and is an immigrant from there. For example an MD from China, or the UK or Aussie etc. So someone who does a degree outside of Canada/US and is also from outside of Canada/US.

An IMG is a generic term for anyone who does a foreign degree(relative to us, a non-Canadian MD).

A CSA is a Canadian who studied abroad, thus a subclass of IMG.

A canadian who does an USMD based on CaRMS definitions is considered "equal to" a CMG. The pool of students who fit this is too small to accurately say if they are 'worse off" than CMGs. But logically, not having a home school advantage and as much exposure in the Canadian medical system would put them at a disadvantage compared to the "known" quantity of CMGs. That said, im sure going to a known USMD school where there would be less concern would help subjectively. As well doing electives in Canada etc etc.  A USMD for CaRMS purposes is as close as you can get to being a CMG. You compete in the same round as well and arent limited for spots like FMGs/IMGs.

Given the small pool and lack of evidence, I dont think a University of Wisconsin MD grad would be worse off than a UCSF grad. It will be very INDIVIDUAL dependent on the quality of the student, elective performance and ability to make Canadian connections.

[rmorelan]

yeah by the rules a US trained grad has exactly equivalent education and rights to a Canadian trained one. This is just because they are both managed by the same accreditation body.  Equal access to CARMS timing and positions. 

Sometimes they can even have an advantage indirectly in CARMS - they very likely would have done the USMLEs (which opens doors in the US of course), which directly evaluates them. Some places will use those scores to help evaluate candidates if they are available. 

[indefatigable]

I understand perspective of programs, but sometimes it seems as if an individual can be caught in a system which isn't really in their control nor a level playing field.  I don't doubt that USMG is highly similar to a CMG, but it's not a route that is necessarily accessible to that many premeds.  Of course USMLEs are an additional measure of academic ability, but just not that similar to many Canadian curriculums.  Similarly, number of electives, elective timing and even restrictions can clearly make a significant difference in terms of a CMG's competitiveness, which are again factors not necessarily in an individual's control (not to mention research opportunities, curricular differences, etc.).  In another thread the high number of unmatched students was discussed, including the tragic case - to me the question is how many systemic vs individual factors are involved in these situations.

[bearded frog]

On 11/10/2017 at 3:52 PM, celciuszoo said:

If a Canadian completed a US MD degree and wanted to do residency back in Canada and go through CaRMS, would they be considered a FMG? Does the "prestige" of your school matter in whether you're FMG or not? 

For comparison's sake, how would a PD feel about a HMS/Hopkins/UCSF 4th year v.s. a Schulich 4th year?

On paper, the actual university is equal, however, the PD would possibly know the Schulich dean, and perhaps some of the physicians from Schulich writing the reference letters and would be able to get a good relative context, and possibly has even met the student as they probably were able to do an elective there relatively easily. They probably would be less familiar with USMD applicants and might have a little harder time finding context in the transcript/letters of reference, however that student will have an objective measurement in their USMLE results, which could either be an advantage or a disadvantage, depending on performance. Also it might be harder for the USMD student to do an elective in Canada.

[danny55]

It's not too difficult to do an elective as a US MD student. Im currently a 4th year in the US who did a surgery elective at a Canadian institution and got 2 strong letters of recommendation while I was there. I'm assuming this would be as easy for primary care as the majory of students from my institution who wanted to match in Canada for primary care were successful. 

[UWUW]

Trying to follow the topic, but now I'm super confused. So does the saying that "if you leave Canada to pursue med, it is harder to come back to Canadian residency?" still hold some weight? I've been hearing this for the past 4 years but if USMD graduates have equal opportunities and chances alongside CMGs wouldn't it be worth to keep the doors open to US MD schools (Assuming one can sustain the financial burden as a US international student)?

[JohnGrisham]

57 minutes ago, UWUW said:

Trying to follow the topic, but now I'm super confused. So does the saying that "if you leave Canada to pursue med, it is harder to come back to Canadian residency?" still hold some weight? I've been hearing this for the past 4 years but if USMD graduates have equal opportunities and chances alongside CMGs wouldn't it be worth to keep the doors open to US MD schools (Assuming one can sustain the financial burden as a US international student)?

Well if you have the option of attending a canadian school, you should do that. Going to a US school simply lowers your chances and adds extra hurdles. BUT FAR BETTER option by 10000x than other non-canadian schools like carribean, ireland, aussie etc.

[danny55]

10 hours ago, JohnGrisham said:

Well if you have the option of attending a canadian school, you should do that. Going to a US school simply lowers your chances and adds extra hurdles. BUT FAR BETTER option by 10000x than other non-canadian schools like carribean, ireland, aussie etc.

I second this. Also if you want to go into a competitive specialty (ie. ENT, Urology, derm, etc) you can apply to all the Canadian programs and then backup into 100+ US programs if you have trained in the states. For this reason I believe you have a better chance at matching into a competitive specialty in the US/Canada if you train in the US but you obviously have a better chance of matching in Canada in general if you train at a Canadian institution. If you want to do primary care in Canada and don't get into medical school the first time around I would apply broadly to US programs. The path from US MD medical school to Canadian primary care is entirely doable (ie. lots of students at my institution have done this).

[JohnGrisham]

1 minute ago, danny55 said:

I second this. Also if you want to go into a competitive specialty (ie. ENT, Urology, derm, etc) you can apply to all the Canadian programs and then backup into 100+ US programs if you have trained in the states. For this reason I believe you have a better chance at matching into a competitive specialty in the US/Canada if you train in the US but you obviously have a better chance of matching in Canada in general if you train at a Canadian institution. If you want to do primary care in Canada and don't get into medical school the first time around I would apply broadly to US programs. The path from US MD medical school to Canadian primary care is entirely doable (ie. lots of students at my institution have done this).

I would disagree re: competitive specialties. You would just be splitting yourself thin between the two countries.  Not to mention visa limitations and being a non-citizen in general does close some doors.  While primary care is more doable, it is still easier being a CMG first and foremost but I agree if you can get into a USMD but not canada, then it is a reasonable option to take.

[danny55]

On 12/1/2017 at 0:05 PM, JohnGrisham said:

I would disagree re: competitive specialties. You would just be splitting yourself thin between the two countries.  Not to mention visa limitations and being a non-citizen in general does close some doors.  While primary care is more doable, it is still easier being a CMG first and foremost but I agree if you can get into a USMD but not canada, then it is a reasonable option to take.

There are 13 ENT residencies in the entire country of Canada. The state of New York alone has 11 programs. If you score > 250 on step 1 you have a 95% chance of matching ENT, and if you score > 260 on step 1 (I had several friends who did this well) you have literally a 100% chance of matching.

Source --> https://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf

What Canadian med school has a 100% match rate for students interested in ENT?

The visa situation isn't as big of a deal as people make it out to be. In the world of super competitive medical specialties the US is the land of opportunity. 

[JohnGrisham]

31 minutes ago, danny55 said:

There are 13 ENT residencies in the entire country of Canada. The state of New York alone has 11 programs. If you score > 250 on step 1 you have a 95% chance of matching ENT, and if you score > 260 on step 1 (I had several friends who did this well) you have literally a 100% chance of matching.

Source --> https://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf

What Canadian med school has a 100% match rate for students interested in ENT?

The visa situation isn't as big of a deal as people make it out to be. In the world of super competitive medical specialties the US is the land of opportunity. 

Your data and interpretation doesnt take into account non-US citizen status.  

I know of a Canadian US grad who matched ENT, so i know it is doable, dont get me wrong. But it is nowhere as doable as a US citizen without visa issues. 

Getting 250+ and 260+ isn't an easy feat, but yes, if you do score that well, you have strong chances - but there is more to an application than just the score. My point was, you would be spreading yourself thin between Canada and the US. You would have to do audition rotations in both countries, and would be hard to do when applying both sides. Youre better off focusing on one or the other.  

As well, dont forget that not all residencies are easily portable back to Canada. If you want to practice in Canada, it is always easier to just do training here. IF you don't care, then it is likely probably a better idea to just focus on the US...

[danny55]

3 hours ago, JohnGrisham said:

Your data and interpretation doesnt take into account non-US citizen status.  

I know of a Canadian US grad who matched ENT, so i know it is doable, dont get me wrong. But it is nowhere as doable as a US citizen without visa issues. 

Getting 250+ and 260+ isn't an easy feat, but yes, if you do score that well, you have strong chances - but there is more to an application than just the score. My point was, you would be spreading yourself thin between Canada and the US. You would have to do audition rotations in both countries, and would be hard to do when applying both sides. Youre better off focusing on one or the other.  

As well, dont forget that not all residencies are easily portable back to Canada. If you want to practice in Canada, it is always easier to just do training here. IF you don't care, then it is likely probably a better idea to just focus on the US...

If you do well on step 1 you can do your mandatory audition rotation as a 3rd year and spend 4th year auditioning in Canada. If your scores are good you get interviews in the US without the need to audition at multiple places. This is true of most competitive specialties in the states. More programs than not will accept your visa status. In the states it's a numbers game, do well enough on the step exams and you will match into a competitive specialty if you go on enough interviews. This is very different from the Canadian match process. 

If I was a Canadian grad hoping to match into ENT I would write the step exams the summer after 2nd year and cast a wide net in the US as well as Canada. A lot of people who never went through this process make it sound more difficult than it is. I'm good friends with a Canadian pgy5 ENT resident who would never have gotten so much as an interview at a Canadian med school. Matching into a competitive specialty is hard and it's even harder if you limit yourself to a tiny number of programs and positions. 

It is true that not all residencies are super portable back to Canada, but the main reason people stay in the states after training is the compensation and much better job market.

[JohnGrisham]

18 minutes ago, danny55 said:

If you do well on step 1 you can do your mandatory audition rotation as a 3rd year and spend 4th year auditioning in Canada. If your scores are good you get interviews in the US without the need to audition at multiple places. This is true of most competitive specialties in the states. More programs than not will accept your visa status. In the states it's a numbers game, do well enough on the step exams and you will match into a competitive specialty if you go on enough interviews. This is very different from the Canadian match process. 

If I was a Canadian grad hoping to match into ENT I would write the step exams the summer after 2nd year and cast a wide net in the US as well as Canada. A lot of people who never went through this process make it sound more difficult than it is. I'm good friends with a Canadian pgy5 ENT resident who would never have gotten so much as an interview at a Canadian med school. Matching into a competitive specialty is hard and it's even harder if you limit yourself to a tiny number of programs and positions. 

It is true that not all residencies are super portable back to Canada, but the main reason people stay in the states after training is the compensation and much better job market.

Yes, more programs than not - but that is already excluding a good chunk of programs, especially considering how difficult some competitive specialties are.

Don't forget, the vast majority of programs sponsor J1 visa, so if you want an H1B, that will narrow down the potential pool of programs even more. Still doable, but lots being left to chance even if you somehow manage 250+ on the STEPs and have solid auditions. 

Example: If you want to do Ortho in the US, you cant do it on a J1 and have to do it on H1B. So you automatically cut down quite a few programs. Why would they pay the extra money for you to do Ortho, when they have plenty of americans ready with strong scores as well? I'm just playing devils advocate here.

Also, I dont disagree at all with the reasons people stay in the US, or even move to the US. But not everyone wants to live and work in the US in that system, and many would rather come back to Canada.  For super specialized programs though, it usually makes more sense to be in the US for job opportunities...but again, some people still prefer being at home in Canada with their family/friends.

I think you may be underplaying how difficult the process is, but perhaps not? I know dozens of friends and colleagues who have been through the process and its not easy. But of course your whole line of thinking is predicated on getting 250+/260+ applying for ENT...so if you already are at that bench mark, then chances are everything else about a persons theoretical application is going to be super strong also, so the normal caveats perhaps dont apply. 

 

[danny55]

On 12/4/2017 at 4:38 PM, JohnGrisham said:

Yes, more programs than not - but that is already excluding a good chunk of programs, especially considering how difficult some competitive specialties are.

Don't forget, the vast majority of programs sponsor J1 visa, so if you want an H1B, that will narrow down the potential pool of programs even more. Still doable, but lots being left to chance even if you somehow manage 250+ on the STEPs and have solid auditions. 

Example: If you want to do Ortho in the US, you cant do it on a J1 and have to do it on H1B. So you automatically cut down quite a few programs. Why would they pay the extra money for you to do Ortho, when they have plenty of americans ready with strong scores as well? I'm just playing devils advocate here.

Also, I dont disagree at all with the reasons people stay in the US, or even move to the US. But not everyone wants to live and work in the US in that system, and many would rather come back to Canada.  For super specialized programs though, it usually makes more sense to be in the US for job opportunities...but again, some people still prefer being at home in Canada with their family/friends.

I think you may be underplaying how difficult the process is, but perhaps not? I know dozens of friends and colleagues who have been through the process and its not easy. But of course your whole line of thinking is predicated on getting 250+/260+ applying for ENT...so if you already are at that bench mark, then chances are everything else about a persons theoretical application is going to be super strong also, so the normal caveats perhaps dont apply. 

 

I'm not trying to down play how difficult the process is. I'm just trying to make the point that if you are smart enough to crack 250 on step 1 and your goal was to be an ENT somewhere you could significantly increase those chances by applying to programs in the states and Canada. That was my point... And I believe the raw data is on my side. Although they don't publish charting the outcomes data for Canadian allopathic grads matching in the US I have no reason to believe that those performing well on step 1 wouldn't have a significantly better chance of matching in the US compared to Canada. Again I can't cite specific data I can only reference the published data indicating that 10 out of 10 people with high step 1 scores end up matching into an ENT program. The idea that "lots left to chance if you have a 250+ on step 1" simply isn't supported by the data. What we do know is those who matched into this specialty had a 100% success rate with 250+ and close to 100% with 250+. If you think that the visa situation changes that significantly I'd ask you to point to data to prove that. Also like I said in the states audition rotations don't mean jack if you kill step 1.

A lot of people in the states dont know how to interpret the charting outcomes data. If you take a look you will realize it's mostly a numbers game with most of the emphasis places on USMLE marks for the vast majority of specialties. This is very different (not better) to how things are done in Canada.

[JohnGrisham]

I agree, if you crack 250+, then yes, you're probably going to be just fine matching ENT specifically. The assumption being if youre getting 250+, youre hopefully well rounded otherwise and a solid candidate. 

As for audition rotations not mattering if you score 250+, that is the first i have ever heard of that. I would assume you also have no data on this, since assumingly the same scenario plays out: Person scoring 250+ also does due diligence to get exposure at multiple programs they are interested in via audition rotations.  This is what my colleagues have stated, though they were only 240+ applying to slightly less competitive programs than ENT, so perhaps its a different story in the "elite" score range.

Anyways, we've both made our points Good luck with matching!

[danny55]

There are fields where you are advised to do zero away/audition rotations. I sat down with my advisor for general surgery and beyond the core surgery rotation required at my home institution he said it's absolutely not required to do any audition rotations. People going into competitive specialties with less than stellar step scores do multiple audition rotations. However if you crack the 250-260 range you get the interviews you need without having to rotate everywhere. I know this is very different from what happens in Canada and from what people will tell you on the street but it's actually how it goes and you'll just have to take my word for it I guess... I'm basing these opinions off of what the deans, academic advisors, and surgeons I work with  at my school (in the US) are telling me. Take it or leave it.